healthcare

Article
Subjective Well-Being in Cancer Patients: The Roles of Social
Support, Purpose in Life, Resilience, and Informativeness
Lovorka Brajković , Karla Milat-Panža and Vanja Kopilaš *

Faculty of Croatian Studies, University of Zagreb, 10000 Zagreb, Croatia; [email protected] (L.B.)
* Correspondence: [email protected]

Abstract: The aim of this research was to determine the relationship between subjective well-being
(life satisfaction, positive and negative experiences, and prosperity) and various psychosocial factors
(social support received from family members and partners, purpose in life, resilience and infor-
mation) in cancer patients and to examine the possibility of predicting components of subjective
well-being based on these mentioned factors in cancer patients. A total of 338 adult cancer patients
from Croatia participated in the study (41.1% male and 58.9% female). To measure the constructs, the
Diener Subjective Well-Being Scale, the Social Support Scale at work and in the family, the Purpose
in Life Scale, the Short Resilience Scale, and the EORTC-QLQ information questionnaire were used.
Results showed a high level of life satisfaction and prosperity, as well as more frequent positive
compared to negative experiences. A medium to high level of social support received from family
members and from the partner was determined. High levels of purpose in life and medium levels of
resilience and information were found. A high correlation was found among the components of the
construct of subjective well-being, and a low to medium correlation among the predictors. Positive
associations were found between the criteria of life satisfaction and prosperity with psychosocial
factors. Negative associations were established between the positive/negative experience variables
and the factors. Furthermore, the purpose in life was determined as an important predictor of all three
components of subjective well-being, social support (both sources) as important for predicting life
satisfaction, resilience for experiencing positive and negative experiences, and social family support
for predicting the prosperity of cancer patients.
Citation: Brajković, L.; Milat-Panža,
K.; Kopilaš, V. Subjective Well-Being
Keywords: cancer; subjective well-being; social support; resilience; prosperity; informativeness
in Cancer Patients: The Roles of Social
Support, Purpose in Life, Resilience,
and Informativeness. Healthcare 2023,
11, 3181. https://doi.org/10.3390/
healthcare11243181
1. Introduction
Cancer has been a significant public health concern worldwide for an extended period.
Academic Editors: Sara Monteiro and
Despite advances in medicine and the development of treatments for malignancies, the
Isabel M. Santos
mortality rates of individuals diagnosed with cancer remain high, and the experience of
Received: 4 November 2023 cancer is still associated with discomfort, suffering, pain, and death.
Revised: 7 December 2023 According to the Joint Research Centre of the European Commission on the Burden of
Accepted: 15 December 2023 Cancer in European countries in 2020, the burden of cancer increased to 2.7 million new
Published: 16 December 2023 cases and 1.3 million deaths [1].
Numerous studies highlight the role of subjective well-being as extremely important
for the sustainability of a healthy life and work [2]. Also, research from the post-COVID era
Copyright: © 2023 by the authors.
additionally emphasizes the importance of well-being and mental health [3]. The subjective
Licensee MDPI, Basel, Switzerland.
well-being of individuals affected by cancer is substantially compromised due to physical
This article is an open access article
and psychological changes caused by surgical treatment, chemotherapy, radiotherapy, or
distributed under the terms and hormone therapy [4,5]. Those diagnosed with cancer are continuously exposed to various
conditions of the Creative Commons stressors that undermine their psychological health and, consequently, their subjective
Attribution (CC BY) license (https:// well-being. These stressors are closely linked to the disease itself (treatment-related conse-
creativecommons.org/licenses/by/ quences, loss of physical functions, and body image issues), stressors arising from social
4.0/). relationships (financial problems due to the inability to continue working, feelings of

Healthcare 2023, 11, 3181. https://doi.org/10.3390/healthcare11243181 https://www.mdpi.com/journal/healthcare

Healthcare 2023, 11, 3181 2 of 16

loneliness, lack of social support, and problems in family relationships), and existential
stressors (fear of dependence on others, fear of death, and a loss of a sense of purpose) [6].
Furthermore, research dealing with caregivers of people with chronic illnesses found that
the diagnosis brings a significant change in the life of the whole family, which may lead to
depressive symptoms [7,8].
Numerous studies indicate that received social support predicts higher levels of overall
subjective well-being and that there is a significant association between life satisfaction and
support received from significant individuals in an individual’s life [9,10]. Furthermore,
according to the eudaimonic paradigm of well-being, the purpose in life is one of the six
facets of psychological well-being [11–13]. Hence, purpose in life is an important factor
in overall psychological well-being in both the general population and the population of
individuals with a cancer diagnosis.
While we may have varying expectations, assuming that cancer patients exhibit
compromised resilience due to prolonged exposure to stress or increased resilience through
adaptation, existing research in this population reveals no significant difference in resilience
levels compared to healthy individuals [14]. Moreover, studies examining the relationship
between resilience and quality of life consistently show a positive association. For instance,
in a study conducted on individuals suffering from various chronic illnesses, psychological
resilience was found to act as a protective factor for subjective well-being [15]. Similar
results were found in another study on women with breast cancer, where resilience emerged
as a significant predictor of well-being [16]. In addition, cancer patients with high levels
of resilience exhibited lower levels of anxiety and depression, better physical, emotional,
and social functioning, and overall a higher quality of life than those with low levels of
resilience [17].
Providing information to patients suffering from malignant diseases is one of the most
important factors in supportive care for patients [18–21]. The goal of providing information
is to prepare the patient for their treatment, encourage acceptance of the recommended
treatment, increase their own abilities to cope with the cancer, and promote recovery [19].
The requirements for receiving information in cancer patients vary based on factors such as
gender, age, cultural environment, level of education, type and degree of cancer spread, and
coping styles [19]. The provision of information about the cancer itself and its treatment
forms the foundation of supportive care for patients. Offering pertinent information to
patients brings several advantages, including joint decision-making, increased satisfaction
with care, enhanced patient control, reduced affective distress, improved communication
with the patient’s family, and an overall better quality of life [18].
Patient-oriented communication is more effective when health professionals value the
patient’s opinion on the received information. Patients with cancer do not always report
that they have received enough information. In addition, clinicians’ efforts in providing
information and patients’ expectations about receiving information may not always match,
and patients’ expectations can change over time [18]. By providing adequate information
to patients, it is possible to reduce the psychological burden and increase the quality of the
patient’s life and their satisfaction with their care. Patients who are well informed about
cancer, treatment, and subsequent care will finish treatment sooner and be less anxious
later [21].
In previous research, it has been demonstrated that individuals diagnosed with cancer
have a strong desire for information regarding the specific type of cancer, the side effects
of chemotherapy, and the treatment prognosis [22]. They also express a need to know
more about various aspects of care [23]. However, studies have shown that they receive a
substantial amount of information from their specialized oncologists about the disease’s
characteristics but receive less information about more sensitive topics such as prognosis
and treatment outcomes [23]. Nonetheless, the statistics reveal that the majority of those
affected (70.3%) are dissatisfied with the existing options for obtaining information about
their illness [22]. However, the relationship between the level of information and personal
well-being is still inadequately explored.
Healthcare 2023, 11, 3181 3 of 16

Numerous studies have investigated the predictive roles of optimism, internal health
locus of control, self-confidence, purpose in life, and perceived social support in the sub-
jective well-being of individuals undergoing chemotherapy [24–27]. Social support and
purpose in life have also been identified as significant predictors of overall psychological
well-being [28]. Reviewing previous research on dissatisfaction with information provided
by medical professionals reveals that the level of information about the disease and related
topics may play a crucial role in an individual’s well-being [22]. Research indicates that
a higher level of information in cancer patients is linked to better adherence to medical
instructions and treatment plans [29]. Based on this, it is evident that there are factors
that can contribute to enhancing the subjective well-being of individuals diagnosed with
cancer. The Biopsychosocial Model serves as a comprehensive lens, elucidating how the
biological aspects of cancer interact with psychological processes, including the pursuit
of purpose in life and adaptive coping strategies, while also recognizing the pivotal role
of social support networks in fostering subjective well-being and resilience among can-
cer patients [30,31]. This study aims to explore the relationship between social support,
purpose in life, resilience, and information levels with various components of subjective
well-being in individuals diagnosed with cancer in Croatia. Previous research has indicated
a significant association between resilience and life satisfaction, as well as between purpose
in life and life satisfaction. However, the specific role of purpose in life as a potential
mediator in the relationship between resilience and life satisfaction remains less explored.
By employing mediation analysis, we aim to provide an understanding of how purpose in
life may operate as a pathway through which resilient individuals experience enhanced
life satisfaction [32–35]. In addition, the study will evaluate the potential to predict spe-
cific components of subjective well-being in individuals diagnosed with cancer based on
these factors.

2. Materials and Methods

2.1. Participants
The study involved 338 individuals diagnosed with cancer, comprising 199 female
participants and 139 male participants. The average age of the participants was 42.5 years
(M = 42.5; SD = 12.45). Of the total number of participants, 62.1% were employed and 37.9%
were not in active employment. Additionally, 74.9% of participants had a marital partner,
while 24.9% were not in a marital relationship. Consequently, participants who were not
in a marital relationship at the time of questionnaire completion did not respond to the
subscales related to social support within the context of a marital partner.
With regard to the primary site of cancer, most participants had diagnoses related
to breast cancer, leukemia, lymphoma, and prostate cancer (Figure 1). The majority of
participants had cancer at the second stage (33.4%), third stage (22.5%), and first stage of
the disease (21.3%), with a smaller number of participants having cancer at the fourth stage
of the disease (6.5%). Regarding their current health status, the majority of participants
reported remission (49.7%), chronic conditions (21.9%), or an active treatment process
(21.3%), while a smaller number of participants indicated recurrence (1.8%).

2.2. Instruments
2.2.1. Sociodemographic Data and General Disease Information
Participants provided sociodemographic information about their age, gender, place
of residence, marital status, and employment status. Additionally, general information
about the disease was gathered, including the primary cancer site, cancer stage, and current
disease status.
 Healthcare 2023, 11, x FOR PEER REVIEW 4 of 17
Healthcare 2023, 11, 3181 4 of 16

Figure 1. Graphic representation of the primary cancer sites among study participants (N = 338).
Figure 1. Graphic representation of the primary cancer sites among study participants (N = 338).
2.2.2. Diener’s Scales of Subjective Well-Being [36]
2.2. Instruments
To collect information about participants’ subjective well-being, a Croatian adaptation
2.2.1. Sociodemographic
of Diener’s Scales of SubjectiveDataWell-Being
and General Disease
was used, Information
consisting of the Life Satisfaction
Scale, theParticipants
Positive and Negative
provided Experience Scale, information
sociodemographic and the Prosperity Scaleage,
about their [37].gender, place
The Life Satisfaction Scale comprises five items measuring cognitive
of residence, marital status, and employment status. Additionally, general information assessments of
satisfaction with one’s own life. Participants were asked to rate their agreement
about the disease was gathered, including the primary cancer site, cancer stage, and cur- with each
statement on a scale
rent disease from 1 (Strongly Disagree) to 7 (Strongly Agree). The total score is
status.
obtained by summing the responses to all five statements, with higher scores indicating
greater
2.2.2.life satisfaction.
Diener’s Scales of Subjective Well-Being [36]
The Positive and Negative Experience Scale consists of 12 items divided into two
To collect information about participants’ subjective well-being, a Croatian adapta-
subscales. Six items measure positive feelings, and the remaining six items measure
tion of Diener’s Scales of Subjective Well-Being was used, consisting of the Life Satisfaction
negative feelings. Participants rated their experiences over the past four weeks on a
Scale, the Positive and Negative Experience Scale, and the Prosperity Scale [37].
five-point scale (1—Very Rarely or Never, 5—Very Often or Always).
The Life Satisfaction Scale comprises five items measuring cognitive assessments of
The Prosperity Scale comprises eight items describing aspects of human functioning.
satisfaction with one’s own life. Participants were asked to rate their agreement with each
Participants were asked to express their agreement with each item on a seven-point scale
statement on a scale from 1 (Strongly Disagree) to 7 (Strongly Agree). The total score is
(1—Strongly Disagree to 7—Strongly Agree). The total score is calculated by summing all
obtained by summing the responses to all five statements, with higher scores indicating
ratings and can range from 8 to 56, with higher scores indicating greater perceived success
greater life satisfaction.
in important areas of functioning. The study reported satisfactory reliability for the Life
The Positive and Negative Experience Scale consists of 12 items divided into two
Satisfaction Scale (α = 0.86), Positive Experience Scale (α = 0.88), Negative Experience Scale
subscales. Six items measure positive feelings, and the remaining six items measure neg-
(α = 0.84), and Prosperity Scale (α = 0.91).
ative feelings. Participants rated their experiences over the past four weeks on a five-point
scale (1—Veryand
2.2.3. Workplace Rarely or Never,
Family 5—Very Scale
Social Support Often[38]
or Always).
TheThe Prosperity
Workplace andScale comprises
Family eight items
Social Support describing
Scale aspects
consists of of human
36 items, functioning.
organized into
Participants were asked to express their agreement with each item on
4 sets of 9 items each, differing only by the source of support. It measures instrumental a seven-point scale
and emotional social support received from superiors at work, work colleagues, a marital all
(1—Strongly Disagree to 7—Strongly Agree). The total score is calculated by summing
ratings
partner, andand can range
other familyfrom 8 to 56,and
members with higher
close scores indicating
individuals. greaterconsidered
The analysis perceived success
par-
in important areas of functioning. The study reported satisfactory
ticipants’ results on the Social Support Scale received from their partner and the reliability forSocial
the Life
Support Scale received from family members and other significant individuals. Each set of
Healthcare 2023, 11, 3181 5 of 16

items contains five positively worded and four negatively worded items. Participants rated
their agreement with each item on a seven-point scale (1—Strongly Disagree to 7—Strongly
Agree). The total score on each subscale is calculated as the mean of the respective items. It
is important to note that this scale assesses the intensity of perceived social support but not
satisfaction with the received support. The study reported good reliability for the Social
Support Scale received from a partner (α = 0.89) and the Social Support Scale received from
family members and other significant individuals (α = 0.88).

2.2.4. Purpose in Life Test [39]

The Purpose in Life Test (Croatian version) comprises 23 items assessing the emotional
and cognitive aspects of a purpose in life [40]. Participants rated the extent to which the
content of the statements applied to them on a five-point scale (1—Does Not Apply to Me
at All to 5—Applies to Me Completely). The study reported a satisfactory level of reliability
(α = 0.93).

2.2.5. The Brief Resilience Scale [41]

The Brief Resilience Scale (Croatian version) consists of six items, with three positively
worded items (e.g., “I usually bounce back quickly after hard times”) and three negatively
worded items (e.g., “It is hard for me to snap back when something bad happens”). Par-
ticipants rated their agreement with each item on a five-point scale (1—Strongly Disagree
to 5—Strongly Agree) [42]. The study reported good reliability for the Resilience Scale
(α = 0.85).

2.2.6. EORTC QLQ-INFO25 [43]

The Information Scale includes four subscales that assess participants’ level of infor-
mation about their illness, medical tests, treatment, and other medical services. Participants
were asked to evaluate the amount of information they had received about their illness and
treatment on a four-point scale (1—Not at all, 2—A little, 3—Quite a bit, 4—Very much).
Additionally, this scale contains eight standalone items that examine areas not covered by
the previous subscales, such as satisfaction with the amount of received information or the
perceived usefulness of the information. The study reported a satisfactory overall reliability
(α = 0.95).

2.3. Procedure
Convenience sampling was used to recruit participants. Permission for the research
was obtained by the Department of Psychology, Faculty of Croatian Studies at the University
of Zagreb (Zagreb, Croatia). Participants were recruited with the assistance of various
associations for cancer patients and specialist oncologists who forwarded the invitation to
participate in the research to their patients or association members. The associations and
doctors were contacted through official email addresses. Data collection was conducted
online using Google Forms survey forms from May 2022 to July 2022. All participants
received the same instructions and provided informed consent to participate in the research.
The instructions emphasized the anonymity of participation in the research and the
option to withdraw from completing the questionnaire at any time without consequences.
The instructions also stated that the collected data would be analyzed at a group level
and used exclusively for scientific purposes. Participants were asked to carefully read
the instructions and were encouraged to answer the questions honestly in order to gather
information about their experiences. As part of the instructions, participants were provided
with the researchers’ email addresses for any questions or concerns.

3. Results
Statistical Analysis
The statistical analysis of the results was conducted using the SPSS program version 22
(BM Corporation, Armonk, NY, USA). Descriptive analyses were performed on three aspects
Healthcare 2023, 11, 3181 6 of 16

of subjective well-being (life satisfaction, positive and negative experiences, and prosperity),
as well as a descriptive analysis of variables related to social support received from family
members and other close individuals, social support received from a marital partner,
purpose in life, resilience, and information.
Correlation analyses were utilized to examine the relationships between the compo-
nents of subjective well-being and the psychosocial factors mentioned. Multiple regression
analyses were carried out to determine the roles of individual psychosocial factors in
explaining the variance in specific components of subjective well-being, separately for each
criterion (life satisfaction, positive and negative experiences, and prosperity).
We also examined the potential mediating role of purpose in life in the relationship
between resilience and life satisfaction. The analysis mentioned was conducted using
PROCESS (version 4.0. for SPSS). A bootstrapping method was used to test the mediation
effect, with 5000 bootstrap samples and the confidence interval (CI) set at 95%. The indirect
effect of resilience on life satisfaction is considered significant if the range of CI (lower
bound–upper bound) does not contain zero [44,45].
Basic descriptive data for the used variables were determined, and the normality of
distributions was checked (Table 1). The Kolmogorov–Smirnov test showed a statistically
significant deviation from normality for all variables except for the variable Informativeness.
This result was expected, given the large number of different diagnoses within the same
category.

Table 1. Basic descriptive data, results of normal distribution, and distribution parameters for
psychosocial variables and subjective well-being variables.

Variable N M SD Min Max KS Skewness Kurtosis

Life Satisfaction 338 24.65 5.94 5.00 35.00 0.093 ** −0.78 0.50
PN Experiences 338 −7.11 7.98 −24.00 22.00 0.069 ** 0.47 0.34
Prosperity 338 44.97 7.63 22.00 56.00 0.081 ** −0.63 −0.15
Social Support (F) 338 5.35 1.12 1.78 7.00 0.100 ** −0.43 −0.60
Social Support (P) 253 5.64 1.23 1.44 7.00 0.133 ** −0.95 0.40
Purpose in Life 338 90.39 15.11 32.00 115.00 0.125 ** −0.77 0.16
Resilience 338 3.19 0.82 1.00 5.00 0.077 ** −0.21 0.22
Informativeness 338 46.41 12.93 6.48 83.33 0.050 0.33 0.27
Note: ** p < 0.01, PN—Positive and Negative, F—Family, P—Partner, KS—Kolmogorov–Smirnov test.

Values on the subjective well-being scales indicated that the majority of participants
were satisfied with their lives, had higher levels of prosperity, and more frequently experi-
enced positive than negative experiences. According to the average values on the social
support scale, participants perceived high levels of social support received from family and
significant others, as well as social support received from their spouses. Higher values on
the purpose in life scale indicated that the majority of participants had a sense of fulfillment
and meaning. However, the results on the psychological resilience scale showed average
values, suggesting that participants were not extremely resilient but also not completely
sensitive to life stressors. Results on the information questionnaire indicated that partici-
pants were moderately informed about their illness, medical examinations, treatment, and
other medical services.
Most participants expressed that they were only slightly satisfied with the amount of
information received from medical professionals, with very few being completely satisfied
with the amount of information received (Figure 2). However, the majority found received
information to be quite useful during and after treatment, whereas only a small number of
participants found it useless.
 Most participants expressed that they were only slightly satisfied with the amount of
information received from medical professionals, with very few being completely satis-
fied with the amount of information received (Figure 2). However, the majority found
Healthcare 2023, 11, 3181
received information to be quite useful during and after treatment, whereas only a small
7 of 16
number of participants found it useless.

Figure
Figure 2. Graphical
2. Graphical representation of
representation of response
response frequencies
frequenciesto to
items forfor
items Satisfaction withwith
Satisfaction the Amount
the Amount
of Received
of Received Informationand
Information andEstimated
Estimated ofof the
theUsefulness
Usefulness of of
Received Information.
Received Information.

A majority of participants (97.3%) indicated satisfaction with the information provided,

A majority of participants (97.3%) indicated satisfaction with the information pro-
while a minority (2.7%) expressed a desire for less information, specifically citing topics
vided,
suchwhile
as cancera minority
patients’ (2.7%)
survivalexpressed a desire for
rates and treatment less information,
prognosis, as highlighted specifically
by a subsetciting
topics such as cancer
of participants (n = 13). patients’ survival rates and treatment prognosis, as highlighted by a
subset of participants67.5%
Furthermore, (n = 13).
of the participants stated that they wanted to receive more in-
Furthermore,
formation, while67.5%
32.5% of the that
stated participants
they did notstated that
want to they wanted
receive to receive more
more information aboutinfor-
their illness, treatment, and other medical services. A total
mation, while 32.5% stated that they did not want to receive more information aboutof 53% of participants had their
never received information about their illness in written form,
illness, treatment, and other medical services. A total of 53% of participants had and 86% of participants hadnever
never received information on a CD or videotape. Additionally, 140 participants (61.4%)
received information about their illness in written form, and 86% of participants had never
from the group that expressed a desire for more information also mentioned specific topics
received information on a CD or videotape. Additionally, 140 participants (61.4%) from
they would like to receive more information about. Their responses were grouped into
thecategories
group that expressed
based a desire
on the topics theyfor more information
covered. also mentioned
Participants mentioned that theyspecific
would topics
like to they
would like to receive more information about. Their responses were
receive more information about the following: (1) psychological support and assistance grouped into catego-
ries(during
based and on theaftertopics they covered.
treatment), Participants
(2) all topics mentioned
related to illness, that they
treatment, would like
and recovery, andto re-
ceive moreeffects
(3) side information about the
and consequences following:
of treatment (1) psychological
(Figure 3). support and assistance
(duringSubsequently, the results(2)
and after treatment), ofall
thetopics
correlation
relatedmatrix and multiple
to illness, regression
treatment, analyses and
and recovery,
(3) for
sidethe criteria
effects andof consequences
life satisfaction,ofpositive
treatmentand (Figure
negative3).experiences, and prosperity are
presented. These analyses were conducted on a subsample of participants who have a
spouse (n = 253), allowing all predictors to be simultaneously included in the regression
analysis. Individuals who do not have a spouse did not respond to items in the scale of
social support received from a spouse. Hence, their responses cannot be included in the
further analysis.
From Table 2, the interrelations among the three components of subjective well-being
(life satisfaction, positive and negative experiences, and prosperity) can be seen. The
variable of positive and negative experiences was negatively correlated with the variables
of life satisfaction and prosperity. This means that higher levels of life satisfaction and
prosperity were associated with more frequent positive experiences compared to negative
experiences. Furthermore, life satisfaction showed significant low to moderate and positive
associations with the variables of social support received from family and a partner, purpose
in life, resilience, and information. Cancer patients who were more satisfied with their lives
 Healthcare 2023, 11, 3181 8 of 16

Healthcare 2023, 11, x FOR PEER REVIEW 8 of 17

tended to have higher levels of purpose in life, perceived more social support from family
and partners, had higher resilience to stress, and were more informed about their diagnosis,
treatment, and medical services.

Figure 3. Graphical representation of thematic areas about which participants stated a desire for
Figure 3. Graphical representation of thematic areas about which participants stated a desire for
more information (n = 140).
more information (n = 140).
Table 2. Correlations of social support factors (family and partner), purpose in life, resilience, and
Subsequently,
information the results
with components of the correlation
of subjective well-being. matrix and multiple regression analyses
for the criteria of life satisfaction, positive and negative experiences, and prosperity are
1. presented.
2. These analyses3. were4. conducted5. on a subsample 6. 7.
of participants 8.who have a
1. Life satisfaction - spouse −0.527
(n = **253), allowing
0.563 ** all0.339
predictors
** to be
0.380 ** simultaneously
0.551 ** included
0.331 ** in0.171
the **
regression
2. PN experiences analysis. -Individuals −0.712 ** do
who −0.314 **
not have −
a 0.261 ** did
spouse −0.731 −0.470
not **respond to**items−0.202
in the** scale of
3. Prosperity - 0.441 ** 0.298 ** 0.732 ** 0.384 ** 0.183 **
4. Social support (F) social support received from a spouse. - Hence,
0.486 ** their0.464
responses
** cannot
0.226 ** be included
0.115 in the
5. Social support (P) further analysis. - 0.316 ** 0.107 0.130 *
6. Purpose in life From Table 2, the interrelations among the three components - 0.478
of**subjective
0.262 well-being
**
7. Resilience - 0.246 **
8. Informativeness
(life satisfaction, positive and negative experiences, and prosperity) can be seen. -
The var-
iable of positive and negative experiences was negatively
Note: * p < 0.05, ** p < 0.01, PN—Positive and Negative, F—Family, P—Partner.
correlated with the variables of
life satisfaction and prosperity. This means that higher levels of life satisfaction and pros-
perityParticipants
were associated with more
who more frequent
frequently positive
experience experiences
positive compared
experiences, to negative
as opposed to ex-
periences. Furthermore,
negative ones, tend to have life satisfaction
a stronger senseshowed
of purposesignificant low to
in life, perceive moderate
more and positive
social support,
have higher with
associations resilience to stress, and
the variables are more
of social informed
support about their
received frommedical
family condition.
and a partner, pur-
pose in Prosperity was significantly
life, resilience, and positively
and information. correlated
Cancer withwho
patients otherwere
variables,
moreindicating
satisfied with
that individuals with higher levels of prosperity also tend to have a stronger sense of
their lives tended to have higher levels of purpose in life, perceived more social support
purpose in life, perceive more social support, have higher resilience, and tend to be better
from family and partners, had higher resilience to stress, and were more informed about
informed about their condition.
their diagnosis,
In order to treatment,
examine theand medical services.
contribution of the observed variables (social support from
family or marital partner, purpose in life, resilience, and informativeness) in explaining
Table 2. Correlations
the three aspects of of social support
subjective factors
well-being of (family and partner),
individuals purpose
with cancer, in life,
multiple resilience, and
regression
information with components of subjective well-being.
analyses were conducted (Tables 3–5). There were no deviations from the multicollinearity
assumption between predictors of conducted regression analysis. The values of Variance
1. 2. 3. 4. 5. 6. 7. 8.
Inflation Factor (VIF) and tolerance did not exceed critical values, i.e., the values of VIF
1. Life satisfaction - −0.527 ** 0.563 ** 0.339 ** 0.380 ** 0.551 ** 0.331 ** 0.171 **
ranged from 1.103 to 1.635, and of tolerance from 0.612 to 0.91.
2. PN experiences - −0.712 ** −0.314 ** −0.261 ** −0.731 ** −0.470 ** −0.202 **
3. Prosperity - 0.441 ** 0.298 ** 0.732 ** 0.384 ** 0.183 **
4. Social support (F) - 0.486 ** 0.464 ** 0.226 ** 0.115
5. Social support (P) - 0.316 ** 0.107 0.130 *
6. Purpose in life - 0.478 ** 0.262 **
7. Resilience - 0.246 **
Healthcare 2023, 11, 3181 9 of 16

Table 3. Regression analysis results for the criterion of life satisfaction.

Unstandardized Coefficients Standardized Coefficients

Model B Standard Error β T p
Constant 3.483 2.012 1.731 0.085
Social Support (F) 0.052 0.319 0.01 0.164 0.87
Social Support (P) 1.022 0.258 0.235 3.962 <0.001
Purpose in life 0.152 0.024 0.418 6.391 <0.001
Resilience 0.642 0.382 0.099 1.678 0.095
Informativeness 0.001 0.022 0.001 0.027 0.979
R R2 Adjusted R2 Standard Error F p
0.595 0.354 0.341 4.338 27.042 <0.001
Note: F—Family, P—Partner.

Table 4. Regression analysis results for the criterion of positive and negative experiences.

Unstandardized Coefficients Standardized Coefficients

Model B Standard Error β T p
Constant 30.137 2.492 12.092 <0.001
Social Support (F) 0.523 0.395 0.069 1.325 0.186
Social Support (P) −0.47 0.319 −0.072 −1.471 0.143
Purpose in life −0.361 0.03 −0.659 −12.202 <0.001
Resilience −1.709 0.474 −0.176 −3.607 <0.001
Informativeness 0.011 0.027 0.017 0.392 0.695
R R2 Adjusted R2 Standard Error F p
0.748 0.559 0.55 5.373 62.684 <0.001
Note: F—Family, P—Partner.

Table 5. Regression analysis results for the criterion of prosperity.

Unstandardized Coefficients Standardized Coefficients

Model B Standard Error β T p
Constant 9.835 2.305 4.266 <0.001
Social Support (F) 0.767 0.365 0.111 2.101 0.037
Social Support (P) 0.23 0.296 0.039 0.78 0.436
Purpose in life 0.323 0.365 0.646 11.807 <0.001
Resilience 0.46 0.027 0.052 1.049 0.295
Informativeness −0.01 0.438 −0.018 −0.408 0.684
R R2 Adjusted R2 Standard Error F p
0.74 0.548 0.539 4.9698 59.951 <0.001
Note: F—Family, P—Partner.

The first regression analysis performed (Table 3) indicated the significance of the
proposed model (F (5, 247) = 27.04; p < 0.001). All predictors included in the analysis
explain 35.4% (R2 adj = 0.341; p < 0.001) of the variance in life satisfaction. Purpose in life
(β = 0.418, t = 6.39, p < 0.001) and social support from a marital partner (β = 0.235, t = 3.96,
p < 0.001) were the only significant predictors, with purpose in life being the strongest one.
The multiple regression analysis with Positive and Negative Experiences as a criterion
variable (Table 4) indicated the significance of the model (F (5, 247) = 62.68; p < 0.001). All
Healthcare 2023, 11, 3181 10 of 16

predictors included in the analysis explain 55.9% (R2 adj = 0.55, p < 0.001) of the variance of
positive and negative experience, with purpose in life (β = −0.659, t = −12.2, p < 0.001) and
resilience (β = −0.176, t = −3.61, p < 0.001) as the only variables that exhibit statistically
significant predictive validity.
The multiple regression analysis conducted for Prosperity (Table 5) indicated the
significance of the model, with 54.8% of the variance in the criterion variable explained
by the observed set of predictors (F (5, 247) = 59.95; p < 0.001, R2 adj = 0.539). The only
significant predictor was purpose in life (β = 0.646, t = 11.81, p < 0.001).
The mediating role of purpose in life between resilience and life satisfaction was
examined. Direct, indirect, and total effect results, as well as lower and upper confidence
intervals for indirect effect, are presented in Table 6. The path coefficients from resilience
to purpose in life, path a (B = 8.539, p < 0.001), and from purpose in life to life satisfaction,
path b (B = 0.185, p < 0.001), were significant. Bootstrapped 95% confidence intervals
indicated a significant indirect effect of resilience on life satisfaction through purpose in
life (LLCI = 1.082, ULCI = 2.156). Hence, purpose in life mediated the relationship between
resilience and life satisfaction. It should be noted that the total effect of resilience to life
satisfaction was significant, path c (B = 2.144; p < 0.001); however, after including the
mediated variable, the direct effect, path c’ (B = 0.566, p = 0.145), became insignificant.

Table 6. Mediation analysis results of resilience on life satisfaction through purpose in life.

Indirect Effect
Predictor (X) M (Purpose in Life) Y (Life Satisfaction)
95%CI
Lower Upper
B SE B SE
Bound Bound
Resilience a *** 8.539 0.986 c 0.566 0.387
c *** 2.144 0.385
Purpose in life b *** 0.185 0.022 1.082 2.156
R2 = 0.229 R2 = 0.31
F(1.252) = 74.95, p < 0.001 F(2.251) = 56.32, p < 0.001
Note: SE—standard error; B—unstandardized coefficients, CI—confidence interval, *** p < 0.001.

4. Discussion
This study aimed to examine the relationships between various psychosocial factors
and the subjective well-being of individuals diagnosed with cancer. The research was
conducted with the objective of affirming established knowledge and advancing com-
prehension in this field, thereby offering practical implications for the improvement of
subjective well-being among cancer patients. Our findings can provide new perspectives
and guidelines for professionals working with cancer patients, thus directly assisting
patients and clients in achieving a better quality of life.

4.1. The Prevalence of Subjective Well-Being and Psychosocial Factors

Consistent with the initial expectations, the research has shown that participants
generally report satisfaction with their lives. The obtained results align with findings
from other studies, which have shown that 50% of adult cancer patients express high
life satisfaction, and that younger adult cancer patients also report above-average life
satisfaction [46,47]. Similar results were found in samples of women with breast cancer and
individuals with colorectal cancer [48,49]. Considering that cancer patients are continually
exposed to various stressors that can potentially disrupt their overall functioning, it can
be concluded that cancer patients successfully cope with these stressors, and they do not
compromise their life satisfaction [6].
In relation to the average score on the prosperity scale, participants generally re-
ported a high level of prosperity. The findings indicate that participants have fulfilled
their universal psychological needs, such as the need for connection, competence, and
self-acceptance [37]. High levels of prosperity suggest that participants are capable and
Healthcare 2023, 11, 3181 11 of 16

competent in meeting personally important goals and needs, which is one of the indicators
of high individual subjective well-being [50]. When these facts are considered in the con-
text of cancer diagnosis, it can be inferred that participants mostly resist challenging and
stressful circumstances, and these challenges do not prevent them from fulfilling important
life goals and needs. Previous findings also demonstrate that the subjective well-being of
cancer patients is not compromised when compared to a group of healthy individuals [51].
Participants predominantly experienced positive emotions in contrast to negative
ones, which differs from the previous findings of the study that found a more frequent
experience of negative emotions compared to positive ones among women with breast
cancer [52]. The difference in results might be due to using Diener’s scale in this study,
which measures general emotions. Other studies used scales capturing more complex
emotions and experiences, like gratitude, hope, acceptance, empathy, and serenity, or
contrasting emotions like shock, shame, helplessness, and “emotional block” [52,53].
Other studies focused solely on measuring negative experiences, i.e., the measurement
of anxiety and depression levels in cancer patients, so we do not have information about
positive experiences for comparison [54]. It should be noted that there were very few
individuals in the sample who had stage IV cancer, where it is expected that the individual’s
physical and mental condition is worse, and with it, there will be more frequent negative
experiences.
Participants received a certain level of support derived from close relationships with
others, but it seems that they believed they could receive even more. It is worth noting
that the measurement pertained to the intensity of received support, leaving the question
of participants’ satisfaction with it unanswered [38]. Received support was assessed in
terms of concrete assistance (action; instrumental support) from close individuals, as well
as emotional support in the form of understanding, acceptance, and comfort.
The participants’ age range was from 20 to 75 years, encompassing adult participants
in various stages of life. They also differed in terms of marital status, employment status,
primary site of cancer diagnosis, the stage of their disease at the time of study participation
(stages I–IV), and the phase of treatment or recovery. Despite these differences among
participants, the results indicated a high level of purpose in life, emphasizing its importance
and serving as an incentive for deeper future research into personal meaning in individuals
diagnosed with cancer.
Participants’ ability to successfully recover from stressful situations was at a moderate
level. They were not exceptionally sensitive to stress and challenging circumstances, but
they did require a certain amount of time for recovery. The obtained results were consistent
with findings from other studies, showing that cancer patients do not differ from healthy
individuals in terms of resilience, and that there is no difference in resilience based on the
stage of the disease [14,55].
An analysis of individual items from the awareness questionnaire showed that partici-
pants’ levels of information were not high, and there is room for improvement in providing
useful information to patients.

4.2. The Relationship between Subjective Well-Being and Psychosocial Factors

Significant moderate to high correlations were found between the constituent vari-
ables of subjective well-being (life satisfaction, positive and negative experiences, and
prosperity) [37]. A positive direction of association was confirmed between the variables
of life satisfaction and prosperity, while a negative direction of association was observed
between the variable combining positive and negative experiences and the remaining
variables [37]. Associations were also found between life satisfaction and various factors
(social support, purpose in life, resilience, and information awareness). These findings
are consistent with the results of other research, confirming a moderate to high positive
association between a purpose in life, and social support with life satisfaction in a sample
of cancer patients [10,56].
Healthcare 2023, 11, 3181 12 of 16

A negative association was found between the variable representing positive/negative

experiences and psychosocial factors. Given that this variable combines the results of the
Positive Experiences Scale and the Negative Experiences Scale, this result was expected. It
indicates that a higher number of positive experiences (and, concurrently, fewer negative
experiences) are associated with higher received support, a sense of purpose, levels of
resilience, and information awareness. These findings are in line with the results in previous
research [57].
Prosperity is most strongly associated with a purpose in life, but is also linked to
other factors. These results align with the initial expectations, indicating that prosperity
is associated with positive life experiences, emotions, and feelings of fulfillment and
acceptance. The predictors used in this study do not explain a significant portion of
the variance in life satisfaction. However, as expected, the significant predictors of life
satisfaction were found to be purpose in life and social support received from one’s spouse.
These results confirm findings from previous research, which emphasized the importance
of a purpose in life and social support in the study of subjective well-being in cancer
patients [56,58]. Received social support was shown to be a significant factor in predicting
higher levels of overall subjective well-being [9].
Resilience predicted more frequent positive experiences such as happiness, joy, and
comfort. This is consistent with previous research, where resilience was found to be
a significant predictor of psychological well-being in a sample of women with breast
cancer [16]. In addition to resilience, which emerged as a significant predictor, a high level of
importance was attributed to purpose in life. It has been shown that individuals diagnosed
with cancer who possess high levels of purpose in life tend to experience fewer negative
and stressful incidents, emphasizing the importance of a purpose in life in predicting both
positive and negative experiences [57]. Contrary to initial expectations, none of the forms
of social support emerged as significant predictors in explaining the experiences of both
positive and negative aspects. The reason for this might be that this study measured the
intensity of social support received from family members and partners rather than the
satisfaction with the support received [38]. Satisfaction with received support might play a
more crucial role in experiencing positive events more frequently than merely the quantity
of support received. This finding underscores the value of investigating satisfaction with
support in individuals with cancer to gain a better understanding of the relationship
between social support and the experiences of positive and negative aspects.
The level of informativeness did not prove to be a significant predictor of the experi-
ences of positive and negative aspects. Once again, the reason for these results may be that
this regression analysis examined the level of informativeness rather than the satisfaction
with the level of information. For instance, a substantial amount of information received
might help some individuals better understand their physical condition, thereby helping
them to cope with their diagnosis and treatment. However, others might find an extensive
amount of received information overwhelming [23].
In analyzing the results for the final component of subjective well-being, prosperity,
it was possible to explain more than half of the variance in prosperity using the set of
predictors. Individuals who have a high purpose in life are more likely to fulfill other psy-
chological needs, such as competence, acceptance, and self-acceptance, thus experiencing
full psychological prosperity. Nevertheless, the factors of resilience and informativeness
did not appear to be significant predictors of prosperity in this study. This result does not
align with other findings, indicating that resilience is a critical protective factor of subjective
well-being [15]. The discrepancies might be attributed to methodological shortcomings and
limitations in the study.
Our findings align with previous research suggesting that individuals with higher
resilience tend to have a stronger sense of purpose, ultimately contributing to greater life
satisfaction [32–35]. Purpose in life serves as a meaningful mediator, elucidating how
resilience positively influences life satisfaction.
Healthcare 2023, 11, 3181 13 of 16

Interestingly, our study reveals a shift in in the relationship between resilience and life
satisfaction after incorporating purpose in life as a mediator. This interplay emphasizes the
importance of purpose in life in explaining how resilience influences life satisfaction. These
findings offer additional insights compared to previous studies, highlighting the need for a
comprehensive understanding of the complex dynamics between psychological resilience,
purpose in life, and overall life satisfaction.

4.3. Limitations, Implications, and Recommendations for Future Research

The primary issue to address pertains to the cross-sectional design and the limitations
of multiple regression analysis. Specifically, one must contemplate the potential bias in the
results due to the inclusion of the informativeness factor, which exhibits very low correla-
tions with the remaining variables (criteria and predictors). An improvement suggestion
may involve the inclusion of the participant’s satisfaction variable with the quantity and
quality of received information in the analysis. Future research could employ a longitudinal
design in order to monitor potential changes of these aspects over time.
Given the limited external validity as a fundamental concern of multiple regression
analysis, using a convenience sample can lead to the instability of regression coefficients
and pose a threat to the validity of the obtained results. Another validity threat related to
the participants in this study was the potential (un)conscious need for self-presentation and
the display of socially desirable behaviors. Convenience sampling also presents a limitation
since it could have led to the selection bias.
Despite the aforementioned limitations, this study holds certain theoretical and prac-
tical implications. Based on a literature review, this work can be considered the first in
Croatia to consolidate various psychosocial factors of the subjective well-being of cancer
patients. It can serve as an initial assessment of subjective well-being in this specific pop-
ulation and provide an overview of the important psychosocial factors of this construct.
Given the comprehensiveness and elaboration of the subjective well-being construct into
three components and the analysis of five different factors, it can undoubtedly serve as
a foundation for future research in this field. The obtained results indicate a relatively
high subjective well-being among cancer patients in Croatia, but there is always room
for improvement, as it concerns a generally malleable construct among individuals in
vulnerable life circumstances.
These theoretical insights can be utilized in the education of all healthcare staff who
play a significant role in the treatment of cancer patients. They can also benefit family
members as well as cancer patients by providing education and developing various skills
to achieve the highest possible subjective well-being, to improve overall quality of life, and
to extend the lifespan for cancer patients.

5. Conclusions
This study revealed high levels of life satisfaction and prosperity, coupled with a
more frequent occurrence of positive experiences compared to negative ones. The findings
indicate a noteworthy level of subjective well-being among cancer patients in Croatia. The
research also identified a moderate to high level of social support received from family
members and other significant individuals, along with a moderate to high level of support
from spouses.
High levels of purpose in life were observed, as well as a moderate level of psycholog-
ical resilience and awareness regarding the disease, screenings, treatment, and other forms
of assistance. Furthermore, a strong interrelationship was found among the components
of the subjective well-being construct, while low to moderate correlations were identified
among different psychosocial factors. Positive associations were observed between life
satisfaction and various factors (meaning in life, social support, resilience, and awareness),
as well as between prosperity and the mentioned psychosocial factors.
Purpose in life and social support from spouses emerged as the strongest predictors
of life satisfaction. Purpose in life and resilience were identified as the primary factors
Healthcare 2023, 11, 3181 14 of 16

explaining both positive and negative experiences, while purpose in life was the most
influential predictor of prosperity among cancer patients. In conclusion, purpose in life
stands out as an exceptionally significant predictor of subjective well-being among cancer
patients, followed by social support from spouses and the psychological resilience of
participants. Notably, social support from family and close individuals, as well as the
participants’ level of awareness, did not prove to be significant predictors of subjective
well-being in this study. Purpose in life plays a mediating role between resilience and life
satisfaction.
These findings not only inform the education of healthcare professionals and fam-
ily members caring for cancer patients, but also directly benefit the patients by raising
awareness, fostering understanding, and providing guidance for psychotherapeutic in-
terventions, ultimately aiming to maximize subjective well-being, expedite recovery, and
enhance overall quality of life.

Author Contributions: Conceptualization, L.B. and K.M.-P.; methodology, K.M.-P., L.B. and V.K.;
formal analysis, K.M.-P.; data curation, K.M.-P.; writing—original draft preparation, L.B. and K.M.-P.,
writing—review and editing, L.B., K.M.-P. and V.K.; supervision, L.B. and V.K. All authors have read
and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: This study was conducted in accordance with the Declaration
of Helsinki, and permission for this research was obtained from the Department of Psychology, Faculty
of Croatian Studies at the University of Zagreb (Protocol number:(640-16/22-2/0001, approval date:
12 May 2022).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the
study.
Data Availability Statement: The data presented in this study are available on request from the
corresponding author.
Conflicts of Interest: The authors declare no conflict of interest.

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