Spiritual Well-Being and Quality of Life in Maintenance Hemodialysis Patients: A Latent Profile Analysis and Serial Mediation Model

Background Spiritual health and psychosocial factors are critical yet underexplored determinants of health-related quality of life (HRQoL) in patients undergoing maintenance hemodialysis (MHD). This study examines the heterogeneous patterns of spiritual health and its sequential mediating pathways (via family care and spiritual coping) in shaping HRQoL among MHD patients, addressing a gap in chronic disease management research. Methods A cross-sectional design was employed with 220 MHD patients recruited from two tertiary hospitals in Guangdong, China (August 2023–January 2024). Validated instruments—the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-SP-12), Family Care Index, Spiritual Coping Questionnaire (SCQ), and Short Form-12 (SF-12)—were administered. Latent profile analysis (LPA) categorized spiritual health subgroups, while chain mediation models (PROCESS macro, 5,000 bootstraps) tested hypothesized pathways. Results HRQoL scores averaged 56.50±22.29. Significant correlations emerged: spiritual health ( r =0.557, P <0.001), family care ( r =0.426, P <0.001), and positive spiritual coping (r =0.565, P <0.001) positively predicted HRQoL, whereas negative coping correlated inversely ( r =−0.343, P <0.001). LPA identified four distinct profiles: Low Spiritual Health (36.8%), Moderate Spiritual Health (20.0%), Peaceful Mindset with Low Belief (13.6%), and High Spiritual Health (29.5%). The mediation analysis revealed that family support and spiritual coping partially mediated the relationship between spiritual well-being and HRQoL (effect sizes: 0.074–0.175, 95% CI excluding 0). The chain mediation pathway "spiritual well-being → family support → spiritual coping → HRQoL" was statistically significant, with total indirect effects of 0.268 and 0.114 (95% CIs excluding 0). Conclusions This study highlights the cascading mechanism by which spiritual health enhances HRQoL through family support and adaptive coping strategies. The heterogeneity of spiritual health profiles underscores the need for tailored interventions, particularly for subgroups like Peaceful Mindset with Low Belief. Clinicians should integrate spiritual assessments and family-centered care into routine MHD management to optimize long-term outcomes.