Tumor Patients´ Perceived Changes of Specific Attitudes, Perceptions, and Behaviors Due to the COVID-19 Pandemic and Its Relation to Reduced Wellbeing

Meaning in life during the COVID-19 pandemic in Brazil: Impact of quality of life and sociodemographic factors

Research on meaning in life typically emphasizes the psychological aspects of quality of life, neglecting broader dimensions. Additionally, its relevance to the COVID-19 context remains limited. This study investigated the relationship of meaning in life with quality of life and sociodemographic factors related to COVID-19 pandemic in Brazil. A total of 4133 Brazilian adults completed Meaning in Life Questionnaire (MLQ), WHOQOL-BREF, WHOQOL-SRPB BREF, and sociodemographic information. Our results indicated a positive correlation between the presence of meaning and quality of life dimensions, with psychological health exhibiting the strongest relationship. We found a lower presence of meaning among individuals experiencing heightened social isolation, while vaccinated individuals exhibited a greater presence of meaning. Additionally, non-working participants reported lower presence and higher search for meaning than employed individuals, with frontline workers showing the highest search for meaning. Theoretical and practical implications of these findings are discussed.

Stability of psychological wellbeing during the COVID-19 pandemic among people with an anthroposophical worldview: the influence of wondering awe and perception of nature as resources

Background

During the COVID-19 pandemic, differences in responses and behaviors were observed among specific groups. We aimed to address how people with an anthroposophical worldview behaved with respect to the perception of burden, fears, and wellbeing. As it is an integral part of their lifestyle and convictions, we addressed the influence of wondering awe and gratitude and perception of nature and times of mindful quietness as resources to cope.

Methods

In two cross-sectional surveys with standardized instruments, participants were recruited in 2020 (n = 1,252) and 2021 (n = 2,273).

Results

Psychological wellbeing was much higher than in other studied groups and populations, with slightly lower scores in 2021 compared to the 2020 sample (Eta2 = 0.020), while the perception of the COVID-19-related burden and fear of the future were low in 2020 with a slight increase in 2021 (Eta2 = 0.033 and 0.008, respectively). Their transcendence conviction was negatively related to fears of their own infection or the infection of others. Best predictors of their wellbeing were low burden and awe/gratitude, while the best predictors of their burden were low wellbeing and lack of social contacts.

Conclusion

Compared to the general population in Germany, the anthroposophical lifestyle and related convictions may have buffered some of the COVID-19-related burden and helped them to stabilize their psychological wellbeing.

The impact of the COVID-19 pandemic restrictions on the health care utilization of cancer patients

BACKGROUND

COVID-19 has impacted both society and medical care. While Germany entered the first lockdown in spring 2020, the PIKKO study (Patient information, communication and competence empowerment in oncology) was still active. The intervention modules, patient navigator (PN), services of the Saarland Cancer Society (SCS), psycho-social counseling and different courses, and online knowledge database (ODB) continued to be offered, but in an adapted form. It was the aim of this supplementary survey to identify the restrictions and burdens of the pandemic containment strategies on the PIKKO patients and thus on the PIKKO study itself. Furthermore, this work shows how the PIKKO modules were used during the lockdown.

METHODS

All patients in the PIKKO intervention group (IG) were invited to complete a questionnaire, n = 503. Furthermore, utilization of the SCS and log files of the ODB were analyzed. For socio-demographic data and contacts with the PN, data from the regular PIKKO surveys were used. In addition to descriptive statistics, chi²-tests, F-tests and linear regression analyses were performed.

RESULTS

356 patients participated in this supplemental survey. 37.6% reported restrictions. "Restrictions on accompanying persons", "ban on visits to the wards" and "protective mouth-nose-mask" were reported as the greatest burdens. 39.0% expressed fears that the restrictions would have an impact on the course of their disease. Linear regression analyses showed differences in feelings of burden among age groups (more among < 60-year-olds), gender (more among women), children in the household (more with children), and preexisting financial stress (more with financial worries). In April 2020, there was more patient contact with PNs by phone, more SCS psycho-social counseling by phone, adapted SCS course offering, but with significantly fewer participants, and high activity on the ODB.

CONCLUSION

Cancer patients in the IG reported restrictions from the pandemic containment strategies and feared an impact on their recovery. However, whether a burden is perceived as heavy depends more on gender, age, or pre-existing burdens than on whether the lockdown affects PIKKO or not. The utilization of counseling, courses or the ODB despite lockdown shows the need for such services, especially in times of crisis.

TRIAL REGISTRATION

This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21 Feb 2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703 .

Perceptions of change in the environment caused by the COVID-19 pandemic: Implications for environmental policy

COVID-19 lockdown measures have impacted the environment with both positive and negative effects. However, how human populations have perceived such changes in the natural environment and how they may have changed their daily habits have not been yet thoroughly evaluated. The objectives of this work were to investigate (1) the social perception of the environmental changes produced by the COVID-19 pandemic lockdown and the derived change in habits in relation to i) waste management, energy saving, and sustainable consumption, ii) mobility, iii) social inequalities, iv) generation of noise, v) utilization of natural spaces, and, vi) human population perception towards the future, and (2) the associations of these potential new habits with various socio-demographic variables. First, a SWOT analysis identified strengths (S), weaknesses (W), opportunities (O), and threats (T) generated by the pandemic lockdown measures. Second, a survey based on the aspects of the SWOT was administered among 2370 adults from 37 countries during the period from February to September 2021. We found that the short-term positive impacts on the natural environment were generally well recognized. In contrast, longer-term negative effects arise, but they were often not reported by the survey participants, such as greater production of plastic waste derived from health safety measures, and the increase in e-commerce use, which can displace small storefront businesses. We were able to capture a mismatch between perceptions and the reported data related to visits to natural areas, and generation of waste. We found that age and country of residence were major contributors in shaping the survey participants ´answers, which highlights the importance of government management strategies to address current and future environmental problems. Enhanced positive perceptions of the environment and ecosystems, combined with the understanding that livelihood sustainability, needs to be prioritized and would reinforce environmental protection policies to create greener cities. Moreover, new sustainable jobs in combination with more sustainable human habits represent an opportunity to reinforce environmental policy.

Does cognitive function impairment affect the duration of hospitalization and in-hospital mortality in geriatric patients hospitalized for COVID-19?

AIMS

To assess the effect of cognitive function, performance of activities of daily living (ADLs), degree of depression, and fear of infection among geriatric patients hospitalized in internal medicine wards for COVID-19 on the duration of hospitalization and in-hospital mortality.

METHODS

This observational survey study was conducted during the second, third, and fourth waves of the COVID-19 pandemic. The study included elderly patients of both sexes, aged ≥ 65 years, hospitalized for COVID-19 in internal medicine wards. The following survey tools were used: AMTS, FCV-19S, Lawton IADL, Katz ADL, and GDS15. The duration of hospitalization and in-hospital mortality were also assessed.

RESULTS

A total of 219 patients were included in the study. The results showed that impaired cognitive function in geriatric patients (AMTS) was associated with higher in-hospital mortality among COVID-19 patients. There was no statistical significance between fear of infection (FCV-19S) and risk of death. The impaired ability to perform complex ADLs (Lawton IADL) before the onset of the disease was not associated with higher in-hospital mortality among COVID-19 patients. The diminished ability to perform basic ADLs (Katz ADL) before the onset of the disease was not associated with higher in-hospital mortality in COVID-19. The degree of depression (GDS15) was not associated with higher in-hospital mortality in COVID-19 patients. Statistically, significantly better survival was observed for patients with normal cognitive function (p = 0.005). No statistically significant differences in survival were observed in relation to the degree of depression or independence in performing ADLs. Cox proportional hazards regression analysis showed a statistically significant effect of age on mortality (p = 0.004, HR 1.07).

CONCLUSION

In this study, we observe that cognitive function impairments and the older age of patients treated for COVID-19 in the medical ward increase the in-hospital risk of death.

Religiousness in the first year of COVID-19: A systematic review of empirical research

The COVID-19 pandemic emerged suddenly in early 2020, posing a serious health threat and creating tremendous stress and distress across the world. Religion has been shown to play important and varied roles in previous disasters and health crises, but its roles in the pandemic have yet to be outlined. We aimed to summarize the research conducted on religion and COVID-19 in the first year of the pandemic with a systematic review of studies that specifically involved individual-level religiousness and COVID-19. Searches were conducted in PubMed, Scopus, CINAHL, and PsycINFO covering a one-year period from the first published mention of the novel coronavirus (Jan. 5, 2020) through January 4, 2021. We included articles about COVID-19 that were peer-reviewed and empirical, measured and reported results on religion on an individual level, and were available in English. Our search produced 137 empirical articles that met the inclusion criteria. In the course of sorting studies by their primary focus, eight categories of empirical findings emerged: general distress and wellbeing (53 articles), COVID-19-specific stress (24 articles), beliefs in science, conspiracies, and misinformation (15 articles), COVID-19 public health behaviors (12 articles), perceived risk of COVID-19 (10 articles), perceived growth or positive changes taking place during the pandemic (nine articles), health behaviors (three articles), and consumer behavior (three articles). Findings indicated that religiousness was associated with both unique benefits and challenges and played a significant role in the pandemic. Religiousness was associated with a broad range of outcomes across geographical regions and populations during the first year of COVID-19. It was a commonly reported coping mechanism with varying levels of favorable associations with mental health and COVID-19-related behaviors.

Positive religious coping acts through perception of nature and silence in its association with well-being and life satisfaction among Polish Catholics

Previous studies indicate that perceptions of nature and thought-provoking silence can have positive consequences for individual functioning. The purpose of the present study was to assess the relationships between religious coping (assessed with the Brief RCOPE), perceptions of nature and silence (a subscale of the Perception of Change Questionnaire), well-being (the World Health Organization's five-item Well-Being Index) and life satisfaction (the Brief Multidimensional Life Satisfaction Scale). An online questionnaire was completed between 2021-2022 by 1,010 Polish Catholics ages 18 to 73, 61% of whom were women. Structural equation modeling showed that positive religious coping was positively related to well-being (β = 0.08, p = 0.011) and life satisfaction (β = 0.22, p < 0.001). In contrast, negative religious coping was related to reduced well-being (β = -0.07, p = 0.040) and life satisfaction (β = -0.25). In addition, more frequent perceptions of nature and reflective times of silence partially mediated the associations of positive religious coping with well-being (β = 0.04, p = 0.011) and life satisfaction (β = 0.04, p = 0.008). The data might suggest that interventions that help people develop an ability or awareness for nature as an exceptional encounter and may help to strengthen the ways they can utilize their religiosity as a resource and thus contribute to well-being and life satisfaction among Catholics.

Experience of nature and times of silence as a resource to cope with the COVID-19 pandemic and their effects on psychological wellbeing-Findings from a continuous cross-sectional survey in Germany

Background

The COVID-19 pandemic with its lockdowns affected social relations and mental health conditions of people worldwide. We aimed to analyze the relevance of nature and times of silence as resources to cope with the pandemic. Of interest were how experiences of nature and times of silence are related to the perception of wondering awe and gratitude and psychological wellbeing and how these have changed during the different phases of the pandemic. Finally, we asked whether Nature/Silence would mediate the link between Awe/Gratitude and wellbeing.

Methods

A cross-sectional survey with standardized questionnaires (i.e., PCQ, GrAw-7, BMLSS-10, WHO-5) enrolling participants during the different phases of the COVID-19 pandemic was conducted. The total sample of 5,155 participants from Germany consisted of 65% women and 34% men, with a mean age of 45.0 ± 14.0 years.

Results

Directly after the first lockdown, Nature/Silence and Awe/Gratitude scores were high and decreased along with wellbeing with the onset of the second lockdown in winter 2020, while perceived burden constantly increased. Nature/Silence was rated lowest by people with reduced wellbeing (eta2 = 0.058) and feeling lonely or socially isolated (eta2 = 0.042). Predictor analyses revealed that wellbeing as a dependent variable was predicted best by corona-related perception of burden, Awe/Gratitude, reflection of life, and Nature/Silence and further by perceived changes in terms of relationships and spirituality (R2 = 0.55). In mediation analyses, Awe/Gratitude proved to be a significant predictor for Nature/Silence (β = 0.55, p< 0.0001) and wellbeing (β = 0.05, p < 0.0001). The mediation analysis explained 37% of the variability in the data. The direct influence of Awe/Gratitude on wellbeing was estimated as β = 0.09 (p < 0.0001), and the mediation effect of Nature/Silence on the link between Awe/Gratitude and wellbeing was significant, too (β = 0.03, p < 0.0001), explaining 25% of the total effect.

Conclusion

Nature/Silence and Awe/Gratitude were used as relevant resources during the pandemic, although they cannot fully buffer the negative effects of the social restrictions that resulted in decreases in wellbeing and increases in perceived burden. Perception of nature as a sensitizer of positive experiences particularly during difficult phases of life could be trained to stabilize wellbeing and thus to contribute to public health.

Cross-cultural validity of the Death Reflection Scale during the COVID-19 pandemic

Background

The global COVID-19 pandemic confronts people with their fragility, vulnerability, and mortality. To date, scales to measure death awareness mainly focus on the anxiety-provoking aspect of mortality cues. This study aims to cross-culturally adapt and validate the Death Reflection Scale (DRS), a scale for measuring positive, growth-oriented cognitions of life reflection and prosocial behavior following confrontation with the finiteness of life.

Materials and Methods

The Death Reflection Scale was translated and adapted in a multi-step process to the German language. In this anonymous, cross-sectional, online survey at a large university in Germany, students, healthcare professionals (HCP) and other staff completed the DRS alongside comparison measures. Multi-group confirmatory factor analysis was used to assess configural, metric, and scalar measurement equivalence across four age and occupational groups. Convergent/divergent validity testing was done via Spearman correlations.

Results

1,703 participants provided data for a response rate of ∼5%. 24% of respondents were HCP, 22% students. Confirmatory factor analysis showed a higher-order structure of the DRS with a strong general factor and the originally proposed five subscales (CFI 0.945, SRMR 0.045, RMSEA 0.055). Multi-group CFA showed partial metric equivalence across age groups and partial scalar invariance across occupational groups. Non-invariant scales were the Motivation to live, Putting life into perspective, and Legacy subscales. In the convergent validity testing, two hypotheses were fully confirmed, two partially and four were not confirmed. Experiencing a propensity for increased contemplation and life reflection during the pandemic together with spirituality showed correlations of moderate to large size to the DRS and its subscales (Spearman’s rho ranging from 0.31 to 0.52).

Conclusion

Further conceptual work for death awareness to explore the construct’s stability in different population groups needs to be undertaken. However, the DRS can be mostly used to assess positive and growth-oriented aspects of death awareness and death reflection which may be an important avenue when developing counseling and support interventions for groups experiencing a high burden during the pandemic.

The psychosocial and emotional experiences of cancer patients during the COVID-19 pandemic: A systematic review

BACKGROUND

COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. Global social lockdowns were instigated to reduce spread and prevent health-services from becoming overwhelmed. People having treatment for cancer are known to have heightened psychological/emotional burden. The combined impact of managing pandemic regulations alongside this may present additional burden. The purpose of this systematic review is to examine current evidence of the psychological and emotional impact of COVID-19 on people with cancer, early in the pandemic.

METHODS

Five electronic databases were searched (Embase, Global Health, HMIC, PsychINFO, CINAHL) from September 2019 to October 2021. Qualitative, quantitative and mixed-method primary research studies exploring emotional and psychological impacts of COVID-19 on cancer patients, limited to English language, were included. Quality appraisal was conducted using the MMAT.

RESULTS

Fifty-one papers, with 27,356 people from 21 countries treated for cancer, were included. 43 studies were quantitative with a survey method approach, six studies qualitative and four used a mixed methods design. MMAT score was mostly two or three. Four themes were identified: Emotional aspects and Quality of Life; Psychosocial aspects; Impact of COVID-19 on self; Impact of COVID-19 on cancer, with themes overlapping.

CONCLUSION

Whilst emotional/psychological impacts such as anxiety, isolation, employment fears, and uncertainty about the future were potentially universal concerns early in the pandemic, they may have been particularly acute for people living with cancer and represent complex, overlapping factors. As COVID-19 continues to impact health-services and society, it is important to focus on any ongoing impact to the experience of cancer patients. Most of the studies reviewed used tools that do not provide deeper understanding of how and why emotional states of people with cancer were affected. Further qualitative work may reveal patterns of what was unique to cancer patients during the pandemic, compared to general populations.

The Role of Spirituality and Religiosity in Healthcare During the COVID-19 Pandemic: An Integrative Review of the Scientific Literature

The pandemic caused by the new coronavirus SARS-CoV-2 has been affecting populations globally since the end of 2019. Previous studies have indicated that spirituality in these times of crisis serves as a source of hope and well-being that helps people get through the day. This study investigated the role of spirituality and religiosity in healthcare during the COVID-19 pandemic. An integrative review of the scientific literature available on PubMed, Scopus, and Web of Science databases and a review of the gray literature in the Information System on Gray Literature in Europe (OpenGrey) were carried out. From a total of 1,338 articles searched; 25 articles were included in this review (22 quantitative observational, 2 qualitative and one randomized controlled trial). Our findings revealed the importance of including spirituality in clinical practice for both health professionals and patients. On the one hand, spirituality can be considered a good coping strategy used by healthcare professionals to promote mental health and well-being during the COVID-19 pandemic and resulting in greater patient satisfaction with the care given. On the other hand, addressing spiritual needs of individuals leads to a reduction in stress, anxiety, depression, and an increase in resilience and hope among patients.

Perceived Changes of Attitudes and Behaviors of Seventh-Day Adventists During the COVID-19 Pandemic: Findings from a Cross-Sectional Survey in Germany

To analyze which pandemic related changes of attitudes and behaviors were perceived by Seventh-day Adventists (SDA) and how these relate to wellbeing, a cross-sectional survey with standardized questionnaires was performed. Participants (n = 1,494) stated changes for Relationships, Digital media usage and Nature/Silence/Contemplation, but not for Spirituality or Reflection of life. Best predictors of psychological wellbeing (WHO-5) were Spiritual wellbeing, perceived Restrictions and Awe/Gratitude (R² = .32). Mediation analyses (R² = 0.51) revealed a mediation effect of Awe/Gratitude between spiritual to psychological wellbeing (β = 0.11, p < 0.0001). Perceived changes were less relevant to buffer the negative effects of the pandemic; instead, they were related to fears of future. More relevant to stabilize SDAs´ wellbeing was their spirituality.

Loss of Faith and Decrease in Trust in a Higher Source During COVID-19 in Germany

Many people relied on their faith as one resource in order to cope during the COVID-19 pandemic. In Germany, between the eighteen months from June 2020 to November 2021, different participants at different times were assessed during different phases of the COVID-19 pandemic. The total sample of this continuous cross-sectional survey consisted of 4,693 participants. Analyses revealed that with the 2nd wave of the infection and its 2nd lockdown, trust in a Higher Source, along with praying and meditation decreased. Also, the sharp increase in corona-related stressors was associated with a decline of wellbeing and a continuing loss of faith. These developments were observed in both Catholics and Protestants, and in both younger and older persons. In addition, the long phases of insecurity and social isolation lacking the significant support usually given by religious communities may have likewise challenged the religious-coping capacities of religious/spiritual people themselves.

The Psychosocial Impact of COVID-19 on Older Adults with Cancer: A Rapid Review

Background: Older adults with cancer are amongst the most vulnerable population to be negatively impacted by COVID-19 due to their likelihood of comorbidities and compromised immune status. Considering the longevity of the pandemic, understanding the subjective perceptions and psychosocial concerns of this population may help ameliorate the psychological aftermath. In this review, we systematically analyze the literature surrounding the psychosocial impact and coping strategies among older adults with cancer within the context of COVID-19. Methods: We conducted a rapid review of literature following PRISMA guidelines between January 2020 to August 2021 using (1) MEDLINE, (2) Embase, (3) CINAHL, and (4) PsychINFO and keyword searches for “cancer” and “COVID-19” focused on adults 65 years or older. Results: Of the 6597 articles screened, 10 met the inclusion criteria. Based on the included articles, the psychosocial impact of COVID-19 was reported under four domains, (1) impact of COVID-19 on quality of life (QoL), (2) concerns related to COVID-19, (3) coping with the impact of COVID-19, and (4) recommendations for future care. Results pertaining to perceived quality of life were inconsistent across the included articles. The most common concerns related to: contracting COVID-19, survivorship transitions, and feelings of isolation. Coping strategies reported by older adults included: spiritual care, lived experience, acceptance, and positive reinterpretation. Conclusions: We found many psychosocial impacts of the pandemic on older adults with cancer. The findings from this review can inform interventions related to shared decision-making and tailored patient care in the future.

Impact of COVID-19 on patient and healthcare professional attitudes, beliefs, and behaviors toward the healthcare system and on the dynamics of the healthcare pathway

BACKGROUND

COVID-19 has dramatically changed how healthcare is delivered and experienced.

METHODS

One-on-one interviews and a virtual ethnographic roundtable were conducted among 45 patients, caregivers, and healthcare professionals (HCPs) in 4 therapeutic areas from the United States and Japan: overactive bladder, vasomotor symptoms, prostate cancer, and metastatic urothelial carcinoma. The goal was to identify the impact of COVID-19 on patient/caregiver and HCP attitudes, interactions, beliefs, and behaviors toward the healthcare system and care pathway.

RESULTS

Four foundational themes were identified: 1) COVID-19 risk is relative; 2) isolation is collateral damage; 3) telehealth is a parallel universe; and 4) COVID-19 is destabilizing the foundations of healthcare. Numerous insights, influenced by diverse cultural, social, and psychological factors, were identified within each theme.

CONCLUSIONS

The impacts of COVID-19 were noticeable at multiple points of care during the "universal" care pathway, including at initial screening, referral to specialists, diagnosis, treatment initiation/surgery, and during ongoing care. Greater appreciation of the short- and long-term impacts of COVID-19 and resulting gaps in care may act as a catalyst for positive change in future patient care.

COVID-19 and patients with cancer: Investigating treatment impact, information sources, and COVID-19-related knowledge, attitudes, and practices

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has caused enormous strain on public health. Patients with cancer are particularly susceptible to the disease, and their treatment plans have been threatened by public health restrictions designed to contain the spread.

METHODS

This study examined the effects of the pandemic on cancer patients' psychology, knowledge, attitudes, and practices concerning COVID-19 as well as their perceptions of the impact of COVID-19 on their cancer health care services. A survey was sent to 5800 patients at a cancer center in Toronto, Canada. Descriptive results were summarized. Qualitative feedback was coded and summarized. To examine for potential associations, regression models were tested for the outcomes of patient psychological well-being, knowledge, attitudes, and practices, and they accounted for several demographic, health literacy, and disease variables.

RESULTS

A total of 1631 surveys were completed. Most patients saw their appointments shifted to virtual visits, and for a substantial minority, there was no change. A majority of the patients (62%) expressed fears about contracting the virus. There were no independent predictors of COVID-19-related knowledge. Fears were more pronounced among patients who did not speak English and those who used social media more often. Female participants, those who scored higher on knowledge questions, and those who used cancer center materials were more likely to take preventative measures against infection.

CONCLUSIONS

This study provides a snapshot of the state of cancer patient treatment and the knowledge, attitudes, and practices of patients between the first 2 waves of the pandemic. The study's results can inform our understanding of adaptation to conditions during and after the outbreak.

Wondering Awe as a Perceptive Aspect of Spirituality and Its Relation to Indicators of Wellbeing: Frequency of Perception and Underlying Triggers

Background: Spirituality is a multidimensional construct which includes religious, existentialistic, and relational issues and has different layers such as faith as the core, related attitudes and conviction, and subsequent behaviors and practices. The perceptive aspects of spirituality such as wondering awe are of relevance for both, religious and non-religious persons. These perceptions were related to perceiving the Sacred in life, mindful awareness of nature, others and self, to compassion, meaning in life, and emotional wellbeing. As awe perceptions are foremost a matter of state, it was the aim (1) to empirically analyze the frequency of wondering awe perceptions (i.e., with respect to gender, age cohorts, religious or non-religious persons) and (2) to qualitatively analyze a range of triggers of awe perceptions.

Methods: Data from 7,928 participants were analyzed with respect to the frequency of Awe/Gratitude perceptions (GrAw-7 scale), while for the second part of the study responses of a heterogeneous group of 82 persons what caused them to perceive moments of wondering awe were analyzed with qualitative content analysis techniques.

Results: Persons who experience Awe/Gratitude to a low extend were the youngest and had lowest wellbeing and lowest meditation/praying engagement, while those with high GrAw-7 scores were the oldest, had the highest wellbeing, and were more often meditating or praying (p<0.001). Gender had a significant effect on these perceptions, too (Cohen’s d=0.32). In the qualitative part, the triggers can be attributed to four main categories, Nature, Persons, Unique Moments, and Aesthetics, Beauty, and Devotion. Some of these triggers and related perceptions might be more a matter of admiration than wondering awe, while other perceptions could have more profound effects and may thus result in changes of a person’s attitudes and behaviors.

Conclusion: Emotionally touching experiences of wondering awe may result in feelings of interconnectedness, prosocial behavior, mindful awareness, and contribute to a person’s meaning in life and wellbeing and can also be a health-relevant resource. These perceptions can be seen as a perceptive aspect of spirituality, which is not exclusively experienced by religious people but also by non-religious persons.

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.

[Religiosity and spirituality as ressources for head neck cancer patients]

OBJECTIVE

 Spiritual Care is a well established part of palliative medicine. Are religiosity / spirituality also ressources of patients during the arly phases of a head neck cancer (HNC) disease?

MATERIAL AND METHODS

 We included 113 HNC patients (27 women, 84 men, 2 divers) to a prospective study using questionnaires focused on actual burden (NRS), spirituality as ressource (SpREUK-15, spiritual needs (SpNQ-20), interpretation of illness (IIQ), and life satisfaction of patients (BMLSS-10, BMLSS-Support, WHO-5). 39 patients were still under therapy, 74 participants were cancer-survivors.

RESULTS

 Only 31/111 (28 %) patients feel themselve as spiritual and/or relgious. 72 % are neither spiritual nor religious. 51/111 see reflexion about their cancer disease as a specific ressource to overcome their actual cancer situation. Spiritual needs are religious in 35/112, existential in 67/112, inner peace in 90/112, and generativity in 84/112 patients. The accepted own religiosity and the actual stadium of disease are highly relevant impact factors on spiritual needs and ressources. HNC patients show a high part of depressive moods (WHO-5) and are (in trend) un-satisfied with their life and support situation.

CONCLUSION

 Up to 90 % of HNC patients have specific spiritual needs which are often hidden. Modern concepts of integrative oncology discover them, and enourage via these ressources the quality of life and the coping of cancer patients.

Neuro-oncological patients' and caregivers' psychosocial burden during the COVID-19 pandemic-A prospective study with qualitative content analysis

OBJECTIVE

The COVID-19 pandemic may reinforce psychosocial distress of neuro-oncological patients. We aimed to (1) differentiate the burden caused by the pandemic versus the tumor and (2) establish topics relevant for brain tumor patients (BTPs) and caregivers.

METHODS

Patients and caregivers were prospectively assessed from April 2020-July 2020 by a 10-item comprising interview over the phone, including qualitative and quantitative questions. They were quantitatively evaluated i.a. by the distress thermometer (DT, score 1-10). The qualitative questions were analyzed using structured content analysis: The interview questions defined the main categories. Subcategories were derived by an inductive approach assessing the frequency of patients' and caregivers' answers.

RESULTS

A total of 69 patients and 20 caregivers were interviewed; n = 36 were female (49%), mean age was 53 years (range 32-81). Patients' disease-related DT scores were higher than the COVID-19-related DT scores: the median of the disease-related DT score was 7 (range 2-10) versus median of COVID-19-related distress: 5.0 (range 2-7). Caregivers perceived a higher burden due to the disease (DT median disease: 8; range 2-10 vs. DT pandemic: 3, range 0-10). A total of five main and 21 subcategories were elaborated, most frequently mentioned were "restrictions in public and private affairs" (28%), "changes in the psychological well-being" (23%), "limited social interaction by contact restriction" (25%). Subcategories relevant for caregivers were similar to those of BTPs.

CONCLUSION

A considerable proportion of patients and caregivers still perceived the brain tumor disease as more burdensome than the pandemic. We established main and subcategories of interview items possibly of great relevance to patients during these difficult times, which could be implemented in the content-related adaption of the psychosocial assessment.

[Indirect and direct psychosocial consequences of the corona pandemic-part 1 of a (preliminary) review]

The pandemic triggered by the coronavirus disease 2019 (COVID-19) has, apart from a few positive effects, led to massive and manifold impairments of human living conditions for which this article suggests a taxonomy. According to the severity, these impairments have resulted in a deterioration of the psychological well-being for many people and an increased vulnerability for psychological disorders. This has been confirmed by numerous studies and review articles, which also dealt with the question of factors that positively as well as negatively influencing mental health. This review shows that, e.g. suffering from COVID-19 disease, younger age and female gender as well as a pre-existing psychiatric or somatic disease must be considered as special risk factors. Psychotherapists are confronted with the pandemic in different ways. In view of the societal impact psychotherapists have a special role. In addition, the pandemic raises questions on specific issues and specific groups which must be addressed.

Individual Differences Facing the COVID-19 Pandemic: The Role of Age, Gender, Personality, and Positive Psychology

Research on individual differences in facing the COVID-19 pandemic seems to be crucial in order to design diverse and highly effective intervention strategies. This study uses a sample of 302 North American participants who were recruited through the crowdsourcing platform ProA; different profiles were established, profiling variables of interest in facing the COVID-19 outbreak. Socio-demographic and psychological (personality traits, gratitude, life purpose, and religiosity) variables were explored. These results are of interest if we want to deepen the study of individual differences at both a theoretical and applied level.

Tumor patients' fears and worries and perceived changes of specific attitudes, perceptions and behaviors due to the COVID-19 pandemic are still relevant

Objective

During the COVID-19 pandemic, tumor patients not only perceived fears and worries but were experiencing also positive changes as the perception of nature and silence, moments of wondering awe, and more intense relationships. We intended to analyze whether these perceptions may differ between patients from waves 1 and 2 of the pandemic.

Methods

Cross-sectional study at two time periods (May to June, sample 1) and September to November 2020 (sample 2) with standardized questionnaires (i.e. WHO-5, MLQ, PCQ-12).

Results

Patients from sample 1 (n = 292) and sample 2 (n = 221) did not differ with respect to gender, age, partner or tumor status. Most are still “irritated by statements about danger and course of the infection” (58%) and are “worrying to be infected and to have complicated course of disease” (55%). Neither their well-being nor meaning in life nor fears and worries were significantly different. In sample 2 patients, Worrying reflections and loneliness scored significantly lower, while their Perception of nature and silence was lower in trend only; more intense relationships are still relevant. Moments of wondering awe and religious trust were perceived less often during wave 2. Particularly religious patients scored stronger for Perception of nature and silence and Worrying reflections and loneliness.

Conclusion

Oncologists/psychologist have to know that patients’ situation has not changed within the time of pandemic and that they still require information, close support and encouragement to rely on their resources to cope. Perceived changes are reflecting coping strategies that could be trained to increase patients’ resilience during further pandemic waves.

Take care or "German Angst"? Lessons from cancer care during COVID-19 pandemic in spring 2020

Objective

While the second wave of COVID-19 has started in Europe, data are still missing on the consequences of the first one for patients with cancer. The aim of our study was to learn more about the experiences of German patients and staff in the oncology services.

Materials and methods

An anonymous online survey was conducted among cancer patients and their therapists (physicians, medical staff, psychologists, spiritual care givers) in Germany between April and May 2020 asking about burden, fears, and perceived changes in German oncology service system. Besides answer frequencies of different stakeholders, uni- and multivariate analyses were performed for selected items to identify areas of high impact.

Results

In total 752 participants were included. All groups have identified high mental burden as central problem. A majority was confused about varying information policies and strategies against the pandemic. Patient reported restricted visits, isolation and delay of treatment as central fears and problems. The majority of fears could be coped by the health care workers. The patients describe processes at the oncology services during the first wave. Personal experiences with COVID-19 have had no influence on the felt burden of the patients. Physicians, medical staff, psychologists and spiritual care givers were extremely stressed but repressed their own burden. They await financial, physical and mental problems for their own future.

Conclusions

The presented personal views and experiences allow focusing the discussions about heath care systems during the on-going pandemic. Support for health care workers, as much routine as possible in oncology services, and transparency in information will be the keys for good management in futural situations of crisis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00432-020-03492-4.

Do Chronic Pain Patients Wish Spiritual Aspects to Be Integrated in Their Medical Treatment? A Cross-Sectional Study of Multiple Facilities

Background: Chronic pain is a complex, multidimensional experience. Spirituality is hypothesized to impact pain experience in various ways. Nevertheless, the role that spirituality plays in multimodal pain therapy remains controversial and, to date, quantitative data on whether and for which patients spiritual aspects should be considered in the treatment of chronic pain is lacking. The aim of this study was thus to investigate the proportion and characteristics of patients with chronic pain who wish spiritual aspects to be integrated in their treatment. Methods: Two hundred nine patients with chronic pain were recruited from five inpatient departments and outpatient clinics in the German-speaking part of Switzerland. Patients filled out validated questionnaires, such as the Hospital Anxiety and Depression Scale (HADS), the Resilience Scale (RS-11), the Spiritual and Religious Attitudes in Dealing with Illness (SpREUK), and the 12-item Spiritual Well-Being Scale (FACIT-Sp-12). Results: More than 60% (CI_95%: 55.5-67.9%) of the patients wanted to address spiritual aspects in their treatment. These patients were significantly younger, had higher levels of education, and suffered from more frequent and more severe pain than patients who did not wish to address spiritual aspects. Furthermore, there were high correlations with existing spiritual resources and higher scores of spirituality. Conclusions: These results confirm that the majority of chronic pain patients wish spiritual aspects to be considered in their treatment. Additionally, the finding that these patients had more spiritual resources underlines the importance of integrating spiritual aspects in a resource-oriented, patient-centered care approach for this condition.

Dynamics of Perceived Positive Changes and Indicators of Well-Being Within Different Phases of the COVID-19 Pandemic

Background: During the COVID-19 pandemic, people reported about fears, depressive states, and phases of loneliness. However, there have also been positively experienced changes in terms of awareness of nature, reflection of life, more intensive relationships, meaningful digital media usage to connect with others, and interest in spirituality. We were interested in the dynamics of these indicators directly after the first lockdown, the summer months and during the second wave of the pandemic with its second lockdown, and how they relate to the perceived restrictions, fears, and worries. Method: Survey with standardized questionnaires, i.e., Perceived Changes Questionnaire, WHO-Five Well-being Index, Brief Multidimensional Life Satisfaction Scale, Awe/Gratitude scale. Participants were categorized as cohort 1 (June 2020; n = 1,333), cohort 2 (July to September 2020, n = 823), and cohort three (October 2020 to January 2021, n = 625). Results: Participants perceived changes in specific attitudes and behaviors, which have impacted their well-being and life satisfaction. Compared to their experiences directly after the first wave of the pandemic (cohort 1), well-being (Hedge's g = 0.83) and life satisfaction (g = 0.63) decreased during the second wave (cohort 3) and participants' stressors increased (g = -0.94). At the same time, positive perceptions such as Nature/Silence/Contemplation (g = 0.67), Spirituality (g = 0.62), Relationships (g = 0.55), and Digital media usage declined (g = 0.31), but not Reflections on life (g = -0.03). In cohort 3, the proportion of persons relying on their faith as a strong hold was declining also in nominally religious persons. Awe/Gratitude was among the best predictors of perceived positive changes, indicating a resource which is nevertheless declining during the second wave of the pandemic (g = 0.60). Conclusions: Several perceptions, attitudes, and behaviors have changed, particularly during the second wave of the pandemic, which had a strong influence on psychological health. Although Awe/Gratitude was confirmed as the best predictor of perceived positive changes, this resource may not buffer against the negative outcomes of the pandemic but helps to recognize the still positive aspects in life. There is a need for new and not yet defined public health communities that could focus on persons which are affected in their physical, mental, social, and spiritual health and well-being due to the pandemic.

Awe/Gratitude as an Experiential Aspect of Spirituality and Its Association to Perceived Positive Changes During the COVID-19 Pandemic

Background: While the COVID-19 pandemic has affected the lives of almost all people worldwide, many people observed also positive changes in their attitudes and behaviors. This can be seen in the context of posttraumatic growth. These perceived changes refer to five main categories: Nature/Silence/Contemplation, Spirituality, Relationships, Reflection on life, and Digital media usage. A previous study with persons recruited in June 2020 directly after the lockdown in Germany showed that the best predictors of these perceived changes related to the Corona pandemic were the ability to mindfully stop and pause in distinct situations, to be "spellbound at the moment" and to become "quiet and devout," indicating moments of wondering awe, with subsequent feelings of gratitude. Now, we intended to analyze (1) by whom and how strongly awe/gratitude was experienced during the COVID-19 pandemic, and (2) how these feelings relate to perceived changes and experienced burden, and (3) whether or not feelings of awe/gratitude contribute to participants' well-being or may buffer perceived burden in terms of a resilience factor. Methods: Online survey with standardized questionnaires [i.e., WHO-Five Well-being Index (WHO5), Life satisfaction (BMLSS), Awe/Gratitude scale (GrAw-7), and Perceived Changes Questionnaire (PCQ)] among 2,573 participants (68% women; mean age 48.7 ± 14.2 years, 74% with a Christian affiliation) from Germany recruited between June and November 2020. Results: Awe/Gratitude scored significantly higher particularly among women (Cohen's d = 0.40), older persons (d = 0.88), persons who rely on their faith as a "stronghold in difficult times" (d = 0.99), those with higher well-being (d = 0.70), and lower perceptions of loneliness (d = 0.49). With respect to perceived changes during the pandemic, more intense feelings of Awe/Gratitude were particularly related to Nature/Silence/Contemplation (r = 0.41), Spirituality (r = 0.41), and Relationships (r = 0.33). Regression analyses revealed that the best predictors of Awe/Gratitude (R ² = 0.40) were the frequency of meditation, female gender, life satisfaction and well-being, faith as a stronghold, and perceived burden and also life reflection, while Nature/Silence/Contemplation and Relationships had a further, but weaker, impact on Awe/Gratitude as a dependent variable. Awe/Gratitude was moderately associated with well-being (r = 0.32) and would predict 9% of participants' well-being variance. The best predictors of participants' well-being were multidimensional life satisfaction and low perceived burden (related to the pandemic), and further Awe/Gratitude and Nature/Silence/Contemplation; these would explain 47% of variance in well-being scores. However, Awe/Gratitude cannot be regarded as a buffer of the negative aspects of the COVID-19 pandemic, as it is only marginally (though negatively) related to perceived burden (r = -0.15). Mediation analysis showed that Awe/Gratitude mediates 42% of the link between well-being as a predictor on Nature/Silence/Contemplation as an outcome and has a direct effect of β = 0.15 (p < 0.001) and an indirect effect of β = 0.11 (p < 0.001). Further, Awe/Gratitude mediates 38% (p < 0.001) of the link between Nature/Silence/Contemplation as a predictor on well-being as the outcome; the direct effect is β = 0.18 (p < 0.001), and the indirect effect is β = 0.11 (p < 0.001). Conclusions: The general ability to experience Awe/Gratitude particularly during the COVID-19 pandemic may sensitize to perceive the world around (including nature and concrete persons) more intensely, probably in terms of, or similar to, posttraumatic growth. As this awareness toward specific moments and situations that deeply "touch" a person was higher in persons with more intense meditation or prayer practice, one may assume that these practices may facilitate these perceptions in terms of a training. However, the experience of Awe/Gratitude does not necessarily buffer against adverse events in life and cannot prevent perceived burden due to the corona pandemic, but it facilitates to, nevertheless, perceive positive aspects of life even within difficult times. As Awe/Gratitude is further mediating the effects of Nature/Silence/Contemplation on well-being, intervention programs could help to train these perceptions, as these self-transcendent feelings are also related to prosocial behaviors with respectful treatment of others and commitment to persons in needs, and well-being.

Perceived changes of specific attitudes, perceptions and behaviors during the Corona pandemic and their relation to wellbeing

Background

During the COVID-19 pandemic, most people had to cope with the restrictions of the lockdown, leaving them to their fears, insecurity and isolation. On the other hand, due to the unexpected ‘extra time’ there was room for new experiences and for personal reflections on what is essential in life, to perceive nature and relations more consciously etc. We, therefore, intended to analyze perceived changes of attitudes and behaviors during the time of lockdown, and whether these perceptions would contribute to personal wellbeing during the pandemic.

Methods

An anonym cross-sectional online survey was performed for data collection, using standardized questionnaires, i.e., the WHO-Five Well-being Index (WHO-5), Brief Multidimensional Life Satisfaction Scale (BMLSS), Awe/Gratitude scale (GrAw-7), and the newly developed Perceived Changes Questionnaire (PCQ).

Results

Within the number of respondents (n = 1277), women were predominating (67.5%). Participants’ mean age was 50.9 ± 14.9 years. Exploratory factor analyses showed that the 24-item Perceived Changes Questionnaire differentiated five factors that would account for 61% of variance: (1) Nature/Silence/Contemplation (Cronbach’s alpha = .87), (2) Spirituality (Cronbach’s alpha = .83), (3) Relationships (Cronbach’s alpha = .80), (4) Reflection on life (Cronbach’s alpha = .74), (5) Digital media usage (Cronbach’s alpha = .74). Strongest changes were observed for Relationships and Nature/Silence/Contemplation. Perceived changes were stronger among older persons, among persons with higher wellbeing, and among those who relied on their faith as a resource. These changes were predicted best by a person’s perception of wondering awe in distinct situations with subsequent feelings of gratitude. Stepwise regression analyzes revealed that participants’ wellbeing was explained best by low perceived burden and high life satisfaction (R² = .46). Awe/gratitude, perceived changes in terms of Nature/Silence/Contemplation and low Reflections of live are further variables that would predict a person’s wellbeing among the COVID-19 pandemic.

Conclusions

During the Corona pandemic, people tried to find ways to adapt to the outcomes of the restrictions. The perceived changes of attitudes and behaviors can be interpreted in terms of a reappraisal strategy. These can be measured with the extended version of the PCQ which was found to have good quality indices and a plausible factor structure. The reported changes contribute to persons’ wellbeing only to some extend, indicating that they represent an independent quality of relevance in peoples’ life.