The trajectory of religious coping across time in response to the diagnosis of breast cancer

Evaluation of Religious Coping in Tunisian Muslim Women with Newly Diagnosed Breast Cancer

Studies evaluating religious coping in Arab-Muslim populations are few. We aimed to evaluate religiosity and religious coping in a sample of breast cancer women, and to analyze the association between religiosity, religious coping, depression, anxiety, cancer clinical data, and sociodemographic data in our patients. A cross-sectional and descriptive study was conducted over a 4-month period in 61 newly diagnosed breast cancer women. We used the following scales: The Depression Anxiety Stress Scales (DASS-21), the Arabic-Brief Religious Coping Scale (A-BRCS) and the Arabic Religiosity Scale. The majority of participants (98.4%) had a moderate to high level of religiosity. A weak correlation was found between religious coping scores and stress, depression, and anxiety scores. Our patients had high scores of positive religious coping, with a mean score of 26.13 out of 28 and used more positive coping than negative coping to cope with the cancerous disease. High levels of affective religiosity were the main predictive factor of positive religious coping. Therapies should reinforce the positive religious coping patterns of breast cancer patients, and detect a possible resort to negative religious coping that may negatively affect the patients' quality of life.

Do Religious/Spiritual Preferences and Needs of Cancer Patients Vary Based on Clinical- and Treatment-Level Factors?

BACKGROUND

The objective of this study is to characterize the religion and spiritual (R&S) needs of patients who undergo cancer-directed surgery. In addition, we seek to examine how R&S needs vary based on R&S identity and clinical and surgical treatment characteristics.

PATIENTS AND METHODS

A cross-sectional survey was administered to potential participants who were recruited through outpatient clinics and online. Respondent desires for R&S resources and engagement with the healthcare team  around R&S topics were assessed.

RESULTS

Among 383 potential participants who were identified, 236 respondents were included in the analytic cohort. Mean age was 58.8 (SD 12.10) years, and most participants were female (75.8%) and White/Caucasian (94.1%). The majority (78.4%) identified as currently cancer free. Commonly treated malignancies included breast (43.2%), male reproductive (8.9%), skin (8.5%), and gastrointestinal (GI) (7.2%). Two-thirds of the respondents indicated a desire to have R&S incorporated into their cancer treatment (63.3%). Patients who identified as highly/moderately religious reported wanting R&S more often (highly religious: 95.2% versus moderately religious: 71.4% vs. nonreligious but spiritual: 4.5%). On multivariable analysis, patients who believed their health would improve in the future were more likely to report wanting R&S service (OR 2.2, 95% CI 1.0-4.7) as well as wanting to engage their healthcare providers on R&S topics (OR 2.4, 95% CI 1.2-4.7). In contrast, perception of current or future health status was not associated with patient desire for the actual surgeon/doctor him/herself to be involved in R&S activities (OR 1.83, 95% CI 0.97-3.45).

CONCLUSIONS

Two-thirds of patients undergoing cancer-directed surgery expressed a desire to have R&S incorporated into their cancer treatment. Incorporating R&S into cancer treatment can help a subset of patients throughout their cancer experience.

Exploring breast cancer diagnosis and treatment experience among a sample of South African women who access primary health care

Despite the known impact of a cancer diagnosis and related treatments on quality of life, and the complexity of patient journeys in low-resource settings, there has been little published research into the relevant issues faced by South African women living with breast cancer. In this study, we aimed to understand the experiences of breast cancer diagnosis and treatment among a sample of South African women who access primary health care. A convenience sample of 12 women between the ages of 48 and 66 years attending a primary health care facility took part in our study. Women undergoing breast cancer treatment were invited to take part in face-to-face interviews. The interviews were semi-structured and guided by an interview schedule. Interviews were analysed thematically using ATLAS.ti v 8 computer software. We identified three important themes that explained how women experience diagnosis and treatment, namely, (1) reactions to the diagnosis experience, (2) the importance of faith, and (3) the value in having a sense of agency. Women’s initial reaction to their cancer diagnosis was one of shock and disbelief. Despite these reactions, faith and agency played an important role in how women in this study made sense of their illness experience and how they coped. Our findings demonstrate that women’s experiences of breast cancer diagnosis and treatment were accompanied by some psychological distress for which they need support. Furthermore, supporting women to make positive choices about coping and valuing the role of religion when appropriate should form part of any therapeutic engagement, medical or otherwise.

Positive religious coping predicts self-reported HIV medication adherence at baseline and twelve-month follow-up among Black Americans living with HIV in the Southeastern United States

This paper presents the results of secondary data analyses investigating the influence of religious coping on HIV medication adherence across time among 167 Black Americans living with HIV (BALWH) in the Southeastern United States. Participants were recruited from a large urban clinic in Atlanta, GA and completed questionnaires about their religious coping at baseline assessment and about their medication adherence at baseline and 12-month follow-up assessment. Descriptive analyses and multiple linear regression were used to determine the association between religious coping and HIV medication adherence. Findings indicated that after controlling for age and depressive symptoms at baseline, positive religious coping significantly predicted medication adherence at baseline and 12-month follow-up. Negative religious coping was inversely associated with medication adherence at baseline after controlling for age and depressive symptoms but not at 12-month follow-up. The implications of these findings for future research and intervention work related to medication adherence among BALWH are discussed.

Espiritualidad y calidad de vida en mujeres con cáncer de mama: una revisión integrativa

Introducción: Las mujeres que padecen cáncer de mama requieren de acciones que busquen mejorar su calidad de vida, a pesar del tratamiento. La espiritualidad parece ser un mecanismo de afrontamiento a la enfermedad. Objetivo: Identificar las evidencias disponibles sobre espiritualidad, para la mejora de la calidad de vida de mujeres con cáncer de mama, por medio de una revisión integrativa como metodología. Métodos: La búsqueda fue realizada en las bases de datos: PubMed, LILACS y Scopus, en un intervalo de 10 años. Se incluyeron artículos en los idiomas: inglés, portugués y español; con una temática relacionada a la espiritualidad, calidad de vida y cáncer de mama. Resultados: La muestra final fue de 23 artículos, mismos que fueron analizados y agrupados en tres categorías: Calidad de vida y espiritualidad; La espiritualidad como estrategia de afrontamiento y las Intervenciones que apoyan la espiritualidad. Discusión: Mujeres con cáncer de mama de diferentes culturas y prácticas espirituales, infieren que la espiritualidad les ayudó a reorganizarse psicológicamente, por lo tanto, es importante reconocer las necesidades espirituales de estas mujeres, proporcionar un cuidado holístico y humanizado, por ende mejorar su calidad de vida. Conclusiones: Las instituciones de salud deben poner énfasis en la incorporación de prácticas espirituales y religiosas, como parte integral en el tratamiento, una vez que, en su mayoría no requieren de recursos financieros, sino de los recursos espirituales propios de cada una de estas mujeres.

Spirituality in cancer survivorship with First Nations people in Canada

BACKGROUND

Advancements in cancer survivorship care have shown that holistic approaches, tailored to people's unique survivorship needs, can decrease cancer burden and enhance well-being and quality of life. The purpose of this study was to explore the meanings of spirituality in cancer survivorship for First Nations people, the largest Indigenous population in Canada, and describe how spiritual practices are incorporated into healing.

METHODS

This study is part of a larger arts-based project about cancer survivorship with First Nations people. Thirty-one cancer survivors discussed spirituality as part of their cancer survivorship experiences. Data were generated through sharing sessions (n = 8) and individual interviews (n = 31). Qualitative descriptive analysis was conducted.

RESULTS

Three themes emerged about the meaning of spirituality in cancer survivorship. Spirituality was expressed as a complex phenomenon that (1) interconnected self with traditional roots and culture, (2) merged the body and mind, and (3) gave meaning, strength, and faith in the cancer journey. First Nations people incorporated spirituality into cancer survivorship by giving thanks, attending places of spiritual connectedness, singing, praying, speaking to the Creator, and engaging the sun and moon.

CONCLUSION

First Nations cancer survivors have viewed cancer as an opportunity for emotional and spiritual growth that enabled healing. Understanding the role of spirituality in cancer survivorship is important to develop and deliver culturally safe health services that reduce the burden of cancer and ultimately improve outcomes for First Nations people in Canada.

Spirituality, Distress and Posttraumatic Growth in Breast Cancer Patients

Breast cancer is the most common type of cancer for women and is associated with increased distress. Spirituality and posttraumatic growth (PTG) have been associated with illness adjustment, but the relationship between these variables is still not well understood. A sample of 100 breast cancer patients completed a demographic and clinical questionnaire, the Posttraumatic Growth Inventory, Spiritual and Religious Attitudes in Dealing with Illness, and the Hospital Anxiety and Depression Scale. Results showed an association between PTG, spirituality and distress. Women with a longer diagnosis and recurrence showed more distress. Younger age, recurrent cancer and spirituality predicted higher PTG. Patients' spirituality should be part of intervention with breast cancer patients since it seems to be related to greater growth and adjustment to the illness.

Different dimensions of religiousness/spirituality are associated with health behaviors in breast cancer survivors

OBJECTIVE

Religiousness/spirituality (R/S) may influence cancer survivors' health through multiple pathways. We aimed to examine one potentially key pathway that has seldom been examined: relationships between survivors' R/S and their health behaviors.

METHODS

The present study investigated links between four core dimensions of R/S (beliefs, behaviors, identity, and coping) and three health behaviors (fruit/vegetable consumption, physical activity, and maintenance of a healthy weight) in 172 breast cancer survivors.

RESULTS

Both spiritual identity and use of religious coping were positively related to fruit and vegetable intake, while private prayer was marginally positively related. Both service attendance and religious identity (marginally) were related to engaging in less physical activity, while private prayer was positively related. Afterlife beliefs and private prayer were positively associated with BMI.

CONCLUSIONS

R/S has complex but meaningful associations with health behaviors in breast cancer survivors. More research is needed to understand these relationships and to determine whether different dimensions of R/S may play useful roles in lifestyle change interventions.

Longitudinal Reciprocal Relationships Between Quality of Life and Coping Strategies Among Women with Breast Cancer

BACKGROUND

Research on quality of life (QoL) among women with breast cancer has often examined the impact of coping strategies on QoL. However, the transactional model of stress and coping would argue that QoL can impact coping. This reciprocal relationship between QoL and coping has been inadequately studied.

PURPOSE

This study examined reciprocal relationships over 18 months between QoL and coping (positive and negative coping) among women with breast cancer.

METHODS

Three-wave cross-lagged structural equation modelling (SEM) analysis was used over three timepoints post-diagnosis (T1-T3; N = 637, 577, 553, respectively).

RESULTS

SEM results revealed a significant reciprocal relationship between negative coping and QoL, indicating that negative coping predicted subsequent QoL, which in turn predicted later negative coping. Although QoL at cancer diagnosis predicted subsequent positive coping, we did not find a reciprocal relation between QoL and positive coping.

CONCLUSION

Findings expand our knowledge of the relation between QoL and coping by suggesting the reciprocal relationship between negative coping and QoL among women with breast cancer.

"Letting Go": From Ancient to Modern Perspectives on Relinquishing Personal Control-A Theoretical Perspective on Religion and Coping with Cancer

The concept of "letting go" or relinquishing control has a long intellectual history, including the earliest Taoist writings, long-standing religious traditions, modern conceptualizations of religious coping, and current psychological control theory. This paper briefly traces the ancient roots of "letting go," with an emphasis on Stoic philosophers, and plants it firmly in current control theory and religious coping research, with a focus on its more modern conceptualization, that of secondary control. Presenting the theoretical perspective, which is grounded in religious conceptions of control of outcomes integrated with modern control theory in psychology, is the main goal of this paper. However, the theoretical integration is bolstered by some initial descriptive findings based on cancer patients and survivors. This integration of religious coping and psychological theory has important implications for testing the utility of personal control and God-referenced control as ways to cope with the uncertainties of a serious illness such as cancer. Finally, the theory and descriptive findings lay the groundwork for future empirical studies and the development of counseling interventions.

Religious beliefs, coping, and psychological well-being among Greek cancer patients

Using a prospective design, the aim of this study was to examine the relationship between coping and psychological well-being (distress and positive affect) in a sample of Greek cancer patients ( N = 86), giving a special emphasis on the role of religiosity (religious beliefs and coping). Results showed that religious coping during chemotherapy was the only predictor of positive affect 7 months later, when engagement and disengagement strategies were included in the model. The present findings suggest that religious coping may play a positive role in the well-being of patients facing a life-threatening disease, such as cancer.

[The impact of religious coping on adaptation strategy among the sick]

The influence of religious practice on sick people's adaptation processes has been demonstrated in many studies. It is important for the clinical reasoning implemented by caregivers to integrate this aspect in a context defined by the principle of "laïcité" as understood in France.

Regulatory Flexibility: An Individual Differences Perspective on Coping and Emotion Regulation

People respond to stressful events in different ways, depending on the event and on the regulatory strategies they choose. Coping and emotion regulation theorists have proposed dynamic models in which these two factors, the person and the situation, interact over time to inform adaptation. In practice, however, researchers have tended to assume that particular regulatory strategies are consistently beneficial or maladaptive. We label this assumption the fallacy of uniform efficacy and contrast it with findings from a number of related literatures that have suggested the emergence of a broader but as yet poorly defined construct that we refer to as regulatory flexibility. In this review, we articulate this broader construct and define both its features and limitations. Specifically, we propose a heuristic individual differences framework and review research on three sequential components of flexibility for which propensities and abilities vary: sensitivity to context, availability of a diverse repertoire of regulatory strategies, and responsiveness to feedback. We consider the methodological limitations of research on each component, review questions that future research on flexibility might address, and consider how the components might relate to each other and to broader conceptualizations about stability and change across persons and situations.

Intrinsic religiousness and well-being among cancer patients: the mediating role of control-related religious coping and self-efficacy for coping with cancer

We examined the relationship between intrinsic religiousness and well-being, with control-related religious coping and self-efficacy for coping with cancer as potential mediators of this relationship among cancer patients. In a cross-sectional design, 179 ambulatory cancer patients completed measures of intrinsic religiousness, religious coping, self-efficacy for coping with cancer, well-being, and demographic variables. Type of cancer, stage of cancer, and time since diagnosis were collected from electronic medical charts. In a path model, the positive association between intrinsic religiousness and three types of well-being--physical, functional, and social-was fully mediated by active religious surrender and self-efficacy for coping with cancer. In addition, the negative association between passive religious deferral and all four types of well-being--physical, functional, social, and emotional--was fully mediated by self-efficacy for coping with cancer. Finally, there was a negative direct association between pleading for God's direct intercession and emotional well-being. These findings suggest pathways by which intrinsic religiousness and control-related religious coping are linked to various dimensions of well-being among cancer patients.

Religious Coping in Caregivers of Family Members With Dementia

The degree of depression experienced by caregivers of individuals with dementia was examined in relation to religious coping strategies, religious practice, and spirituality in the framework of the stress and coping model. Caregivers of 191 persons with dementia completed the Religious Coping Scale, self-report measures of religious practices and spirituality, burden, and depression. There was no evidence that any religious coping strategy or religious practice moderated the relationship between caregiving stress and depression. Certain types of religious coping strategies had a direct effect on depression. Higher levels of religious coping working with God were associated with decreased depression, whereas higher levels of religious coping working through God were associated with increased depression. Higher burden, lower overall caregiver health rating, and worse reactions to memory and behavior problems were associated with higher levels of depression. Frequency of prayer and the importance of spirituality were weakly associated with lower levels of depression.

Predictive factors for psychological distress related to diagnosis of breast cancer

OBJECTIVE

The aims of the present study were as follows: (i) to clarify the proportion of women who experience psychological distress during breast cancer diagnosis and (ii) to identify the predictors of psychological distress related to the diagnostic process.

METHODS

This was a longitudinal prospective study of women who required further breast examination. Questionnaires were administered at pre-medical consultations (Time 1), after describing radiological examination (Time 2), and after explaining pathological findings (Time 3). All participants completed Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy--Breast, and Functional Assessment of Chronic Illness Therapy--Spiritual subscale at Time 1 to identify predictors. Participants also completed HADS at Times 2 and 3 to identify the presence or absence of psychological distress.

RESULTS

Of the 222 eligible patients, at Time 2, 31 (22.6%) participants with no clinical abnormalities and 39 (45.9%) participants with abnormal findings had HADS scores of ≥ 11 points (χ2 test, 13.14; p < 0.001). At Time 3, 14 (28.0%) participants with benign breast changes and 24 (68.6%) participants with breast cancer had scores of ≥ 11 (χ2 test, 13.71; p < 0.001). Higher HADS scores at Time 1 were associated with the presence of psychological distress at all stages of breast cancer diagnosis. Advanced tumor stage was a predictor of psychological distress for participants with breast cancer (odds ratios = 3.314, 95% confidence interval = 1.033-9.509; p = 0.044).

CONCLUSION

These results suggest that intensive psychological intervention is necessary for breast cancer patients with large tumors, as well as for women with suspected breast cancer with high HADS scores at pre-consultation.

It is out of my hands: how deferring control to God can decrease quality of life for breast cancer patients

OBJECTIVE

This paper seeks to contribute to the understanding of how and why religion affects psychosocial health outcomes. We propose a theoretical model predicting that when women with breast cancer defer control to God they will experience fewer breast cancer related concerns. Deferring control to God, however, should also reduce the likelihood that they take a proactive coping approach, which will be exacerbated by lowered breast cancer concerns. We therefore predict that this passive coping style will ultimately result in lower levels of quality of life.

METHODS

Data were collected as part of a randomized clinical trial funded by the National Cancer Institute. A total of 192 women with breast cancer participated in a computer-mediated social support group. Deferring control to God statements were captured by using computer-aided content analysis of discussion posts. Psychosocial outcomes were measured using longitudinal survey data. Analysis was performed using structural equation modeling.

RESULTS

The results of our analysis largely confirm our mediation model for which we find significant model fit. As predicted, deferring control to God leads to lower levels of breast cancer concerns but also to more passive coping styles. Ultimately, deferring control to God can lead to lower levels of quality of life.

CONCLUSIONS

Our study demonstrates how and why religious coping can lead to both positive and negative psychosocial health outcomes. Health care practitioners should encourage patients who are relying on religion to keep their end of the bargain and maintain an active coping style.

Does a cancer diagnosis influence religiosity? Integrating a life course perspective

Based on a life course framework we propose that a cancer diagnosis is associated with increased religiosity and that this relationship is contingent upon three social clocks: cohort (1920-1945, 1946-1964, 1964+), age-at-diagnosis, and years-since-diagnosis. Using prospective data from the National Survey of Midlife Development (N=3443), taken in 1994-1995 and 2004-2006, we test these arguments. Results showed that a cancer diagnosis was associated with increased religiosity. Moreover, we found: (a) no evidence that the influence of cancer varied by cohort; (b) strong evidence that people diagnosed with cancer at earlier ages experienced the largest increases in religiosity; and (c) no evidence that changes in religiosity are influenced by years-since-diagnosis. Our study emphasizes how personal reactions to cancer partly reflect macro-level processes, represented by age-at-diagnosis, and shows that the religion-health connection can operate such that health influences religiosity. The study also highlights the sociological and psychological interplay that shapes people's religiosity.

Two years after cancer diagnosis, what is the relationship between health-related quality of life, coping strategies and spirituality?

This study aimed to analyze the relationship between spirituality, coping strategies and health-related quality of life (HRQL) among a large representative sample of patients two years after cancer diagnosis. Using a cross-sectional design, medical and self-reported data were collected by physicians and a patient telephone interview, respectively. Among 4270 participants, 54.6% reported that spirituality was not a source of comfort at all during the disease, 23.4% stated that it was a source of moderate comfort and 22.5% a source of great comfort. After adjustment for age, gender, educational level and living in a couple, a multivariate analysis showed that a lower mental HRQL score was independently associated with finding moderate comfort in spirituality when compared with finding no comfort at all. After multiple adjustment, a lower score of physical HRQL and a higher score of fighting spirit were independently associated with having found great comfort in spirituality when compared with those who found no comfort at all. This study aimed to understand the dynamics of religious beliefs among cancer patients over the disease duration and to understand how these beliefs could be considered and utilized by patients as a source of comfort and support. The results highlight not only the role spirituality may play in disease management and the extent to which it may be a valuable source of comfort during the follow-up of cancer patients, but also its role in the evaluation of the different dimensions of HRQL.

The advanced cancer patient experience of undertaking meaning and purpose (MaP) therapy

Objective:

The objective of this study was to describe the experience of undertaking meaning and purpose (MaP) therapy for patients with advanced cancer, with an aim of refining therapeutic processes involved prior to pilot testing. Specifically, we were interested in examining the themes arising from participation in the intervention in relation to our therapeutic goals, and how acceptable both the number of sessions and processes used were.

Method:

A convenience sample of people living with advanced cancer was recruited to participate in this process, resulting in 24 therapy sessions for analysis.

Results:

A thematic analysis of each session illustrated that the process of MaP therapy is one that encourages reflection, offers insights, and can be confrontational, but can also allow participants to “shift” their perspective and focus onto meaningful goals. Results illustrate how the therapist creates a therapeutic frame that holds up a poignant portrayal of the meaning of life lived, and mirrors this to the patient, such that they grasp its rich texture. Participants' descriptions showed how they were buoyed forward as a result, with renewed vigor and enthusiasm, despite their illness and any physical restrictions that it imposed.

Significance of results:

A planned pilot test of this intervention will enable us to determine potential effect sizes of this therapy in reducing distress and increasing meaning prior to a full randomized controlled trial. Understanding the processes involved and the experiences of participation in meaning-based therapies is crucial to the future strength of this area of psychotherapy.

Twenty-five years later--what do we know about religion/spirituality and psychological well-being among breast cancer survivors? A systematic review

INTRODUCTION

A diagnosis of cancer is a life-changing event for most people. The trauma and uncertainties of a breast cancer diagnosis can affect survivors' psychological well-being. Religion and/or spirituality can provide a means of support for many women as they live with the realities of a diagnosis of cancer. The purpose of this focused review is to critically analyze and synthesize relationships among psychological well-being, religion, and spirituality among women with breast cancer.

METHODS

MEDLINE, CINAHL, Web of Science, Cambridge Scientific Abstracts, Cochrane CENTRAL, and PsycINFO databases were searched: January 1985-March 2010. The search terms religi*(religious/religion), spiritu*(spiritual/spirituality), breast cancer, psychological adjustment, psychological outcomes, psychological distress, psychological well-being, and outcomes were searched for separately and in combination.

RESULTS

Eighteen quantitative studies were analyzed in order to examine associations among religion, spirituality, and psychological well-being for women diagnosed with breast cancer. These three variables were operationally defined as follows: (a) religious practice, religious coping, and perception of God; (b) spiritual distress, spiritual reframing, spiritual well-being, and spiritual integration; and (c) combined measure of both the religion and spirituality constructs.

DISCUSSION/CONCLUSIONS

Results of this review suggest that within this population, limited relationships exist among religion, spirituality, and psychological well-being. Given the various definitions used for the three variables, the strength and clarity of relationships are not clear. In addition, the time of assessment along the course of the disease varies greatly and in some instances is not reported. Diagnosis and/or prognosis, factors that could influence psychological well-being, are frequently not factored into results. There does, however, appear to be sufficient evidence to include a brief, clinically focused assessment of women diagnosed with breast cancer regarding the importance of a given belief system as they face the diagnosis and treatment of their disease.

IMPLICATIONS FOR CANCER SURVIVORS

The implications for cancer survivors are as follows: (a) Psychological well-being of women diagnosed with breast cancer may depend to some extent on their belief system. (b) Coping through "turning to God" for women without a significant prior relationship with God, or minimal spiritual behaviors, may experience diminished well-being. (c) Longitudinal studies suggest that struggling with, or questioning, one's belief system in early survivorship may also be associated with lower levels of well-being. This diminished well-being often resolves over time.

The relationship of spiritual concerns to the quality of life of advanced cancer patients: preliminary findings

PURPOSE

Religion and/or spirituality (R/S) have increasingly been recognized as key elements in patients' experience of advanced illness. This study examines the relationship of spiritual concerns (SCs) to quality of life (QOL) in patients with advanced cancer.

PATIENTS AND METHODS

Patients were recruited between March 3, 2006 and April 14, 2008 as part of a survey-based study of 69 cancer patients receiving palliative radiotherapy. Sixteen SCs were assessed, including 11 items assessing spiritual struggles (e.g., feeling abandoned by God) and 5 items assessing spiritual seeking (e.g., seeking forgiveness, thinking about what gives meaning in life). The relationship of SCs to patient QOL domains was examined using univariable and multivariable regression analysis.

RESULTS

Most patients (86%) endorsed one or more SCs, with a median of 4 per patient. Younger age was associated with a greater burden of SCs (β = -0.01, p = 0.006). Total spiritual struggles, spiritual seeking, and SCs were each associated with worse psychological QOL (β = -1.11, p = 0.01; β = -1.67, p < 0.05; and β = -1.06, p < 0.001). One of the most common forms of spiritual seeking (endorsed by 54%)--thinking about what gives meaning to life--was associated with worse psychological and overall QOL (β = - 5.75, p = 0.02; β = -12.94, p = 0.02). Most patients (86%) believed it was important for health care professionals to consider patient SCs within the medical setting.

CONCLUSIONS

SCs are associated with poorer QOL among advanced cancer patients. Furthermore, most patients view attention to SCs as an important part of medical care. These findings underscore the important role of spiritual care in palliative cancer management.

Role of religious involvement and spirituality in functioning among African Americans with cancer: testing a mediational model

The present study tested a mediational model of the role of religious involvement, spirituality, and physical/emotional functioning in a sample of African American men and women with cancer. Several mediators were proposed based on theory and previous research, including sense of meaning, positive and negative affect, and positive and negative religious coping. One hundred patients were recruited through oncologist offices, key community leaders and community organizations, and interviewed by telephone. Participants completed an established measure of religious involvement, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-SP-12 version 4), the Positive and Negative Affect Schedule (PANAS), the Meaning in Life Scale, the Brief RCOPE, and the SF-12, which assesses physical and emotional functioning. Positive affect completely mediated the relationship between religious behaviors and emotional functioning. Though several other constructs showed relationships with study variables, evidence of mediation was not supported. Mediational models were not significant for the physical functioning outcome, nor were there significant main effects of religious involvement or spirituality for this outcome. Implications for cancer survivorship interventions are discussed.

Exploring global meaning in Greek breast cancer patients: validation of the Life Attitude Profile--Revised (LAP-R)

OBJECTIVE

The aim of this study was to examine the factor structure and the psychometric properties of the Life Attitude Profile-Revised (LAP-R) among a sample of Greek breast cancer patients, and to test the fit of a structural equation model with one latent factor underlying the measured LAP-R dimensions.

METHODS

A total of 153 patients with breast cancer completed the LAP-R. Convergent validity was assessed by examining the correlations between the LAP-R subscales and measures of perceived stress, intrusiveness, mental health, and coping styles. Known-groups validity was also assessed.

RESULTS

Principal axis factor analysis with promax rotation yielded four factors: purpose-coherence-vacuum, choice, death acceptance, and goal seeking. Internal consistency reliability of the subscales and convergent validity of LAP-R were satisfactory. LAP-R was able to detect differences in meaning between different age groups. Confirmatory factor analysis provided support for a single-factor model including a latent meaning-variable indicated by the observed subscales.

CONCLUSIONS

The LAP-R is a reliable and valid measure of global meaning in life, when administered to breast cancer patients. The use of LAP-R in evaluating meaning-centered psychotherapy interventions for patients with cancer is emphasized.

The relationship between religious/spiritual factors and perceived growth following a diagnosis of breast cancer

This study investigates the role of religious salience, God image and religious coping in relation to perceived growth following a diagnosis of breast cancer. Eighty-seven breast cancer patients were followed from pre-diagnosis up to 24 months post-surgery. The findings of this study provided limited support for the role of positive aspects of spirituality in relation to perceived growth. Religious involvement at pre-diagnosis was predictive of less growth at 24 months post-surgery while a positive image of God had no association with growth. While some forms of positive religious coping demonstrated positive associations, others evidenced no relationship or negative relationships with growth. Negative aspects of spirituality were more consistently related to growth with the nature of the association again depending on the type of negative spirituality being assessed. For example, passive deferral coping was related to less growth while spiritual discontent coping was related to greater growth across time. Such findings underscore the need to attend to negative aspects of spirituality from early on in the process of cancer adjustment as such expressions may have implications for women's ability to develop and maintain a positive perspective in their coping over the long-term.