Measuring meaning in life following cancer

Hope, meaning in life and religious/spiritual struggle predicts the quality of life in cancer patients with early and advanced malignancy: a structural equation modeling approach

Purpose

This study examined hope, meaning in life (MIL), and religious/spiritual struggle (RSS) as predictors of the quality of life (QOL) in cancer patients. We hypothesized a positive association of QOL with hope and MIL, whereas a negative association with RSS. The stage of cancer was hypothesized as a moderator variable between QOL and hope. Hope and MIL were assumed as positive predictors and RSS as negative predictor of QOL.

Methods

Data stem from the cross-sectional survey study of 300 cancer patients (Mean age = 50.97 ± 13.50 SD). Herth Hope Index, Meaning in Life Scale, Religious Spiritual Struggle Scale and WHO-QOL-BRIEF were used. The correlation coefficient and partial least square structural equation modeling approach (PLS-SEM) were used for assessing the measurement model and the structural model.

Results

As hypothesized, QOL was found positively associated with Hope and MIL, but negatively associated with RSS. The stage of cancer was hypothesized as a negative moderator. The three predictors significantly predicted QOL in cancer patients and explained 75.3% of the variance in QOL, and the overall model fit was adequate (SRMR = 0.075). Hope and MIL had a positive impact on QOL (β = .356, p < 0.01; β = .355 p < 0.01, respectively), whereas RSS had a negative impact (β =  -.102, p < .05). The Stage of cancer did not moderate the path coefficient between the hope and QOL to a significant degree (β = .097, p > 0.01).

Conclusion

In cancer patients, hope and MIL are facilitators of QOL. Addressing religious and spiritual concerns and struggles is critical to overall QOL improvement.

Presence of meaning in life and meaning confusion mediate the effects of adverse childhood experiences on mental health among university students

Few studies have explored meaning in life as a mediator between adverse childhood experiences (ACEs) and mental health. This study examined the protective and risk factors associated with meaning in life, as they mediate the effect of ACEs on mental health. The sample was 293 university students in Hong Kong (mean age = 21 years). The results of analyses based on three-wave longitudinal data and structural equation modeling demonstrated that the presence of meaning mediated the negative association between ACEs and happiness, and that meaning confusion mediated the positive association between ACEs and depression and anxiety. This study provides evidence that the presence of meaning may play a protective role and that meaning confusion may be a risk factor for the effects of ACEs on mental health. This study's results have implications for the development of prevention and intervention strategies to alleviate the detrimental impact of ACEs and promote mental health in young adults.

What Promotes Positive Parenting During Breast Cancer? A Cross-Sectional Analysis of Social Support, Emotion Regulation, and Meaning in Life

BACKGROUND

Motherhood and maintaining the child-parent relationship are top priorities for mothers with breast cancer (BC). The current study aimed to assess the positive intra- and inter-personal resources related to positive parenting among mothers with BC, as these may be promotive factors for positive parenting. Specifically, we examined whether social support (family, friend, spiritual), emotion regulation, and a sense of meaning in life are related to positive parenting among mothers undergoing BC treatments.

METHODS

The sample consisted of 100 Israeli mothers (mean age = 46.02 years, SD = 6.06 years) who were undergoing treatment for BC. Participating mothers had at least one child aged 6-17 years. Participants were recruited via closed social media groups to complete a questionnaire containing: the Alabama Parenting Questionnaire, Cancer Perceived Agents of Social Support tool, Emotion Regulation Questionnaire, Meaning in Life Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and sociodemographic and clinical questions. We used structural equation modeling to regress the study variables on positive parenting.

RESULTS

Friend support (β = .35, p = .009) and meaning in life (β = .30, p = .012) were significantly related to positive parenting. Family support, spiritual support, cognitive reappraisal, and the sociodemographic and clinical variables were not related to positive parenting.

CONCLUSIONS

Our study suggests that promoting meaning in life and friend support may be key to helping mothers to sustain positive parenting behaviors throughout their cancer treatment. Future research may examine whether psychosocial interventions which foster meaning in life and friend support impact positive parenting among mothers with BC.

Biopsychosocial Correlates of Quality of Life in Multiple Sclerosis Patients

Multiple sclerosis (MS) is a demyelinating chronic disease that has had increasing prevalence over the last years. We have investigated whether the perceived quality of life is reduced in multiple sclerosis patients compared to control participants with a cross-sectional approach, and how it relates to sociodemographic, clinical, and psychosocial variables in MS with multiple regression. To that end, a group of MS patients (n = 50) and a control group (n = 50) that was matched for age and education level filled in the WHOQOL-BREF (perceived quality of life across four domains) and a sociodemographic questionnaire. The participants in the MS group also filled in a clinical questionnaire and three instruments measuring psychosocial variables (the DASS-21 for depression, anxiety, and stress, the Brief-COPE for coping skills, and the Meaning in Life Scale). The results showed that the perceived quality of life was lower in the MS group than in the control group. Multiple regression models incorporating the variables that showed significant correlations with the quality of life indicated that age, professional status, recovery from relapses, depression, active coping, and meaning in life predicted at least one domain of the quality of life. Meaning in life predicted the quality of life in all four of the domains. Although the quality of life in MS is linked to multiple biopsychosocial variables, meaning in life seems crucial.

Valued Outcomes in the Cancer Experience (VOICE)™: Development and validation of a multidimensional measure of perceived control

Objective

Enhancing cancer patients’ sense of control can positively impact psychological well-being. We developed and assessed the psychometric properties of Valued Outcomes in the Cancer Experience (VOICE)TM, a measure of patients’ perceived control over key personal priorities within their cancer experience.

Methods

VOICE construction and testing were completed in three phases with separate participant samples: (1) item generation and initial item pool testing (N = 459), (2) scale refinement (N = 623), and (3) confirmatory validation (N = 515).

Results

A 21-item measure was developed that captures cancer patients’ sense of control in seven key domains: (1) Purpose and Meaning, (2) Functional Capacity, (3) Longevity, (4) Quality Care, (5) Illness Knowledge, (6) Social Support, and (7) Financial Capability. VOICE demonstrated adequate internal consistency (full-scale α = 0.93; factor α = 0.67–0.89) and adequate to strong convergent and discriminatory validity.

Significance of results

VOICE measures cancer patients’ perceived control across a diverse range of personal priorities, creating a platform for elevating patient perspectives and identifying pathways to enhance patient well-being. VOICE is positioned to guide understanding of the patient experience and aid the development and evaluation of supportive care interventions to enhance well-being.

Study design and protocol for tailored Acceptance and Commitment Therapy (ACT) to optimize quality of life in women living with metastatic breast cancer

Women living with metastatic (stage IV) breast cancer face unique challenges, including arduous treatments, side effects, chronic symptom burden, and emotional distress. Nevertheless, most research has paradoxically focused on optimizing quality of life in women with early-stage, non-metastatic breast cancer. Acceptance and Commitment Therapy (ACT) is an evidence-based, third-wave cognitive behavioral therapy that focuses on creating 'a life worth living' by promoting meaning and purpose and optimizing quality of life. ACT may be particularly well-suited for women with metastatic breast cancer as it addresses salient existential concerns, while allowing for the co-occurrence of feelings of grief and loss that are normal and expected when facing a life-limiting prognosis. This manuscript describes the rationale and study design of a pilot randomized controlled trial to develop and assess the feasibility and acceptability of a tailored ACT intervention for women living with metastatic breast cancer. Participants (N = 30) will be randomized 1:1 to either ACT, cognitive behavioral stress management (CBSM), or a usual care control. Both ACT and CBSM are 8-week, group-based interventions that will be delivered online. Primary outcomes are rates of acceptance, retention, and satisfaction. Preliminary effects on variables of interest, including meaning and purpose, psychological flexibility, and several domains of quality of life, will also be examined. Findings will inform the conduct of a full-scale randomized controlled trial of our tailored ACT intervention in women living with metastatic breast cancer.

The role of goal and meaning in life for older adults facing interpersonal stress

Interpersonal stressful events (ISE) have been shown to be potent predictors of major depressive symptoms among older adults. This study examines the relationships between recent ISE and depressive symptoms in late life and explores whether having coping cognitive resource (e.g. finding meaning and goal in life) can buffer the effects of ISE on depressive symptoms for older adults. We utilized a sample of residents in Florida retirement communities (N = 588) who participated in a long-term-panel study using yearly assessments for six years. Additionally, we modeled within-person differences in ISE and depressive symptoms simultaneously with multilevel modeling. Then, we tested the moderating effect of coping resource (i.e. meaning in life and goal in life) in the association between ISE and depressive symptoms. We found that the mean level of ISE is associated with higher depressive symptoms and lower life satisfaction. In addition, higher levels of within-person meaning and goal buffered the negative effect of ISE on depressive symptoms for older adults. Similarly, within-person meaning and goal also attenuated the negative effect of ISE on life satisfaction.

Spiritual Needs Assessment in Post-Secular Contexts: An Integrative Review of Questionnaires

Research across healthcare contexts has shown that, if provided appropriately, spiritual care can be of significant benefit to patients. It can be challenging, however, to incorporate spiritual care in daily practice, not least in post-secular, culturally entwined, and pluralist contexts. The aim of this integrative review was to locate, evaluate and discuss spiritual-needs questionnaires from the post-secular perspective in relation to their applicability in secular healthcare. Eleven questionnaires were evaluated and discussed with a focus on religious/spiritual (RS) wording, local culturally entwined and pluralist contexts, and on whether a consensual understanding between patient and healthcare professional could be expected through RS wording. By highlighting some factors involved in implementing a spiritual-needs questionnaire in diverse cultural and vernacular contexts, this article can assist by providing a general guideline. This article offers an approach to the international exchange and implementation of knowledge, experiences, and best practice in relation to the use of spiritual needs-assessment questionnaires in post-secular contexts.

Spiritual AIM: assessment and documentation of spiritual needs in patients with cancer

The chaplain is an essential member of the palliative care (PC) team, yet, standard methods to document chaplain assessments are lacking. The study team performed a retrospective analysis of chaplaincy documentation in an outpatient PC clinic at an academic medical center over 6 months (April 2017 to October 2017). The study team identified unique adult patients with cancer, then manually extracted variables from the electronic medical record. The primary objective was to assess the number of spiritual assessments documented by the chaplain. Secondary objectives included descriptive analysis of identified spiritual needs. Out of the 376 total patient encounters, 292 (77.8%) included documentation of a chaplain's spiritual assessment. The most frequent spiritual need was self-worth/community (n = 163, 55.8%).This study demonstrates that chaplains can effectively document Spiritual AIM-based screening and assessment. Moreover, this may be an effective documentation method across institutions to facilitate chaplain-based data.

Effectiveness of Logotherapy on Death Anxiety, Hope, Depression, and Proper use of Glucose Control Drugs in Diabetic Patients with Depression

Background:

Logotherapy encourages the individual to find meaning in life, which is recognized as the driving force of every individual in their lifetime. Diabetes, caused by the impairment in metabolism of glucose, fat, and protein, is associated with lack of secretion or dysfunction of insulin. This study aims to investigate the effectiveness of logotherapy on death anxiety, hope, depression, and proper use of glucose control medication in diabetic patients with depression.

Methods:

The population in the present quasiexperimental pretest–posttest study with control group is comprised of diabetic patients with depression attending Baghban Endocrine Clinic in Sari. A sample of 40 diabetic patients (20 in the trial and 20 in the control group) entered the study. Data were collected using Templer Death Anxiety Scale, Miller Hope Scale, Beck's Depression Inventory, and Medication Adherence Scale. Covariance analysis was used to evaluate the effectiveness of logotherapy on death anxiety, hope, depression, and proper use of glucose control medication, where P value lower than 0.05 is considered significant.

Results:

Death anxiety and depression of diabetic patients with depression were reduced by following logotherapy training, and their hope was increased. The results confirmed the effectiveness of logotherapy training on death anxiety, hope, and depression in diabetic patients with depression (P < 0.05). Logotherapy was effective on proper use of blood- glucose drugs in depressed diabetic patients and 19% of changes in scores of proper use of medication were caused by the effectiveness of logotherapy (P < 0.05).

Conclusions:

Logotherapy appears to be a suitable psychological treatment for diabetic patients with depression.

A View of Spirituality and Spiritual Care in a Sample of Spanish Nurses

The aim of this paper was to explore a select group of Spanish nurses’ views of spirituality and spiritual care. An exploratory design using both qualitative and quantitative methods was used in this study. The participants were nurses who were enrolled in a Master of Nursing Research. Data were collected via an open questionnaire. Furthermore, participants completed the Meaning in Life Scale (MiLS-Sp), whose results were analysed using quantitative methodology. The results that were obtained from the quantitative analyses reported a satisfactory mean score on nurses’ self-reported spirituality. Qualitative data were analysed using grounded theory procedures. Qualitative analysis showed two approaches to spirituality nurses’ views: (i) a clinical approach that influenced by the context of their clinical practice and (ii) an alternative approach where spirituality was viewed as a health resource, moving away from the biomedical model of nursing training. Nurses are sensitive to spirituality issues and acknowledge their importance to practice. Despite this, they view spirituality in a rather mechanistic way without changing their attitudes, competences and perspectives on healthcare.

Stress and Growth in Cancer: Mechanisms and Psychotherapeutic Interventions to Facilitate a Constructive Balance

Post-traumatic stress and growth are common responses to adverse life events such as cancer. In this article, we establish how cancer becomes a "fertile land" for the emergence of stress and growth responses and analyze the main mechanisms involved. Stress-growth responses on adjusting to cancer is potentially determined by factors like the phase of the illness (e.g., initial phases vs. period of survivorship), patient's coping strategies, meaning-making, and relationships with significant others. We also review the mechanisms of constructive and adaptative stress-growth balances in cancer to study the predictors, interrelated associations, triggering mechanisms, long-term results, and specific trajectories of these two responses to cancer. Finally, we update the evidence on the role of these stress-growth associations in psychologically adjusting to cancer. Together with this evidence, we summarize preliminary results regarding the efficacy of psychotherapeutic interventions that aim to facilitate a constructive psychological balance between stress and growth in cancer patients. Recommendations for future research and gaps in knowledge on stress-growth processes in this illness are also highlighted. Researchers are encouraged to design and use psychotherapeutic interventions according to the dynamic and changeable patients' sources of stress and growth along the illness. Relevant insights are proposed to understand the inconsistency of stress-growth literature and to promote psychotherapeutic interventions to facilitate a constructive balance between these key responses in cancer.

Psychological and clinical correlates of posttraumatic growth in cancer: A systematic and critical review

OBJECTIVE

The objective of this study is to describe major findings on posttraumatic growth (PTG) in cancer, by analyzing its various definitions, assessment tools, and examining its main psychological and clinical correlates.

METHODS

A search in relevant databases (PsycINFO, Pubmed, ProQuest, Scopus, and Web of Science) was performed using descriptors related to the positive reactions in cancer. Articles were screened by title, abstract, and full text.

RESULTS

Seventy-two met the inclusion criteria. Most articles (46%) focused on breast cancer, used the PTG inventory (76%), and had a cross-sectional design (68%). The PTG resulted inversely associated with depressive and anxious symptoms and directly related to hope, optimism, spirituality, and meaning. Illness-related variables have been poorly investigated compared to psychological ones. Articles found no relationship between cancer site, cancer surgery, cancer recurrence, and PTG. Some correlations emerged with the elapsed time since diagnosis, type of oncological treatment received, and cancer stage. Only few studies differentiated illness-related-life-threatening stressors from other forms of trauma, and the potentially different mechanisms connected with PTG outcome in cancer patients.

CONCLUSIONS

The evaluation of PTG in cancer patients is worthy, because it may promote a better adaption to the illness. However, many investigations do not explicitly refer to the medical nature of the trauma, and they may have not completely captured the full spectrum of positive reactions in cancer patients. Future research should better investigate issues such as health attitudes; the risks of future recurrences; and the type, quality, and efficacy of medical treatments received and their influence on PTG in cancer patients.

Development of the Chinese version of Meaning in Life Scale for cancer patients and psychometric evaluation

AIMS AND OBJECTIVES

To develop a Meaning in Life Scale for cancer patients in Chinese version and to test the validity and reliability.

BACKGROUND

Meaning in life is a protective factor of psychological well-being and is negatively related to depression and demoralisation among cancer patients. The existing scales measuring meaning in life are mostly designed in English and there is no scale designed for Chinese cancer patients based on Chinese cultural background.

DESIGN

Process of instrument development and psychometric evaluation were used.

METHODS

Items were generated from literature review and a focus group interview. Delphi technique was used to test the content validity. Item analysis and exploratory factor analysis were performed with data from 251 cancer patients. The internal consistency of the scale was tested by Cronbach's alpha.

RESULTS

A 25-item Meaning in Life Scale in Chinese version with five domains was developed. The five factors explained 62·686% of the variance. The Cronbach's alpha for the total scale was 0·897.

CONCLUSIONS

The Meaning in Life Scale in Chinese version has acceptable internal consistency reliability and good content validity and acceptable construct validity. The content of the scale reflected the attitudes of cancer patients towards meaning in life based on Chinese cultural background.

RELEVANCE TO CLINICAL PRACTICE

The Chinese version of Meaning in Life Scale for Cancer Patients appears to be a new scale to assess meaning in life among Chinese cancer patients exactly and the concept of meaning in life presented in this scale provides new ideas of meaning intervention in routine clinical practice.

Exploring Meaning in the Life of Chinese Breast Cancer Survivors

BACKGROUND

Breast cancer is the most common cancer among women worldwide, and spiritual fulfillment such as experiencing meaning in life plays an important role in coping with the disease.

OBJECTIVE

The objectives of this study were to explore and understand Chinese breast cancer survivors' perspective on meaning in life.

METHODS

This study used Grounded Theory; 23 participants were recruited using convenience sampling, purposive sampling, and theoretical sampling. Semistructured interviews were conducted, and the data were analyzed using open coding, axial coding, and selective coding.

RESULTS

A core category emerged as "satisfaction with my life" to explain Chinese breast cancer survivors' perspective of meaning in life, and 4 subcategories described the core category including (1) living a healthy and peaceful life, (2) having a good relationship with others, (3) achieving purpose in life, and (4) fulfilling responsibility.

CONCLUSION

Chinese breast cancer survivors value physical health as well as spiritual fulfillment. The experience of adapting to life with cancer, having a good relationship with others, pursuing life goals, and fulfilling responsibility consists of a satisfying life, which makes life more meaningful.

IMPLICATIONS FOR PRACTICE

Health providers should pay more attention to survivors' experience of meaning in life and help them enhance meaning in life and improve their quality of life through building good relationship with others, achieving purpose in life, and fulfilling responsibility for family and society.

Spiritual beliefs, practices, and needs at the end of life: Results from a New Zealand national hospice study

OBJECTIVE

International studies have shown that patients want their spiritual needs attended to at the end of life. The present authors developed a project to investigate people's understanding of spirituality and spiritual care practices in New Zealand (NZ) hospices.

METHOD

A mixed-methods approach included 52 semistructured interviews and a survey of 642 patients, family members, and staff from 25 (78%) of NZ's hospices. We employed a generic qualitative design and analysis to capture the experiences and understandings of participants' spirituality and spiritual care, while a cross-sectional survey yielded population level information.

RESULTS

Our findings suggest that spirituality is broadly understood and considered important for all three of the populations studied. The patient and family populations had high spiritual needs that included a search for (1) meaning, (2) peace of mind, and (3) a degree of certainty in an uncertain world. The healthcare professionals in the hospices surveyed seldom explicitly met the needs of patients and families. Staff had spiritual needs, but organizational support was sometimes lacking in attending to these needs.

SIGNIFICANCE OF RESULTS

As a result of our study, which was the first nationwide study in NZ to examine spirituality in hospice care, Hospice New Zealand has developed a spirituality professional development program. Given that spirituality was found to be important to the majority of our participants, it is hoped that the adoption of such an approach will impact on spiritual care for patients and families in NZ hospices.

Psychosocial resources and sleep disturbance before chemotherapy for gynecologic cancer

Personal psychosocial resources (e.g., positive affect, social support, perceived mastery, meaning in life) are associated with better sleep in noncancer populations, but there have been few studies in cancer patients. The present study examined psychosocial resources and sleep in gynecological cancer patients. Before chemotherapy, 72 participants completed self-report measures of sleep and psychosocial resources; 63 also completed actigraphic monitoring. Subjective sleep was associated with positive affect, social support, perceived mastery, and meaning in life; objective sleep was associated with social support. Future studies should examine whether interventions to enhance psychosocial resources result in improved sleep in this population.

The Causal Factors Associated with the Loving Care of the Mothers of Children with Multiple Disabilities

BACKGROUND

Families with disabled children need more psycho-social considerations. Motherhood care of the children with multiple disabilities is difficult. Due to its importance, the aim of this study was to investigate the causal factors affecting loving care of mothers of children with multiple disabilities.

METHODS

The study used a cross-sectional method in which 75 mothers of exceptional children with multiple disabilities (physical and mental) in elementary schools in Shiraz, Iran. The data were collected through questionnaires which, besides demographical factors, evaluated the relationship between mothers' loving care of children with multiple disabilities and four other variables including purpose in life, life satisfaction, religious attitude, and sense of coherence. Mann-Whitney U was used for comparison between mothers' loving care and other variables.

RESULTS

Results revealed that demographic variables did not have a significant relationship with loving care. In the case of social variables, there was a significant relationship between mothers' loving care and purpose in life (P<0.001), religious attitude (P<0.001), and life satisfaction (P=0.01).

CONCLUSION

Motherhood care of disabled children is a unique phenomenon which is due to attachment of mother-child situation. Nevertheless, these mothers are vulnerable and marginalized people who need more attention and social supports provided by related governmental institutions and also NGOs actors.

Assessment of spiritual suffering in the cancer context: A systematic literature review

OBJECTIVE

An important goal of cancer medicine is relief of patients' suffering. In view of the clinical challenges of identifying suffering patients, we sought to identify valid instruments for assessing the spiritual suffering of people diagnosed with cancer.

METHOD

A systematic review of the literature was conducted in the Medline, Embase, the Cochrane Library, and PsycINFO databases seeking assessment instruments that measure either suffering or one of its synonyms or symptoms. The psychometric properties of the identified measures were compared.

RESULTS

A total of 90 articles were identified that supplied information about 58 measures. The constructs examined were: suffering, hopelessness/demoralization, hope, meaning, spiritual well-being, quality of life where a spiritual/existential dimension was included, distress in the palliative care setting and pain, distress or struggle of a spiritual nature. The Pictorial Representation of Illness and Self Measure (PRISM) (patient completed) was the most promising measure identified for measuring the burden of suffering caused by illness due to its ease of use and the inclusion of a subjective component.

SIGNIFICANCE OF RESULTS

Although the appropriateness of any measure for the assessment of spiritual suffering in cancer patients will depend on the context in which it is intended to be utilized, the PRISM is promising for measuring the burden of suffering due to illness.

Spirituality and religion in oncology

Despite the difficulty in clearly defining and measuring spirituality, a growing literature describes its importance in oncology and survivorship. Religious/spiritual beliefs influence patients' decision-making with respect to both complementary therapies and aggressive care at the end of life. Measures of spirituality and spiritual well-being correlate with quality of life in cancer patients, cancer survivors, and caregivers. Spiritual needs, reflective of existential concerns in several domains, are a source of significant distress, and care for these needs has been correlated with better psychological and spiritual adjustment as well as with less aggressive care at the end of life. Studies show that while clinicians such as nurses and physicians regard some spiritual care as an appropriate aspect of their role, patients report that they provide it infrequently. Many clinicians report that their religious/spiritual beliefs influence their practice, and practices such as mindfulness have been shown to enhance clinician self-care and equanimity. Challenges remain in the areas of conceptualizing and measuring spirituality, developing and implementing training for spiritual care, and coordinating and partnering with chaplains and religious communities.

Meaning in life of patients with cancer

OBJECTIVE

The aim of this study was to evaluate meaning in life and its predictors in Turkish patients with cancer.

METHODS

A convenience sample of 182 patients with cancer at a Turkish university hospital completed a structured questionnaire including demographic characteristics, disease/treatment characteristics, symptom level, and the meaning in life scale for patients with cancer in 2007. The researcher visited the oncology clinic five work days in every week and conducted interviews with the patients. In analysis of the data, correlation, t-tests, Kruskal-Wallis variance and regression analysis were used.

RESULTS

In this study, the mean score of the total meaning in life showed that the patients tended to be undecided concerning meaning in life. Education level, age, and diagnosis duration of the independent variables were effective predictors of meaning in life. Together the independent variables explained 24.3% of the variance of the purpose subscale, 26.2% of the variance of the coherence subscale, 14% of the variance of the choice/responsibleness subscale, and 44.1% of the total variance of the goal seeking subscale. Overall the independent variables explained 19.8% of the total variance of the total meaning in life.

SIGNIFICANCE OF RESULTS

The results in this study should increase the awareness of cancer care professionals about a range of the meaning in life and may help them to target particular patient groups for detail support interventions.

Global stress predicts both positive and negative emotional adjustment at diagnosis and post-surgery in women with breast cancer

OBJECTIVES

Individual differences in stress appraisal, coping, optimism and social support have contributed to variability in adjustment to breast cancer, but less is known about their relative influence particularly at diagnosis. The purpose of this study was to compare the predictive role of these variables on both positive and negative adjustment in a sample of recently diagnosed women.

METHOD

Data was collected from 241 women at diagnosis and post-surgery (4 months later). They completed questionnaires which assessed global and cancer-specific stress, general and cancer-specific coping, emotional adjustment (depression, anxiety, positive and negative affect) at Times 1 and 2 and benefit finding at Time 2.

RESULTS

Hierarchical regression analyses (all p < 0.01) taking account of age and cancer related variables (disease stage and type of surgery) showed that stress appraisal was the strongest and most consistent predictor of adjustment. The coping strategies, while significant, were less powerful predictors of emotional adjustment, but they explained more variance than stress on benefit finding. Stress and coping outweighed the impact of social support and optimism.

CONCLUSIONS

Global appraisal of stress was the most powerful predictor in the model, and findings suggest that it contributes to patients' affective status, indicating that women should be screened as part of the diagnostic process to identify those at risk for poor adaptation to the illness.

Meaning in life in palliative care patients

CONTEXT

The construct "meaning in life" (MiL) has recently raised the interest of clinicians working in psycho-oncology and end-of-life care and has become a topic of scientific investigation.

OBJECTIVES

The aim of this study was to compare MiL in palliative care (PC) patients with a representative sample of the German population.

METHODS

In this cross-sectional study, all PC patients treated in the PC inpatient unit and through the PC consult service at Ludwig-Maximilians-University Hospital, Munich, from May 2005 to July 2007 were eligible to participate. Patients were interviewed by a doctoral student, psychologist, or physician, all previously trained to administer the Schedule for Meaning in Life Evaluation (SMiLE) in a standardized way. In the SMiLE, respondents first list individual areas that provide meaning to their life before rating their current level of importance and satisfaction with each area. Overall indices of weighting (IoW, range 20-100), satisfaction (IoS, range 0-100), and weighted satisfaction (IoWS, range 0-100) are calculated.

RESULTS

One hundred PC patients completed the SMiLE: the IoS was 70.2 ± 19.7, the IoW was 84.7 ± 11.5, and the IoWS was 72.0 ± 19.4. The representative sample (n=977) scored significantly higher in the IoS (82.8 ± 14.7) and IoWS (83.3 ± 14.8) but not in the IoW (85.6 ± 12.3). Compared with healthy individuals, PC patients are more likely to list partner, friends, leisure, spirituality, well-being, nature/animals, and pleasure as meaningful areas. Examining the satisfaction ratings, it is noteworthy that PC patients' satisfaction scores are fairly high (and not lower than their healthy counterparts') in a number of domains: family, partner, home/garden, spirituality, and finances. On the other hand, they score significantly lower in nature/animals, leisure, friends, well-being, altruism, work, pleasure, and health.

CONCLUSION

These findings underscore the potential of the SMiLE for identifying areas that are particularly important to individuals, and that can be targeted by the PC team to improve overall life satisfaction at the end of life.

Spirituality and well-being in cancer patients: a review

OBJECTIVE

Cancer places many demands on the patient and threatens the person's sense of meaning to life. It has been shown that cancer patients use their spirituality to cope with these experiences. The present literature review summarizes the research findings on the relationship between spirituality and emotional well-being. Special attention is given to the strength of the research findings.

METHODS

A literature search was performed in Pubmed and Web of Science. Spirituality does not necessarily coincide with religiosity. Therefore, studies were excluded that focused on religiosity. Forty publications met the inclusion criteria: Twenty-seven studies that investigated the relationship between spirituality and well-being, and 13 publications that explored the relationship between meaning in life and well-being.

RESULTS

The majority of the cross-sectional studies (31 of 36) found a positive association between spirituality and well-being. The four studies with a longitudinal design showed mixed results. The significance of the findings is challenged, because most spirituality questionnaires contain several items that directly refer to emotional well-being.

CONCLUSIONS

Despite that the majority of the studies concluded that spirituality was associated with higher well-being, no definitive conclusions on this relationship can be drawn due to major methodological shortcomings of these studies. Longitudinal research utilizing spirituality and well-being measures that do not overlap in content is recommended.

Effects of global meaning and illness-specific meaning on health outcomes among breast cancer patients

Growing attention has focused on meaning-making processes and their health correlates among cancer patients. However, much of this work is marked by conceptual and methodological limitations. The current study evaluated global meaning and theoretically distinct aspects of illness-specific meaning (i.e., seeking sense, found sense, seeking benefits, found benefits) among breast cancer survivors who had completed primary treatment. Health outcomes (i.e., emotional distress, health-related quality-of-life) were assessed 4 months later. Different facets of meaning had different longitudinal associations with outcomes. Findings underscore the importance of distinguishing among conceptually discrete dimensions of personal meaning.

Measuring Meaning in Life in South Africa: Validation of an Instrument Developed in the USA

Investigations into the construct of meaning in life is an important focus area of psychological research. Research has consistently shown a sense of meaning in life to be a significant correlate of mental health and well-being. Most of this research on meaning in life is conducted worldwide with instruments developed in North America. However, inter-cultural measurement of psychological constructs is a concern, as psychometric instruments in one culture are not necessarily transferable to different cultures. In this case study, we examine whether the Life Regard Index (LRI), developed in the USA and a popular scale for measuring meaning in life, is transferable to a sample from South Africa. The results confirm the construct validity of the LRI, but indicate that the LRI's factor structure has changed and two of the original 28 items were not part of the covariance structure. From these results, we conclude that the LRI is transferable to the South African sample, but not irrespectively and without adjustments. It should be used as a one-dimensional instrument with only 26 items before applying it to the South African sample. The study provides evidence that LRI, which was developed in the USA and became a popular instrument for measuring meaning in life, cannot be transferred indiscriminately to a South African sample. This insight contributes to the quality of future research studies in South Africa, not only on the important aspect of life meaning, but also when applying other psychometric instruments developed elsewhere.

Spirituality as a core domain in the assessment of quality of life in oncology

OBJECTIVES

This study investigated including spiritual wellbeing as a core domain in the assessment of quality of life (QOL) in an Australian oncology population.

METHODS

Four hundred and ninety consecutive cancer patients with mixed diagnoses completed the Functional Assessment of Chronic Illness Therapy--Spiritual Well-Being (FACIT-Sp) and the Mental Adjustment to Cancer (MAC) scale.

RESULTS

Overall, 449 patients completed assessments. Spiritual wellbeing demonstrated a significant, positive association with QOL (r=0.59), fighting spirit (r=0.49) and a significant, negative relationship with helplessness/hopelessness (r=-0.47) and anxious preoccupation (r=-0.26). A hierarchical multiple regression showed spiritual wellbeing to be a significant, unique contributor to QOL beyond the core domains of physical, social/family, and emotional wellbeing (R(2) change=0.08, p=0.000). However, high levels of meaning/peace or faith did not appear to significantly impact patients' ability to enjoy life despite chronic symptoms of pain or fatigue, making the current results inconsistent with other findings.

CONCLUSION

Results lend further support to the biopsychosocialspiritual model. By failing to assess spiritual wellbeing, the 'true' burden of cancer is likely to be miscalculated. However, at this stage, the exact clinical utility of spirituality assessment is unclear.

Measures of spiritual issues for palliative care patients: a literature review

Members of the Quality of Life Group (QLG) of the European Organisation for Research and Treatment of Cancer (EORTC) are developing a stand-alone functional measure of spiritual well being for palliative care patients, which will have both a clinical and a measurement application. This article discusses data from a literature review, conducted at two time points as part of the development process of this instrument. The review identified 29 existing measures of issues relating to patients' spirituality or spiritual well being. Twenty two are stand-alone measures of which 15 can be categorised as substantive (investigating the substance of respondents' beliefs) and seven as functional (exploring the function those beliefs serve). However, perhaps owing to the lack of consensus concerning spirituality or spiritual well being, the functional measures all have different (although sometimes overlapping) dimensions. In addition, they were all developed in a single cultural context (the United States), often with predominantly Christian participants, and most were not developed with palliative care patients. None is, therefore, entirely suitable for use with palliative care patients in the United Kingdom or continental Europe.

Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator

BACKGROUND

Continuing symptoms and poor health following cancer treatments may alter meaning in life for cancer survivors. Gynecologic cancer survivors are particularly troubled with physical sequelae. In addition, for the most common sites of disease, such as breast and gynecologic cancers, the prevalence of depression is also high.

PURPOSE

This study tests meaning in life as a mechanism for the relationship between physical symptoms and depressive symptoms.

METHODS

Gynecologic cancer survivors (N = 260) participated. Measures of physical sequelae (nurse rated symptoms/signs, patient-reported gynecologic symptoms), meaning in life (harmony, life purpose, spirituality, and conversely, confusion and loss), and depressive symptoms were obtained at the time of a routine clinical follow-up visit 2-10 years following the completion of treatment. Latent variables were defined, and structural equation modeling tested a mediator model.

RESULTS

Analyses support partial mediation. That is, survivors with more physical sequelae also reported lower levels of meaning in life, which was associated with higher levels of depressive symptoms.

CONCLUSIONS

Gynecologic cancer patients have been neglected in psychosocial research, and findings highlight the importance of existential issues in their lives. While many adjust well, those with persistent physical functioning deficits may experience depressive symptoms. By appreciating the role of meaning in their experience, we may help survivors foster their own growth and perspectives important for their future.

Life goals and purpose in life in cancer patients

GOAL OF WORK

The purpose of the study was to analyze associations between life goals and purpose in life in cancer patients.

PATIENTS AND METHODS

A sample of 153 cancer patients was assessed before the start of chemotherapy and about 9 months later. Purpose in life was measured with a German version of Crumbaugh and Maholick's purpose in life test, and the perceived importance of social, psychological, materialistic, and health-related goals was assessed with Likert scales.

MAIN RESULTS

High importance of social, psychological, and health-related goals was related to higher purpose in life. In addition, having high levels of social goals at the first time of measurement predicted an increase in purpose of life over time. However, higher importance of material goals was associated with lower purpose in life at the second time of measurement and with a decline of purpose in life over time.

CONCLUSIONS

There is continuity and change in the sources of purpose in life during cancer therapy, and a lack of fit between goals and changed living conditions is a risk factor for a decline in purpose in life.

Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors

OBJECTIVES

Impairments in physical and social functioning are often associated with distress for the cancer survivor. Impaired functioning may also lead individuals to question previously held beliefs about meaning in life. Meaning in life was hypothesized to mediate the relationship between functioning and distress.

DESIGN AND METHODS

Two studies were conducted. In the cross-sectional study (I), cancer survivors (N=420) were accrued via the Internet and completed measures of social and physical functioning, meaning and distress. In the longitudinal study (II), breast cancer survivors (N=167) completed measures of functioning at 18 months, meaning at 24 months and distress at 30 months post-diagnosis.

RESULTS

In Study I, meaning in life was a significant, partial mediator for both of the effects of physical and social functioning impairments on heightened distress. In Study II, significant indirect effects of functioning impairments on distress through meaning were replicated even when functioning and distress were measured 1 year apart. The relationship of social functioning and distress was fully mediated by meaning in life, whereas the relationship of physical functioning and distress was partially mediated by meaning.

CONCLUSIONS

The negative social and physical sequelae of cancer are associated with heightened distress, and this association appears to be accounted for, in part, by patients' loss of meaning in their lives.

Strategies used in coping with a cancer diagnosis predict meaning in life for survivors

The search for meaning in life is part of the human experience. A negative life event may threaten perceptions about meaning in life, such as the benevolence of the world and one's sense of harmony and peace. The authors examined the longitudinal relationship between women's coping with a diagnosis of breast cancer and their self-reported meaning in life 2 years later. Multiple regression analyses revealed that positive strategies for coping predicted significant variance in the sense of meaning in life--feelings of inner peace, satisfaction with one's current life and the future, and spirituality and faith--and the absence of such strategies predicted reports of loss of meaning and confusion (ps < .01). The importance and process of finding meaning in the context of a life stressor are discussed.