The concept of spirituality in the context of Chinese patients with cancer: A scoping review

AIM

To elucidate how the concept of spirituality has been addressed in studies with Chinese people with cancer.

DESIGN

A scoping review.

METHODS

Patterns in conceptual definitions of spirituality and indicators for measuring spirituality were analysed.

DATA SOURCES (INCLUDE SEARCH DATES)

Literature published from inception to August 2022 was searched in five electronic databases (CINAHL, PubMed, Web of Science, PsycINFO and a Chinese database).

RESULTS

Using data from 10 qualitative studies, a new taxonomy of concepts of spirituality among Chinese people with cancer was derived, consisting of four categories: Creation of meaning, Connection, Transcendence and Existence. A total of 12 instruments developed outside of Chinese contexts and used to measure dimensions of spirituality across 27 quantitative studies were compared to the taxonomy developed in this review, and patterns were identified according to the dimensions of spirituality. Several instruments required modifications or additional explanations in questions regarding God/Higher Power and religion.

CONCLUSION

The four categories of spirituality classified in the current review are considered universal across all cultural contexts. Spirituality is multidimensional and functional concept, and the components of the instruments differed depending on which dimension of spirituality was being measured.

IMPACT

The findings of this study suggest that for measuring spirituality in research and clinical settings with Chinese people with cancer, it is important to use culturally appropriate scales that are consistent with the dimensions of spirituality being measured.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Even instruments developed outside of the Chinese context could be used for Chinese people with cancer if appropriately selected for their intended use.

REPORTING METHOD

This paper adheres to the EQUATOR guidelines and has no direct patient or public contribution.

Exploring the Meaning of Spirituality and Spiritual Care in Chinese Contexts: A Scoping Review

Spirituality is recognised as a fundamental aspect of health and nursing care. Yet, there are few studies exploring how this concept may be understood outside of Western culture. This scoping review seeks to address this omission by focusing specifically on research conducted with Chinese populations. This is important because people from Chinese backgrounds (PBC) are now residing all over the world, and their spirituality and spiritual needs should be considered when providing healthcare. Adopting a purely generalist understanding and application of spirituality may not capture the cultural difference that exists between the East and West. This scoping review adopted Arksey and O'Malley's method to focus on spirituality and spiritual care among PBC in health and nursing. The systematic strategy was adopted and used to search the main databases in health and nursing. Eighteen (n = 18) empirical studies were included in the review: 11 qualitative studies and seven quantitative involving 1870 participants. The scoping review revealed that in the Chinese understanding of spirituality is an abstract and personal concept which can refer to an internal vital force, experiences of suffering, and traditional Chinese cultural and religious values. As the multidimensional understanding of spirituality and spiritual care may cause confusion, these findings may provide a direction for the researchers emphasising the need for cultural and religious sensitivity when understanding of spirituality.

Spirituality and wellbeing in later life: a multidimensional approach

Objectives: Previous studies pointed at positive associations between spirituality and Subjective Wellbeing (SWB) in later life, but were typically limited to one dimension of spirituality and/or one measure of SWB. Applying Fisher's (2010) multidimensional approach to spirituality and measuring both positive and negative aspects of SWB, this study aims at providing deeper understanding of this association. Method: The study was based on an online survey with 306 individuals aged 50 years and over. The questionnaire included the SHALOM spirituality scale as well as measures of depression, satisfaction with life, and personal background. Results: Personal and communal spirituality were the most dominant domains reported by study participants, followed by environmental spirituality. Transcendental spirituality was the least reported domain. Personal spirituality was the only domain positively associated with SWB (lower depression and higher life satisfaction), whereas communal and transcendental spirituality were associated with more depression. Conclusion: These findings demonstrate that not all spirituality domains are equally dominant in people's lives or positively associate with SWB. They also suggest that encouraging elderly people to develop their personal spirituality and self-growth may contribute to their wellbeing.

The Relationship Between Religious Beliefs and Quality of Life Among Patients With Multiple Sclerosis

Patients with chronic diseases, such as multiple sclerosis (MS), are prone to emotional distresses and reduction in life quality more than others. This study aimed to assess the relationship between religious beliefs and quality of life among patients with MS. In this study, 145 MS patients completed 36-Item Short-Form Health Survey (SF-36) and the Duke University Religion Index (DUREL) questionnaires. The results indicated that unorganized religious activities were significantly associated with marital status and education level. Besides, internal religion was positively correlated to mental health. However, religious variables were not effective prognostic factors in physical and mental quality of life. Overall, further studies have to be conducted to determine the role of religion in quality of life of MS patients with different religious backgrounds.

An Integrative Review of the Concept of Spirituality in the Health Sciences

Spirituality is a universal human phenomenon, yet confusion and incomprehension of the concept is ever-present. The purpose of this study was to explore how research on the concept of spirituality has been reported in the health literature in the past decade and develop an ontological and theoretical understanding of spirituality. The examination was based on quantitative and qualitative integrative review approaches, which integrated empirical research on spirituality. The sample included 73 spirituality research articles, which were published in English between January 1990 and September 2000. An electronic data-collection tool was designed for use in this project and formatted using Excel software for transfer of codeddata into the NVivo software for the data analysis. The results identified essential elements of spirituality, current use of operational definitions and instruments, conceptual frameworks used in spirituality research, and cultural aspects of spirituality. Historical comparison among decades and barriers in researching spirituality are discussed.

Transcending Breast Cancer

Purpose: This qualitative approach study describes the experience of self-transcendence in women newly diagnosed with breast cancer. Method: Fourteen women participated from a larger sample of women in a support group project. Each woman was interviewed three times over an 8-month period. Audiotaped transcripts were analyzed using Colaizzi’s phenomenological techniques. Findings: Loss of a personal perception of good health and fear of dying from cancer forced women to reach both inside and outside of themselves for support and information. Bonding with other women with breast cancer led to further expansion of self-boundaries that brought comfort, a desire to modify life priorities, and enhanced appreciation of supportive others and of life itself. Over time, clarification and modification of values and behaviors assisted women to create meaning from their experiences. Implications: Nurse referrals to support groups or other resources (such as cancer advocacy organizations) where women interact with similar others may facilitate transcending breast cancer.

Men of Prayer: Spirituality of Men With Prostate Cancer

Spirituality plays a powerful role in cancer treatment and recovery; it has been identified by hospitalized patients as one of their top priorities of care. However, health care providers struggle to find ways to address the spirituality of their patients. The purposes of this study were to discover what spirituality means for men with prostate cancer and how it influences their treatment. Eleven men, ages 54 to 71, with prostate cancer were interviewed within several days following radical prostatectomy with bilateral lymph node staging. This grounded theory methodology generated three categories of spirituality: (a) praying, (b) receiving support, and (c) coping with cancer. The basic social process, coping with cancer, occurred in four phases: facing cancer, choosing treatment, trusting, and living day by day. These results were validated by four of the participants for truthfulness. The findings of this study provide holistic nurses with knowledge and a midrange theory of spirituality that can be usedin building a research-based practice.

How well does spirituality predict health status in adults living with HIV-Disease: A Neuman systems model study

The purpose of this study was to examine the relationship between spirituality and health status of 39 adult men and women living with HIV-disease. A model building approach was used to explore the associations among the five variables of the Neuman systems model, which was the guiding framework for the study. The model presented includes existential well-being, meaningfulness, age, and income.

A Qualitative Descriptive Study of Spirituality Guided by the Neuman Systems Model

The purposes of this qualitative descriptive study were to explore the meaning of spirituality as described by aging adults in various states of health, to describe the relationship between spirituality and health, and to explain client expectations for healthcare providers related to spirituality. All identified meanings and themes were compared to the characteristics of spirituality proposed by Betty Neuman in the Neuman systems model to determine the credibility of the model for assessing and guiding holistic nursing practice. Three themes were formulated: a) Spirituality is an individual, conscious, committed connection to God, requiring a human response; b) positive spirituality contributes to personal wholeness and health; and c) spirituality sustains and comforts in times of stress.

The emotional journey of women experiencing a breast abnormality

Using grounded theory, a multidisciplinary study team compared the narratives of 30 women who had recently experienced a breast cancer scare. Even though 10 women received a benign diagnosis, all women reported a difficult time prediagnosis, characterized by an array of emotions and contemplation of the meaning of life. Diagnosis separated the two groups with emotional relief dominant for the benign group and intensification of emotions for the cancer group. For those diagnosed with cancer, three factors contributed to arriving at a point of acceptance about the diagnosis and treatment: (a) sustained coping mechanisms; (b) a belief system that shifted the meaning of the cancer experience; and (c) the ability to manage non-cancer-related stressful events. Implications include the need for tailored biopsychosocial treatments that focus on reducing stress, enhancing support systems, reframing beliefs about the illness, and providing the opportunity for the women to talk about their experiences.

Psychometric Evaluation of the Spanish and English Versions of the Spiritual Coping Strategies Scale

The Spiritual Coping Strategies (SCS) Scale measures how frequently religious and nonreligious (spiritual) coping strategies are used to cope with a stressful experience. This study’s purpose is to evaluate the psychometric properties of the newly translated Spanish version of the SCS. A total of 51 bilingual adults completed the SCS in Spanish and English, with 25 completing them again 2–3 weeks later. Internal consistency reliability for the Spanish (r = 0.83) and English (r = 0.82) versions of the SCS in the total sample were good. Test–retest reliability was .84 for the Spanish and .80 for the English version. Spanish and English responses to the SCS items and the resulting score for the subscales and the total scale were not significantly different. Scores on the English and Spanish versions were correlated as expected with time since the stressful event and happiness with family and with spouse or partner, supporting the validity of the Spanish SCS. Study findings support the reliability and validity of the newly translated Spanish SCS.

Women's Experience of Spirituality Within End-Stage Renal Disease and Hemodialysis

The purpose of this descriptive, phenomenological qualitative study is to describe women's lived experiences of spirituality within end-stage renal disease (ESRD) and hemodialysis. The purposive volunteer sample of 16 women regularly attended two outpatient dialysis centers in a large Midwestern city. Audiotaped, transcribed interviews were analyzed using Colaizzi's method. These women affirmed that spirituality was extremely important in living with their illness and necessary treatment regime. Four major clusters of themes pertaining to the women's spiritual experience within their illness emerged: acceptance, understanding, fortification, and emotion modulation. Findings show that spirituality is of great importance in living with ESRD while receiving hemodialysis and suggest that spirituality may be a significant consideration in nursing and interdisciplinary health care. These findings may be used to improve holistic nursing practice and education in related areas.

Effectiveness of psychosocial group intervention for reducing anxiety in women undergoing in vitro fertilization: a randomized controlled study

OBJECTIVE

To evaluate the effect of the Eastern Body-Mind-Spirit (EBMS) group intervention on anxiety-reduction of Chinese women undergoing IVF.

DESIGN

Randomized controlled study.

SETTING

Tertiary assisted reproduction unit.

PARTICIPANT(S)

Two hundred twenty-seven women undergoing their first cycle of IVF treatment.

INTERVENTION(S)

The intervention group (n = 69) received four sessions of EBMS group counseling, while the control group (n = 115) did not receive any intervention.

MAIN OUTCOME MEASURE(S)

State-Trait Anxiety Inventory.

RESULT(S)

Compared with the control group, the intervention group had a significant drop in State Anxiety mean score following intervention. A comparable number of embryos were transferred for each group, but there was a nonsignificant trend of a higher pregnancy rate in the intervention group.

CONCLUSION(S)

The Eastern Body-Mind-Spirit group intervention approach effectively reduces the anxiety level of women undergoing IVF treatment.

Threading Spirituality Throughout Nursing Education

In a survey of 132 baccalaureate nursing programs in the United States, few had defined spirituality or spiritual nursing care. There is a paucity of literature on spirituality in nursing education. This article describes the integration of spirituality in a baccalaureate nursing program. Interventions such as establishing a trusting relationship, providing and facilitating a supportive spiritual environment, responding sensitively to the patient's spiritual and cultural belief systems, demonstrating caring, acknowledging the importance of "presence" during spiritual distress, and integrating spirituality into the plan of care are reflected in student clinical journal entries.

The hidden suffering among breast cancer patients: a qualitative metasynthesis

The aim of this study was to review literature on how the lived experience of breast cancer and suffering was described in nursing/caring literature between 1990 and 2000, and to interpret and discuss the result from the perspective of suffering. The frequent reports of changing courses, called by various names, such as transition, transformation, transcendence, and finding meaning, were found as paths whereby the person regained integrity, balance, and wholeness. When findings were interpreted from the perspective of suffering and an ontological health model, actions, values, and existential concerns were understood as both expedients for alleviating suffering and a sign of the patient's inner struggle.

Older persons' ethical problems involving their health

Although older persons (aged 65 years and older) experience stressful ethical problems involving their health, research is lacking about this phenomenon. The purpose of this study was to describe and examine the content and basic nature of older persons' ethical problems concerning their health. The conceptual framework and method combined ethical enquiry and phenomenology. The participants were 18 older persons and 12 of their children or grandchildren (for contextual understanding). The 19 women and 11 men, 73% of whom were Caucasian, described 184 ethical problems, from which emerged 10 content categories. The basic nature of the ethical problems consisted of conflict, resolution and rationale. The results could assist health professionals to promote older persons' ethical decision making, quality of life, and good death.