Religion as an Empowerment Context in the Narrative of Women with Breast Cancer

The Effect of Spiritual Group Therapy on the Quality of Life and Empowerment of Women with Breast Cancer: A Randomized Clinical Trial in Iran

This randomized clinical trial was carried out on 74 women with breast cancer between May 2015 and April 2016 in the south of Iran. The patients were selected using a simple sampling method and randomly divided into an intervention (n = 30) and a control (n = 37) group. Five spiritual therapy sessions were conducted for the intervention group. Each session lasted one hour. The quality of life and empowerment of the patients were measured before and one month after the intervention. To collect data, four instruments were used, including a demographic information form, the European Organization for Research and Treatment of Cancer QOL questionnaire Cancer-30 (EORTC QLQ C-30), EORTC QLQ Breast-23 (EORTC QLQ-BR23), and the Cancer Empowerment Questionnaire (CEQ). After the intervention, a difference was observed between the groups concerning the mean score of general health (P = 0.016) and emotional function (P = 0.029), but there was no significant difference between the groups concerning the mean score of empowerment (P = 0.62). Thus, it appears that spiritual group therapy can improve the quality of life of this group of patients.IRCT registration number: IRCT 2014050417546N2.

Strategies to Promote Empowerment Status of Breast Cancer Women

Background

As the second leading cause of death in women in the world, breast cancer has several physical and psychological effects. Nowadays, nonclinical approaches such as patient empowerment have been considered by physicians along with clinical care. Given the increasing number of breast cancer women worldwide, promoting the empowerment of these patients is one of the key factors affecting their survival and quality of life. Therefore, because of no comprehensive research on the empowerment needs and related improvement strategies, this study is aimed at determining the empowerment status of breast cancer patients referred to the Shahid Motahari Breast Cancer Clinic in Iran, Shiraz, and at providing strategies to improve their empowerment in 2021.

Methods

This applied study was conducted in two phases. In the quantitative phase, 310 Cancer-Related Patient Empowerment Scale questionnaires (Persian format) were distributed among the studied patients selected through the random sampling method in the clinic, and the items with "unacceptable status" became the basis for determining the empowerment strategies through the scoping review and semistructured interviews with 22 medical staff and patients through the thematic analysis. The collected data were analyzed using the SPSS 20.0 and MAXQDA10 software.

Results

The mean score of the participants' empowerment strategies was 3.58. The results showed that trust in the physician, family support, and spiritual beliefs could affect the empowerment of the studied patients. Moreover, the participants needed empowerment strategies in 11 scale items with unacceptable status, for which 46 strategies were determined in the scoping review and interview phase.

Conclusion

The results of this study provided useful strategies for empowering breast cancer patients, the most important of which were classified into five categories of financial support, informational support, interaction with the physician, occupational support, and complementary therapies, the use of which by the stakeholders could help to improve the patients' quality of life while improving their empowerment.

Latency of breast cancer stigma during survivorship and its influencing factors: A qualitative study

Introduction

Breast cancer diagnosis and treatment have been shown in studies to have a negative impact on patients’ physical, psychological, and social well-being, as well as overall quality of life. Psychologically, it’s linked to sadness, anxiety, and demoralisation. Stigma contributes to the hidden burden of breast cancer as a chronic illness. Research on the elements that breast cancer survivors encounter as influences on stigma associated to the disease is lacking. Based on the lived experiences of breast cancer survivors, this study sought to investigate the factors that lead to the manifestations of both self- and public breast cancer stigma.

Methods

Individual semi-structured interviews with 24 patients diagnosed with breast cancer were performed, followed by five focus groups with 25 patients diagnosed with breast cancer. Interviews were verbatim transcribed and analysed using thematic framework analysis.

Results

Two major themes have emerged from the data: a) Breast cancer stigma among breast cancer survivors, highlighting the various manifestations of stigma and the variables that influence them; including disease-related factors, patients’ views of cancer, public perceptions of breast cancer, family and interpersonal dynamics, and b) Stigma resilience and empowerment, emphasising the necessity of sociocultural transformation and coping strategies to preserve resilience.

Conclusions

To improve the well-being of breast cancer survivors, practitioners and health policymakers should be aware of the breast cancer stigma that underpins patients’ emotional and behavioural outlooks and its potential consequences on patients’ quality of life. They need to develop interventions to address the different stages of cancer stigma taking into consideration sociocultural influences, norms, and beliefs.

Explaining the Process of Spiritual Adjustment in Parents of a Child with Cancer: A Qualitative Study

Introduction: Having a child with cancer impacts the family members and reduces their quality of life. Considering the fact that spirituality creates tranquility, hope for the future, and acceptance of the disease, this study aimed to explain the process of spiritual care in parents of a child with cancer. Methods: This study was carried out using a qualitative method and grounded theory approach. The setting of this research was oncology and radiotherapy wards, governmental oncology clinics and pediatric hospitals. Using purposive and theoretical sampling method, 22 participants (eight mothers, three fathers with childhood cancer experience and 11 individuals working in oncology departments of different Iranian pediatric hospitals) were selected and individual and semi-structured interviews were conducted. Results: The data analysis led to the creation of a core variable of "bridge towards spirituality" which included five main categories of "unstable situation", "spirituality," "crossing rocky path", "multi-dimensional support", and "rethink". Conclusion: Due to the significant impacts of a child's cancer on parents and the fact that people's spiritual needs increase in critical and stressful situations, paying attention to the spirituality process is essential for managing the conditions created by the child's disease and help parents through developing a comprehensive program of spiritual care in health care centers. Spiritual care is currently absent in the health care system of Iran, which necessitates attention to this issue in the parents of children with cancer.

"I'd Want to Know, Because a Year's Not a Long Time to Prepare for a Death": Role of Prognostic Information in Shared Decision Making among Women with Metastatic Breast Cancer

Context: Increasing emphasis on patient-centered care has led to highlighted importance of shared decision making, which better aligns medical decisions with patient care preferences. Effective shared decision making in metastatic breast cancer (MBC) treatment requires prognostic understanding, without which patients may receive treatment inconsistent with personal preferences. Objectives: To assess MBC patient and provider perspectives on the role of prognostic information in treatment decision making. Methods: We conducted semi-structured interviews with MBC patients and community oncologists and separate focus groups involving lay navigators, nurses, and academic oncologists. Qualitative analysis utilized a content analysis approach that included a constant comparative method to generate themes. Results: Of 20 interviewed patients with MBC, 30% were African American. Academic oncologists were mostly women (60%), community oncologists were all Caucasian, and nurses were all women and 28% African American. Lay navigators were all African American and predominately women (86%). Five emergent themes were identified. (1) Most patients wanted prognostic information but differed in when they wanted to have this conversation, (2) Emotional distress and discomfort was a critical reason for not discussing prognosis, (3) Religious beliefs shaped preferences for prognostic information, (4) Health care professionals differed on prognostic information delivery timing, and (5) Providers acknowledged that an individualized approach taking into account patient values and preferences would be beneficial. Conclusion: Most MBC patients wanted prognostic information, yet varied in when they wanted this information. Understanding why patients want limited or unrestricted prognostic information can inform oncologists' efforts toward shared decision making.

Taking Refuge in Spirituality, a Main Strategy of Parents of Children with Cancer: a Qualitative Study

Background:

Due to the rise in prevalence of childhood cancer the impact on family caregivers is increasing. Spirituality may be an alleviating factor for improving the quality of parent life. There is a lack of organized spiritual care in health care facilities, so that this aspect needs more emphasis. Thus this study aimed to evaluate the spiritual strategy of parents of children with cancer.

Materials:

This qualitative study was conducted with a conventional content analysis approach. Fifteen parents of hospitalized children with cancer at the Oncology and Hematology departments of governmental pediatric hospitals nationwide were purposefully selected. Semi-structured in-depth interviews were conducted for data collection and inductive content analysis.

Results:

Eleven sub-themes were extracted in the data analysis, which resulted in the generation of three themes: “spiritual strategy,” “spiritual escape” and “spiritual growth”.

Conclusion:

The spiritual approach of parents of children with cancer had a significant influence on spiritual care and consequently the acceptance of disease and coping with the associated conditions. Spiritual care clearly should be introduced into the health care system of Iran, particular for the parents of children with cancer.

A Survey on the Relationship between Religiosity and Quality of Life in Patients with Breast Cancer: A Study in Iranian Muslims

OBJECTIVE

This study aimed to assess the relationship between religiosity and quality of life (QoL) in patients with breast cancer in a Muslim population.

METHODS

This descriptive-correlational study was conducted in 84 Muslim patients with breast cancer who were admitted to Ahvaz Shafa Hospital, Iran, during 2015. QoL and religiosity were measured with the Short Form-36 questionnaire and Muslim Religiosity questionnaire based on the Glock and Stark model, respectively. Data were analyzed using a software program for descriptive statistics, the Chi-square test, Pearson's correlation, and an independent sample t-test.

RESULTS

Most patients had high religiosity (69%) and moderate QoL (46.5%) scores. Total scores and all subscales scores for QoL were significantly higher in patients with high religiosity than patients with moderate religiosity (P < 0.0001). Moreover, a direct correlation was found between religiosity (total and all subscales) and QoL (total and all subscales) (P < 0.0001).

CONCLUSIONS

A significant relationship was found between religiosity and QoL in patients with breast cancer. Accordingly, care team members, especially midwifery and nursing staff, should pay more attention to religious beliefs among these patients to improve their QoL.

A New Questionnaire (QRFPC25) Regarding the Religiosity and Spirituality in People with Life-Threatening Disease: Reliability and Validity in a Population of Cancer Patients Undergoing Radiotherapy

The development of a questionnaire (QRFPC25) assessing the religiosity of cancer patients. The method used for the questionnaire comprises seven multi-item and three single-item scales formed from a 25-question module. The questionnaire was completed on-site and a week after antineoplastic therapy. The final sample included 156 patients. The main topics of the QRFPC25 are the following: worship, relationship with the divine, spiritual discussion, hope, participation in holly communion, faith, life after death, love, bioethics and global quality of life (QoL). The average time of both times taken to complete the questionnaire was approximately 10 min. All multi-item scales met the minimal standards of reliability (Cronbach's alpha coefficient ≥.70) before or after treatment. Test-retest reliability in terms of the intraclass correlation coefficient was also satisfactory (p < 0.01). Validity was assured by inter-item correlations and correlations with the European Organisation for Research and Treatment of Cancer's Core Quality of Life Questionnaire (QLQ-C30, version 3.0), along with factor analysis which showed eight factors incorporated in the model. The QRFPC25 is a reliable and valid gauge for the assessment of religiosity in cancer patients undergoing radiotherapy.

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.