Patient Perceptions About the Role of Religion and Spirituality During Cancer Care

A single-arm pilot of MyInspiration: a novel digital resource to support spiritual needs of patients undergoing cancer-directed surgery

PURPOSE

This study aimed to assess the feasibility, acceptability, and satisfaction associated with the MyInspiration intervention, a digital spiritual support tool for patients undergoing cancer surgery. Additionally, we evaluated changes in spiritual well-being and the ability to find meaning in their experience with cancer before and after the intervention.

METHODS

This was a prospective, single-arm pilot study. Feasibility and acceptability were assessed by ratio of participants who completed all assessments among individuals who had signed consent forms. Satisfaction was assessed with 5 Likert-style questions around user experience. Patient spiritual well-being and finding meaning in their experience with cancer were measured at baseline and post-intervention.

RESULTS

Forty patients were enrolled, the majority of whom were female (80.0%) and diagnosed with breast cancer (52.5%), with an average age of 54.4 years (SD = 13.7, range 29.0-82.0). Regarding feasibility and acceptability, 76.9% of patients who consented to participate completed the full study protocol. In assessing satisfaction, 59% of patients were satisfied with the overall experience of MyInspiration. There was no difference in spiritual well-being pre-/post-intervention. There was a difference in pre (M = 1.95, SD = .95) and post (M = 2.23, SD = .86) scores relative to "finding meaning in the cancer experience" with a mean difference of 0.28 (p = 0.008).

CONCLUSION

MyInspiration was feasible and acceptable to patients, and the majority were satisfied with the tool. The intervention was associated with changes in patients' ability to find meaning within their cancer experience. A randomized control trial is needed to evaluate the efficacy of the tool in a broader population of patients with cancer.

Evaluation of the Spiritual Care Needs of Patients with Cancer in a Chemotherapy Unit in Turkey

This study was conducted to determine the spiritual care needs of cancer patients receiving chemotherapy. A cross-sectional descriptive design was used to analyze a total of 104 patients at a university hospital in Turkey. The data were collected using the Spiritual Care Needs Scale. The mean age of the patients participating in the study was 61.0 (10.2). It was determined that 31.7% of the patients stated that the concepts of spirituality and spiritual care are related to religion and worship. As a result, it was found that the patients receiving chemotherapy had high-spiritual care needs. The dimensions in which the spiritual needs of the patients were remarkably high were belief and spiritual practices, being in peace and security, the love and support of their relatives and being informed about health. The spiritual care need score of the patients increased significantly with marital status (p = 0.001), having children (p = 0.002), having a chronic disease (p = 0.04) and having an undergraduate/graduate level education (p = 0.01). Nurses should be aware of patient's spiritual needs, plan patient-specific spiritual care practices, conduct more studies on the effects of spiritual care on the patient and family and create guidelines for spiritual care practices in patients receiving chemotherapy in Turkey.

Medicine for the soul: (Non)religious identity, coping, and mental health during the COVID-19 pandemic

Although the threat and uncertainty of the COVID-19 pandemic has become a significant source of distress, using religion to cope may be associated with more positive health. Given the severity and chronicity of the pandemic, religious individuals may also have relied on a variety of non-religious coping methods. Much of the existing COVID-19 research overlooks the role of religious group membership and beliefs in relation to coping responses and associated mental health, with an additional lack of such research within the Canadian context. Thus, this cross-sectional study investigated relations among religiosity, stressor appraisals, (both religious and non-religious) coping strategies, mental and physical health in a religiously-diverse Canadian community sample (N = 280) during the pandemic's 2nd wave from March to June 2021. Numerous differences were apparent in appraisal-coping methods and health across five (non)religious groups (i.e., Atheists, Agnostics, "Spiritual but not religious", Christians, and those considered to be religious "Minorities" in Canada). Religiosity was also associated with better mental health, appraisals of the pandemic as a challenge from which one might learn or grow, and a greater reliance on problem-focused, emotional-engagement, and religious coping. Moreover, both problem-focused and emotional-engagement coping mediated the relations between religiosity and health. Taken together, this research has implications for individual-level coping as well as informing culturally-sensitive public health messages promoting targeted self-care recommendations with integrated religious or spiritual elements during times of threat and uncertainty, such as the COVID-19 pandemic.

Physicians Disclosing Religion in Online Biographies: Patient Perceptions and Decision-Making in the United States

The inclusion of personal information about a healthcare provider is becoming more prevalent within online biographies as a means to help patients make more informed decisions about their future care. While many physicians indicate they are religious, and that spiritual well-being is an important part of one's overall health, what is unclear is what impact this sort of disclosure within an online biography might have on a prospective patient's perceptions of that provider. The current study took the form of a 2 (gender of provider: man; woman) × 2 (religion disclosure: yes; no) × 2 (activity: singing in choir; playing on softball team) between-subjects experiment. Participants (n = 551) in the USA were randomly assigned to view one of the eight biography conditions and then asked to rate their perceptions of the physician, and whether they would choose to make a future appointment with that physician. While there were no differences in perceptions (e.g., liking, trustworthiness), more participants who viewed a biography with a religion disclosure indicated an unwillingness to make a future appointment with that physician. A moderated mediation analysis revealed that this effect is only significant for participants with low levels of religiosity and is explained by these participants feeling less similar to an explicitly religious physician. Open-ended responses justifying their decisions found that religion disclosure played a much larger role in not choosing the physician (20% of responses) than for choosing the physician (3% of responses). However, participants wanting a physician of a different gender was the most cited reason for not wanting to select the provider (27.5% of responses). Recommendations for physicians contemplating adding an item about religion within their online biographies are discussed.

The effect of physical and psychological symptoms on spiritual well-being and emotional distress in inpatient cancer patients

PURPOSE

This study was conducted to examine the effects of physical and psychological symptoms seen in inpatient cancer patients on spiritual well-being and emotional distress.

METHOD

This descriptive and cross-sectional study was conducted with 98 cancer patients treated in oncology, haematology, and stem cell services at a university hospital between April and June 2022. Socio-demographic characteristic form, Karnofsky performance scale, Nightingale Symptom Assessment Scale, Hospital Anxiety and Depression Scale, distress thermometer and spiritual well-being scale were used to collect data. Statistical analyses were made by taking the descriptive features of the data.

RESULTS

It was determined that 55.1% of the patients were diagnosed with cancer for more than one year, 53.1% receiving treatment for more than one year, 61.2% were diagnosed with haematological cancer, and 62.2% were treated only with chemotherapy. Cancer type (p<0.01), treatment (p<0.05) and Karnofsky scores (p<0.01) had an effect on the spiritual well-being and distress scores. It was determined that 39.8% of the patients were in the yellow zone of the distress thermometer, could not manage their stress well and needed psychological support. As the psychological symptoms of the patients increased, their spiritual well-being declined (r=-0.447, p<0.01), and as their physical (r=0.222, p<0.05) and psychological (r=0.311, p<0.01) symptoms increased, their distress scores increased.

CONCLUSION

It is anticipated that identifying the problems that patients have and making interventions to solve those problems by oncology nurses would significantly contribute to the patient's spiritual well-being and emotional distress.

The Effect of Religious-Spiritual Psychotherapy on Illness Perception and Inner Strength among Patients with Breast Cancer in Iran

Women diagnosed with breast cancer often suffer from illness-related issues, which negatively impact their illness perception and inner strength following diagnosis and/or during treatment. An investigation of the effectiveness of religious-spiritual psychotherapy based on the Twelver Shia Sects of Islam (RSP-TSS) was conducted among hospitalized cancer patients to determine whether it improved their disease perception and inner strength. Forty-five women (ages 31-58) diagnosed with breast cancer in Iran were randomly assigned to RSP-TSS (n = 15), attention control (n = 15) and untreated control groups (n = 15). To meet the needs of hospitalized participants, the manualized RSP-TSS protocol was adapted to consist of ten sessions, each lasting 90 min. Sessions were conducted once weekly for 10 weeks. Primary outcome measures were the Revised Illness Perception Questionnaire (IPQ-R) and the Inner Strength Questionnaire (ISQ). Data were collected in pre-intervention, post-intervention, and 4 months following the intervention. Repeated MANOVA measures showed that, as compared with the attention control and untreated control groups, the RSP-TSS group achieved significant improvements in illness perception and inner strengths, and those gains were maintained during the 4-month follow-up. By reframing illness perception and building inner strength, spiritual and religious-based interventions may improve patients coping with cancer and improve the quality of life for women hospitalized with breast cancer. These promising results warrant further investigation into the efficacy of spiritual and religious-based interventions to remediate illness perception and inner strength problems in women diagnosed with serious medical illnesses.

Post-traumatic Growth in Cancer Patients: A Correlational Study in Turkey

This study aims to evaluate the factors that influence post-traumatic growth (PTG), including religious coping and resilience. This descriptive and correlational study involved 111 cancer patients, followed up at a hematology inpatient clinic of a university hospital in Turkey. Religious coping scale, resilience scale, and PTG inventory were used for data collection. PTG was positively associated with negative religious coping and was negatively associated with age. PTG scores were higher for patients without children, who were recently diagnosed, had higher knowledge about the disease, and used negative religious coping.

Beneficial Effects of Spiritual Experiences and Existential Aspects of Life Satisfaction of Breast and Lung Cancer Patients in Poland: A Pilot Study

Spiritual and existential issues are important factors for oncology patients' well-being. This study aimed to examine the beneficial role of spiritual experience, hope, and meaning in life for life satisfaction in patients diagnosed with breast and lung cancer. It was hypothesized that spiritual experiences and life satisfaction are indirectly related through hope, as well as meaning in life mediates the relationship between hope and life satisfaction. It was a pilot study with a sample consisting of 4 men and 46 women, 24-83 years of age oncology patients. The following measures were used: Cantril Ladder, Purpose in Life Test, Herth Hope Index as well as Daily Spiritual Experiences Scale. A sample of Polish patients with breast and lung cancer confirmed the beneficial effects of spiritual experiences and existential aspects of life for their life satisfaction. According to obtained results, hope was indirectly related to life satisfaction through meaning in life. Also, spiritual experiences were positively indirectly related to life satisfaction through the pathway of hope and meaning in life. Theoretical and practical implications of the achieved results were discussed.

Spiritual Care Needs of Patients in Oncology Units and Nursing Practices in Turkey: A Qualitative Study

This descriptive qualitative study was planned to determine the spiritual care needs of patients hospitalized in the oncology department and nursing care practices. Twenty-five patients and 15 nurses were interviewed. Concerning the spiritual care practices expected from nurses, the following themes were determined: Interest-Compassion, Smiling Face, Confidence, Being Informative, Morale, and Understanding. The themes for spiritual nursing practices were Chatting-Suggesting, Smiling Face, Giving Opportunities for Religious Practice, Love and Belonging, Giving Hope-Precedent Examples, and Giving Information. Patients expected nurses to ask about their spiritual needs. However, nurses did not ask about spiritual issues because they were afraid of affecting patients adversely.

The Influence of Religiosity and Spirituality on Health in Canada: A Systematic Literature Review

The association between religion and health has been the subject of growing interest in academia. However, limited reviews of such studies in Canada exist. The paper systematically reviews and synthesizes existing literature on the relationship between spirituality and health in Canada. Available general databases such as: Medline; Web of Science, PubMed, Sociological abstract, Social Service Abstracts, Google scholar, Humanities International Index, JSTOR, CPI.Q Canadian Periodicals, and American Theological Library Association were searched for the period between 2000 and April 2019 inclusive. Collected data were then systematically analysed for common themes about spirituality and health in Canada. In total, 151 articles were found, but only 128 had relevance with the study objectives. Overall, the analysis showed that religion and spirituality do influence health behaviours, and well-being. However, more gender-based studies need to be conducted to tease out the differences in religion/spirituality and health across different genders, and ethnic groups in Canada.

Gender Differences in Psychosocial, Religious, and Spiritual Aspects in Coping: A Cross-Sectional Study with Cancer Patients

Background: There is a growing awareness of religiosity and/or spirituality (R/S) as a possible resource in coping with cancer. Gender differences in religious coping have not yet been thoroughly examined. This study aimed to analyze differences in religious coping between men and women with cancer and compare the impact of R/S on anxiety and depression symptoms.

Methods: This cross-sectional study was conducted at the Divisions of Hematology and Oncology of the Medical University of Vienna. In total, 352 patients with a cancer diagnosis, who regarded themselves as religious and/or spiritual, were interviewed at Vienna's university hospital with standardized questionnaires. To answer our research questions, we used the Hospital Anxiety and Depression Scale (HADS), the Benefit Through Spirituality/Religiosity (Benefit) questionnaire, and collected demographic characteristics.

Results: Of 689 cancer patients, 51% (352) regard themselves as religious and/or spiritual. Women with cancer tend toward R/S more significantly (57%) than men (45%). In patients with an R/S belief, women scored higher in almost all items of the Benefit questionnaire and showed higher prevalence of anxiety (p < 0.001) and depression than men. Regarding the socioeconomic characteristics, more women were widowed, and had significantly lower income than men.

Conclusions: The results show a significant gender gap concerning the importance of R/S for cancer patients and the effect on psychological well-being.

Women in this study were more religious/spiritual than men and scored higher on anxiety and depression. We support the notion that the gender perspective is essential and can contribute to better patient care in identifying gender-specific concerns.

Healthcare provider self-reported observations and behaviors regarding their role in the spiritual care of cancer patients

PURPOSE

The provision of spiritual care by an interprofessional healthcare team is an important, yet frequently neglected, component of patient-centered cancer care. The current study aimed to assess the relationship between individual and occupational factors of healthcare providers and their self-reported observations and behaviors regarding spiritual care in the oncologic encounter.

METHODS

A cross-sectional survey was administered to healthcare providers employed at a large Comprehensive Cancer Center. Pearson's chi-square test and logistic regression were used to determine potential associations between provider factors and their observations and behaviors regarding spiritual care.

RESULTS

Among the participants emailed, 420 followed the survey link, with 340 (80.8%) participants completing the survey. Most participants were female (82.1%) and Caucasian (82.6%) with a median age was 35 years (IQR: 31-48). Providers included nurses (64.7%), physicians (17.9%), and "other" providers (17.4%). There was a difference in provider observations about discussing patient issues around religion and spirituality (R&S). Specifically, nurses more frequently inquired about R&S (60.3%), while physicians were less likely (41.4%) (p = 0.028). Also, nurses more frequently referred to chaplaincy/clergy (71.8%), while physicians and other providers more often consulted psychology/psychiatry (62.7%, p < 0.001). Perceived barriers to not discussing R&S topics included potentially offending patients (56.5%) and time limitations (47.7%).

CONCLUSION

Removing extrinsic barriers and understanding intrinsic influences can improve the provision of spiritual care by healthcare providers.

A mixed-methods approach to comparing perceptions of cancer patients' and cancer care providers' religious and spiritual beliefs, behaviours, and attitudes

OBJECTIVES

To compare the perceptions of cancer patients' and cancer care providers' religious and spiritual (R&S) beliefs, behaviours, and attitudes.

METHODS

A concurrent, nested, quantitative dominant, mixed-methods design was utilised. Data were collected from patient and provider groups via online survey. Analyses include chi-square tests of independence and independent t-tests for quantitative data and content analysis for qualitative data.

RESULTS

The final analytic cohort for the study included 576 participants (n_patients  = 236, n_providers  = 340) with an average age of 47.4 years (SD = 15.0). Over half of participants were partnered (n = 386, 70.1%), female (n = 317, 57.3%) and had an advanced degree (n = 284, 51.2%). The most common diagnosis for patients was breast cancer (n = 103, 43.2%). The most common provider role was nurse (n = 220; 64.7%), while a smaller subset included physicians (n = 61; 17.9%) and "other" providers (n = 59; 17.4%). There was no difference between patients and providers in relation to R&S identity (p = 0.49) or behaviour (p = 0.28). Providers more frequently indicated that patients should receive R&S resources in the hospital (n = 281, 89.7% vs. n = 111, 49.6%, p < 0.001). For resource type, patients most frequently endorsed written resources (n = 93, 83.8%) while providers endorsed relational resources (n = 281, 97.9%).

CONCLUSION

Aligning patient and provider expectations of spiritual care will contribute to provision of optimal patient-centred cancer care.

Patient Spirituality as a Component of Supportive Care: Assessment and Intervention

OPINION STATEMENT

National supportive care guidelines for patients with cancer include recognition of patients' spirituality and spiritual needs. Experts differ on how best to address this dimension to our patients' lives. Some suggest that patients' medical team should take on spiritual care, and others suggest referral to chaplains or collaboration with outside clergy. In our view, the patient's medical team ought to best acknowledge patient spirituality when so desired by the patient, but intervention in the case of serious spiritual crisis ought to be the responsibility of those with specific training in this realm. For some patients, "concordance" between the specific spiritual tradition of the patient and chaplain is necessary where for others, non-denominational, secular, or inter-faith chaplaincy services are welcome. The central role for physicians and nurses in this area, is listening, awareness, respect, and where necessary, referral.