Comparison of Spiritual Experiences and Hope between Breast Cancer Survivors and Healthy Counterparts

A digital, coach-assisted intervention to address the psychosocial needs of young adult cancer survivors: Randomized controlled trial protocol and intervention adaptation process

BACKGROUND

Given the increasing number of young adult cancer survivors and the impacts of cancer on various life domains, interventions addressing the psychosocial needs of young adult survivors are crucial. However, such intervention research is limited, and the existing literature has often: 1) overlooked young adult survivors' psychosocial needs; 2) targeted depression, anxiety, or fear of recurrence - rather than positive outcomes like well-being; and 3) failed to consider scalable approaches, like digital health.

METHODS

This paper documents the development and refinement of an 8-week digital, coach-assisted intervention targeting hope among young adult cancer survivors (ages 18-39, within 3 years of treatment completion) and presents the protocol of the 2-arm RCT (comparing intervention vs. attention control). The intervention builds upon a 2017-2018 pilot trial (n = 56); intervention refinements were based on subsequent semi-structured interviews among young adult survivors (n = 23).

RESULTS

The pending trial design involves an increased sample size (n = 150) to increase power and diversified recruitment efforts (i.e., clinic-based, social media, community-based organizations, etc.) to facilitate intervention reach, accessibility, and scalability. The intervention was enhanced by integrating highly relevant theoretical and therapeutic frameworks, specifically the concept of hope and Acceptance and Commitment Therapy, as well as updating intervention delivery technology. Intervention outcomes include feasibility and acceptability at end-of-treatment and preliminary efficacy on hope (primary outcome) and quality of life measures (secondary outcomes) at end-of-treatment and 16-week follow-up.

CONCLUSIONS

This paper may facilitate discussion regarding approaches for addressing the significant psychosocial challenges faced by young adult survivors and catalyze dissemination of trial results.

TRIAL REGISTRATION

NCT05905250.

Young Adult Cancer Survivors' Perspectives on Cancer's Impact on Different Life Areas Post-Treatment: A Qualitative Study

Purpose: Young adult cancer survivors experience disruptions in various life domains (e.g., relationships, academic/career) during and after treatment. This study examined life disruptions and related supports to update interventions to improve psychological outcomes. Methods: In April-July 2023, young adult survivors (n = 23) were recruited (via clinics, support groups, nonprofit organizations, etc.) to complete semi-structured interviews assessing cancer's impact across life domains, how they coped with related disruptions, and facilitators to improved psychosocial well-being. We used a dual deductive-inductive approach to develop a codebook and then coded transcripts in Dedoose. Results: This sample was on average 33.7 years old (standard deviation [SD] = 4.4), 78.3% female, 73.9% non-Hispanic White, 47.8% married/cohabitating, 2.4 (SD = 1.0) years post-diagnosis, 1.4 years (SD = 0.9) post-treatment, and largely diagnosed with breast cancer (52.1%) or leukemia/lymphoma (34.7%). The most salient themes related to disruptions included mental health, feelings of isolation during survivorship, and disruptions to career and relationships with family or partners. Participants reported challenges navigating these feelings and disruptions, and difficulty understanding and conveying their needs. Many experienced limited support for navigating cancer-related trauma and life disruptions as a survivor. Participants also reported some positive impacts, like reevaluating their values and goals or feeling resilient, and emphasized the need to identify supports, accept that life had changed because of cancer, and have their needs and continued struggles validated by others during survivorship. Conclusions: Young adults experience ongoing disruptions across multiple life domains, underscoring the need for integrated, longer-term psychosocial supports to help them navigate these disruptions and reevaluate their goals.

Breast Cancer and Spirituality Among Women in Poland: A Case-Control Study

In this case-control study, we assessed differences in daily spiritual experiences between patients with breast cancer diagnoses and healthy controls in relation to other breast cancer risk factors. The participants were 201 newly diagnosed Polish patients with breast cancer (58 ± 6 years) and 201 age-matched healthy controls. Spiritual experiences were assessed using the Daily Spiritual Experiences Scale (DSES). Adjusted odds ratios (OR) and 95% confidence intervals (CI) of the DSES score for breast cancer diagnosis were calculated with logistic regression. The DSES score was significantly higher in the healthy controls than in the cases. After controlling for alcohol use, education, BMI, and rural residence, higher spirituality was associated with a lower risk of breast cancer (OR 0.98, 95% CI 0.97-1.00). Two DSES item scores differed significantly between cases and controls, being lower in breast cancer cases: "I am spiritually touched by the beauty of creation" (p = 0.01) and "I feel selfless caring for others" (p = 0.049). After controlling for other variables (i.e., hormone replacement therapy, family history, breastfeeding, and diet quality), the DSES score was statistically non-significant (OR 0.99, 95% CI 0.97-1.006). Therefore, the original relationship DSES score and breast cancer was quite weak. Although the study found little relationship between the analyzed variables, presented differences in spirituality may differentiate the patterns of spiritual well-being among breast cancer patients; however, more data are needed from longitudinal study designs to establish causal inferences.

Effect of Spiritual Care Based on the Sound Heart Model on Spiritual Experiences of Hemodialysis Patients

Hemodialysis patients require spiritual care due to their spiritual distress. This study aimed to investigate the effect of spiritual care on spiritual experiences of hemodialysis patients. This randomized controlled trial was conducted in 2017 at hemodialysis departments of Baqiyatallah and Cham ran hospitals in Tehran. The volunteer patients were selected by available sampling according to the inclusion criteria. Participants were randomly assigned to intervention and control groups. Interventions were performed in the educational-supportive nursing system according to the patients' self-care ability. Eight individual counseling sessions, 15-45 min, face-to-face, during dialysis, once a week were implemented for intervention group. Developing the relationship with God, self, people and nature were the main goals of care. Daily spiritual experience questionnaire was completed by patients before and three months after the intervention. There was no significant difference in the spiritual experience score of the intervention (75.20 ± 9.14) and control group (76.63 ± 10.03), before the intervention (P = 0.523). There was a statistically significant difference between the intervention (82.93 ± 5.69) and the control group score (77.24 ± 12.09) three months after the intervention (P < 0.0001). Due to the need for holistic and community-oriented care and the positive effect of this study, the use of the Sound Heart Model is recommended for Muslim patients.