Improving spiritual well-being among cancer patients: implications for clinical care

Stigma, social support, and spirituality: associations with symptoms among Black, Latina, and Chinese American cervical cancer survivors

PURPOSE

Few studies have examined experiences of stigma and factors associated with symptoms among cervical cancer survivors from diverse racial and ethnic backgrounds. We investigated survivorship experiences and patient-reported outcomes in the SPADE symptom cluster (sleep disturbance, pain interference, anxiety, depression, and energy/fatigue) among Black, Latina, and Chinese American women diagnosed with cervical cancer.

METHODS

In two phases of research with cervical cancer survivors, we collected qualitative data through individual interviews (N=12; recruited through community referrals) and quantitative data from an observational cohort study (N=91; recruited through 4 national cancer registries). We coded interview transcripts to describe the survivors' experiences. We then evaluated associations between social support, spirituality, and SPADE symptom cluster domains using linear regression models.

RESULTS

Qualitative analysis yielded four themes: perceptions of stigma, empowerment, physical and psychological effects, and social support. These concepts revolved around internal and external stigmas, emotional responses, strengthened faith, and different social support types. Quantitative analyses indicated that greater spirituality was associated with lower symptom burden on all five SPADE domains (p<0.01). We observed nuanced associations between specific types of social support and SPADE domains.

CONCLUSIONS

The survivorship experiences of Black, Latina, and Chinese American women with cervical cancer are negatively influenced by perceptions of stigma. Higher scores on spirituality and varied types of social support were significantly associated with fewer symptoms in the SPADE symptom cluster.

IMPLICATIONS FOR CANCER SURVIVORS

Results suggest targets for future interventions to reduce symptom burden among women diagnosed with cervical cancer by leveraging spirituality and social support.

Spiritual well-being and associated factor among adult cancer patients in Hawassa University Comprehensive Specialized Hospital, Oncology Center, Hawassa, Ethiopia

Background

Spiritual well-being has been shown to boost resistance to mental health crises in cancer patients during the diagnosis and treatment process, but there is a paucity of studies about spirituality in cancer patients, which may make it difficult for healthcare clinicians to assess spirituality and provide spiritual care.

Objective

The aim of this study was to assess the level of spiritual well-being and associated factors among cancer patients in HUCSH Oncology Center in 2022.

Methods and materials

An institution-based cross-sectional study was done from May 30 to June 30, 2022 among 267 cancer patients, and the respondents were selected by a simple random sampling technique. Data was collected by using standardized interviewer-administered questionnaires (FACIT sp12). Data was entered using Epi data version 4.6, and analysis was carried out by using Statistical Package for Social Science version 25. Bivariate and multivariate logistic regression was conducted to determine the relationship between the independent and dependent variables. The strength of association was tested by using p-value at 95% CI. Ethical clearance was obtained from the Institutional Review Board of Hawassa University College of Medicine and Health Science. During data collection, the purpose of the study was clearly explained to the patients, and consent was obtained.

Result

A total of 267 cancer patients were included in the study. There was 100% response rate. Majority of the patients (80.5%) were in a poor spiritual well-being state. Mental distress (AOR = 0.246; 95% CI: 0.114-0.531) and religious education (AOR = 1.288; 95% CI: 1.438-9.142) were factors significantly associated with spiritual well-being among cancer patients.

Conclusion and recommendation

This study showed that more than two-thirds of patients had poor spiritual well-being. Mental distress and religious education were factors associated with spiritual well-being. Attention should be given by nurses of the center for spiritual well-being assessment in clinical practices favoring holistic care in the center.

Implementing nursing diagnoses and care for the spiritual dimension of people with cancer: educational actions

OBJECTIVE

To establish the implementation of nursing diagnoses and care for the spiritual dimension of people with cancer.

METHOD

Action research in a university hospital in the north-east of Brazil. Nine nurses and thirteen nursing technicians from the Onco-hematology and Bone Marrow Transplant Unit of this hospital took part. Data collection took place in four phases and involved the talking map technique, pedagogical workshops and a logbook. The groups' speeches were coded using Maxqda software, subjected to Braun and Clarke's thematic analysis and interpreted in the light of Paulo Freire's constructs.

RESULTS

Phase 1 sought to apprehend the participants' prior knowledge on the subject; in phase 2, proposals emerged for spiritual care organized in the Nursing Process; in phase 3, the diagnoses and care plan for the spiritual dimension for clinical practice were contemplated; and in phase 4, through the final evaluation, it was possible to see the transformations that occurred in the nursing team's practice with the proposed implementation.

CONCLUSION

The educational actions provided significant learning for the nursing team and the implementation of diagnoses and nursing care for the spiritual dimension of people with cancer.

Effects of Music Therapy on Spiritual Well-Being among Patients with Advanced Cancer in Palliative Care: A Meta-Analysis of Randomized Controlled Trials

PURPOSE

Patients with advanced cancer in palliative care often experience physical and psychological symptoms that negatively impact their quality of life (QoL) and spiritual well-being. Music therapy can be used for symptom management in these patients. However, the effectiveness is uncertain. To determine the effectiveness of music therapy on spiritual well-being, QoL, pain, and psychological distress using randomized controlled trials (RCTs).

DATA SOURCE

A systematic search was conducted in EMBASE, PubMed, Cochrane Library, CINAHL, Web of Science, and the ClinicalTrial.gov registry up to September 2022.

CONCLUSION

The meta-analysis included seven RCTs with a total of 747 advanced cancer patients. Music therapy was found to significantly improve spiritual well-being with a mean difference of 0.43 (95% CI: 0.25 to 0.61, P < .001) in the intervention group compared to the control group. However, no significant group differences were found between the intervention and control groups for QoL (SMD: 0.53, 95% CI: -0.12 to 1.13, P = .11), pain (MD: -0.81, 95% CI: -2.06 to 0.44, P = .20), and psychological distress (SMD: -0.05, 95% CI: -0.41 to 0.32, P = .81). Music therapy can effectively improve the spiritual well-being of palliative care patients. However, its beneficial effects on QoL, pain, and psychological distress were minimal.

IMPLICATIONS FOR NURSING PRACTICE

Music therapy interventions can be introduced to help patients deal with spiritual/existential needs. Future studies should identify optimal characteristics of music therapy interventions to aid in enhancing the quality of palliative care for patients with advanced cancer.

Start With the Body or the Mind? Differential Benefits of Mindfulness and Qigong Practices for Colorectal Cancer Survivors: A Qualitative Study

BACKGROUND

Mindfulness and qigong are 2 distinct forms of mind-body practice that have been well-received by cancer survivors. Although there is evidence supporting the effectiveness of mindfulness or qigong in promoting wellness of cancer survivors, little is known about the differential benefits of these common forms of mind-body practices among survivors.

OBJECTIVE

To compare the potential biopsychosocial-spiritual impacts of mindfulness and Baduanjin (BDJ) qigong on colorectal cancer survivors.

METHODS

Sixty cancer survivors who participated in a mindfulness intervention (n = 38) and BDJ qigong (n = 22) intervention were invited to provide qualitative feedback for their experiences. Content analyses were conducted to identify emerging themes from the data, and χ2 tests were conducted to compare the responses of the mindfulness and BDJ groups in the major categories.

RESULTS

Both practices positively influenced psychosocial wellness. The practice of BDJ qigong led to more prominent improvements in physical well-being, whereas mindfulness worked best in enhancing spiritual growth and intrapersonal connectedness.

CONCLUSIONS

Survivors of colorectal cancer who are looking for ways to enhance their vitality and rejuvenate their physical body may find the practice of BDJ helpful, whereas survivors who are looking for spiritual comfort or growth may consider practicing mindfulness as an entry point toward mind-body unity.

IMPLICATIONS FOR PRACTICE

Mindfulness and BDJ may be helpful for survivors of colorectal cancer to improve their holistic wellness. Oncology nurses can consider prescription of mindfulness and/or BDJ for patients recovering from colorectal cancer.

What is the role of spiritual care specialists in teaching generalist spiritual care? The perspectives of pastoral care staff in a large Catholic health and aged care organisation

The value of spiritual care training for all staff working in health and aged care has been demonstrated. This study investigated how spiritual care specialists (SCSs) perceive their role in delivering spiritual care education to other staff. Fourteen SCSs participated in three online focus groups. Two key themes were identified: First, SCSs build upon existing capacity of staff by: (i) recognising existing strengths and capabilities; (ii) using relevant stories; (iii) using language which makes spiritual care accessible; (iv) making training relevant and practical; (v) tapping into staff vocation or calling; and (vi) building awareness of one's own spirituality. Second, SCSs assist staff to draw upon SCS expertise by establishing a trusting relationship and developing staff awareness of the SCS role. The SCS's role in delivering spiritual care education is an important one, and further consideration regarding how to support them in this role is warranted.

Dimensions of spiritual well-being in relation to physical and psychological symptoms: a cross-sectional study of advanced cancer patients admitted to a palliative care unit

OBJECTIVES

Advanced cancer patients face various symptoms, which can cause physical and psychological distress. As a multidimensional construct, spiritual well-being (SWB) may be an inner resource for dealing with these problems. Our study explored the impact of different dimensions of SWB on physical and psychological symptoms in advanced cancer patients admitted to a palliative care unit.

METHODS

This cross-sectional study was conducted among 108 advanced cancer patients in the Hospice Ward, Shengjing Hospital of China Medical University. Patients completed questionnaires on SWB and cancer-related symptoms (insomnia, fatigue, pain, depression and anxiety) at the time of admission. Linear regression analysis was applied to determine the relationship between SWB (meaning, peace and faith) and symptom distress.

RESULTS

SWB accounted for an additional variance of cancer-related symptoms (17.8% to 44.4%). Meaning was negatively associated with insomnia (β = -0.516, p < 0.001) and fatigue (β = -0.563, p < 0.001). Peace and faith were related to lower psychological symptoms, while meaning represented a positive effect on anxiety (β = 0.275, p = 0.036). Higher peace was associated with lower cancer pain (β = -0.422, p < 0.001).

CONCLUSIONS

Our findings suggested that achieving peace and faith appeared to function consistently as a positive resource for advanced cancer patients on depression, anxiety and pain, while meaning may serve to facilitate or hinder positive adjustment. Future studies should focus on the potential clinical implications by identifying the distinct dimension of SWB as symptom management targets in the palliative care practice.

Association of pain management and positive expectations with psychological distress and spiritual well‑being among terminally ill cancer patients admitted to a palliative care unit

BACKGROUND

Although palliation of psycho-spiritual distress is of great importance in terminally ill cancer patients, there is a little information about screening patients who benefit from palliative care and identifying the cancer care targets. This study explored the relationship of pain management and positive expectations with depression, anxiety and spiritual well-being (SWB) in terminal cancer patients admitted to a palliative care unit.

METHODS

Eighty-four terminal cancer inpatients were recruited from the Hospice Ward, Shengjing Hospital of China Medical University. Optimism and general self-efficacy (GSE) were evaluated at admission. Patients completed self-report questionnaires on SWB, depression, anxiety and pain both on admission and one week later. The repeated designed analysis of variance was used to explore the correlates of depression, anxiety and SWB (meaning, peace, faith).

RESULTS

In our sample, only cancer pain diminished significantly one week later. For depression (p = 0.041) and faith (p = 0.013), there was a significant pain group (relieved vs. not relieved) × time interaction effect, such that those with satisfied pain control experienced the improved psycho-spiritual outcomes at 1 week. The relationship between positive expectations, peace and faith was also statistically significant, indicating that the improvement of peace or faith was significant in the low group of optimism and GSE.

CONCLUSIONS

Our findings indicated that pain management lied at the center of depression and SWB, meaning that effective pain management may reduce depression, and improve SWB among terminal cancer patients. Moreover, positive expectations, especially for optimism, may be the new target for SWB-related intervention research. Palliative care nurse should require the identification of terminal cancer patients who may more benefit from short-term palliative care, and target them with effective cancer care.

Spiritual well-being and its association with hope and meaning in life among gastrointestinal cancer patients: a cross-sectional study

PURPOSE

Spiritual well-being is a critical element of individuals' quality of life and is overestimated by healthcare providers. A body of evidence is conducted on the spiritual well-being of cancer patients, but few on gastrointestinal (GI) cancer patients, which constitute a great proportion of the cancer burden. This study aimed to investigate the spiritual well-being of GI cancer patients and its association with hope and meaning in life.

METHODS

A cross-sectional study was conducted. A total of 237 GI cancer patients were recruited in this study by convenience sampling in 2022. All the participants completed the sociodemographic and clinical characteristics, Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing, Herth Hope Index, and Meaning in Life Questionnaire. Multiple linear regression analysis was conducted to explore the associated factors with spiritual well-being.

RESULTS

The GI cancer patients experience a relatively low level of spiritual well-being (mean = 31.54, SD = 9.84). The presence of meaning (B = 0.847, 95% CI [0.640, 1.054], p < 0.001), inner positive readiness and expectancy (B = 1.033, 95% CI [0.548, 1.518], p < 0.001), residence (B = 2.828, 95% CI [1.045, 4.612], p = 0.002), and search for meaning (B = 0.247, 95% CI [0.072, 0.422], p = 0.006) were associated with the spiritual well-being of GI cancer patients. These four associated variables accounted for 57.8% of the variance in spiritual well-being (F = 81.969, p < 0.001).

CONCLUSION

The spiritual well-being of GI cancer patients was relatively low and associated with the presence of meaning, inner positive readiness and expectancy, residence, and search for meaning. Healthcare professionals may consider improving GI patients' spiritual well-being by enhancing their sense of meaning in life and inner positive readiness and expectancy.

"A Pain Deep in Your Soul (Being) that is Not Physical:" Assessing Spiritual Pain in Integrative Oncology Consultations

CONTEXT

Spiritual pain contributes to the suffering of cancer patients. However, it is unclear whether patients seen outside of palliative care report spiritual pain and its relationship with symptom burden.

OBJECTIVES

Characteristics of patients reporting spiritual pain were examined, as well as the association of spiritual pain with symptom burden and how spiritual pain affected the factor structure of the Edmonton Symptom Assessment System (ESAS).

METHODS

A retrospective chart review was conducted of integrative oncology patients who completed the PROMIS10 and a modified ESAS (ESAS-FS) including financial distress and spiritual pain (pain deep in your soul/being that is not physical). Multiple logistic regression was used to assess associations between demographics and spiritual pain. T-tests compared ESAS-FS symptoms and global health for patients endorsing spiritual pain (0 vs. ≥1). Principal component analyses (oblique rotation) were also used to determine ESAS-FS symptom clusters.

RESULTS

The sample (N = 1662) was mostly women (65%) and 39% endorsed spiritual pain at least ≥one. Men and older individuals were less likely to endorse spiritual pain (ps < 0.05). Presence of spiritual pain was associated with worse symptoms on the ESAS-FS and global health (ps < 0.001). The ESAS-FS had two symptom clusters, with the psychological factor including depression, anxiety, wellbeing, sleep, financial distress, and spiritual pain (Cronbach's alpha 0.78).

CONCLUSION

Assessing spiritual pain and understanding the effects of its presence or absence in the context of other physical and psychosocial symptoms may provide additional opportunities for preventing exacerbation of symptoms, improving quality of life, and enhancing overall experience of care.

Barriers and facilitators to multidimensional symptom management in palliative care: A focus group study among patient representatives and clinicians

OBJECTIVES

It is widely acknowledged that co-occurring symptoms in patients with a psychosocial and spiritual aspects should also be considered. However, this multidimensional approach is difficult to integrate into daily practice, especially for generalist clinicians not specialized in palliative care. We aimed to identify the barriers and facilitators to multidimensional symptom management.

METHODS

Focus group meetings were conducted with the following stakeholders: (1) patient representatives, (2) generalist community nurses, (3) generalist hospital nurses, (4) general practitioners, (5) generalist hospital physicians, and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analyzed.

RESULTS

Fifty-one participants (6-12 per group) reported barriers and facilitators with 3 main themes: multidimensional symptom assessment, initiating management of nonphysical problems, and multidisciplinary collaboration. As barriers, generalist clinicians and palliative care specialists reported that generalist clinicians often lack the communication skills to address nonphysical problems and are unaware of available resources for multidimensional symptom management. Palliative care specialists felt that generalist clinicians may be unaware that assessing nonphysical problems is important and focus on pharmacological interventions. Generalist nurses and palliative care specialists indicated that hierarchical difficulties between them and generalist physicians are barriers to multidisciplinary collaboration. Reported facilitators included using symptom assessment scales and standardized questions on nonphysical problems.

SIGNIFICANCE OF RESULTS

Generalist clinicians can be supported by improving their communication skills, increasing their awareness of available resources for multidimensional symptom management, and by using a standardized approach to assess all 4 dimensions of palliative care.

Does Spiritual Well-Being Affect Death Anxiety and Psychological Resilience in Cancer Patients?

This study was conducted to research the effects of spiritual well-being on death anxiety and psychological resilience in cancer patients. This cross-sectional, descriptive and correlational study was carried out with 260 cancer patients who were admitted to oncology and haematology outpatient clinic of a university hospital in east of Turkey between October 2021 and April 2022. The data were collected by using "Personal Information Form", "Spiritual Well-being Scale (FACIT-sp), Death Anxiety Scale (DAS) and The Brief Resilience Scale (BRS). It was found that mean DAS total score of cancer patients was 12.51 ± 3.39, while their mean FACIT-sp total score was 26.10 ± 6.93 and their mean BRS total score was 16.1 ± 7.05. It was found that FACIT-sp total score affected DAS and BRS total score positively, while DAS total score affected BRS total score negatively (p < .001). It was found that cancer patients had moderate level of spiritual well-being and psychological resilience and high level of death anxiety. It was also found that death anxiety and psychological resilience of cancer patients increased as their spiritual well-being levels increased. Psychological resilience was found to decrease as death anxiety increased.

What Aspects of Religion and Spirituality Affect the Physical Health of Cancer Patients? A Systematic Review

In recent years, the literature on the relationship between religion and spirituality (R/S) and the health of cancer patients has been flourishing. Although most studies focus on mental health, many study the physical health of these individuals. In order to summarize the findings of these studies, we reviewed the most recent research on this subject using the PubMed and PsycInfo databases. The objective of this systematic review was to recognize the primary R/S variables studied in research on physical health in cancer contexts. We found that spiritual well-being was the most-researched variable in studies of these characteristics, followed by R/S struggles and other variables such as religious coping; religious commitment or practice; or self-rated R/S. In general, R/S seems to have a positive association with the physical health of cancer patients, although the results are quite heterogeneous, and occasionally there are no relationships or the association is negative. Our results may assist in improving interventions that include spirituality in clinical settings as well as the development of holistic approaches, which may have a positive impact on the quality of life and well-being of cancer patients.

Influence of Spirituality and Religiosity of Cancer Patients on Their Quality of Life

Taking into account the spiritual and religious dimensions is important when it comes to taking care of patients with cancer and their quality of life. The study aimed to show the degree of dependence between the level of spirituality/religiosity of people who have just been diagnosed with cancer or have been diagnosed with cancer in the past and their quality of life. The Daily Spiritual Experience Scale (DSES), the EORTC QLQ-C30 quality of life and EORTC QLQ-FA12 fatigue-related quality of life questionnaire were used. One hundred one respondents of the Catholic faith obtained 65.22 points in DSES; 49.84 points on the QLQ-C30 functioning scale, 58.75 points on the physical scale, 60.73 points on the social scale, 50.17 points on the emotional scale, 64.69 points on the cognitive scale, 55.45 points in fulfilling one’s role and 28.38 points in financial impact. In the QLQ-FA12, respondents obtained 45.94 points on the physical scale, 47.53 points on the emotional scale and 30.69 points on the cognitive scale. In the respondents’ opinion, fatigue was the disease that reduced their quality of life the most—on average, 51.27 points. The oncological patients were characterized by a high level of spirituality/religiosity and an average level of quality of life. Spirituality/religiosity had a positive relationship with physical, emotional and social functioning. On the other hand, it was negatively associated with disease symptoms, such as pain or emotional and physical fatigue. Future research is needed in the context of the quality of life, focused on the spiritual and religious sphere of functioning of cancer patients, conducted in various cultural, ethnic and religious circles, which can serve to improve the education of nurses and develop their spiritual competences.

Living experiences of patients with advanced cancer with low socioeconomic status: protocol for a systematic review of qualitative evidence

INTRODUCTION

The number of patients with advanced cancer is rapidly increasing, and the disease burden among those with low socioeconomic status (SES) has accordingly become a global concern. Low SES can adversely impact patients with advanced cancer. The purpose of this systematic review is to shed light on the life experiences of patients with advanced cancer with low SES to help provide targeted and effective strategies to improve their quality of life.

METHODS AND ANALYSIS

We will include the following English databases: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PubMed, MEDLINE, Embase, Web of Science, Joanna Briggs Institute (JBI) Database of Systematic Reviews, PsycINFO and OpenGrey, and the following Chinese databases: China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals and Wanfang Data Knowledge Service Platform. A comprehensive search of qualitative studies on the experiences of patients with advanced cancer with low SES will be conducted from the above databases, with no age limit. Quality assessments of the studies will be independently performed by two reviewers using the JBI Critical Assessment Checklist, and any disagreements will be resolved through a discussion with a third reviewer. Relevant data will be extracted using the JBI standardised data extraction tools. The JBI meta-aggregation tool will be used to compare, analyse and summarise the original results. The reliability and credibility of the overall quality of the studies included will be evaluated using the JBI ConQual approach.

ETHICS AND DISSEMINATION

This study is based on existing public literature and therefore does not require a formal ethics review. The results of the study may be presented in peer-reviewed international journals and presented at scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42021250423.

Social Support and Spiritual Well-Being of Patients With Esophageal Cancer Aged Over 50 Years: The Mediating Role of Rumination

BACKGROUND

Spiritual well-being plays an important role in helping patients cope with disease. Previous studies have investigated the association between social support and spiritual well-being, whereas few studies have explored the relationship in patients with esophageal cancer (EC), and the mechanisms behind this pathway have not been thoroughly examined.

OBJECTIVE

This study aimed to explore the relationship between social support and spiritual well-being of Chinese patients with EC aged over 50 years and to analyze whether the relationship was mediated by rumination.

METHODS

A cross-sectional survey was conducted with 197 EC patients. Participants completed the general information questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Scale, the Chinese Event Related Rumination Inventory, and the Perceived Social Support Scale (PSSS).

RESULTS

Results demonstrated that social support of patients with EC aged over 50 years was positively correlated with spiritual well-being and deliberate rumination and negatively correlated with intrusive rumination; spiritual well-being was positively associated with deliberate rumination and negatively correlated with intrusive rumination. The effect of social support on spiritual well-being was partially mediated by deliberate rumination and intrusive rumination.

CONCLUSIONS

The findings suggest that interventions directed toward enhancing social support and deliberate rumination and reducing the level of intrusive rumination may help patients with EC aged over 50 years improve spiritual well-being.

A Resilience Model for Patients With Colorectal Cancer: A Structural Equation Modeling Analysis

BACKGROUND

Patients with colorectal cancer (CRC) experience multiple symptoms. Resilience is a positive health outcome that can assist patients to face and adapt to their disease.

OBJECTIVE

The purpose of this study was to evaluate a proposed resilience model for patients with CRC.

METHODS

Patients (n = 416), who were given a diagnosis of stage Ι to III CRC within the past 5 years, were recruited from 2 medical centers in Northern Taiwan. Symptom Severity Scale, Fatigue Symptom Inventory, and Center for Epidemiological Studies Depression scale were used to assess the risk factors of symptom severity, fatigue, and depressive symptoms, respectively. Cancer Behavior Inventory and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale were used to assess the protective factors of self-efficacy for coping with cancer and spiritual well-being, respectively. Resilience was assessed using the Resilience Scale. Structural equation modeling was used to evaluate the proposed resilience model for patients with CRC.

RESULTS

The initial structural equation modeling fit indices did not support the proposed model. In the revised model, depressive symptoms was a partial mediator between protective factors and resilience with an acceptable model fit (comparative fit index, 0.968; root mean square error of approximation, 0.085; standardized root mean square residual, 0.034).

CONCLUSIONS

Patients with CRC who had higher levels of protective factors had higher levels of resilience. This study provides new information on the role of depressive symptoms as a partial mediator between protective factors and resilience.

IMPLICATIONS FOR PRACTICE

Oncology nurses need to evaluate for depressive symptoms as well as protective factors and resilience in patients with CRC.

Spiritual Distress in Patients With Cancer Initiating Chemotherapy: A Cross-Sectional Study

PURPOSE

To assess spiritual distress in patients with cancer who were initiating chemotherapy.

METHODS

This was a quantitative, observational, cross-sectional study. Data collection was conducted between February and June of 2019. The Spiritual Distress Scale (SDS) was administered to 332 patients with cancer.

FINDINGS

Most participants (56.6%) were female, with the mean age at 60.3 years (SD = ±11.73). The mean SDS score was 56.6 (SD = ±13.39), with 30% of the participants reporting moderate and 9.6% reporting high levels of spiritual distress. Younger age (β = -0.687, p = .008) and participants having no religious affiliation were predictors of SDS (β = -8.322, p = .035) in patients with cancer initiating chemotherapy.

CONCLUSIONS

Given the degree of spiritual distress reported, this study provides further evidence to support the need for nurses to assess spirituality in order to provide holistic care inclusive of spiritual domain.

CLINICAL RELEVANCE

These results are relevant to clinical practice and indicate a need for nurses to use the clinical reasoning process to assess spiritual distress and to plan nursing interventions aimed at meeting the spiritual needs of patients with cancer who are initiating chemotherapy.

The role of spirituality in symptom experiences among adults with cancer

PURPOSE

Adults with cancer experience symptoms such as pain, fatigue, depression, and sleep disturbance, which can impede quality of life. Research suggests that addressing spirituality may be one route to support holistic symptom management. The purpose of this study is to explore how spirituality relates to common cancer-related symptoms (including severity, distress, and interference) among a sample of adults with cancer.

METHODS

This is a secondary analysis of data from N = 200 solid tumor cancer patients undergoing chemotherapy. Symptom experiences were assessed with a modified version of the Memorial Symptom Assessment Scale and the M. D. Anderson Symptom Inventory-Interference Subscale. Spirituality was assessed using a subset of items from the Fox Simple Quality of Life Scale. A series of ordinal and linear regressions were used to examine the relationship between spirituality and symptom severity, symptom-related distress, and symptom interference across four cancer-related symptoms (pain, fatigue, depression, and sleep disturbance).

RESULTS

Higher spirituality trended toward an association with lower pain severity, although results were not significant (p < .058). Higher spirituality was significantly associated with lower severity of fatigue (p < .003), depression (p < .006), and sleep disturbance (p < .004). Spirituality was not significantly associated with any of the four symptom-related distress outcomes. Higher spirituality was significantly associated with lower overall symptom interference (p < .004).

DISCUSSION

This study highlights the role of spirituality in the experience of cancer-related symptoms. Additional research is needed among more diverse samples of people with cancer. This foundational work could lead to the development of symptom management interventions that incorporate aspects of spirituality.

Longitudinal changes in spiritual well-being and associations with emotional distress, pain, and optimism-pessimism: a prospective observational study of terminal cancer patients admitted to a palliative care unit

PURPOSE

Although spiritual well-being (SWB) is gaining increasing attention within the international palliative care (PC) guidelines, a lack of insight exists into the correlates and course of SWB among cancer patients. We therefore conducted a prospective observational study to capture trend of SWB and to identify their predictors in Chinese inpatients with terminal cancer receiving short-term PC.

METHODS

A prospective observational study was conducted of terminal cancer inpatients in the hospice ward, Shengjing Hospital of China Medical University. A total of 108 patients completed self-report questionnaires on Functional Assessment of Chronic Illness Therapy-Spiritual Well-being, Hospital Anxiety and Depression Scale, Numerical Rating Scales, and Life Orientation Scale-Revised anonymously at baseline; SWB, depression, anxiety, and pain were subsequently assessed at 1-week interval. Multilevel regression was used to analyze the temporal course and predictors of SWB.

RESULTS

Patients' existential well-being (B =  - 0.99, p = 0.008; 95%CI =  - 1.72 to - 0.26) and meaning dimension (B =  - 0.87, p < 0.001; 95% CI =  - 1.29 to - 0.43) significantly decreased after admission to the PC unit, but peace and faith did not change over time. Increases in depression and pain were related to lower existential well-being, particularly in the meaning dimension. Optimism-pessimism moderated the linear trend of existential well-being and meaning domain, such that those with higher optimism and lower pessimism paired with a decrease in outcomes.

CONCLUSIONS

Terminal cancer patients experienced worsening existential well-being, particularly in the meaning facet while hospitalized, indicating that PC should include content that targets the existential concerns of spirituality in China. These findings also supported the need for an integrated PC to address personality traits and emotional and physical distress in this population.

The Importance of Spirituality for Women Facing Breast Cancer Diagnosis: A Qualitative Study

Breast cancer remains significantly distressing and produces profound changes in women’s lives. Spirituality is an important resource at the time of diagnosis and treatment decisions. This qualitative study aimed to explore the spiritual experience of women diagnosed with breast cancer and the considerations of spirituality in health care using the existential phenomenology approach. The sampling procedure was intentional, based on the study’s exclusion and inclusion criteria. Forty women participated in individual interviews. The research was conducted in the outpatient clinic of a reference federal university hospital in South-Eastern Brazil. Throughout the research process, ethical principles were carefully followed. Five themes were identified: (1) meaning of spirituality–source of spiritual strength, (2) well-being in the relationship with God, (3) well-being in religious fellowship, (4) values and purpose of life–meaning in life, and (5) spirituality as a foundation to continue. Respect for patient’s spiritual values was recognised as a fundamental principle in health care. Spirituality was revealed as a source of support during the complex process of being diagnosed with breast cancer. Thus, health care professionals that value and encourage spirituality are needed, favouring better patient response to the diagnosis.

Exploring the relationship between spiritual well-being and death anxiety in patients with gynecological cancer: a cross-section study

Background

In recent years, spiritual well-being has gradually gained the attention of health care providers in China, especially those in oncology departments, who have recognized the importance of improving spiritual well-being in cancer patients. Since most of the current research on spiritual well-being has been carried out in areas with religious beliefs, this study was conducted in the context of no development of formal religion. The purpose of this study was to explore the relationship between death anxiety and spiritual well-being and the related factors of spiritual well-being among gynecological cancer patients.

Methods

This cross-section study was conducted among 586 gynecological cancer patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-spiritual well-being32 (EORTC QLQ-SWB32) and Templer's Death Anxiety Scale (T-DAS) were used to measure spiritual well-being and death anxiety. The Multiple Linear Regression Model was used to determine the relationship between spiritual well-being and death anxiety.

Results

For all participants, the highest QLQ-SWB32 centesimal score was 75.13 on the Relationship with Other scale, and the lowest was 60.33 on the Relationship with Someone or Something Greater Scale. The mean Death Anxiety score was 5.31 (SD 3.18). We found that Relationship with Someone or Something Greater was the only scale not associated with death anxiety. Overall, patients with lower death anxiety have a higher level of spiritual well-being. Besides, a high Relationship with Other score was associated with living with a partner (B = 2.471, P < 0.001) and married (B = -6.475, P = 0.001). Patients with higher Global-SWB were retired (B = 0.387, P = 0.019).

Conclusions

Our study found that the spiritual well-being of patients with gynecological cancer in China was no worse than in other countries with religious beliefs and patients with lower death anxiety have a higher level of spiritual well-being. Clinical staff should pay attention to the spiritual health of cancer patients, and spiritual care should be regarded as an essential element in cancer care.

Psychometric evaluation of the Persian version of the spiritual well-being scale (SWBS) in Iranian patients with cancer

OBJECTIVE

The spiritual well-being scale (SWBS) is a widely used clinical scale which should be evaluated for Iranian patients with cancer. The aim of this study is to evaluate the psychometric properties of the Persian version of the SWBS in Iranian patients with cancer.

METHOD

This cross-sectional, methodological study was conducted among Iranian patients with cancer (n = 400). The participants were recruited using convenience sampling. The content, construct, convergent and discriminant validity, and reliability of the Persian version of the SWBS were evaluated.

RESULTS

A two-factor structure for the scale was indicated with the factors being: connecting with God and meaningless life that explained 54.18% of the total variance of the concept of spiritual well-being. The results demonstrated the model had a good fit. Cronbach's alpha, McDonald's omega, and the inter-item correlation values of the factors indicated good internal consistency of the scale.

SIGNIFICANCE OF RESULTS

These results suggest that the Persian version of the SWBS is a reliable and valid measure to assess the spiritual well-being of patients with cancer through 16 items related to connecting with God and meaningless life.

Optimism and social support as contributing factors to spirituality in Cancer patients

BACKGROUND/OBJECTIVE

The impact a cancer diagnosis and its treatment are affected by psychosocial factors and how these factors interrelate among themselves. The objective of this study was to analyze the relationship between optimism and social support in spiritual wellbeing in cancer patients initiating chemotherapy.

METHODS

A cross-sectional, multi-center (15 sites), prospective study was conducted with 912 cancer patients who had undergone curative surgery for a stage I-III cancer and were to receive adjuvant chemotherapy. They completed the Functional Assessment of Chronic Illness-Spiritual Well-being Scale (FACIT-Sp), Life Orientation Test-Revised (LOT-R), and the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

Significant differences on spirituality scales (meaning/peace and faith) were detected depending on age (≤ 65 vs > 65), sex, marital status, employment, and cancer treatment. Married or partnered participants had significantly higher meaning/peace scores compared to their non-partnered counterparts (p = 0.001). Women, > 65 years, unemployed, and patients treated with chemotherapy and radiotherapy had significantly higher faith scores versus men, ≤ 65 years, employed, and subjects only receiving adjuvant chemotherapy (all p < 0.030). Multivariate analyses indicated that meaning/peace and faith correlated positively with optimism and social support.

CONCLUSION

During oncological treatment, the positive effects of optimism and social support exhibit a positive correlation with spiritual coping. A brief assessment evaluation of these factors can aid in identifying at risk for a worse adaptation to the disease.

Spiritual Wellbeing of Cancer Patients: What Health-Related Factors Matter?

This study aimed to determine the predictors of spiritual wellbeing of non-terminal stage cancer patients hospitalized in oncology units in Lithuania. An exploratory cross-sectional study design was employed. During structured face-to-face interviews, 226 cancer patients hospitalized in oncology units responded about their spiritual wellbeing, perception of happiness, satisfaction with life, pain intensity, levels of education and physical functioning, and length of inpatient stay. A set of standardized tools were used: spiritual wellbeing scale SHALOM, brief multidimensional life satisfaction scale, Oxford Happiness Questionnaire, Barthel Index questionnaire, and verbal pain intensity scale. Additionally, social- and health-related factors were included in data analyses. Structural equation modeling was adapted for a comprehensive assessment of the mediating effect of spiritual wellbeing on the relationship between different health- and value-related factors. The overall fit of the structural model was generally good: [Formula: see text] = 66.94 (χ²/df = 2.31), CFI = 0.94, RMSEA = 0.08, and SRMR = 0.06. Data were analyzed using the Statistical Package for Social Sciences (IBM SPSS Statistics) version 24.0 and Mplus version 8.2. Level of happiness, life satisfaction, and spiritual wellbeing scored in the moderate upper range. The communal domain of spiritual wellbeing rated with the highest mean score and transcendental domain with the lowest score. Education (b = 0.208, p = 0.004), physical functioning (b = 0.171, p = 0.025), and hospital duration (b = - 0.240, p = 0.001) were significant predictors of spiritual wellbeing. Happiness and life satisfaction were negatively influenced by pain intensity, which ranged from mild to moderate. Levels of education, physical functioning, and length of hospital stay predict spiritual wellbeing of non-terminally ill cancer patients. Happiness, as well as life satisfaction, was negatively predicted by pain intensity but had no direct influence on spiritual wellbeing of cancer patients. Spiritual wellbeing positively influences emotional wellbeing (happiness and life satisfaction), and its influence is stronger than the negative influence of physical pain has on emotional wellbeing.

The effect of applying Spiritual Care Model on well-being and quality of care in cancer patients

PURPOSE

The study was an attempt to explore the effect of applying spiritual model of nursing care on spiritual well-being and quality of spiritual care in cancer patients.

METHOD

A quasi-experimental study, the present inquiry was carried out with control and intervention groups with participation of 72 patients and 63 nurses in an advanced center in Iran. The Spiritual Care Model (SCM) was designed by the researchers in this study and was performed on the intervention group by nurses after they received proper training. The data were collected using Demographic Information Questionnaire, Spiritual Well-Being Scale (SWBS), and Spiritual Care Delivery Rating Scale (SCDRS) in pre-intervention and post-intervention stages and were analyzed with SPSS v.16.

RESULTS

Before the intervention, the means for spiritual well-being and the quality of spiritual care were not significantly different for the intervention and control groups (p < 0.05). After the intervention, i.e., upon discharge from the hospital, the mean of spiritual well-being in the intervention group was significantly higher than that of the control group (p < 0.001). Based on the opinions of both nurses and patients, the mean of the spiritual care quality was significantly higher in the intervention group in comparison to that in the control group once the intervention was over (p < 0.001).

CONCLUSION

Given the positive effect of the SCM on enhancing the spiritual care quality and improving the patients' spiritual well-being, it is recommended that the SCM be used as a proper guideline and as a model for boosting nurses' professional performance in spiritual care.

Well-being in high-risk pregnancy: an integrative review

BACKGROUND

A prerequisite to the interventions for well-being improvement in high-risk pregnancy (HRP) is to make the concept clear, objective, and measurable. Despite the wealth of studies into the concept of well-being in HRP, there is no clear definition for it. This study aimed to explore the concept of well-being in HRP.

METHODS

This integrative review was conducted using the Whittemore and Knafl's approach. A literature search was done without any data limitation in dictionaries, thesauruses, encyclopedias, well-being-related textbooks, midwifery, psychology, and mental health journals, and Iranian and international databases. The most primary inclusion criterion was relevance to well-being in HRP. The full-texts of all these articles were assessed using the checklists of the Joanna Briggs Institute. Data were analyzed through the constant comparison method and were managed using the MAXQDA 10 software. Meaning units were identified and coded. The codes were grouped into subcategories and categories according to the attributes, antecedents, and consequences of well-being in HRP.

RESULTS

Thirty articles were included in the review, from which 540 codes were extracted. The codes were grouped into seven main attributes, eight main antecedents, and five main consequences of well-being in HRP. The four unique dimensions of well-being in HRP are physical, mental-emotional, social, and spiritual well-being. These dimensions differentiate well-being in HRP from well-being in low-risk pregnancy and in non-pregnancy conditions.

CONCLUSION

As a complex and multidimensional concept, well-being in HRP refers to the pregnant woman's evaluation of her life during HRP. It includes physical, hedonic, and eudaimonic components. The assessment of well-being in HRP should include all these components.

Perceptions of Clergy Regarding the Provision of Spiritual Care in Lithuanian Hospitals for Cancer Patients

This paper presents an analysis of narratives drawn from research that examined the views of clergy in regard to the provision of spiritual care in Lithuanian hospitals. The purpose of this research was to examine the shared responsibilities between what nurses do in the provision of holistic care and that of the clergy who are employed to provide spiritual care. A thematic analysis was undertaken, guided by questions related to how spirituality was perceived by the clergy; how spiritual care was defined; clergy's perceptions to nurses' provision of spiritual care, and whether there was a delineation between these two roles. Findings showed that although the clergy believed that their role was important in the provision of spiritual care, both nurses and clergy acknowledged that both played a role in spiritual support. However, scope of practice for each role was not yet defined. For nurses and clergy to understand their roles and the boundaries between them, clear standards of practice need to be developed.