Quiet Ego as a Mediator Between Transcendence and Hopelessness in Cancer Patients in Türkiye: A Psycho-Oncology Study.

Résumé

Cancer profoundly affects patients' existential meaning systems alongside their psychological well-being, often intensifying vulnerability to hopelessness. Within religion and health research, distinctly spiritual resources such as transcendence have been proposed as protective factors, reflecting a sense of connection to higher meaning and purpose; however, the psychological mechanisms linking spirituality to emotional outcomes remain insufficiently understood. This study examined the mediating role of quiet ego-a balanced self-orientation characterized by mindfulness, humility, and relational awareness-in the relationship between the transcendence dimension of spiritual well-being and hopelessness among cancer patients in Türkiye. A cross-sectional correlational design was employed with 206 oncology patients. Participants completed the Beck Hopelessness Scale, the Three-Factor Spiritual Well-Being Scale, and the Quiet Ego Scale. Because hopelessness represents a clinically measurable indicator of diminished future-oriented expectations, it was used as the primary outcome reflecting inverse aspects of hope within psycho-oncology research. In line with methodological critiques regarding contaminated spirituality measures, spiritual well-being was analyzed at the subdimension level, with primary emphasis on the transcendence subscale due to potential conceptual overlap between other subdimensions and psychological distress indicators. Mediation analyses using Hayes' PROCESS macro (Model 4) indicated that transcendence was associated with lower hopelessness both directly and indirectly through quiet ego, which partially mediated the relationship and explained 33% of the variance. Age was the only socio-demographic variable significantly related to hopelessness. Findings highlight quiet ego as a psychological pathway through which distinctly spiritual orientation contributes to resilience in cancer contexts, supporting the integration of spiritually informed psycho-oncological interventions.