Prospective study of religious coping among patients undergoing autologous stem cell transplantation

Conceptualizing an Integrative Multiple Myeloma Care: The Role of Nutrition, Supplements, and Complementary Modalities

Multiple Myeloma (MM) is the second most prevalent hematologic malignancy, and its incidence has been increasing enormously in recent years. The prognosis of MM has changed radically with the introduction of new drugs that have improved life expectancy; recurrences are a common occurrence during the course of the disease and are characterized by an increase in refractory to treatment. Moreover, MM patients are challenged by quality of life-related concerns while limited conventional therapy may be offered. This includes bone pain and dialysis due to the complications of acute renal failure. We, therefore, believe that it is very important to add new treatment modalities, including supplements, nutritional modifications, acupuncture, and mind-body therapies, with the goal of improving treatment tolerance, effectiveness, and patients' quality of life. Moreover, many patients use some of these supplements on their own, in the hope of reducing the side effects, so it is even more important to know their action and potential. The purpose of this review is to illustrate all these strategies potentially available to enrich our approach to this, to date, incurable disease.

The Influence of Religiosity and Spirituality on the Quality of Life of Patients With Multiple Myeloma

INTRODUCTION

The majority of patients with advanced neoplasms have religious/spiritual needs, and for most of them religion and/or spirituality is important. The psychology of religion and spirituality is one the forms of support offered to patients with advanced cancer. R/S are factors which impact health-related quality of life (HRQoL). The aim of this paper was to assess the influence of R/S on the HRQoL of patients diagnosed with MM.

MATERIALS AND METHODS

The patients filled out anonymous questionnaires about R/S and the HRQoL scale. The clinical data were collected from medical records.

RESULTS

The study sample consisted of 83 patients with MM (51.8% women), with a mean age of 64.9 years. The leading denomination among the respondents was Catholic (N = 83, 100%): 36% described themselves as deep believers (N = 30), 53% as believers (N = 44), and 11% as nonpracticing believers (N = 9). Most patients were receiving ongoing treatment (59.8%), while 40.2% were in remission from the disease. Patients in remission declared a significantly higher interest in R/S issues than patients in active treatment and had a higher rate of intrapsychic R/S struggles dominated by anxiety and guilt. A moderate negative correlation between interest in R/S issues and unfavorable assessment of physical functioning and role functioning was observed. Anger towards God positively correlated with a negative assessment of emotional functioning.

CONCLUSIONS

The findings highlight the importance of R/S for the HRQoL of MM patients and show that their QoL depends on the types of R/S coping used.

Spiritual coping strategies: Relationship with physical, anxiety, and depression symptoms of patients with cancer

Introduction

Spirituality is considered an important source against chronic diseases and can promote self-esteem, mental comfort, and hope in patients. Concerning its importance, the present study aims to investigate spiritual coping strategies and its relationship with physical, anxiety, and depression symptoms of patients with cancer who are referred to the oncologic ward.

Method

This was a descriptive-correlative study that 159 patients with cancer participated in the study. Information was collected using a four-part questionnaire including sociodemographic characteristics, Spiritual Coping Strategies Scale, physical symptoms as well as anxiety and depression symptoms. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis, and Spearman correlation coefficient.

Results

Results of the study showed that the mean (±SD) of the application of methods of spiritual coping strategies was 35.69 ± 10.92 and for its subscales the mean (±SD) of the application of religious coping and nonreligious coping strategies were 16.92 ± 5.6 and 18.77 ± 6.24, respectively. Furthermore, physical symptoms perceived by patients were tiredness, drowsiness, and lack of appetite. There was no significant correlation between physical, anxiety, and depression symptoms and spiritual coping strategies (r = -0.12, P = 0.12; r = 0.07, P = 0.41; and r = -0.05, P = 0.5 respectively).

Discussion

Regarding no significant relationship between physical, anxiety and depression symptoms and spiritual (religious and nonreligious) coping strategies in this study, belief towards cancer and cultural aspects of patients may be more essential to their sense of wellness and help them to cope with negative aspects of illness or treatment. Therefore, more study needs to be done in this area.

Instruments for Assessing Spiritual/Religious Coping in Multicultural Clinical Settings

ABSTRACT

A review of literature was conducted to discover and compare various instruments that could be used in daily nursing practice to assess spiritual and religious coping in a variety of multicultural clinical settings. Fifteen spiritual and religious (S/R) instruments were identified, used in 31 studies in multiple countries. These S/R coping tools may be useful to nurses in assessment and for planning interventions.

Yields of mesenchymal stromal cells from synovial fluid reflect those from synovium in patients with rheumatoid arthritis

The yield of primary synovial mesenchymal stromal cells (MSCs) from synovium of patients with rheumatoid arthritis (RA) is highly variable, but cell transplantation therapy with autologous synovial MSCs requires accurate prediction of the synovial MSC yield per synovium weight. Here, we determined whether the yield of synovial fluid MSCs might predict the ultimate yield of primary MSCs from the synovium of RA knees. Synovial fluid and synovium were harvested during total knee arthroplasty from the knee joints of 10 patients with RA. Synovial fluid (1.5 mL) was diluted fourfold and plated equally into six 60 cm² dishes. Nucleated cells from digested synovium were similarly plated at 1 × 10⁴ cells in 6 dishes. All dishes were cultured for 14 days and analyzed for MSC yields and properties, including in vitro chondrogenesis. The cultured synovial cell number was correlated with the cultured synovial fluid cell number (n = 10, R² = 0.64, p < 0.01). Synovial fluid cells formed cell colonies and showed MSC-like surface epitopes and multi-differentiation potential. However, the cartilage pellet weight indicated a greater chondrogenic potential of the synovial MSCs (n = 8). The primary MSC yields from synovial fluid and synovium were correlated, indicating that the synovial fluid MSC yield can predict the ultimate synovial MSC yield.

Bi-directional associations between religious attendance and mental health: findings from a British birth cohort study

BACKGROUND

There is evidence that religious attendance is associated with positive outcomes for mental health; however, there are few longitudinal studies, and even fewer, which take into account the possibility of bi-directional associations. This study aimed to investigate bi-directional associations between religious attendance and mental health.

METHODS

Participants were 2125 study members who provided data at age 68-69 from the Medical Research Council National Survey of Health and Development (1946 British birth cohort study). Mental health was assessed using the 28-item General Health Questionnaire at ages 53, 60-64 and 68-69. Religious attendance was measured using a 4-point scale (weekly=3, monthly=2, less than monthly=1 or never=0) at ages 43, 60-64 and 68-69. Cross-lagged path analysis was used to assess reciprocal associations between mental health and religious attendance, adjusting for gender and education.

RESULTS

Previous religious attendance was strongly related to later attendance (r=0.62-0.74). Similarly, mental health at baseline was strongly associated with subsequent mental health scores (r=0.46-0.54). Poor mental health at age 53 and 60-64 was associated with more frequent religious attendance at age 60-64 (b=0.04; 95% CI: 0.02 to 0.06; p<0.05), and 68-69 (b=0.03; 95% CI: 0.02 to 0.06; p<0.05), respectively. There was no evidence that religious attendance at age 43, 60-64 or 68-69 was associated with later or concurrent mental health.

CONCLUSION

Using birth cohort data from the UK, it was found that poor mental health was associated with later religious attendance but not vice versa. Future research should confirm these novel findings and explore the underlying mechanisms between religious attendance and mental health.

Positive and negative religiousness and search for meaning: Impact on treatment of substance abuse after 6 months

BACKGROUND

Religiousness and meaning in life are protective factors against addiction. Understanding this relationship may help to improve treatment. The aim of the current study was to assess the associations of positive and negative religiousness and search for meaning with treatment outcome, for patients with substance disorder (SUD).

METHOD

The sample consisted of 115 participants attending a Christian drug addiction treatment center in the Netherlands. The study had a longitudinal design in which associations of positive/negative religiousness and search for meaning at baseline (T0) with treatment outcome after six months (T1) were assessed by means of regression analyses. Treatment outcome was measured by clinical dysfunction and the degree of addiction. Instruments used were the ROM (Routine Outcome Monitoring) Meaning and Religious Faith, the Outcome Questionnaire (OQ-45) and the Measurements in the Addictions for Triage and Evaluations (MATE-1).

RESULTS

A high degree of positive religiousness at T0 was associated with less addiction at T1 (p < .01). A high degree of negative religiousness at T0 was related to more clinical dysfunction at T1 (p = <0.05). A higher search for meaning at T0 predicted a higher level of addiction at T1 (p = <0.05).

CONCLUSIONS

Positive religiousness is associated with less, whereas search for meaning is associated with more addiction after six months. Negative religiousness is not associated with addiction, but with clinical dysfunction. Health professionals are recommended to assess these factors at the start of treatment and to consider possibilities to integrate them into treatment.

Top Ten Tips Palliative Care Clinicians Should Know About Spirituality in Serious Illness

Assessment of spiritual suffering and provision of spiritual care are a central component of palliative care (PC). Unfortunately, many PC clinicians, like most medical providers, have received limited or superficial training in spirituality and spiritual distress. This article, written by a group of spiritual care providers, and other PC and hospice clinicians, offers a more in-depth look at religion and spirituality to help to enhance readers' current skills while offering a practical roadmap for screening for spiritual distress and an overview of partnering with colleagues to ensure patients receive values-aligned spiritual care provision.

Anxiety, depressive, and trauma symptoms during the COVID-19 pandemic: Evaluating the role of disappointment with God

BACKGROUND

The COVID-19 pandemic has led to pervasive social and economic disruptions. This cross-sectional investigation aimed to evaluate associations between religious/spiritual factors and mental health symptoms among community residents in a southern US state. In particular, we focused on perceptions of God's distance, a salient aspect of religious/spiritual struggle that has received little scrutiny in health research.

METHODS

Participants included 551 respondents assessed during a period of gradual reopening but rising infection rates. Mental health outcomes were assessed using standardized measures of generalized anxiety, depression, and trauma symptoms. Perceptions of an affirming relationship with God, anger at God, and disappointment at God's distance were evaluated using an adapted version of the Attitudes-Toward-God Scale-9.

RESULTS

In multivariate analyses that accounted for pandemic-related and demographic factors, positive relationships with God were related to diminished symptoms on all three mental heatlh indices (all p's ≤.003), whereas disappointment with God's distance was associated with more pronounced difficulties (all p's ≤.014).

LIMTATIONS

The cross-sectional design precludes causal conclusions.

CONCLUSIONS

Findings suggest that perceived relationships with God are tied to clinically relevant mental health outcomes during periods of major upheaval. Disappointment with God's distance may be an important, understudied dimension of religious/spiritual struggle meriting further investigation.

Religious/spiritual struggles and psychological distress: A test of three models in a longitudinal study of adults with chronic health conditions

OBJECTIVE

This study tested three conceptual explanatory models that have been theorized to account for the linkages between religious/spiritual (R/S) struggles and psychological distress: the primary model (i.e., R/S struggles lead to psychological distress), the secondary model (i.e., psychological distress leads to R/S struggles), and the complex model (i.e., R/S struggles and psychological distress reciprocally exacerbate each other).

METHODS

Using prospective data from a sample of US adults living with chronic health conditions (n = 302), we performed a cross-lagged panel analysis with three timepoints to test for evidence of potential causal relations between R/S struggles and psychological distress.

RESULTS

Consistent with the complex conceptual model of R/S struggles, we found evidence of positive reciprocal associations between R/S struggles and psychological distress.

CONCLUSION

The findings highlight the importance of attending to the dynamic interplay between R/S struggles and psychological distress when working with adults who have chronic health conditions.

Associations Between Religious/Spiritual Coping and Depression Among Adults with Cystic Fibrosis: A 12-Month Longitudinal Study

Individuals with cystic fibrosis (CF) face a challenging disease, and depression is a significant concern. Many patients draw on religious/spiritual resources to assist them in managing the demands of chronic illness; however, these coping efforts rarely have been evaluated among adults with CF. This longitudinal study examined relationships between distinct types of positive and negative religious/spiritual coping at baseline (assessed with the RCOPE) and depression screening outcomes 12 month later (assessed with the Hospital Anxiety and Depression Scale). In logistic regression analyses controlling for disease severity (FEV₁% predicted), lower likelihood of depression caseness at 12 months was predicted by higher general religiousness at baseline, greater use of benevolent religious reappraisal coping, greater use of spiritual connection coping, and lower spiritual discontent. Results suggest that distinct aspects religious/spiritual coping have differential associations with subsequent depression outcomes. Findings extend prior research to an important, understudied medical population, and address a clinically meaningful outcome.

Psychometric evaluation of the brief RCOPE and relationships with psychological functioning among caregivers of children undergoing hematopoietic stem cell transplant

OBJECTIVE

Spiritual and religious (S/R) coping is a relevant yet understudied domain of coping among caregivers of children undergoing hematopoietic stem cell transplantation (HCT). The aims of this manuscript are to: (1) conduct the first psychometric evaluation of the Brief RCOPE in this population; (2) examine levels of and changes in S/R coping over time; and (3) explore the relationship between S/R coping trajectories and psychological functioning post-HCT.

METHODS

Caregivers (n = 170) of children (ages ≤12 years, n = 170) undergoing HCT completed the Brief RCOPE and the Brief Symptom Inventory (BSI) pre- and at multiple time points post-HCT discharge. Factor structure, internal consistency, and validity were examined. Growth mixture models were used to identify subgroups with similar S/R coping trajectories, with group memberships added to mixture models to explore relationships between group membership and caregiver psychological functioning trajectories.

RESULTS

The Brief RCOPE exhibited the previously-supported two factor structure and each subscale demonstrated strong internal consistency (α = 0.85 and 0.92). Validity was supported by significant correlations with BSI scores. There were distinct subgroups of caregivers with different patterns of positive (n = 4 subgroups) and negative (n = 3 subgroups) S/R coping, with negative coping subgroup membership predicting changes in psychological functioning.

CONCLUSIONS

The Brief RCOPE is a promising measure for assessing S/R coping among caregivers of children undergoing HCT and has the potential to identify caregivers at risk for poorer long-term psychological functioning.

Religious/Spiritual Coping in Young Adults with Cancer

Purpose: The study used a cross-sectional descriptive design to explore the prevalence and correlates of religious/spiritual (R/S) coping and struggle in young adults (YAs) during the first 2 months of cancer treatment. Methods: Self-report measures of R/S coping, R/S struggle, depression, quality of life (QoL), intensity of treatment experience, and spiritual/religious identification and practices were obtained using REDCap Survey. Self-report of selected demographic characteristics (age, ethnicity, race, gender, education, occupational status, marital status, parental status, and cancer diagnosis) was also obtained. Results: The prevalence of positive R/S coping was high and higher compared with negative R/S coping. Female gender was associated with more R/S struggle, lower QoL, and higher depression. The Religious and Spiritual Struggles Scale and both the negative and positive R/S coping scale of the Brief RCOPE were significantly positively correlated, despite focusing on differing types of spiritual struggle/distress. Conclusions: Both positive R/S coping and R/S struggle occur in YAs during the first 2 months of cancer treatment. Further research to elucidate the experiences of YAs with cancer, and interventions to promote effective coping, will promote holistic cancer care for this population.

Religious Coping in Cancer: A Quantitative Analysis of Expressive Writing Samples From Patients With Renal Cell Carcinoma

CONTEXT

Past religiosity/spirituality (R/S) research has mainly relied on self-report instruments, which may result in self-presentation and defensive biases.

OBJECTIVES

To address these limitations, we reviewed the writing samples that were generated as part of an expressive writing (EW) trial, coded the samples for R/S content, and examined cross-sectional and prospective associations between R/S content and symptom and psychosocial outcomes.

METHODS

Participants diagnosed with renal cell carcinoma who were randomized to the EW arm completed a standard writing protocol. Before randomization, they completed validated measures of R/S, depressive symptoms, social support, fatigue, and sleep disturbances and one, four, and 10 months after completing the intervention. Writing samples were coded for positive and negative religious coping (RC), and personal (e.g., private prayer) and collective (e.g., church attendance) religious engagement (RE).

RESULTS

Of the 138 patients, 117 provided at least one writing sample, and 89% of participants made at least one R/S reference with 70% including at least one positive RC statement, and 45.3% revealed personal and 42.3% collective RE. Negative RC was rare (8%). Although positive RC and RE were significantly associated with the R/S Index (P < 0.01), negative RC was not. In prospective analyses, RE was associated with reduced cancer-related symptoms over time (P = 0.04), and negative RC was associated with increased psychological distress over time (P = 0.004).

CONCLUSION

Behavioral coding of EW samples supported the literature suggesting that positive RC is common among patients with cancer. Although negative RC may be relatively rare, it may be associated with psychological distress.

Religious Crisis as an Independent Causal Predictor of Psychological Distress: Understanding the Unique Role of the Numinous for Intrapsychic Functioning

Religious and spiritual (R/S) struggles are tensions or conflicts one experiences in relationship to what is considered sacred or transcendent. In this study, we tested competing causal models of psychological distress as it relates to personality and R/S struggle using structural equation modeling. The study sample consisted of 226 (72.0%) females and 88 (28.0%) males (n = 314) drawn from the Amazon’s Mechanical Turk (MTurk) worker population. We found that though the five-factor model (FFM) of personality was a robust predictor of psychological distress, the R/S struggle added significant, incremental predictiveness. SEM analyses supported our contention that R/S struggle may represent a new, causal pathway of psychological distress that is independent from the FFM. Our findings are taken as evidence that R/S struggles require unique ways of conceptualizing their causal impact on clinical impairment and that psychological interventions need to systematically address numinous constructs in order to ensure that all aspects of emotional dysphoria are considered and their influences treated.

Examining the impact of cancer on survivors' religious faith: A report from the American Cancer Society study of cancer survivors-I

OBJECTIVES

The impact of religion/spirituality (R/S) on cancer outcomes, including health-related quality of life (HRQoL), has been the topic of much investigation. Reports of the opposite, that is, the impact of cancer on R/S and associations with HRQoL, are few. The current study sought to explore the positive and negative impacts of cancer on the religious faith of survivors as well as the associations of such impacts with HRQoL.

METHODS

Participants included 2309 9-year survivors of cancer from the American Cancer Society's Studies of Cancer Survivors-I. The impact of cancer on R/S was measured using items from the Patient-Reported Outcomes Measurement Information System (PROMIS) psychosocial impact of illness-faith, and HRQoL was measured with the 12-item short form (SF-12). Hierarchical regressions were used to examine the impact of cancer on R/S controlling for medical and demographic covariates.

RESULTS

Consistent with hypotheses, the majority of survivors (70%) reported that cancer had a positive impact on religious faith, while the negative impact of cancer on religious faith was relatively rare (17%). In multivariable models, the negative impact of cancer on faith was associated with poorer HRQoL, both mental and physical, while the positive impact of cancer on faith was associated with greater mental well-being.

CONCLUSIONS

Cancer has a negative impact on religious faith for a minority of survivors. However, when it is reported, such negative impact is indicative of poorer mental and physical well-being. As such, it is important to identify those survivors at risk early in survivorship and provide support and intervention as needed.

Religious and Spiritual Salience, Well-Being, and Psychosocial Functioning Among Psychotherapy Clients: Moderator Effects for Humility

A number of studies have examined the mediating factors in the relationship between religion and spirituality (R/S) and psychological health. Humility is a virtue that has been positively correlated with R/S variables, measures of well-being, and indicators of psychosocial functioning. In this study, we investigate dispositional humility as a potential moderator in the relationship between religious and spiritual salience and (1) well-being and (2) psychosocial functioning outcomes in a clinical sample. Results indicated that dispositional humility significantly moderated the relationships tested. Implications for future research and clinical practice are discussed.

Positive and Negative Religious Coping Styles as Prospective Predictors of Well-Being in African Americans

Research on religious coping has proliferated in recent years, but many key questions remain, including the independent effects of positive and negative religious coping styles on well-being over time. Further, little research on religious coping styles has been conducted with African Americans in spite of their documented importance in this population. The present study examined the independent prospective effects on well-being of positive and negative religious coping styles over the subsequent 2.5 years in a national sample of African American community-dwelling adults. Well-being indicators included depressive symptoms and positive and negative affect as well as self-esteem and meaning in life. Results indicated that when considering positive and negative religious coping styles together, baseline positive religious coping consistently and positively predicted the well-being indicators 2.5 years later, while negative religious coping consistently and negatively predicted the well-being indicators 2.5 years later. These effects remained when examining change in well-being levels over time, although they attenuated in magnitude. Finally, negative religious coping more strongly predicted the negative aspects of well-being (e.g., depressive symptoms, negative affect) 2.5 years later than did positive religious coping, an effect that also remained but was attenuated when controlling for baseline levels of well-being. These results highlight the nuanced relationships between both positive and negative religious coping styles and positive and negative aspects of well-being over time among African Americans. Future research might usefully examine how to minimize negative effects and capitalize on the salutary effects of positive religious coping.

Religious/Spiritual Struggle in Young Adult Hematopoietic Cell Transplant Survivors

PURPOSE

This study describes the prevalence of religious and/or spiritual (R/S) struggle in long-term young adult (YA) survivors following hematopoietic cell transplantation (HCT) as well as existential concerns (EC), social support, and demographic, medical, and emotional correlates of R/S struggle.

METHODS

Data were collected as part of an annual survey of survivors of HCT aged 18-39 years at survey completion; age at HCT was 1-39 years. Study measures included measures of R/S struggle (defined as any non-zero response on the negative religious coping subscale from Brief RCOPE), quality of life (QOL), and depression. Factors associated with R/S struggle were identified using multivariable logistic regression models.

RESULTS

Fifty-two of the 172 respondents (30%), who ranged from less than a year to 33 years after HCT, had some R/S struggle. In bivariate analysis, depression was associated with R/S struggle. In a multivariable logistic regression model, individuals with greater EC were nearly five times more likely to report R/S struggle. R/S struggle was not associated with age at transplant, time since transplant, gender, race, R/S self-identification, or medical variables.

CONCLUSION

R/S struggle is common among YA HCT survivors, even many years after HCT. There is a strong correlation between EC and R/S struggle. Given the prevalence of R/S struggle and its associations with EC, survivors should be screened and referred to professionals with expertise in EC and R/S struggle as appropriate. Further study is needed to determine longitudinal trajectory, impact of struggle intensity, causal relationships, and effects of R/S struggle on health, mood, and QOL for YA HCT survivors.

Longitudinal effects of religious involvement on religious coping and health behaviors in a national sample of African Americans

Many studies have examined associations between religious involvement and health, linking various dimensions of religion with a range of physical health outcomes and often hypothesizing influences on health behaviors. However, far fewer studies have examined explanatory mechanisms of the religion-health connection, and most have overwhelmingly relied on cross-sectional analyses. Given the relatively high levels of religious involvement among African Americans and the important role that religious coping styles may play in health, the present study tested a longitudinal model of religious coping as a potential mediator of a multidimensional religious involvement construct (beliefs; behaviors) on multiple health behaviors (e.g., diet, physical activity, alcohol use, cancer screening). A national probability sample of African Americans was enrolled in the RHIAA (Religion and Health In African Americans) study and three waves of telephone interviews were conducted over a 5-year period (N = 565). Measurement models were fit followed by longitudinal structural models. Positive religious coping decreased modestly over time in the sample, but these reductions were attenuated for participants with stronger religious beliefs and behaviors. Decreases in negative religious coping were negligible and were not associated with either religious beliefs or religious behaviors. Religious coping was not associated with change in any of the health behaviors over time, precluding the possibility of a longitudinal mediational effect. Thus, mediation observed in previous cross-sectional analyses was not confirmed in this more rigorous longitudinal model over a 5-year period. However, findings do point to the role that religious beliefs have in protecting against declines in positive religious coping over time, which may have implications for pastoral counseling and other faith-based interventions.

Advancing our understanding of religion and spirituality in the context of behavioral medicine

Recognizing and understanding the potentially powerful roles that religiousness and spirituality (RS) may serve in the prevention and amelioration of disease, as well as symptom management and health related quality of life, significantly enhances research and clinical efforts across many areas of behavioral medicine. This article examines the knowledge established to date and suggests advances that remain to be made. We begin with a brief summary of the current knowledge regarding RS as related to three exemplary health conditions: (a) cardiovascular disease; (b) cancer; and, (c) substance abuse. We then focus on particular concerns for future investigations, emphasizing conceptual issues, possible mediators and moderators of relationships or effects, and methodology. Our discussion is framed by a conceptual model that may serve to guide and organize future investigations. This model highlights a number of important issues regarding the study of links between RS and health: (a) RS comprise many diverse constructs, (b) the mechanisms through which RS may influence health outcomes are quite diverse, and (c) a range of different types of health and health relevant outcomes may be influenced by RS. The multidimensional nature of RS and the complexity of related associations with different types of health relevant outcomes present formidable challenges to empirical study in behavioral medicine. These issues are referred to throughout our review and we suggest several solutions to the presented challenges in our summary. We end with a presentation of barriers to be overcome, along with strategies for doing so, and concluding thoughts.

Perceived and Actual Change in Religion/Spirituality in Cancer Survivors: Longitudinal Relationships With Distress and Perceived Growth

This observational cohort study examined the relationships between actual and perceived R/S change at 12 months post cancer diagnosis with depression, anxiety, and perceived growth 6 months later. Older adult military veteran cancer survivors (n = 111) completed self-report surveys at 6, 12, and 18 months post cancer diagnosis. Perceived R/S change was assessed at 12 months postdiagnosis with "Have your religious or spiritual beliefs changed as a result of your cancer" (more R/S, less R/S, other). Actual R/S change was assessed at 6 and 12 months postdiagnosis on a single item, "I have faith in God or a Higher Power" (no, somewhat, yes). A notable minority reported perceived (18.9%) and actual (14.4%) change. Greater perceived R/S change predicted more severe symptoms of depression and anxiety and greater perceived growth at 18 months postdiagnosis; perceived growth was positively associated with anxiety. Cancer survivors who report R/S changes may benefit from spiritual and/or psychological support.

The impact of disease-related symptoms and palliative care concerns on health-related quality of life in multiple myeloma: a multi-centre study

BACKGROUND

Multiple myeloma, the second most common haematological cancer, remains incurable. Its incidence is rising due to population ageing. Despite the impact of the disease and its treatment, not much is known on who is most in need of supportive and palliative care. This study aimed to (a) assess symptom severity, palliative care concerns and health-related quality of life (HRQOL) in patients with multiple myeloma, and (b) to determine which factors are associated with a lower quality of life. We further wanted to know (c) whether general symptom level has a stronger influence on HRQOL than disease characteristics.

METHODS

This multi-centre cross-sectional study sampled two cohorts of patients with multiple myeloma from 18 haematological cancer centres in the UK. The Myeloma Patient Outcome Scale (MyPOS) was used to measure symptoms and concerns. Measures of quality of life included the EORTC QLQ-C30, its myeloma module and the EuroQoL EQ-5D. Data were collected on socio-demographic, disease and treatment characteristics and phase of illness. Point prevalence of symptoms and concerns was determined. Multiple regression models quantified relationships between independent factors and the MyPOS, EORTC global quality of life item and EQ5D Index.

RESULTS

Five-hundred-fifty-seven patients, on average 3.5 years (SD: 3.4) post-diagnosis, were recruited. 18.2 % had newly diagnosed disease, 47.9 % were in a treatment-free interval and 32.7 % had relapsed/progressive disease phase. Patients reported a mean of 7.2 symptoms (SD: 3.3) out of 15 potential symptoms. The most common symptoms were pain (72 %), fatigue (88 %) and breathlessness (61 %). Those with relapsed/progressive disease reported the highest mean number of symptoms and the highest overall palliative care concerns (F = 9.56, p < 0.001). Factors associated with high palliative care concerns were a general high symptom level, presence of pain, anxiety, low physical function, younger age, and being in the advanced stages of disease.

CONCLUSION

Patients with multiple myeloma have a high symptom burden and low HRQOL, in the advanced and the earlier stages of disease. Identification of patients in need of supportive care should focus on assessing patient-reported outcomes such as symptoms and functioning regularly in clinical practice, complementary to traditional biomedical markers.

Spiritual Coping: A Gateway to Enhancing Family Communication During Cancer Treatment

The researchers examined the spiritual coping, family communication, and family functioning of 95 participants in 34 families by an online survey. Multilevel linear regression was used to test whether individuals' and families' higher endorsement of more use of spiritual coping strategies to deal with a member's cancer would be associated with higher scores on family communication and family functioning, and whether better communication would also be associated with higher family functioning scores. Results revealed that spiritual coping was positively associated with family communication, and family communication was positively associated with healthier family functioning. The researchers provide suggestions for further research.

Religion/spirituality and health in the context of cancer: Cross-domain integration, unresolved issues, and future directions

This article summarizes the findings of 3 previous meta‐analytic reviews presented in this issue that evaluate associations between religiousness/spirituality (R/S) and patient‐reported outcomes across mental, physical, and social health domains. The results are synthesized, caveats in interpreting this set of analyses are discussed, directions are provided for future research, and tentative suggestions are made for clinical applications.

Spiritual Pain in Meals on Wheels' Clients

BACKGROUND

Meals on Wheels' clients are at risk for spiritual pain due to advanced age, social isolation, and failing health. They are also prone to stress, depression, and loneliness, placing them at risk for adverse biological disruptions and health outcomes. The purpose of the study was to examine associations of spiritual pain with psychosocial factors (stress, depression, loneliness, religious coping) and salivary biomarkers of stress and inflammation (cortisol, IL-1β) in Meals on Wheels' clients.

METHODS

Data were collected cross-sectionally from 88 elderly (mean age 75.4). Spiritual pain, stress, depression, loneliness, and religious coping were measured with standardized instruments, and salivary biomarkers were assessed with enzyme immunoassays.

RESULTS

Spiritual pain was significantly and positively correlated with stress (r = 0.35, p ≤ 0.001), depression (r = 0.27, p = 0.01), and negative religious coping (r = 0.27, p = 0.01). Correlations with loneliness, positive religious coping, and salivary biomarkers were non-significant.

CONCLUSION

Spiritual pain is an important concept in this population. Research should be expanded to understand the significance of spiritual pain in conjunction with psychosocial and biological variables and its potential impact on physical, mental, and cognitive health outcomes in the elderly.

Religion, spirituality, and physical health in cancer patients: A meta-analysis

Although religion/spirituality (R/S) is important in its own right for many cancer patients, a large body of research has examined whether R/S is also associated with better physical health outcomes. This literature has been characterized by heterogeneity in sample composition, measures of R/S, and measures of physical health. In an effort to synthesize previous findings, a meta-analysis of the relation between R/S and patient-reported physical health in cancer patients was performed. A search of PubMed, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library yielded 2073 abstracts, which were independently evaluated by pairs of raters. The meta-analysis was conducted for 497 effect sizes from 101 unique samples encompassing more than 32,000 adult cancer patients. R/S measures were categorized into affective, behavioral, cognitive, and 'other' dimensions. Physical health measures were categorized into physical well-being, functional well-being, and physical symptoms. Average estimated correlations (Fisher z scores) were calculated with generalized estimating equations with robust variance estimation. Overall R/S was associated with overall physical health (z = 0.153, P < .001); this relation was not moderated by sociodemographic or clinical variables. Affective R/S was associated with physical well-being (z = 0.167, P < .001), functional well-being (z = 0.343, P < .001), and physical symptoms (z = 0.282, P < .001). Cognitive R/S was associated with physical well-being (z = 0.079, P < .05) and functional well-being (z = 0.090, P < .01). 'Other' R/S was associated with functional well-being (z = 0.100, P < .05). In conclusion, the results of the current meta-analysis suggest that greater R/S is associated with better patient-reported physical health. These results underscore the importance of attending to patients' religious and spiritual needs as part of comprehensive cancer care.

Religion, spirituality, and health outcomes in cancer: A case for a meta-analytic investigation

A growing body of research shows that a majority of patients with cancer report having religious and spiritual (R/S) beliefs, engaging in R/S behaviors, or deriving comfort from R/S experiences. These studies have been reviewed but not subjected to rigorous critical analysis. A meta-analytic approach is needed to provide a more definitive understanding of the relationships between R/S (affective, behavioral, and cognitive dimensions) and physical, mental, and social health in all phases of cancer including diagnosis, treatment, survivorship, and palliative care. A meta-analysis can quantify the degree of association between R/S dimensions and patient-reported health outcomes and the conditions under which these associations are strengthened or attenuated. Results can, in turn, help focus future work in this area by highlighting key variables for inclusion in studies of R/S and cancer and identifying particular subgroups for whom dimensions of R/S are particularly important to their health.

A meta-analytic review of religious or spiritual involvement and social health among cancer patients

Religion and spirituality (R/S) play an important role in the daily lives of many cancer patients. There has been great interest in determining whether R/S factors are related to clinically relevant health outcomes. In this meta-analytic review, the authors examined associations between dimensions of R/S and social health (eg, social roles and relationships). A systematic search of the PubMed, PsycINFO, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature databases was conducted, and data were extracted by 4 pairs of investigators. Bivariate associations between specific R/S dimensions and social health outcomes were examined in a meta-analysis using a generalized estimating equation approach. In total, 78 independent samples encompassing 14,277 patients were included in the meta-analysis. Social health was significantly associated with overall R/S (Fisher z effect size = .20; P < .001) and with each of the R/S dimensions (affective R/S effect size = 0.31 [P < .001]; cognitive R/S effect size = .10 [P < .01]; behavioral R/S effect size = .08 [P < .05]; and 'other' R/S effect size = .13 [P < .001]). Within these dimensions, specific variables tied to social health included spiritual well being, spiritual struggle, images of God, R/S beliefs, and composite R/S measures (all P values < .05). None of the demographic or clinical moderating variables examined were significant. Results suggest that several R/S dimensions are modestly associated with patients' capacity to maintain satisfying social roles and relationships in the context of cancer. Further research is needed to examine the temporal nature of these associations and the mechanisms that underlie them.

Religious Coping and Psychological and Behavioral Adjustment After Hurricane Katrina

Positive and negative religious coping are related to positive and negative psychological adjustment, respectively. The current study examined the relation between religious coping and PTSD, major depression, quality of life, and substance use among residents residing in Mississippi at the time of Hurricane Katrina. Results indicated that negative religious coping was positively associated with major depression and poorer quality of life and positive religious coping was negatively associated with PTSD, depression, poorer quality of life, and increased alcohol use. These results suggest that mental health providers should be mindful of the role of religious coping after traumatic events such as natural disasters.

The role of religion and spirituality in mental health

PURPOSE OF REVIEW

There has been increased interest in the relationship between religion and spirituality and mental health in recent years. This article reviews recent research into the capacity of religion and spirituality to benefit or harm the mental health of believers. We also examine the implications this may have for assessment and treatment in psychiatric settings.

RECENT FINDINGS

Studies indicate that religion and spirituality can promote mental health through positive religious coping, community and support, and positive beliefs. Research also shows that religion and spirituality can be damaging to mental health by means of negative religious coping, misunderstanding and miscommunication, and negative beliefs. Tools for the assessment of patients' spiritual needs have been studied, and incorporation of spiritual themes into treatment has shown some promise.

SUMMARY

Religion and spirituality have the ability to promote or damage mental health. This potential demands an increased awareness of religious matters by practitioners in the mental health field as well as ongoing attention in psychiatric research.

Intrinsic religiousness and well-being among cancer patients: the mediating role of control-related religious coping and self-efficacy for coping with cancer

We examined the relationship between intrinsic religiousness and well-being, with control-related religious coping and self-efficacy for coping with cancer as potential mediators of this relationship among cancer patients. In a cross-sectional design, 179 ambulatory cancer patients completed measures of intrinsic religiousness, religious coping, self-efficacy for coping with cancer, well-being, and demographic variables. Type of cancer, stage of cancer, and time since diagnosis were collected from electronic medical charts. In a path model, the positive association between intrinsic religiousness and three types of well-being--physical, functional, and social-was fully mediated by active religious surrender and self-efficacy for coping with cancer. In addition, the negative association between passive religious deferral and all four types of well-being--physical, functional, social, and emotional--was fully mediated by self-efficacy for coping with cancer. Finally, there was a negative direct association between pleading for God's direct intercession and emotional well-being. These findings suggest pathways by which intrinsic religiousness and control-related religious coping are linked to various dimensions of well-being among cancer patients.

Resilience and psychosocial outcomes in parents of children with cancer

BACKGROUND

The psychosocial function of parents of children with cancer can impact the well-being of the entire family. Resilience resources are likely related to psychosocial outcomes and may be amenable to intervention. We hypothesized that parents with lower resources would report worse outcomes.

METHODS

In the "Understanding Resilience in Parents of Children with Cancer" study, comprehensive surveys were mailed to consecutive, English-speaking parents of children with cancer who were treated at Seattle Children's Hospital and completed therapy between January 1, 2009 and December 31, 2010. Resilience resources were measured by the Connor-Davidson Resilience Scale; outcome measures included psychological distress, health-related behaviors, social and family function, and perceived communication with the medical team.

RESULTS

Ninety-six parents (86% of contactable) completed the survey. Compared to population norms, enrolled parents had lower resilience resources, higher psychological distress, and more commonly reported binge drinking. Conversely, they reported higher social support and family adaptability (P < 0.001-0.006). Lower resilience resources were associated with higher distress, lower social support, and lower family function (P < 0.001-0.007). Parents in the lowest quartile of resilience resources had higher odds of frequent sleep difficulties (OR 5.19, 95% CI 1.74,15.45), lower health satisfaction (OR 5.71, 95% CI 2.05,15.92), and decreased ability to express worries to the medical team (OR 4.00, 95% CI 1.43,11.18).

CONCLUSIONS

Parents of children with cancer are at risk for poor psychosocial outcomes and those with low resilience resources may be at greater risk. Interventions directed at promoting resilience resources may provide a novel and complimentary approach toward improving outcomes for families facing pediatric cancer.

Negative religious coping as a correlate of suicidal ideation in patients with advanced cancer

OBJECTIVE

The purpose of this study is to examine the relationship between negative religious coping (NRC) and suicidal ideation in patients with advanced cancer, controlling for demographic and disease characteristics and risk and protective factors for suicidal ideation.

METHODS

Adult patients with advanced cancer (life expectancy ≤6 months) were recruited from seven medical centers in the northeastern and southwestern USA (n = 603). Trained raters verbally administered the examined measures to patients upon study entry. Multivariable logistic regression analyses regressed suicidal ideation on NRC controlling for significant demographic, disease, risk, and protective factors.

RESULTS

Negative religious coping was associated with an increased risk for suicidal ideation (OR, 2.65 [95% CI, 1.22, 5.74], p = 0.01) after controlling for demographic and disease characteristics, mental and physical health, self-efficacy, secular coping, social support, spiritual care received, global religiousness and spirituality, and positive religious coping.

CONCLUSIONS

Negative religious coping is a robust correlate of suicidal ideation. Assessment of NRC in patients with advanced cancer may identify patients experiencing spiritual distress and those at risk for suicidal ideation. Confirmation of these results in future studies would suggest the need for interventions targeting the reduction of NRC to reduce suicidal ideation among advanced cancer patients.

Struggle with the divine in Swiss patients visited by chaplains: prevalence and correlates

A body of evidence is developing that describes harmful effects of religious struggle that includes struggle with the divine (e.g. feeling abandoned or punished by God). We examined the prevalence and correlates of divine struggle among 540 Swiss hospital patients. Some divine struggle was reported by 46 percent of the sample. Unexpected hospital admission and scores on a measure of faith were associated with a greater likelihood of reporting any divine struggle. Higher levels of anxiety and depression were also associated with divine struggle. Screening for divine struggle or other forms of religious struggle will permit, where indicated, appropriate religious assessment and care to mitigate the harmful effects that may accompany religious struggle.

Cancer survivor rehabilitation and recovery: protocol for the Veterans Cancer Rehabilitation Study (Vet-CaRes)

Background

Cancer survivors are a rapidly growing and aging population in the U.S., but there are many challenges associated with the survivorship experience such as functional disabilities and psychosocial distress. When viewed next to the general population, Veterans are especially at risk for these challenges as they are older and have a high incidence of co-morbid conditions. While the Institute of Medicine (IOM) has called for further cancer survivorship research to address these challenges, we still know little about this experience from the perspective of aging Veterans.

Methods/design

We conducted a longitudinal, mixed-methods study over the course of three and a half years at the Boston and Houston VA Medical Centers. We recruited 170 Veterans diagnosed with head and neck, colorectal and esophageal/gastric cancers that were identified from the VA tumor registry. Veterans completed three in-depth interviews, conducted at 6, 12 and 18 months after pathology confirmation, measuring the physical, social and psychological factors related to cancer survivorship. The longitudinal design allowed us to assess any changes in cancer related disability and distress over time.

Discussion

Weekly teleconference study team meetings were a key aspect to the research process. Issues related to recruitment, data management and analysis, and the dissemination of research results was discussed. Interviewers presented detailed case reports of completed interviews that allowed us to refine our interview protocols. We also discussed issues relevant to the Veteran population of which we were previously unaware and some of the challenges of the research process itself. This novel study produced a robust data set that documents the functional and psychosocial cancer survivorship experiences of aging Veterans. The longitudinal design will help us more fully understand the recovery patterns for this specific population, and identify the unique needs and gaps in health services.

Testing the Validity of a Protocol to Screen for Spiritual Struggle among Parents of Children with Cystic Fibrosis

Spirituality is important to many Americans and is used to cope with adverse events. Some forms of spiritual coping are maladaptive or troubling, and are known as negative spiritual coping or spiritual struggle. These forms of spirituality are often associated with poorer physical and mental health outcomes. Thus, in clinical contexts there is a need to identify persons who may be experiencing spiritual struggle and, if indicated, offer spiritual care that may address that struggle. Twenty-two parents of children with cystic fibrosis (CF) completed semi-structured interviews and questionnaires exploring spirituality's role in their child's illness. Interviews included oral administration of a protocol to screen for spiritual struggle. The parents also completed the negative religious coping subscale of the Brief RCOPE, a commonly used measure of spiritual struggle. Descriptive statistics were obtained. The screening protocol identified 18% of the parents as potentially having spiritual struggle. Thirty-two percent had negative religious coping scores suggestive of spiritual struggle. Comparison of results with both measures found the screening protocol had good specificity (87%) but relatively low sensitivity (29%). Using either measure, indications of spiritual struggle were associated with higher levels of depressive symptoms. The screener's administration was acceptable and feasible. The low sensitivity may be due in part to differences between the focus of the screener and that of the negative religious coping subscale, which focuses on struggle with the Divine. Further work is needed to establish the best approach to screening for spiritual struggle.

Is religious coping related to better quality of life following acute myocardial infarction?

Although few studies have examined the extent to which religiousness is related to better well-being following acute myocardial infarction (AMI), studies from the broader literature suggest that positive religious coping may be helpful while more negative forms of religious coping may be related to poorer well-being. To assess the relationship between positive and negative religious coping and depressive symptoms in patients with AMI, we collected data twice over a 1-month period from 56 patients hospitalized with a first AMI. Controlling for demographic variables and social support, both positive and negative religious coping were independently related to higher levels of depressive symptoms both in hospital and at a one-month follow-up. Further, even when controlling for baseline depressive symptoms, religious coping predicted higher subsequent depressive symptoms. These results suggest that religious coping appears to be maladaptive in dealing with acute MI, perhaps because this type of recovery requires more active forms of coping.

Screening for spiritual distress in the oncology inpatient: a quality improvement pilot project between nurses and chaplains

AIMS

A quality improvement initiative of nursing/chaplain collaboration on the early identification and referral of oncology patients at risk of spiritual distress.

BACKGROUND

Research shows that spiritual distress may compromise patient health outcomes. These patients are often under-identified, and chaplaincy staffing is not sufficient to assess every patient. The current nursing admission form with a question of 'Any spiritual practices that may affect your care?' is ineffective in screening for spiritual distress.

METHOD(S)

Ten nurses on the oncology unit were recruited and trained in a two-question screening tool to be utilized upon admission.

RESULTS

Six nurses made referrals; a total of 14 patients. Four (28%) were at risk of spiritual distress and were assessed by the chaplains.

CONCLUSIONS

Nurses are interested in the spiritual well-being of their patients and observe spiritual distress. They appreciate terminology/procedures by which they can assess more productively the spiritual needs of their patients and make appropriate chaplain referrals.

IMPLICATIONS FOR NURSING MANAGEMENT

The use of a brief spiritual screening protocol can improve nursing referrals to chaplains. The better utilization of chaplains that this enables can improve patient trust and satisfaction with their overall care and potentially reduce the harmful effects of spiritual distress.

Screening for religious/spiritual struggle in blood and marrow transplant patients

PURPOSE

A growing body of research documents the harmful effects of religious/spiritual (R/S) struggle (e.g., feeling abandoned or punished by God) among patients with a wide variety of diagnoses. Documented effects include poorer quality of life, greater emotional distress, poorer recovery, and increased disability. This study reports the use of a screening protocol that identified patients who may have been experiencing R/S struggle. We also examined the prevalence and correlates of possible R/S struggle, its association with quality of life, pain, and depressive symptoms and compared the results from the screening protocol with social workers' assessments.

METHODS

One hundred seventy-eight blood and marrow transplant patients completed the Electronic Self-Report Assessment--Cancer (ESRA-C) which included the Rush Religious Struggle Screening Protocol and other measures of quality of life, pain, and depressive symptoms prior to transplant therapy. All participants were assessed by a social worker, 90 % within 2 weeks of the ESRA-C assessment.

RESULTS

Using the Rush Protocol, 18 % of the patients were identified as potentially experiencing R/S struggle. R/S struggle was not reported in any social work assessments. In a multivariable model, potential R/S struggle was more likely in patients who were more recently diagnosed, male, and Asian/Pacific Islanders. There were no significant associations between potential R/S struggle and quality of life, pain, or depressive symptoms.

CONCLUSIONS

Early identification of patients with R/S struggle will facilitate their referral for further assessment and appropriate intervention. Further research is needed to identify the best methods of screening patients for R/S struggle.

Religious coping and psychological distress in military veteran cancer survivors

Research on the relationship between religious coping and psychological well-being in cancer survivors is limited. Forty-eight veteran cancer survivors completed measures of psychological distress, posttraumatic growth, and positive and negative religious coping. Negative religious coping was associated with greater distress and growth. Positive religious coping was associated with greater growth. Gender, race, and religious affiliation were significant predictors of positive and negative religious coping. Veteran cancer survivors who utilize negative religious coping may benefit from referral to clergy or a mental health professional. Assessment of religious coping may be particularly important for female, non-White, and Christian cancer survivors.

Religiosity and spirituality in military veteran cancer survivors: a qualitative perspective

Religiosity/spirituality (R/S) is often involved in coping with cancer. Qualitative research effectively captures the individuality of R/S constructs. Fourteen military veteran cancer survivors participated in focus groups. R/S questions included "How have your religious/spiritual beliefs affected how you cope with your cancer" and "How have your religious/spiritual beliefs changed as a result of your experience with cancer?" Five primary themes emerged: impact of cancer on R/S, meaning-making, prayer, religious/spiritual role of others, and facing death. Consistency and individuality characterized the role of R/S in cancer survivorship across themes. Implications for future research are discussed.

[Psychosocial impact of cancer on Moroccan adolescent and young adult: experience of National Institute of Oncology of Rabat]

Cancer is an uncommon disease; its imaginary concept is very particularly on adolescent and young adults. It disturbs their lives on the whole. The purpose of this study is to describe the specific psychosocial effects of cancer on adolescent and young adults in Moroccan population in order to help physicians educate and counsel future young patients and their families. During the period from January to July 2009, patients aged between 15 and 30 years with histologically confirmed cancer, were prospectively interviewed by a questionnaire covering socio-epidemiological characteristics, repercussions of disease on physical, psychic, sexual and religious practices. The aim of this study is to determine the impact of cancer, particularly on this young North African population, which is underrepresented in the psychosocial cancer literature.