Spiritual well-being and demands of illness in people with colorectal cancer

Assessment of psychological distress in end stage renal disease: is it spirituality related?

Introduction

Patients undergoing hemodialysis (HD) are faced with bearing this burden and report poor mental health. Spirituality can be a key factor in managing these problems among HD patients.

Aim

This cross-sectional study aimed at exploring possible factors that are associated with psychological distress among HD patients and testing its relation to spirituality.

Methods

HD patients were recruited from six dialysis units in Greece. Psychological distress was assessed using the scale Symptom Check List 90-R and spirituality using the Facit Sp-12 questionnaire. In addition, a special design questionnaire regarding demographic, social, and clinical characteristic was administrated.

Results

According to the results, factors such age, gender, marital status and area of residence are associated with psychological distress, while dimensions of spirituality such Meaning in Life and Peace can have a positive influence on psychological distress.

Conclusion

This study highlights the vital role of spirituality, which can act as a mechanism for managing stressful situations. In particular, this study highlights the positive effect of the meaning and purpose of life, as well as the role of peace and harmony.

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

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

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

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

Quality of Life in Hospice Patients with Terminal Illness

To better understand quality of life (QOL) and its important correlates among patients with terminal illness, a cross-sectional correlational design was used in a study based on Stewart, Teno, Patrick, and Lynn’s conceptual model of factors affecting QOL of dying patients and their families. Sixty participants were recruited from two local hospice programs in the midwestern region of the United States. Data were collected at the participants’ homes. The participants had an above average QOL. Living with the caregiver, spirituality, pain intensity, physical performance status, and social support as a set explained 38% of the variance in their QOL. Among these five predictors, living with the caregiver, spirituality, and social support statistically were significant predictors of the QOL of these participants. Participants who did not live with their caregivers experienced less pain intensity, perceived higher spirituality, had more social support, and had a significantly better QOL. Important contributions of these findings are discussed.

Spirituality, Chronic Illness, and Rural Life

Purpose:The purpose of this article is to report the findings of an exploration of the associations among spirituality, hope, depression, social support, and well-being in rural dwelling people who have one or more chronic conditions. Method:A mail survey was completed by 111 rural-dwelling people with chronic illness in two rural western states. Findings:Spirituality, hope, depression, and social support had overlapping influence on well-being, although spiritualitywas not shown to have an independent effect. Participants reported unexpectedly high levels of hope and lowlevels of depression despite living with chronic illness. Conclusions:Although spirituality did not have an independent effect, the group as a whole had active spiritual and religious lives, possibly influencing the high levels of hope and low levels of depression found. Implications:The positive picture of rural people with chronic illness needs further investigation for possible mitigating effects of spirituality on problems associated with chronic illness.

LIFE QUALITY RELATED TO SPIRITUAL HEALTH AND FACTORS AFFECTING IT IN PATIENTS AFFLICTED BY DIGESTIVE SYSTEM METASTATIC CANCER

INTRODUCTION

Spiritual health is of the basic elements in chronic patients. This concept can be considered as an important approach in promoting physical & spiritual health & life quality.

GOAL

The present study has been planned aiming to study life quality related to metastatic phase gastrointestinal (digestive) cancer referring to Mazandaran Medical Science University Educational Center in Iran.

MATERIAL AND METHODS

This research has been done by descriptive-analytical method with 250 patients through available sampling method. The data has been collected via spiritual health & life quality questionnaire. The data analysis has been performed by calculating X², T Test, variance analysis and Pearson correlation coefficient.

RESULTS

The mean & standard deviation of the patients were 12.56 ±94/47. The highest relationship between age & spirituality was related to ages over 60. There was a meaningful statistical relationship between spirituality & life quality scale (p<0.001), between spirituality & respiratory disorder (p<0.047), anorexia (p<0.004), exhaustion (p<0.006), financial problems (p<0.006).

CONCLUSION

regarding the results, we can perceive the necessity behind improving spiritual health aspect as an influencing factor on the patients' life quality. Through enhancing spiritual beliefs, it is possible to help the patients' spiritual quality get promoted.

Psychosocial predictors of health outcomes in colorectal cancer: a comprehensive review

BACKGROUND

A diagnosis of colorectal cancer (CRC) and its long-term treatment may lead to significant psychological distress and impaired health-related quality of life (HRQoL) for a significant proportion of patients.

METHODS

We searched the PubMed/MEDLINE electronic database for available literature on the associations between personality characteristics, depression, psychological distress and HRQoL in CRC. Additional references were identified through the citation tracking of the included articles.

RESULTS

Recent evidence indicates that Type-D (distressed) personality may predict distress among CRC patients. Additionally, other personality traits, such as specific ego defense mechanisms, influence the coping responses and HRQoL. Although the presence of a stoma has been linked to the development of depressive symptoms and impairment in HRQoL in CRC patients, more prospective studies are necessary to confirm these associations. Sense of coherence (SOC) has both a moderating and mediating effect on health (especially mental health and HRQoL), and preliminary data indicate that SOC may be an independent predictor of CRC survival.

CONCLUSIONS

The interplay between personality variables during the elaboration of "the impaired role" is complex, and the assessment of personality traits may be incorporated into a comprehensive psychosomatic evaluation of CRC patients. More well-designed prospective investigations are necessary to establish the contributory role of personality dimensions for the development of and protection from distress and impairment in the HRQoL of CRC patients, which could eventually lead to the development of psychosocial interventions that are personalized to this patient population (for example, manual-based psychotherapies).

Relationship between mental health and spiritual wellbeing among hemodialysis patients: a correlation study

CONTEXT AND OBJECTIVE

The stress of living with a terminal disease has a negative impact on the mental health of hemodialysis (HD) patients. Spirituality is a potential coping mechanism for stressful experiences. Studies on the relationship between spirituality and mental health among HD patients are scarce. The purpose of this study was to evaluate the relationship between mental health and spiritual well-being among HD patients.

DESIGN AND SETTING

Cross-sectional observational study on hemodialysis patients at a single center in Brazil, between January and December 2011.

METHODS

Mental health was assessed using the General Health Questionnaire and spiritual wellbeing was assessed using the Spiritual Wellbeing Scale; 150 HD patients participated in the study.

RESULTS

A significant correlation was found between mental health and spiritual wellbeing (P = 0.001). Spiritual wellbeing was the strongest predictor of mental health, psychological distress, sleep disturbance and psychosomatic complaints.

CONCLUSION

Poor mental health was associated with lower spiritual wellbeing. This has important implications for delivery of palliative care to HD patients.

The Relation between Awareness of Cancer Diagnosis and Spiritual Health among Cancer Patients

INTRODUCTION

Disclosure of cancer diagnosis is one the main challenges in caring of patients with cancer since it may have negative effects on the spiritual health of patients. No study has ever been performed in Iran to investigate the relationship between awareness of cancer diagnosis and spiritual health in cancer patients. Therefore, the present study aimed to review the effects of awareness of cancer on spiritual health in patients with cancer.

METHODS

This was a descriptive-comparative study conducted in Shahid Ghazi Tabatabaei University Hospital in 2009. The subjects included 150 patients aware of their cancer diagnosis and 150 unaware patients. The patients were selected through convenient sampling method. Using a questionnaire, the patient's spiritual health was assessed. Data analysis was conducted in SPSS17 using descriptive and inferential statistics.

RESULTS

RESULTS showed the mean (SD) of spiritual health among aware and unaware patients to be 75.1 (3.8) and 75.4 (3.9), respectively. Statistically, there was no significant difference between the spiritual health of the two groups (p = 0.96).

CONCLUSION

These findings showed that awareness of cancer diagnosis had no effects on spiritual health of patients. It is not surprising considering Iranian culture. However, confirmation of this finding requires further studies.

Information needs across the colorectal cancer care continuum: scoping the literature

Because cancer care requires a multifaceted approach, providing useful and timely information to people with colorectal cancer may be fragmented and inconsistent. Our interest was in examining what has and has not captured the attention of researchers speaking to the information needs of people with colorectal cancer. We followed Arksey and O'Malley's framework for the methodology of scoping review. Focusing solely on colorectal cancer, we analysed 239 articles to get a picture of which information needs and sources of information, as well as the timing of providing information, were attended to. Treatment-related information received the most mentions (26%). Healthcare professionals (49%) were mentioned as the most likely source of information. Among articles focused on one stage of the care continuum, post-treatment (survivorship) received the most attention (16%). Only 27% of the articles consulted people with colorectal cancer and few attended to diet/nutrition and bowel management. This study examined the numerical representation of issues to which researchers attend, not the quality of the mentions. We ponder, however, on the relationship between the in/frequency of mentions and the actual information needs of people with colorectal cancer as well as the availability, sources and timing of information.

Meaning making: psychological adjustment to breast cancer by Chinese women

Based on a study exploring the phenomenon of coping among Hong Kong Chinese women afflicted with breast cancer, from diagnosis to completion of treatment, we report the findings on meaning making by the informants. Using the grounded theory method, we conducted 35 interviews with 24 women suffering from breast cancer. Among them, we followed and interviewed 5 women thrice, from diagnosis to 3 months after completion of treatment. We noted the evolution of reframing as the key category in the adjustment process through which the women identified meaning at different points of time in the cancer experience, to achieve different outcomes. Chinese women identified a sustaining force from minimizing social disturbance during treatment. The integration of cancer into their lives after completion of treatment was achieved through positive transformation in their philosophy of life and social relationships. Nurses should aim to understand the cancer patients' interpretation of the situation, explore personally meaningful sustaining forces, and reflect on their cancer experience.

Gender differences in quality of life among long-term colorectal cancer survivors with ostomies

PURPOSE/OBJECTIVES

To describe how gender shapes the concerns and adaptations of long-term (i.e., more than five years) colorectal cancer survivors with ostomies.

DESIGN

Qualitative study using content analysis of focus group content.

SETTING

Oregon, southwestern Washington, and northern California.

SAMPLE

Four female and four male focus groups (N = 33) selected from 282 quantitative survey participants with health-related quality-of-life (HRQOL) scores in the highest or lowest quartile.

METHODS

Eight focus groups discussed the challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis.

MAIN RESEARCH VARIABLES

HRQOL domains of physical, psychological, social, and spiritual well-being.

FINDINGS

All groups reported avoiding foods that cause gas or rapid transit and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality and intimacy. Coping and adjustment difficulties mostly were discussed by women, with men only discussing these issues to a small extent. Difficulties with sleep primarily were identified by women with low HRQOL. Problems with body image and depression were discussed only by women with low HRQOL.

CONCLUSIONS

Common issues included diet management, physical activity, social support, and sexuality. Although both genders identified challenges, women described more specific psychological and social issues than men.

IMPLICATIONS FOR NURSING

Application of these gender-based differences can inform educational interventions for colorectal cancer survivors with ostomies.

The central importance of spirituality in palliative care

The potential of spirituality to contribute to improving the quality of life of those experiencing life-threatening illness is yet to be fully realised in most palliative care settings. This may be due to many health professionals relegating spiritual issues to the background of palliative care instead of regarding spirituality as a domain equal to the physical, social, and psychological domains. The aim of this paper is to demonstrate, by reviewing the literature and providing examples from the author's personal experience as a chaplain, why spirituality should be considered on an equal footing with other key themes in palliative care, like relieving pain and advance care planning. It is hoped that this will create more self-awareness and generate greater discussion about the subject.

Psychometric properties of the Functional Assessment of Chronic Illness Therapy--Spiritual Well-being (FACIT-Sp) in an Arabic-speaking, predominantly Muslim population

OBJECTIVE

This study determined the psychometric properties of the Arabic Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp) Version 4 and explored associations between its three factors (Peace, Meaning, and Faith) and health-related quality of life (HrQoL) among Arab patients with cancer.

METHODS

A total of 205 Arabic-speaking, study-eligible cancer patients who were in treatment at the King Hussein Cancer Center, Amman, Jordan, completed the FACIT-Sp scale.

RESULTS

Cronbach's alpha reliability coefficients suggest that the Arabic FACIT-Sp is reliable and that moderate to strong correlations among subscales suggest validity. Correlation analyses showed that the 12-item Spiritual Well-being scale was associated with Social (r = 0.45, p = 0.01) and Functional Well-being (r = 0.48, p = 0.01). Hierarchical multiple regressions revealed that the Peace factor added 7.5% and the Meaning factor 3.8% to the prediction of HrQoL (p < 0.001). Faith did not significantly contribute to the unique prediction of HrQoL. Correlation analyses revealed that Peace was most prominently associated with the HrQoL subscale of Functional Well-being (r = 0.53, p = 0.01).

CONCLUSIONS

This first study of Arabic-speaking, predominantly Muslim Jordanian cancer patients using the FACIT-Sp indicates that it is a psychometrically sound instrument for detailed assessment of the spiritual well-being of Arabic-speaking cancer patients. The three-factor model appears to allow for discrimination among factors that are most highly associated with different aspects of HrQoL.

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.

An exploration of the status of spiritual health among nursing students in Taiwan

OBJECTIVE

Few studies have investigated the spiritual health of nursing students. The purpose of this study was to examine spiritual health in a group of senior nursing students in Taiwan, and to explore the factors that influenced the spiritual health of the group.

METHOD

This was a cross-sectional study. A total of 1276 senior nursing students were selected using a probability-proportional-to-size (PPS) procedure, and were asked to complete a self-administrated questionnaire that included a spiritual health scale (SHS) and a demographic profile.

RESULTS

All study participants were female with an average age of 20.1 years, and most reported a religious affiliation and participation in religious activities. Their spiritual health was moderate; and generally the study metric "connection to others" was the highest factor, and the metric "religion attachment" was the lowest. Certain demographic characteristics, including age, education level, aboriginal characteristic, level of religious devotion, and family atmosphere were predictors of spiritual health.

CONCLUSION

Nursing educators should be aware of the impact of spiritual health on nursing students, and should consider developing spiritual and religious education programs to enhance students' spiritual health and to nurture their ability to supply spiritual nursing care for patients.

Spiritual well-being and health-related quality of life in colorectal cancer: a multi-site examination of the role of personal meaning

PURPOSE

Individuals diagnosed and treated for cancer often report high levels of distress, continuing even after successful treatment. Spiritual well-being (SpWB) has been identified as an important factor associated with positive health outcomes. This study had two aims: (1) examine the associations between SpWB (faith and meaning/peace) and health-related quality of life (HRQL) outcomes and (2) examine competing hypotheses of whether the relationship among distress, SpWB, and HRQL is better explained by a stress-buffering (i.e., interaction) or a direct (main effects) model.

METHODS

Study 1 consisted of 258 colorectal cancer survivors (57% men) recruited from comprehensive cancer centers in metropolitan areas (age, M=61; months post-diagnosis, M=17). Study 2 consisted of 568 colorectal cancer survivors (49% men) recruited from a regional cancer registry (age, M=67; months post-diagnosis, M=19). Participants completed measures of SpWB (functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp)) and HRQL (functional assessment of cancer therapy-colorectal) in both studies. Measures of general distress (profile of mood states-short form) and cancer-specific distress were also completed in study 1 and study 2, respectively.

RESULTS

After controlling for demographic and clinical variables, faith and meaning/peace were positively associated with HRQL. However, meaning/peace emerged as a more robust predictor of HRQL outcomes than faith. Planned analyses supported a direct rather than stress-buffering effect of meaning/peace.

CONCLUSIONS

This study provides further evidence of the importance of SpWB, particularly meaning/peace, to HRQL for people with colorectal cancer. Future studies of SpWB and cancer should examine domains of the FACIT-Sp separately and explore the viability of meaning-based interventions for cancer survivors.

EXPLORING SPIRITUAL WELL-BEING AMONG SURVIVORS OF COLORECTAL AND LUNG CANCER

This descriptive, exploratory study is part of a larger observational study of the quality of cancer care delivered to population-based cohorts of newly-diagnosed patients with lung and colorectal cancer. The current study explores the role of spiritual well-being in adjustment to life after the cancer diagnosis, utilizing the Functional Assessment of Chronic Illness Therapy - Spiritual Well-being - Expanded (FACIT-Sp-Ex) Scale. Survey data collected from 304 newly-diagnosed cancer survivors were analyzed to explore important aspects of spirituality, such as sense of meaning in one's life, harmony, peacefulness, and a sense of strength and comfort from one's faith. Spiritual well-being scores, particularly meaning/peace, were statistically significant for African Americans, women and colorectal cancer survivors. These findings amplify a need for oncology social workers and other practitioners to assess spiritual well-being in cancer survivors in an effort to strengthen psychosocial treatment plans. Implications for social work practice and research are discussed.

Religious service attendance and spiritual well-being are differentially associated with risk of major depression

BACKGROUND

The complex relationships between religiosity, spirituality and the risk of DSM-IV depression are not well understood.

METHOD

We investigated the independent influence of religious service attendance and two dimensions of spiritual well-being (religious and existential) on the lifetime risk of major depression. Data came from the New England Family Study (NEFS) cohort (n=918, mean age=39 years). Depression according to DSM-IV criteria was ascertained using structured diagnostic interviews. Odds ratios (ORs) for the associations between high, medium and low tertiles of spiritual well-being and for religious service attendance and the lifetime risk of depression were estimated using multiple logistic regression.

RESULTS

Religious service attendance was associated with 30% lower odds of depression. In addition, individuals in the top tertile of existential well-being had a 70% lower odds of depression compared to individuals in the bottom tertile. Contrary to our original hypotheses, however, higher levels of religious well-being were associated with 1.5 times higher odds of depression.

CONCLUSIONS

Religious and existential well-being may be differentially associated with likelihood of depression. Given the complex interactions between religiosity and spirituality dimensions in relation to risk of major depression, the reliance on a single domain measure of religiosity or spirituality (e.g. religious service attendance) in research or clinical settings is discouraged.

Genetic testing for Lynch syndrome in the first year of colorectal cancer: a review of the psychological impact

An increasing number of patients with colorectal cancer (CRC) receive genetic counselling within 1 year after diagnosis. Little is known whether specific subgroups are more vulnerable for genetic testing related distress. A literature review was conducted to identify the psychological impact of CRC in the first year, and the additional impact of genetic testing. The electronic databases of PubMed, PsychInfo, Embase and the Cochrane Library were searched to identify all reports published between January 1997 and October 2007 on the psychological impact of (1) CRC-diagnosis up to 1 year after treatment and of (2) genetic testing for Lynch syndrome in patients with CRC. Studies on the psychological impact of genetic testing in newly diagnosed patient with CRC were not available. Either CRC patients diagnosed several years ago were studied and the focus was also often on the psychological impact of genetic testing prior to DNA-test disclosure. They show that limitations in emotional and social functioning can persist up to 1 year after CRC treatment, especially in those with a stoma or diagnosed before age 60. Female patients and male patients diagnosed before age 50 appear to be more vulnerable to genetic test-related distress. It is well known that being treated for CRC has great impact on psychological functioning. Little is known about the psychological impact during the first year after diagnosis and very little is known about the additional psychological effect of genetic testing for hereditary cancer in this period. We found presumptive evidence that specific subgroups of patients with CRC are more vulnerable for genetic-testing-related distress.

Characteristics of cancer patients in internet cancer support groups

The purpose of this study was to describe characteristics of cancer patients who were attending Internet cancer support groups and to provide direction for future research. A total of 204 cancer patients were recruited through Internet cancer support groups by posting the study announcement on the Web sites of such groups. The participants were asked to fill out Internet survey questionnaires on sociodemographic characteristics and health/disease status. The data were analyzed using descriptive and inferential statistics, including t tests, analysis of variance, and Chi-square tests. Findings indicate that cancer patients recruited through Internet cancer support groups tended to be middle-aged, well-educated, female, and middle class. The findings also indicate that there were significant differences in some characteristics according to gender and ethnicity. Based on the findings, some implications are suggested for future research using and developing Internet cancer support groups.

Experiences of Japanese Patients With Colorectal Cancer During the First Six Months After Surgery

PURPOSE/OBJECTIVES

To investigate the dynamic experience of patients who recently experienced the stressful situation of being diagnosed with colorectal cancer and undergoing surgery.

RESEARCH APPROACH

A qualitative and inductive inquiry.

SETTING

General hospitals in Japan.

PARTICIPANTS

12 patients who had undergone colorectal cancer surgery and had been discharged in the previous six months.

METHODOLOGIC APPROACH

To inductively elicit the findings from patients' real experiences, interviews and qualitative analysis were used.

MAIN RESEARCH VARIABLES

Experience of patients with colorectal cancer.

FINDINGS

Three domains that symbolized experiences of patients with colorectal cancer during the first six months after surgery emerged: types of burdens, steps in accepting the cancer diagnosis, and way of living a normal life. Burdens included vulnerability, lack of control, asking for assistance or support, and a "why has this happened to me?" attitude. Way of living a normal life included resisting vulnerability, constructing a daily living routine, and asking for help.

CONCLUSIONS

Although patients faced many and varied burdens, they were able to take several actions to gradually accept their cancer diagnoses and resume normal lives.

INTERPRETATION

Some of the patients were sincere and skillful in asking for help to live normal lives, but others found that difficult. The present findings are significant in helping nurses provide interventions to enable patients to make use of assistance or support.

Spiritual well-being and health

Data on empirical associations between religious variables and health outcomes are needed to clarify the complex interplay between religion and mental health. The aim of this study was to determine whether associations with health variables are primarily attributable to explicitly religious aspects of spiritual well-being (SWB) or to "existential" aspects that primarily reflect a sense of satisfaction or purpose in life. Three hundred forty-five pairs of twins from the Vietnam Era Twin Registry completed a diagnostic interview and questionnaires containing the 2-factor SWB Scale and general health items. Observed associations between SWB and health outcomes were uniquely explained by the SWB subscale of existential well-being, with much less of a unique explanatory contribution from religious well-being or "spiritual involvement." We concluded that studies of SWB and health should continue to distinguish between explicitly religious variables and others that more closely approximate the psychological construct of personal well-being.

The Degree to Which Spiritual Needs of Patients Near the End of Life Are Met

PURPOSE/OBJECTIVES

To determine to what degree the spiritual needs of patients near the end of life are met.

DESIGN

Descriptive.

SETTING

One inpatient and five outpatient hospices.

SAMPLE

62 female and 38 male hospice patients with a mean age of 67 years; 74% were dying from cancer.

METHODS

Each subject completed the Spiritual Needs Inventory and rated life satisfaction via the Cantril ladder.

MAIN RESEARCH VARIABLES

Spiritual needs and life satisfaction.

FINDINGS

Women, patients residing in a nursing home or an inpatient hospice unit, and patients with lower levels of education reported a higher number of unmet spiritual needs. Needs that could be met independently by patients and were not related to functional status were met at a higher rate than those that were dependent on others and on functional status.

CONCLUSIONS

Spiritual activities are important to patients who are near the end of life, but these patients may have a variety of unmet spiritual needs that depend on many factors, including the care setting.

IMPLICATIONS FOR NURSING

Nurses must recognize the importance of spirituality to patients near the end of life. Assessment for specific spiritual needs can lead to the development of interventions to meet those needs. Meeting patients' spiritual needs can enhance their quality of life.

Spiritual needs of persons with advanced cancer

Spiritual needs, spiritual distress, and spiritual well-being of patients with terminal illnesses can affect their quality of life. The spiritual needs of patients with advanced cancer have not been widely studied. This study assessed the spiritual needs of 90 patients with advanced cancer who were newly admitted to hospice home care. They completed a demographic data form and the Spiritual Needs Inventory shortly after hospice admission. Scores could range from a low of 17 to a high of 85; study scores were 23 to 83. Results showed great variability in spiritual needs. Being with family was the most frequently cited need (80%), and 50% cited prayer as frequently or always a need. The most frequently cited unmet need was attending religious services. Results suggest the importance of a focus on the spiritual more than the religious in providing care to patients at the end of life.

Spiritual Issues of Family Members in a Pancreatic Cancer Chat Room

PURPOSE/OBJECTIVES

To describe spiritual issues addressed by users of a pancreatic cancer informational Web site.

DESIGN

Qualitative, descriptive.

SETTING

The patient and family chat room of Johns Hopkins Hospital's pancreatic cancer Web site.

SAMPLE

600 postings on the pancreatic cancer Web site.

METHODS

Identification of categories and themes in Web postings using the constant comparison method of content analysis.

MAIN RESEARCH VARIABLES

Spirituality, relationship of the person posting a message (poster) to the person with cancer.

FINDINGS

Relationship of the poster to the person with pancreatic cancer was explicit in 68% (n = 410) of the 600 postings, and 83% of those 410 postings indicated that the poster was a family member. Issues of spirituality appeared in 19% (n = 114) of the 600 postings and addressed four themes: spiritual convergence, reframing suffering, hope, and acceptance of the power of God and eternal life. Six percent of postings were by family members reporting on the death of their loved ones, suggesting that the site also served a bereavement function.

CONCLUSIONS

Family members of patients with pancreatic cancer sought and received spiritual comfort in a variety of forms in an Internet-based cancer chat room.

IMPLICATIONS FOR NURSING

Nurse developers of cancer information Web sites should periodically assess how the sites are being used and apply the information to the refinement of the sites to better meet user needs. Further study is needed to develop and evaluate cancer Web sites as an evolving medium for providing spiritual support to family members of patients with life-threatening forms of cancer.

Development and Testing of the Spiritual Needs Inventory for Patients Near the End of Life

PURPOSE/OBJECTIVES

To develop and test an instrument to measure the spiritual needs of patients near the end of life.

DESIGN

Instrumentation methodology.

SETTING

One inpatient and five outpatient hospices.

SAMPLE

62 female and 38 male hospice patients with a mean age of 67 years; most were Caucasian, Protestant, and dying of cancer.

METHODS

Items for the Spiritual Needs Inventory (SNI) were developed from a qualitative study of spiritual needs of dying patients. Data were analyzed for internal consistency using Cronbach's alpha and item-to-total correlations and for content and construct validity using factor analysis.

MAIN RESEARCH VARIABLES

Spiritual needs and life satisfaction.

FINDINGS

The total scale alpha of the 27-item SNI was 0.81. Item-to-total correlations ranged from 0.07-0.65, resulting in seven items being eliminated. A principal component factor analysis with a promax oblique rotation was used to estimate content and construct validity. A total of 17 items comprised the five-factor solution. Cronbach's alpha for the revised SNI was 0.85.

CONCLUSIONS

The SNI is a valid and reliable measurement of spiritual needs of patients near the end of life. Further psychometric testing of this newly developed instrument is warranted.

IMPLICATIONS FOR NURSING

Nurses must recognize the spiritual needs of all patients, particularly those near the end of life. The SNI may be useful in the clinical setting as well as in future studies of spiritual needs of patients.

Three philosophical approaches to the study of spirituality

Since the turn of the century, there has been an expanded interest in the place that spirituality has in nursing practice, education, and research. The purpose of this article is to examine the study of spirituality from the perspective of 3 philosophical paradigms: empiricism, interpretivism, and poststructuralism. The strengths and weaknesses of the paradigms are identified through a review of an exemplar article for each. Each paradigm provides a unique approach to the development of knowledge, and thus makes its own contribution to the understanding of spirituality. It is the researcher's responsibility to identify the appropriate paradigm for the question.

Psychometric Testing of the Social Support Survey on a Taiwanese Sample

BACKGROUND

The Medical Outcomes Study Social Support Survey (MOS-SS) is a multidimensional, self-administered instrument used to assess various functional dimensions of social support. Less is known regarding its value for a Chinese population.

OBJECTIVE

The aim of this study was to assess the psychometric properties of the MOS-SS on an adult sample in Taiwan.

METHODS

A total of 265 adult family caregivers of patients with cancer from four different hospitals in the north, middle, and south regions of Taiwan completed the MOS-SS.

RESULTS

In the original five-factor model, unsatisfactory item discriminant validity was found in almost half of the items; the item-own subscale correlation was lower than the item-other subscale correlation. A two-factor model accounting for 68.98% of the variance was found using exploratory factor analysis. The first factor (emotional support) accounted for 62.28% of the total variance, whereas the second factor (tangible support) accounted for 6.7%; the interfactor correlation was .71. The two-factor model seemed to have satisfactory reliability and validity and better discrimination between different subscales than did the original five-factor model.

DISCUSSION

Good reliability and validity were demonstrated in the MOS-SS when applied to an adult sample in Taiwan. A two-factor model, instead of a five-factor model as found in the Western countries, was found for this sample. Confirmation of the two-factor model and exploration of the two-factor model in related concepts are suggested for future studies.

Relationships of age and gender to hope and spiritual well-being among adolescents with cancer

The purpose of this study was to examine hope and spiritual well-being, with its 2 dimensions of religious well-being and existential well-being, as they relate to age and gender among adolescents with cancer. A cross-sectional design was guided by the conceptual framework, Adolescent Psychosocial Adaptation to the Cancer Experience. A total of 78 adolescents with a diagnosis of cancer were enrolled from 2 pediatric oncology clinics. Middle adolescents (15-17 years of age) reported higher religious well-being than late adolescents (18-20 years of age). Middle-adolescent boys were more hopeful than were early adolescent boys (13- 14 years of age). Also, girls were more hopeful and reported higher spiritual well-being than age the boys. Developmental phase and/or gender may influence adolescents' levels of hope, spiritual well-being, religious well-being, and existential well-being as they cope during the cancer experience. The nurse should consider developmental phase and gender when planning interventions to foster hope and spiritual well-being in adolescents' adaptations to the cancer experience.

Salvaging their normal lives: a qualitative study of patients with recently diagnosed advanced colorectal cancer

PURPOSE/OBJECTIVES

To describe the experiences of patients living with newly diagnosed stage III or IV colorectal cancer.

RESEARCH APPROACH

Qualitative; inductive coding methods were used to identify open codes that were analyzed, compared, and grouped into categories.

SETTING

An urban ambulatory cancer center in the northeastern United States.

PARTICIPANTS

14 patients newly diagnosed with stage III or stage IV colorectal cancer.

METHODOLOGIC APPROACH

Semistructured interviews were recorded on audiotape. Interviewers asked participants to describe their experiences with the diagnosis and treatment of colorectal cancer. Content analysis with inductive coding was used to code the transcribed interview data. Categories were reviewed and organized into larger groupings, from which the core category was derived.

MAIN RESEARCH VARIABLES

Experiences of living with a diagnosis of colorectal cancer, impact on daily living, quality of life, coping strategies used, level of preparedness, and impact on children.

FINDINGS

The coded interview data yielded six domains: feeling life is disrupted, experiencing physicians, feeling unprepared for everything, rethinking parenting, wondering "why me?," and dealing with it. The core category that explained study participants' experiences with recently diagnosed colorectal cancer was "salvaging their normal lives."

CONCLUSIONS

The dominant experience of the study participants focused on four aspects of their illness experience: (a) framing it in ways that enabled them to recreate a semblance of normalcy or of their preillness state, (b) trying to tell children about the illness in stabilizing ways, (c) generating or maintaining a positive outlook no matter what, and (d) concretely managing the distress of the illness and its symptoms.

INTERPRETATION

Targeted assessment is important in the six dimensions of the study domains. Clinicians who work with patients with cancer should offer support as patients search for meanings to explain this potentially devastating life event. Teaching active coping strategies as patients with advanced cancer struggle to come to terms with the demands of the disease while attempting to live their lives as fully and as normally as possible is important.

Religion, spirituality and cancer: current status and methodological challenges

The role of religion and spirituality in health has received increasing attention in the scientific and lay literature. While the scientific attention to this issue has expanded, there continue to be methodological and measurement concerns that often prevent firm conclusions about health and adjustment benefits. Limited attention has been provided to the role of spirituality and religion in cancer. This is true when both disease outcome and adjustment are considered. A recent 'levels of evidence' review examining the link between physical health and religion or spirituality found little overall support for the hypotheses that religion or spirituality impact cancer progression or mortality. Studies examining their impact on quality of life and adjustment are decidedly mixed. In sum, research specifically focusing on the role of religion or spirituality on cancer outcomes has been surprisingly sparse. Such research presents a number of methodological and measurement challenges. Due to these unmet challenges in the literature to date, it is premature to determine what role religion and spirituality play in disease, adjustment, or quality of life outcomes in cancer. A number of suggestions are made for continued research in this area.

Spiritual struggle: effect on quality of life and life satisfaction in women with breast cancer

BACKGROUND

Women with breast cancer experience stressors affecting quality of life (QOL) and life satisfaction. Little is known about effects of spiritual struggle as a coping strategy on QOL and life satisfaction.

PURPOSE

Examine relationships between spiritual struggle, QOL, and life satisfaction.

METHOD

Nonprobablility sample of 100 participants recruited from an Internet Web site with mailed questionnaires. Three instruments were used: breast cancer-specific version of Functional Assessment of Cancer Therapy Scale (FACT-B), Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp-12) combined for QOL, Negative Coping subscale of Religious Coping (RCOPE) for spiritual struggle, and a single-item measuring life satisfaction.

FINDINGS

Small inverse relationships between spiritual struggle, QOL (r = -.36, p < .001), and life satisfaction (r = -.31, p < .001) existed.

CONCLUSIONS

Spiritual struggle gives voice to women's questionings implying lower QOL and life satisfaction.

IMPLICATIONS

Assessment of and assistance with managing spiritual struggle are necessary to promote QOL and life satisfaction among those facing difficult health problems.

Social Support as a Mediator Between Symptom Distress and Quality of Life in Women With Breast Cancer

OBJECTIVE

To examine relationships between symptom distress and quality of life when religious support and personal support were introduced as mediating variables.

DESIGN

Cross-sectional, correlational.

SETTING

Internet recruitment following university institutional review board approval.

PARTICIPANTS

Mailed questionnaires from 100 women with breast cancer, mean age 46, length of time since surgery 1 to 24 months, predominantly White.

INSTRUMENTS

Symptom Distress Scale, Religious Support Scale, FACT-B, and Facit-Sp-12.

RESULTS

Personal support was positively related to quality of life and partially mediated the effects of symptom distress. Religious support did not mediate symptom distress and was not directly related to quality of life.

CONCLUSIONS

Social support from family members and friends helped to decrease the negative effects of symptoms on quality of life. This study underscores the need to continue to assess for symptom distress and adequacy of personal support throughout the cancer trajectory and to facilitate the garnering of support resources when needed.

Life-Closing Spirituality and the Philosophic Assumptions of the Roy Adaptation Model

Secondary analysis of data from a previous study that referenced spirituality was coded, categorized, and grouped into themes. Life-closing spirituality for 44 (45.4%) of 97 total participants was shaped by a core theme ofbelieving that was central to dying persons. Believing was linked to six other themes: comforting, releasing, connecting, giving, reframing, and requesting. These themes supported the philosophic assumptions and principles of humanism and veritivity as defined in the Roy adaptation model.

Spirituality in gynecological oncology: a review

The following is a review of some of the work that has been published on issues related to definitions of spirituality and the many ways in which religious or spiritual concerns inform and can sometimes mold the relationships between gynecologic oncology patients, their physicians, and their health. Moreover, we have raised the question whether there is something specific or unique to the experience of women patients with reproductive cancers? Although it might seem clear to many of us that these patients are unique, it is hard to say exactly why. While there are differences between the various types of reproductive cancers, all share a common thread and all undermine the patient's identity as a woman. For oncologists, exploring the connection between the healing of the body and the healing of the spirit recognizes the comprehensive character of cancer treatment, and furthers the understanding that both physicians and patients share a knowledge that what patients lose in their battle with cancer is more than simply a medical life.

Men's experiences and their resources from cancer diagnosis to recovery

This study describes the experiences and resources of male cancer patients in Finland during the trajectory of their illness. A semi-structured interview schedule was used to collect data on falling ill with cancer, on periods of treatment (surgery, chemotherapy, radiation therapy), and on convalescence. The participants (n=8), aged 42-64 (mean=53) were interviewed in a clinic setting in connection with a check-up visit. The interviews were tape-recorded and transcribed for qualitative content analysis. The male cancer patients described their experiences through the illness trajectory in terms of suspicions, their encounter with cancer, and the cancer becoming a reality. During treatment, men described their experiences in terms of changes in body image, individual illness experiences, and new social roles. Men's experiences during the convalescence period included physical restoration, anxiety following treatment regimes, reflection, and social roles at transition. The results also indicated that men did not consider their status as a chronic one, but rather as a passing and relatively short stage in their life. Both intra- and extrapersonal resources were described: the former included body image and capacity, self-understanding, social situation, and psychological resources; and the latter wives, children, colleagues, health-care personnel, fellow patients, health-care interventions and society. Extrapersonal resources included informational, emotional, and evaluative support, as well as concrete help.

[Relationship between spiritual well-being and minor psychiatric disorders: a cross-sectional study]

OBJECTIVE

To assess the influence of spiritual well-being in mental health of college students.

METHODS

It was interviewed 464 medical and law students of Pelotas, Brazil. Data collection was carried out in groups in the school classroom, 43 absent students were not interviewed and represented a loss of 9.3% of the sample. It was used a self-reported questionnaire with three instruments: 1) Spiritual Well-Being Scale (SWBS), 2) SRQ-20, and 3) a precoded questionnaire with questions on sociodemographic data, religious/spiritual practices, and stressful life events. Statistical analysis was performed using Chi-square test and logistic regression.

RESULTS

Most of the students (80%) declared that they had a spiritual belief and/or religious denomination. The mean score of spiritual well-being was 90.4 with scores 45.6 and 45.1 in the existential and religious subscales, respectively. SWBS showed an association with religious practices, but it was not influenced by sociodemographic and cultural variables. Subjects presenting low and moderate spiritual well-being showed a doubled risk of presenting minor psychiatric disorders (MPD) (OR=0.42; 95%CI: 0.22-0.85). Subjects presenting low or moderate existential well-being showed almost five times more MPD (OR=0.19; 95%CI: 0.08-0.45).

CONCLUSIONS

The study reveals spiritual well-being as a protection factor for minor psychiatric disorders, and that the results were mostly due to the Existential Well-Being subscale.

Psychosocial needs in cancer patients related to religious belief

In a study of psychosocial needs amongst cancer patients, the possession of a religious faith has been identified as a significant factor in determining a range of psychosocial needs. Of the 354 respondents to a questionnaire, which included a comprehensive psychosocial needs inventory, 83% said they had a religious faith, and in general these patients were less reliant on health professionals, had less need for information, attached less importance to the maintenance of independence and had less need for help with feelings of guilt, with their sexuality or with some practical matters than those who said they had no religious faith. In addition, they had fewer unmet needs overall (32% compared with 52%). The knowledge of a patient's spirituality should help service providers to predict aspects of psychosocial need and to respond sensitively and appropriately to a patient's experience of cancer.

Spiritual coping mechanisms in chronically ill patients

Addressing spiritual needs is acknowledged as an essential component of holistic nursing care. Findings are emerging that suggest that chronic illness demands significant changes in patients' lifestyle. In such circumstances it is claimed that spiritual care can be therapeutic to patients (Cohen et al, 2000; Sherwood, 2000). This study was carried out in order to understand further the spiritual coping mechanisms of patients suffering from chronic illness. A qualitative methodology based on descriptive phenomenology was used to capture participants' lived experience. The main themes emerging from this study suggest that chronic illness led participants to use the following spiritual coping mechanisms: faith, prayer, and related sources of support. Patients coping with chronic illness were engaged in both a personal and private struggle. Patients may benefit from nursing interventions that are sensitive, supportive, and responsive to their spiritual needs.