Spiritual Well-Being and Spiritual Distress in Cancer Patients Undergoing Chemotherapy: Utilizing the SWBQ as Component of Holistic Nursing Diagnosis

Proficiency and Practices of Nursing Professionals in Meeting Patients' Spiritual Needs within Palliative Care Services: A Nationwide, Cross-Sectional Study

Spirituality and spiritual needs are integral parts of the human experience, but they are often particularly important for palliative care patients. Spirituality has numerous positive effects, especially for those dealing with serious illness. Nevertheless, the spiritual dimension is sometimes overlooked in patient care. This study aims to determine the frequency of addressing the spiritual needs of palliative care patients in Croatia and to investigate the self-perceived confidence of caregivers in this task. A quantitative cross-sectional study was conducted involving 194 nurses in specialised palliative care services across Croatia. A specially developed and validated questionnaire was used for this study. The most common intervention undertaken by respondents was "promoting hope and optimism in patients" (88.4%), while the least common intervention was "reading books and other publications to patients" (13.9%). No statistically significant differences were found in the frequency of spiritual care in relation to the respondent's level of education, professional experience and nursing environment. Approximately two-thirds of the surveyed nurses stated that they "often" or "always" provided some kind of spiritual care to palliative care patients. However, study participants who indicated that they had received sufficient formal instruction in addressing spiritual needs and spiritual care interventions demonstrated a statistically significant tendency to engage in these practices, as well as greater confidence in their knowledge and skills in this area compared to those who lacked such training. The study suggests that there is a need to identify existing barriers to the provision of spiritual care and to develop strategies to overcome them. By placing emphasis on the spiritual needs and preferences of patients, nursing professionals and other healthcare providers have the opportunity to elevate the standard of holistic care and foster a sense of comfort and dignity among patients.

Spirituality in Adolescents and Young Adults With Cancer: An Evolutionary Concept Analysis

Background: Despite an increased focus on the importance of spirituality to human health, including adolescent health outcomes there remains an absence of evidence-based programs to address the spiritual needs of patients and families. A critical barrier is the absence of a clear conceptual understanding and operational definitions of spirituality for adolescents/young adults (AYAs) with cancer. The purposes of this concept analysis were to (a) clarify the concept of spirituality in the context of the AYAs' cancer experience and (b) generate a definition based on a review of the literature examining spiritual development and the role of spirituality in AYAs' health and cancer treatment. Method: We used Roger's evolutionary concept analysis method to identify antecedents, attributes, and consequences of spirituality in the context of AYAs' cancer using thematic analysis and included identification of case exemplars. Results: Of the 86 articles identified, 21 met our inclusion criteria. Analysis revealed four attributes of spirituality in AYAs with cancer: meaning and purpose, connectedness, life-long universal experience, and independent of or related to religion and faith traditions. Identified antecedents included the presence of spiritual resources, chronic illness, belief, or wonder about a higher power, and existential questions. Identified consequences included hope, meaning, feelings of peace, and enhanced well-being and illness acceptance. Based on the findings, we generated a definition of spirituality in AYAs with cancer. Discussion: Findings inform the development of measures and spiritual care interventions specific to AYAs with cancer. An important limitation to address in future research is the absence of AYAs' first-person accounts of their own spirituality.

Spirituality and Hope Levels of Lung Cancer Patients Who Had Surgery in Turkey

This study explores the relationship between spirituality and hope levels in lung cancer patients. Cancer patients often use their spirituality as a way of coping. Among a sample of 124 Turkish lung cancer patients, spirituality levels were assessed using the Spiritual Orientation Scale (SOS) and hope levels were measured using the Herth Hope Scale (HHS). Spirituality and hope levels in Turkish lung cancer patients were found to be above average. While no significant effect of demographic and disease-related variables was detected on spirituality and hope levels, spirituality and hope were found to be positively correlated in Turkish lung cancer patients.

Vivencia de la espiritualidad en el paciente con cáncer en quimioterapia ambulatoria

Objetivo: Analizar la vivencia de la espiritualidad en el paciente con cáncer en tratamiento con quimioterapia ambulatoria. Materiales y métodos: Se realizó una investigación cualitativa con enfoque histórico hermenéutico. Participaron seis personas con diagnóstico de cáncer que se encontraban en tratamiento de quimioterapia ambulatoria en tres centros asistenciales de la ciudad de Medellín, Colombia entre julio de 2020 y julio de 2021.  La información se recolectó a través de entrevistas semiestructuradas. El proceso de análisis se realizó utilizando técnicas de la teoría fundamentada de Strauss y Corbin, tales como: microanálisis, codificación abierta, codificación axial y comparación constante. Resultado: La forma como los pacientes con cáncer en tratamiento de quimioterapia ambulatoria viven la espiritualidad se representa a través de las siguientes categorías: “Emociones vividas durante el tratamiento como impulso para seguir adelante”, “Las redes de apoyo, una fuente de fortaleza y esperanza”, “El cáncer, una prueba divina entre las limitaciones y el aprendizaje”, “La empatía del personal de salud, un mecanismo para afrontar la enfermedad y generar bienestar” y “La espiritualidad, una fuerza que cambia la perspectiva de la enfermedad”. Conclusiones: Pese a la connotación negativa del diagnóstico de cáncer, la dimensión espiritual en el paciente con cáncer en tratamiento de quimioterapia ambulatoria contribuye a que la persona vea la enfermedad desde una perspectiva positiva, aumente la fe y la esperanza para continuar luchando, le dé un sentido de que todo ha valido la pena, permite ver más allá y proporciona tranquilidad para enfrentar las adversidades ocasionadas por el cáncer.

Digital Competencies for Nurses: Tools for Responding to Spiritual Care Needs

Users show a growing interest in expanding the implementation of digital tools as a support of technical and management issues in healthcare. This medical care has focused on telemedicine but does not include the recognition of needs as an important part of patient-centred healthcare. Nurses interact with patients at critical times in their life journeys, including birth and death, which are historical events linked with religious beliefs. Furthermore, large migration flows have led to multicultural societies in which religion and spirituality are experienced in distinct ways by different people. Finally, most healthcare professionals lack the proper skills to handle the spiritual needs of their patients, especially for core and digital competences. This article shows the results of qualitative research applying as a research tool an open-ended questionnaire, which allows detecting the educational needs for nurses' interventions aimed at providing spiritual support to their patients using digital tools. The results obtained reveal that nurses need education and training on fundamental spiritual concepts and digital competencies to meet the multiple demands of their patients' spiritual needs. Finally, we present an open digital educational proposal for the development of competencies for nurses and other health professionals to provide spiritual care with the support of digital tools.

Correlation of spiritual well-being with hope and depression in oncology patients: The case of Turkey

PURPOSE

This study was conducted to determine the correlation between spiritual well-being and hope and depression in oncology patients.

DESIGN AND METHODS

The sample of the study consisted of 210 cancer patients. For data collection, a Patient Information Form, the FACIT-Sp-12 Scale, the Beck Hopelessness Scale, and the Beck Depression Inventory were used.

FINDINGS

The patients had mean scores of 32.02 ± 5.14 for spiritual well-being, 4.15 ± 4.17 for hopelessness, and 16.05 ± 8.29 for depression. A negative relationship was determined between spiritual well-being and hopelessness and depression, and a positive and significant relationship was found between depression and hopelessness.

PRACTICE IMPLICATIONS

Oncology patients should be given psychosocial care that supports their spiritual well-being and hope, and depression symptoms should be well known and given importance.

Portuguese Version of the Spiritual Well-Being Questionnaire: Validation Study in People under Assisted Reproductive Techniques

Attention has been given to the experience of individuals undergoing assisted reproductive techniques. However, only recent literature has focused on the spiritual journey triggered by such an event and highlighted the nurses and midwives’ roles in the assessment of the spiritual needs of those living with infertility. This study aimed to perform a psychometric test of the factor structure of the Portuguese version of the Spiritual Well-being Questionnaire in a sample of people undergoing assisted reproductive techniques. This descriptive cross-sectional study was conducted between September 2019 and June 2020 on a sample of 104 Portuguese adults attending fertility treatment. An online questionnaire was released on fertility-related websites. A confirmatory factor analysis was conducted on six hypothesized models of the instrument. The findings provided evidence of an adequate internal consistency of the instrument, and the validity and reliability of the oblique four-factor model was confirmed. Spiritual well-being had a significant association with the nature of infertility and a higher score was achieved by participants that perceived religion as very important. This study provides a validated tool for nurses and midwives to assess spiritual well-being and promote an integrated reproductive healthcare approach. Further longitudinal research with bigger samples would provide more evidence of the spiritual needs of people living with this condition.

The relationship between spiritual well-being, hope and depression in gynecologic oncology patients

The authors' aim in this study was to determine the relationship between spiritual well-being, hope and depression in gynecologic oncology patients. This is a descriptive and correlational study. The patients received a total of 41.59 ± 12.11 points from the Spiritual Well-Being Scale, 5.57 ± 4.19 points from the Beck Hopelessness Scale, and 14.92 ± 11.61 points from the Beck Depression Scale. Gynecologic oncology patients had high spiritual well-being levels and low hopelessness and depression levels, and their hopelessness and depression levels decreased and hope levels increased as their spiritual well-being levels increased.

Validation and Utilisation of the Spiritual Well-Being Questionnaire: SHALOM

The Spiritual Well-Being Questionnaire (SWBQ) was developed from a theoretical understanding that spiritual well-being (SWB) is expressed in the quality of relationships that each person has across one or more of four domains, namely with self, others, environment and/or with a transcendent other. Based on the SWBQ, the Spiritual Health And Life-Orientation Measure (SHALOM) is unique in that it compares each person's lived experience with their ideals on the 20 items reflecting the four domains of SWB. This paper builds on previous reviews of the SWBQ-SHALOM, by providing breadth and depth of data and their validity, from a wide range of sources, and expressing the instrument's usefulness in a variety of settings. It provides an overview with details from 60 studies that started with the SWBQ-SHALOM. Presented herein are ideas on what can be done with further investigations of this vital aspect of life.

Perceptions of Spiritual Dryness in Iran During the COVID-19 Pandemic

This study addresses perceptions of spiritual dryness (a specific form of spiritual struggle) during the COVID-19 pandemic among Iranian Muslims (n = 362), and how these perceptions can be predicted. Spiritual dryness was perceived often to regularly by 27% and occasionally by 35%. Regression models revealed that the best predictors of spiritual dryness (SDS-7) were usage of mood-enhancing medications, loneliness/social isolation and praying as positive predictors, and being restricted in daily life concerns as negative predictor. The pandemic challenges mental stability of people worldwide and may also challenge trust in God. Reliable and humble support of people experiencing these phases is required.

Spiritual Care for Individuals with Cancer: The Importance of Life Review as a Tool for Promoting Spiritual Well-Being

OBJECTIVE

To discuss spirituality in the context of cancer, focusing on the use of life review as a tool to help promote spiritual well-being among individuals with cancer.

DATA SOURCES

Literature regarding spirituality and life review of the author in cancer care provided the foundation for this article.

CONCLUSION

Reliance on spirituality as an untapped supportive resource may surprise patients and their families when dealing with a diagnosis of cancer. Coming to terms with advancing disease can be a time of internal and spiritual growth. It is important that all members of the health care team make efforts to understand that spirituality is part of the journey that the person with advanced cancer is going through and that life review is one way to promote spiritual well-being among patients with advanced cancer.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are ideally placed to provide spiritual care. Using life review, nurses can assist individuals coming to terms with their diagnosis and can positively impact spiritual and psychosocial well-being.

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 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.

Accuracy of the clinical indicators for Readiness for enhanced health management

PURPOSE

to analyze accuracy measures of the clinical indicators of Readiness for enhanced health management in patients with arterial hypertension and/or diabetes mellitus METHODS: prospective diagnostic accuracy study conducted with 359 patients with hypertension and/or diabetes mellitus, followed up in primary healthcare. Stratified random sampling was used to recruit participants. An assessment form was applied with sociodemographic data, health conditions, and information related to the clinical indicators under investigation. Sensitivity, specificity, predictive values, and likelihood ratios were analyzed FINDINGS: the sample was composed of 359 participants. The prevalence of Readiness for enhanced health management was 93.8%. There was a statistically significant association between the diagnosis and age under 60 years (p < 0.001), having only one chronic condition (p < 0.001), having normal blood pressure (p = 0.017) and blood glucose (p = 0.013) values, and having a nonsedentary (p = 0.026) and nonalcoholic (p = 0.044) lifestyle. All clinical indicators had high predictive values in predicting the nursing diagnosis under investigation. The indicator expresses desire to enhance management of symptoms was the most sensitive (99.7%) and specific (100%). The indicator expresses desire to enhance management of prescribed regimens was also highly specific (100%) CONCLUSION: all clinical indicators were accurate in predicting Readiness for enhanced health management IMPLICATIONS FOR NURSING PRACTICE: knowing which clinical indicators and sociodemographic/clinical characteristics best predict Readiness for enhanced health management, nurses in primary care can better plan nursing interventions and direct their goals.

Interactions of Spiritual Well-Being, Symptoms, and Quality of Life in Patients Undergoing Treatment for Non-Small Cell Lung Cancer: A Cross-Sectional Study

OBJECTIVES

To investigate the relationship of spiritual well-being and quality of life (QOL) in patients undergoing treatment for non-small cell lung cancer (NSCLC) and to identify the role of four different symptoms (ie, appetite loss, dyspnea, pain, and fatigue) in mediating this relationship DATA SOURCES: A total of 132 consecutive patients undergoing chemotherapy, radiotherapy, or concurrent chemoradiotherapy for NSCLC from National University Hospital were examined. Symptoms were assessed using the symptom subscale of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30 (QLQ-C30). Spiritual well-being was assessed using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale. Global QOL was assessed using the item on global health status from the European Organization for Research and Treatment of Cancer. Data of all self-reported surveys were analyzed using serial multiple mediation analysis.

CONCLUSION

Spiritual well-being directly affected QOL in patients undergoing treatment for NSCLC. In addition, a serial multiple mediation model showed causal relationships of spiritual well-being on appetite loss, appetite loss on dyspnea, dyspnea on pain, pain on fatigue, and fatigue on QOL.

IMPLICATIONS FOR NURSING PRACTICE

Providing integrated care that considers spiritual well-being may improve the QOL of patients undergoing treatment for NSCLC. Our findings emphasized the need to conduct routine assessments of spiritual well-being and symptoms when characterizing patient QOL.

Impact of Islam-Based Caring Intervention on Spiritual Well-Being in Muslim Women with Breast Cancer Undergoing Chemotherapy

This research emphasizes the nurse’s role in incorporating Islamic teaching through the care practices provided in order to promote spiritual well-being in Muslim women with breast cancer undergoing chemotherapy. In addition, religion and spirituality have been recognized as the primary resources for coping. The aim of the study, therefore, was to explore the impact of an Islam-based caring intervention on the spiritual well-being of Muslim women with cancer. Furthermore, data were collected using a questionnaire and, also, the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp) on baseline (Time 1), days 3 (Time 2), 23 (Time 3), and 44 (Time 4). The results showed the significant impact of an Islam-based caring intervention on the participants’ level of spiritual well-being. In addition, the mean scores varied between the intervention and control group over time. Based on the reflection, participants stipulated feeling peace of mind, closer to God, spirit for further life, and healthier.

SUFFERING AMONG PATIENTS WITH CANCER UNDERGOING NEUROTOXIC CHEMOTHERAPY: A PHENOMENOLOGICAL APPROACH

ABSTRACT Objective: reveal experiences of cancer patients undergoing neurotoxic chemotherapy. Method: phenomenology-based, qualitative study, carried out with nine adult patients in antineoplastic neurotoxic treatment, interviewed in June and July 2018. The testimonies were analyzed using an empirical comprehensive model. Results: the following categories were delineated: nerves on edge: perception of limitations caused by neuropathic pain induced by chemotherapy; chemotherapy drains me of energy; the suffering of starting again; the suffering of enduring it; alone in a desert, I heard the cry of my silence; chemotherapy: an infusion of hope; and there is no suffering on earth that heaven cannot heal. Conclusion: the study presented various meanings of suffering that emerge from experiences with neurotoxic treatment and found that many dimensions of suffering interpenetrate, making it impossible to disassociate them.

Religious/spiritual coping and spiritual distress in people with cancer

ABSTRACT Objective: To investigate the relation between the presence of spiritual distress and use of RSC and sociodemographic, clinical and religious/spiritual variables in people with cancer. Method: Cross-sectional study conducted in an association for support to people with cancer. The data obtained with the tools were analyzed using the Spearman‘s correlation coefficient and the Mann-Whitney Test. Results: 129 volunteers participated in the study, of which 57% showed moderate spiritual distress, 96% used medium and high positive religious/spiritual coping. Spiritual distress showed positive correlation with negative religious/spiritual coping (P<0.001) and inverse correlation with age (p 0.002). The use of positive religious coping was statistically significant in people who have religious practices (p 0.001). Conclusão: Spiritual distress is a phenomenon that is present in the lives of people with cancer and has significant relation with the use, in a negative manner, of religion/spirituality as a way of coping with the disease.

How about the reporting quality of case reports in nursing field?

BACKGROUND

As a significantly important part of clinical practice, the professional nursing process can be advanced in many ways. Despite the fact that case reports are regarded to be of a lower quality grade in the hierarchy of evidence, one of the principles of evidence-based medicine is that decision-making should be based on a systematic summary of evidence. However, the evidence on the reporting characteristics of case reports in the nursing field is deficient.

AIM

To use the CARE guidelines to assess reporting quality and factors influencing the quality of case reports in the nursing field.

METHODS

Nursing science citation indexed (SCI-indexed) journals were identified from the professional website. Each of the identified journals was searched on their website for articles published before December 2017. Twenty-one sub-items on the CARE checklist were recorded as “YES”, “PARTLY”, or “NO” according to information reported by the included studies. The responses were assigned corresponding scores of 1, 0.5, and 0, respectively. The overall score was the sum of the 21 sub-items and was defined as “high” (more than 15), “medium” (10.5 to 14.5), and “low” (less than 10). The means, standard deviations, odds ratios (OR), and the associated 95% confidence interval (CI) were determined using Stata 12.0 software.

RESULTS

Ultimately, 184 case reports from 16 SCI-indexed journals were identified, with overall scores ranging from 6.5 to 18 (mean = 13.6 ± 2.3). Of the included case reports, 10.3% were regarded low-quality, 52.7% were considered middle-quality, and 37% were regarded high-quality. There were statistical differences in the mean overall scores of the included case reports with funding versus those without funding (14.2 ± 1.7 vs 13.6 ± 2.4, respectively; P = 0.4456) and journal impact factor < 1.8 versus impact factor ≥ 1.8 (13.3 ± 2.3 vs 13.6 ± 2.4, respectively; P = 0.4977). Five items from the CARE guidelines, 5a (Patient), 6 (Clinical findings), 8c (Diagnostic reasoning), 9 (Therapeutic intervention), and 11d (The main take-away lessons) were well-reported (Reporting rate more than 90%) in most of the included case reports. However, only three items, 2 (Keywords, OR = 0.42, 95%CI: 0.19-0.92, P = 0.03), 4 (Introduction, OR = 0.35, 95%CI: 0.15-0.83, P = 0.017), and 11b (The relevant medical literature, OR = 0.19, 95%CI: 0.06-0.56, P = 0.003) were considered better-reported after the CARE guidelines published in 2013.

CONCLUSION

The reporting quality of case reports in the nursing field apparently has not improved since the publication of the CARE guidelines.

Validation of the Spiritual Distress Scale in Portuguese Cancer Patients Undergoing Chemotherapy: A Methodological Study

Spiritual distress may ascend from unmet spiritual needs. The use of instruments to measure spiritual distress seems to facilitate the approach to spirituality, such as the Spiritual Distress Scale (SDS) that has been used worldwide. No instrument to assess spiritual distress in cancer patients is currently available in Portugal. This study aims to conduct the translation, adaptation and validation of the SDS in Portuguese cancer patients undergoing chemotherapy. Methodological study based on Sousa and Rojjanasrirat (2011), a seven-step approach, started with the linguistic translation to the psychometric tests. The main participants (55.4%) were older than 60 years; about 64.7% were females, married (68.0%), and 86.7% were Catholic. Moderate spiritual distress was experienced by 49.3% of the participants. Linguistic and conceptual equivalences were obtained. The SDS European Portuguese version has an overall Cronbach’s alpha of 0.91, and the subscales were as follows: “relationship with self” (0.92), “relationship with others” (0.63), “relationship with God” (0.64) and “facing death” (0.85). Four factors emerged after Varimax rotation. Overall, these results indicate that the SDS European Portuguese version has good psychometric characteristics and can used in assessing spiritual distress in cancer patients.

Spiritual Well-Being in Cancer Patients Undergoing Chemotherapy in an Outpatient Setting: A Cross-Sectional Study

Purpose: To assess the spiritual well-being (SWB) of cancer patients undergoing chemotherapy in an outpatient setting. Method: Quantitative, cross-sectional, and descriptive study. A convenience sample of 150 participants was obtained. Data collection instrument was a self-reported questionnaire that included the SWB Questionnaire (SWBQ), whose scores range from 20 to 100. SPSS software, version 21, was used in data analysis. The study was approved by the institutional ethics committee. Results: Patients’ ages ranged between 35 and 83 years; most were female (64.7%), married (68.0%), Catholic (86.7%), and with breast cancer (35.3%) and colorectal cancer (25.3%). The average SWBQ total score was 65.91 ( SD = 12.177). The highest score of the SWBQ was obtained in females, widows and singles, Evangelic and Catholic, and with lower educational level and professional occupation. The Cronbach α was 0.89, and the subscales αs ranged between 0.78 and 0.94. Conclusion: The SWBQ scores were reasonable. These results can guide nurses’ clinical reasoning, as the assessment of SWB may precede the diagnosis of risk for spiritual distress, readiness for enhanced SWB, or spiritual distress. Thus, the use of this instrument may facilitate spirituality being effectively implemented in clinical practice, favoring holistic health care.

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

PURPOSE

This study aimed to explore the associated factors of spiritual well-being among cancer patients and the relationship between spiritual well-being (SWB) and quality of life (QOL).

METHODS

This cross-sectional study was conducted in 200 Chinese cancer patients in a tertiary cancer hospital. Functional Assessment of Cancer Therapy-General (FACT-G) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp) were used to measure SWB and QOL levels of participants. Multiple regression analyses were performed to determine the relationship between SWB and QOL.

RESULTS

The mean score of QOL was 59.8 (SD 13.1) with a range of 27-106. The mean score of SWB was 24.4 (SD 6.5), with a range of 8-48. Hospitalization frequency was the only variable associated with SWB. In terms of the relationship between SWB and QOL, the meaning and peace subscales were significantly related to overall QOL. It was also observed that the meaning subscale was positively related to social/family well-being, emotional well-being, and functional well-being. The peace subscale was related to the physical well-being, social/family well-being, and functional well-being. Faith was negatively related to physical and emotional well-being, but it had a positive effect on functional well-being.

CONCLUSIONS

Given that the meaning and peace subscales are related to a higher QOL level, it is important to find ways to improve these dimensions of spiritual well-being among cancer inpatients during treatment.

Review and Characterization of Portuguese Theses, Dissertations, and Papers about Spirituality in Health

Research about spirituality has grown widely in the past decades and the interest in health care is also evident in Portugal. This literature review aims to identify and to characterize Portuguese theses, dissertations, and papers about spirituality in health, and to provide a systematic overview of the knowledge concerning this subject. The search was conducted in February 2017 and updated in January 2018. Four independent reviewers screened and analyzed all citations, and a total of 76 results were included. Publications started in 2002 and include master degree dissertations (n = 37), scientific papers (n = 31), and PhD theses (n = 8). Papers were published in 24 national and international journals. Most papers were psychology- and nursing-related and had a quantitative design (n = 55). Samples were mostly composed of patients living with a chronic disease (n = 20) or elderly (n = 11). The Spiritual Well-Being Questionnaire (SWBQ) was the most used tool. A multidisciplinary approach is regarded as foundational in implementing spirituality in the provision of health care and the results underline the interest on this topic from other disciplines rather than nursing. Further studies must provide a deeper understanding of spirituality in children, adolescents or families’ perspective bringing new insights to advanced health practice.

The cultural expression of spiritual distress in Israel

BACKGROUND

Although spiritual distress is present across cultures, the ways in which patients experience it vary between cultures. Our goal was to examine the cultural expression and key indicators of spiritual distress in Israel.

METHODS

We conducted a structured interview of 202 oncology outpatients in a cross-sectional study. Self-diagnosis of spiritual distress, which is a demonstrated gold standard for identifying its presence, was compared with the Facit-Sp-12 and a number of other items (from the Spiritual Injury Scale and newly developed Israeli items) hypothesized as Israeli cultural expressions of spiritual distress, demographic and medical data, and patient desire to receive spiritual care.

RESULTS

Significant variation was found between Israeli cultural expression of spiritual distress and that found in studies from other countries. Key expressions of spiritual distress in this study included lack of inner peace, grief, and an inability to accept what is happening. Items related to faith were not significant, and loss of meaning showed mixed results. Patients requesting spiritual care were more likely to be in spiritual distress. No demographic or medical data correlated with spiritual distress.

CONCLUSIONS

Specially designed interventions to reduce spiritual distress should address the expressions of the distress specific to that culture. Studies of the efficacy of spiritual care can examine the extent of spiritual distress in general or of its specific cultural expressions.