{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T22:19:31Z","timestamp":1791065971313,"version":"4.1.0"},"reference-count":37,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Medication adherence is a key determinant of treatment effectiveness in early-stage breast cancer, particularly during long-term systemic therapies. As breast cancer is increasingly diagnosed at younger ages, a growing number of women continue to carry active parenting responsibilities during treatment. However, the associations between parenting-related psychosocial factors and medication adherence remain insufficiently explored. This study aimed to examine the associations between parenting stress, spiritual well-being, and medication adherence in women with early-stage breast cancer who maintain active parenting roles. Materials and Methods: This multicenter, cross-sectional study included 432 women with early-stage (I\u2013III) breast cancer receiving active systemic therapy across nine oncology centers. Parenting stress was assessed using the Parenting Stress Scale (PSS), spiritual well-being using the Functional Assessment of Chronic Illness Therapy\u2013Spiritual Well-Being Scale (FACIT-Sp-12), and medication adherence using the 6-item Modified Morisky Adherence Scale (MMAS-6). Spearman correlation analyses and multivariable linear regression models were used to evaluate associations between variables. Mediation analysis was performed using Hayes\u2019 PROCESS macro (Model 4) with 5000 bootstrap samples to assess statistical mediation. Results: Parenting stress was positively associated with poorer medication adherence (\u03c1 = 0.248, p &lt; 0.01), whereas spiritual well-being was negatively associated with non-adherence (\u03c1 = \u22120.225, p &lt; 0.01). Parenting stress showed a strong inverse association with spiritual well-being (\u03c1 = \u22120.597, p &lt; 0.01). In multivariable regression analyses, both parenting stress and spiritual well-being were independently associated with medication adherence (\u03b2 = 0.180, p = 0.002 and \u03b2 = \u22120.199, p = 0.001, respectively). Mediation analysis demonstrated a significant indirect statistical association between parenting stress and medication adherence through spiritual well-being (indirect effect = 0.0155), consistent with partial statistical mediation. Conclusions: Medication adherence among women with early-stage breast cancer and active parenting responsibilities is associated with psychosocial context in addition to clinical factors. Parenting stress is associated with poorer adherence, whereas greater spiritual well-being is associated with better adherence within a statistical mediation framework. These findings generate hypotheses for future longitudinal and interventional studies.<\/jats:p>","DOI":"10.3390\/medicina62020306","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T14:12:46Z","timestamp":1770041566000},"page":"306","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Medication Adherence in Women with Early-Stage Breast Cancer and Active Parenting Responsibilities: The Mediating Role of Parenting Stress and Spiritual Well-Being"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-7659","authenticated-orcid":false,"given":"Veli","family":"\u00c7ak\u0131c\u0131","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine Hospital, \u00c7anakkale Onsekiz Mart University, \u00c7anakkale 17010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7597-422X","authenticated-orcid":false,"given":"Aysel","family":"O\u011fuz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine Hospital, Necmettin Erbakan University, Konya 42080, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9172-8571","authenticated-orcid":false,"given":"S\u00fcleyman","family":"Can","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine Hospital, \u00c7anakkale Onsekiz Mart University, \u00c7anakkale 17010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gizem Bak\u0131r","family":"Kahveci","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine Hospital, Trakya University, Edirne 22030, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8639-3076","authenticated-orcid":false,"given":"Hasibe Bilge","family":"G\u00fcr","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine Hospital, Sakarya University, Sakarya 54000, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-1093","authenticated-orcid":false,"given":"Fahri","family":"Akg\u00fcl","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, I\u011fd\u0131r Dr. Nevruz Erez State Hospital, I\u011fd\u0131r 76000, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdurrahman","family":"Yi\u011fit","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Mersin City Training and Research Hospital, Mersin 33010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9679-9245","authenticated-orcid":false,"given":"Alper","family":"Topal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine Hospital, Tokat Gaziosmanpa\u015fa University, Tokat 60100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8769-1584","authenticated-orcid":false,"given":"P\u0131nar","family":"Peker","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Adana City Training and Research Hospital, Adana 01060, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1562-6340","authenticated-orcid":false,"given":"Erkan","family":"\u00d6zcan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Kastamonu State Hospital, Kastamonu 37100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0382-5396","authenticated-orcid":false,"given":"\u0130vo","family":"G\u00f6kmen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine Hospital, \u00c7anakkale Onsekiz Mart University, \u00c7anakkale 17010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yal\u00e7\u0131n","family":"\u00c7\u0131rak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine Hospital, \u00c7anakkale Onsekiz Mart University, \u00c7anakkale 17010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Smolarz, B., Nowak, A.Z., and Romanowicz, H. 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