Spirituality in Arab Muslim Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Approach

The relationship between compliance with immunosuppressive therapy and religious attitudes of kidney transplant patients

OBJECTIVE

This study was conducted to examine the relationship between adherence to immunosuppressive therapy and religious attitudes of kidney transplant patients.

METHOD

The research was conducted descriptively with patients followed in the transplantation clinic of the between 2015 and 2019. The sample consisted of 142 patients who met the study criteria. Before starting the study, necessary permissions were obtained from the institution, ethics committee and patients.

RESULTS

There was a significant relationship between marital status, educational status, income status and the mean score of the immunosuppressive treatment adherence scale, and between family type and the mean score of the religious attitude scale (p < 0.05). Of these results only; It was determined that there was a significant relationship between the priority order of drugs in life, duration of renal failure and time after transplantation and drug compliance scale average score (p < 0.05). Those who do not want to donate their kidneys to their relatives, those who do not want to donate organs when they die, those whose religious beliefs affect drug compliance, the duration of kidney failure is between 1 and 12 months and the period after transplantation 13- It was determined that those who had 60 months had a "more positive religious attitude" (p < 0.05).

CONCLUSION

It was found that the mean score of the immunosuppressive treatment compliance scale of kidney transplant patients was at a good level, while the mean score of religious attitude was below the middle level. In addition, there was no significant relationship between the mean score of the immunosuppressive treatment compliance scale and the mean score of the religious attitude scale.

The experience of patients with hematological malignancy in their terminal stage: a phenomenological study from Jordan's perspective

BACKGROUND

Patients diagnosed with hematological malignancies residing in low-middle-income countries undergo significant physical and psychological stressors. Despite this, only 16% of them receive proper care during the terminal stages. It is therefore crucial to gain insight into the unique experiences of this population.

AIM

To have a better understanding of the needs and experiences of adult patients with advanced hematological malignancy by exploring their perspectives.

METHODS

A qualitative interpretive design was employed to collect and analyze data using a phenomenological approach. The study involved in-depth interviews with ten participants aged between 49 and 65 years, utilizing a semi-structured approach.

RESULTS

Two primary themes emerged from the participants' experiences of reaching the terminal stage of illness: "Pain, Suffering, and Distress" and "Spiritual Coping." The first theme encompassed physical and emotional pain, suffering, and distress, while the second theme was centered on the participants' spiritual coping mechanisms. These coping mechanisms included seeking comfort in religious practices, relying on spiritual support from family and friends, and finding solace in their beliefs and faith.

CONCLUSION

Patients with hematological malignancies in the terminal stages of their disease experience severe pain, considerable physical and psychosocial suffering, and spiritual distress. While they require support to cope with their daily struggles, their experiences often go unnoticed, leading to disappointment and loss of dignity. Patients mainly rely on their spirituality to cope with their situations. Healthcare providers must acknowledge these patients' needs and provide more holistic and effective care.

"I Am Grateful for Every Day I Live": A Qualitative Study on the Spiritual Experiences of Women With Gynecological Cancer

BACKGROUND

Considering the life-threatening nature of gynecological cancers, spirituality and religious beliefs may play a key role in the experiences of the patients during the disease process and their coping.

OBJECTIVE

The aim of this study was to understand the spiritual experiences of Muslim women with gynecological cancer during the disease process.

METHODS

A qualitative, phenomenological, and hermeneutic approach was followed in the research. Fourteen women with gynecological cancer in Turkey were interviewed individually. The thematic analysis approach of Braun and Clarke was used to evaluate the data.

RESULTS

The results of the data analysis revealed 3 themes (consisting of 9 subthemes): (1) reaction to cancer: spiritual distress (fear of death, perception of punishment, fear of obscurity and uncertainty, and being a cause of spiritual distress in the family); (2) reaction to cancer: spiritual well-being (accepting whatever may come from Allah, strengthening the faith in Allah); and (3) spiritual resources for coping with cancer (religious practices, hobbies and complementary practices, and family support).

CONCLUSIONS

The results of the study shed light on the cases that may cause spiritual distress and improve the spiritual well-being that is experienced by Muslim women with gynecological cancer during the disease process; they also reveal that religion has an effect on the experiences during the cancer process and the coping methods.

IMPLICATIONS FOR PRACTICE

Healthcare professionals who care for Muslim women with gynecological cancer should plan spiritual care by being aware of the cultural characteristics and religious beliefs of these women and their families.

Survivorship Experiences of Chinese Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Study

BACKGROUND

The number of global hematopoietic stem cell transplantation (HSCT) survivors is increasing rapidly. Survivors encounter many challenges, but studies regarding survivorship experiences in China are scarce.

OBJECTIVES

This study aimed to explore the survivorship experiences of Chinese patients with hematological cancers after HSCT and to describe the impact of HSCT on the survivors' lives.

METHODS

Descriptive qualitative research was used. Purposive sampling was used to recruit HSCT survivors who were treated in a teaching hospital in Zhejiang Province from June 2021 to June 2022. Audio-recorded semistructured interviews were conducted, transcribed verbatim, and analyzed via conventional content analysis.

RESULTS

Fifteen HSCT survivors aged 18 to 59 years participated in this study. Four themes and 11 subthemes emerged: (1) transplant being harder than you thought (body function impaired, forced to modify diet, disturbed by survivorship uncertainty), (2) difficulty blending into circles (limited activity space, suffering from discrimination), (3) adjusting value judgment (health being a top priority, contributing to family as much as possible, feeling worthless), and (4) still being the lucky one (recovered better than others, genuine relationships acquired, self-improvement achieved).

CONCLUSION

This study offers insight into subjective survivorship experiences of patients with hematological cancers post-HSCT within a Chinese sociocultural context and presents changed perceptions of HSCT, life alterations, adjusted value judgments, and positive self-evaluation since treatment.

IMPLICATIONS FOR PRACTICE

Nurses can provide person-centered survivorship care based on the understanding of survivorship experiences of Chinese HSCT survivors. Intervention programs and informational materials should be developed to address difficulties encountered by Chinese HSCT survivors.

Experiences of Muslim Cancer Survivors Living in the United States

PURPOSE

To gain an understanding of the cancer diagnosis, treatment, and survivorship experiences of adult Muslim cancer survivors residing in the United States.

PARTICIPANTS & SETTING

A purposive sample of 17 male and 15 female Muslim cancer survivors was recruited from across the United States. Data on Muslim cancer survivors' experience were collected through individual, in-depth, semistructured interviews.

METHODOLOGIC APPROACH

An interpretive, descriptive, qualitative approach was used to gain an understanding of the experience of Muslim cancer survivors.

FINDINGS

Six broad themes were identified to gain an understanding of the cancer experiences of adult Muslim cancer survivors residing in the United States.

IMPLICATIONS FOR NURSING

This study provided key information concerning the unique experience of Muslim cancer survivors residing in the United States. Identifying, understanding, and meeting survivors' religious needs, as well as understanding their cancer experience, may reduce cancer health disparities and enhance health outcomes.

Factors Associated With Depression in Breast Cancer Patients in Saudi Arabia

BACKGROUND

Depressive symptoms in Arab women with breast cancer (AWBC) in Saudi Arabia can be influenced by spirituality, religiosity, social support, and breast cancer's stigma. Understanding the role of these factors can raise awareness and help create policies to improve care for breast cancer patients. Yet, there is limited research addressing the impact of these factors on depressive symptoms in AWBC.

OBJECTIVE

The aim of this study was to investigate factors influencing depressive symptoms in AWBC in Saudi Arabia.

METHODS

A cross-sectional design and convenience sampling were used to recruit 59 AWBC from oncology departments in Jeddah, Saudi Arabia, who were receiving active treatment to participate in this study. Participants completed an online survey or paper-based survey including questions on sociodemographics, social support, spirituality, religiosity, depressive symptoms, and breast cancer's stigma. Pearson correlation and multiple regression analysis were used to examine the influence of numerous factors on depressive symptoms in AWBC; Student t test statistic was used to distinguish the depressive symptom scores between online and paper-based survey.

RESULTS

The average age of participants was 49 years (SD = 8.31). The mean (SD) of depressive symptoms was 20.52 (12.36). Pearson correlation analyses indicated that cancer patients with high levels of depressive symptoms were associated with low levels of spiritualty and religiosity, and high levels of breast cancer stigma.

CONCLUSIONS

Religiosity and spirituality work as protective factors against depressive symptoms in AWBC.

IMPLICATIONS FOR PRACTICE

Including religiosity and spirituality in the intervention plan should be considered when caring for AWBC.

The Role of Spirituality in Patients Undergoing Hematopoietic Stem Cell Transplantation: a Systematic Mixed Studies Review

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) has become the standard treatment for many diseases, but it is an intense and distinctive experience for patients. HSCT-related mortality is present throughout the whole process of transplantation, from pretransplantation to recovery. Long-term rehabilitation and the uncertain risk of death evoke feelings of vulnerability, helplessness, and intense fear. Zimmermann et al. proposed that spiritual well-being is an important dimension of quality of life and that patients at the end stage of life require spiritual support in addition to physical care, psychological care, and social support. Therefore, the purpose of this review is to examine the role of spirituality in the process of HSCT.

METHOD

A systematic mixed studies review (SMSR) was based on Pluye and Hong's framework to understand the role of spirituality in patients' experiences while undergoing HSCT. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement to report the results of integration.

RESULTS

Fifteen original qualitative studies, 19 quantitative studies, and one mixed method study were included in the systematic mixed studies review. The evidence from the review revealed the following three themes: the spiritual experiences of HSCT patients, the spiritual coping styles of HSCT patients, and the spiritual need changes brought about by HSCT.

DISCUSSION

Few medical institutions currently offer spiritual healing, although HSCT patients with different cultural backgrounds may have different spiritual experiences and spiritual coping styles. Psychotherapists or nurses should be considered to provide spiritual care for patients undergoing HSCT, to help patients cope with disease pressures, promote HSCT patients' comfort, and improve their quality of life.

Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis

The present review evaluated health-related quality of life (HR-QoL) outcomes in surgical breast cancer survivors who received breast reconstruction (BR), breast-conservation surgery (BCS) or mastectomy (M), and whether HR-QoL domains across generic and disease/surgery-specific questionnaires are compatible. Six electronic databases were searched for appropriate observational studies. Standardized scores for different HR-QoL domains in the BR, BCS, and M treatment groups were extracted from each study for the purpose of a meta-analysis. Using Stata version 14.0, a random-effects meta-analysis model was adopted for each outcome variable to estimate the effect size, 95% CI-confidence intervals, and statistical significance. Sixteen of the 18 eligible studies with BR (n = 1474) and BCS (n = 2612) or M (n = 1458) groups were included in the meta-analysis. The BR group exhibited a better physical health (k = 12; 0.1, 95% CI 0.04, 0.24) and body image (k = 12; 0.50, 95% CI 0.10, 0.89) than the M group. However, the two groups exhibited comparable social health (k = 13; 0.1, 95% CI -0.07, 0.37), emotional health (k = 13; -0.08, 95% CI - 0.41, 0.25), global health (k = 7; 0.1, 95% CI - 0.01, 0.27), and sexual health (k =11; 0.2, 95% CI - 0.02,0.57). There was no clear evidence of the superiority of BR to BCS for all the six domains. These results suggest that HR-QoL outcomes in BR and BCS groups are better than the M group. Therefore, women opting for BR or BCS are likely to report fairly better HR-QoL outcomes than M. However, due to the significant heterogeneity observed in most BR versus BCS outcomes, developing a unified questionnaire incorporating both breast/surgery-specific and generic HR-QoL domains is warranted.

Evaluation of Distress and Religious Coping Among Cancer Patients in Turkey

The purpose of this study was to determine distress levels and religious coping styles of cancer patients and the relationship between religious coping styles and distress. This study was conducted as descriptive design. It was determined that 60.7% of the patients experienced distress related to the disease. The field of problem from which the patients mostly experienced distress was physical problems. It was observed that positive coping scores of the patients were higher. There was a negative correlation between their mean scores for positive religious styles and distress total scores.

Incidence, Risk Factors and Prognosis of Acute Kidney Injury Following Hematopoietic Stem Cell Transplant: A Pilot Study

Background and Objectives

The burden of acute kidney injury (AKI) has not been explored in Jordanian patients who receive hematopoietic stem cell transplant (HSCT). The aim of this study was to evaluate the frequency, risk factors, and mortality of AKI among patients who underwent HSCT.

Methods

A retrospective pilot study included 70 adult patients who received peripheral HSCT was conducted. Weekly measurement of serum creatinine (SCr) was obtained for 3 months after chemotherapy and HSCT. Then, stages of Risk, Injury, and Failure of Kidney were determined based on the Kidney Disease for Improving Global Outcomes (KDIGO).

Results

The median follow-up was 41 months. Mortality was reported in 16 patients (23%). Out of 60 patients that had SCr values, 19 patients (31.6%) had AKI in 90 days after chemotherapy. Allogeneic HSCT, male donors, high-dose melphalan protocols and values of blood urea nitrogen (BUN) were significantly higher among patients with AKI.

Conclusions

Combining many nephrotoxic drugs and dosing adjustments should be considered in uniform protocols. Multidisciplinary care should be utilized to assess early kidney dysfunction that decreases adverse events and improves outcomes.

Spiritual Experiences of Adults With Advanced Cancer in Outpatient Clinical Settings

CONTEXT

Adults who have advanced cancer experience distress, and many use religion and spirituality to cope. Research on the spiritual experiences of patients with advanced cancer will help guide the provision of high-quality spiritual care.

OBJECTIVES

To qualitatively describe advanced cancer patients' spiritual experiences of illness.

METHODS

We conducted semistructured qualitative interviews at a single cancer center with 21 patients with stage IV solid malignancies who had a prognosis of less than 12 months, as estimated by each patient's medical oncologist. Five investigators conducted a thematic analysis of the transcribed interviews.

RESULTS

We found 31 patients who were eligible for enrollment, and 21 (67.7%) participated in interviews to thematic saturation. Using a thematic-analysis approach, five major themes emerged. Relationships with family and friends was the most important theme among all 21 patients irrespective of their religious or spiritual identity. Relationship with God and faith community was frequently identified by those who considered themselves spiritually religious. Cancer often led to reflection about the meaning of life and the nature of existential suffering. Patients addressed the extent to which identity was changed or maintained through the cancer experience, and some expressed acceptance as a way of coping with illness.

CONCLUSIONS

Spiritual care for dying cancer patients should always include the exploration of relationships with family and friends, as well as God and faith community for some patients. Relationships with family, friends, and God can be a source of strength for many. Making meaning, addressing identity concerns, supporting acceptance as a resource for coping with illness, and acknowledging existential suffering will often arise for these patients.

Quality of Life and Body Image as a Function of Time from Mastectomy

BACKGROUND

We sought to determine the impact of time after surgery on quality of life (QoL) and body image in breast cancer patients undergoing mastectomy.

METHODS

Female patients with unilateral breast cancer who had undergone mastectomy were surveyed regarding their body image (Body Image After Breast Cancer Questionnaire; BIBCQ) and QoL (FACT-B). Data were analyzed using nonparametric statistics (SPSS version 24).

RESULTS

Ninety-four of the 109 patients approached completed both surveys (86.2% response rate). Median patient age at the time of surgery was 49.5 (range 29-82); the survey was administered at a median of 14.2 months postoperatively (range 0.3-192.1 months). Seventy-four patients (78.7%) had reconstruction, and 52 patients (55.3%) chose to undergo contralateral prophylactic mastectomy. Patients who reported an above average overall body image perception on the BIBCQ tended to be further out from their surgery than those who reported a below average perception (median 20.9 vs. 8.1 months, respectively, p = 0.009). Patients who reported above average QoL also tended to be further out from their surgery compared with those with below average overall QoL (median 21.8 vs. 6.4 months, respectively, p = 0.004). Receipt of reconstruction, contralateral prophylactic mastectomy, disease stage, patient race, education, insurance type, income, marital status, employment status, and age at surgery did not significantly affect body image nor QoL in this cohort.

CONCLUSIONS

Better body image perception and higher QoL were associated with being further out from surgery. These findings suggest that body image and QoL may improve with time, as patients acclimatize to their "new normal."

The lived experience of autologous stem cell-transplanted patients: Post-transplantation and before discharge

AIMS AND OBJECTIVES

To explore the lived experience of the patients post-haematopoietic stem cell transplantation and specifically after engraftment and before discharge.

BACKGROUND

Patients post-stem cell transplantation experience significant changes in all life aspects. Previous studies carried out by other researchers focused mainly on the postdischarge experience, where patients reported their perceptions that have always been affected by the life post-transplantation and influenced by their surroundings. The lived experience of patients, specifically after engraftment and prior to discharge (the "transition" phase), has not been adequately explored in the literature. Doing so might provide greater insight into the cause of change post-haematopoietic stem cell transplantation.

DESIGN

This study is a phenomenological description of the participants' perception about their lived experience post-haematopoietic stem cell transplantation. The study used Giorgi's method of analysis.

METHODS

Through purposive sampling, 15 post-haematopoietic stem cell transplantation patients were recruited. Data were collected by individual interviews. Data were then analysed based on Giorgi's method of analysis to reveal the meaning of a phenomenon as experienced through the identification of essential themes.

RESULTS

The analysis process revealed 12 core themes covered by four categories that detailed patients lived experience post-haematopoietic stem cell transplantation. The four categories were general transplant experience, effects of transplantation, factors of stress alleviation and finally life post-transplantation.

CONCLUSION

This study showed how the haematopoietic stem cell transplantation affected the patients' physical, psychological and spiritual well-being. Transplantation also impacted on the patients' way of thinking and perception of life. Attending to patients' needs during transplantation might help to alleviate the severity of the effects and therefore improve experience.

RELEVANCE TO CLINICAL PRACTICE

Comprehensive information about transplantation needs to be provided over different intervals and at different occasions. The role of the haematopoietic stem cell transplantation coordinators is important, and their communication skills and knowledge were found to be significant in patients' preparation and decision-making. As healthcare providers usually attend to only the patients' physical and psychological needs, spirituality was found to play an important role in maintaining morale and making sense of the meaning of life.