Spirituality in gynecological oncology: a review

Faith and mental health in an oncology population

This study compares faith attitudes versus behaviors for their relationship to mental health in current cancer patients and survivors. This cross-sectional survey of ambulatory patients included Hodge's intrinsic religious motivation scale, Benson & Spilka's concept of God scale, frequency of prayer, and the mental health subscale of the MOS SF-36. One hundred and fifty-eighty patients, mostly women with breast cancer, completed questionnaires (92% return). Mental health was positively related to a concept of a loving God (P < .001) and negatively related to the concept of a stern God (P < .002). Mental health was unrelated to goal of treatment (cure vs. chemotherapy/palliation), frequency of prayer, intrinsic faith motivation, or physical pain. Viewing God as loving was strongly related to better mental health, even in the presence of a poor prognosis or pain.

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

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

Work related stress among gynecologic oncologists

OBJECTIVE

Up to one third of oncologists experience burnout. The objective was to determine correlates of work related stress in gynecologic oncologists (GOs).

METHODS

Using an online tool, we surveyed 273 members of the International Gynecologic Cancer (IGCS) Society (60% from North America) to examine demographic, psychological and spiritual correlates of work related stress (WRS) and burnout. Measures of death anxiety (DA) and locus of control (LOC) were also administered.

RESULTS

WRS did not correlate with religion, religiosity, race, or gender, but did correlate with DA (r=0.23, p=0.0006). WRS was also associated with younger age (p=0.01) and fewer years out of training (p=0.0286), higher scores on LOC Chance (r=0.18, p=0.007), higher scores on Powerful Other (r=0.30, p<0.0001), and lower scores on LOC Internality (r=-0.30, p<0.0001).

CONCLUSION

Responses from younger and less experienced GOs, correlate with higher WRS scores especially if their LOC is weighted toward chance and powerful others. Responses of GO's with these two characteristics also correlate with higher DA scores and reports of difficulty talking about death.

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.

The effects of religiosity, spirituality, and social support on quality of life: a comparison between Korean American and Korean breast and gynecologic cancer survivors

PURPOSE/OBJECTIVES

To examine the differences in religiosity, spirituality, and quality of life (QOL) between Korean American and Korean breast and gynecologic cancer survivors and investigate the effect of religiosity, spirituality, and social support on QOL.

DESIGN

Cross-sectional design.

SETTING

Participants were recruited from hospitals and community-based support groups in the areas of Southern California and Seoul, Korea.

SAMPLE

161 women diagnosed with breast and gynecologic cancer (110 Koreans and 51 Korean Americans).

METHODS

Participants completed a mailed questionnaire. To identify the QOL outcomes, religiosity, spirituality, and social support, four standardized measures were used.

MAIN RESEARCH VARIABLES

QOL outcomes, religiosity, spirituality, religious involvement, and social support.

FINDINGS

Religiosity and spirituality were related to some QOL outcomes in different patterns in Korean American and Korean breast and gynecologic cancer survivors. The effect on QOL, however, was not strong after controlling for covariates. Social support partially mediated the effect of spirituality on QOL but only among the Korean American cancer survivors.

CONCLUSIONS

The findings provide evidence that the effect of religiosity and spirituality on QOL varied between Korean American and Korean survivors. The mediating effect of social support between spirituality and QOL for Korean Americans also was demonstrated.

IMPLICATIONS FOR NURSING

The results present nursing practice and research implications that religiosity, spirituality, and social support need to be considered in developing services for enhancing QOL of immigrant cancer survivors.

Development of the palliative care needs assessment tool (PC-NAT) for use by multi-disciplinary health professionals

Needs assessment strategies can facilitate prioritisation of resources. To develop a needs assessment tool for use with advanced cancer patients and caregivers, to prompt early intervation. A convenience sample of 103 health professionals viewed three videotaped consultations involving a simulated patient, his/her caregiver and a health professional, completed the Palliative Care Needs Assessment Tool (PC-NAT) and provided feedback on clarity, content and acceptability of the PC-NAT. Face and content validity, acceptability and feasibility of the PC-NAT were confirmed. Kappa scores indicated adequate inter-rater reliability for the majority of domains; the patient spirituality domain and the caregiver physical and family and relationship domains had low reliability. The PC-NAT can be used by health professionals with a range of clinical expertise to identify individuals' needs, thereby enabling early intervention. Further psychometric testing and an evaluation to assess the impact of the systematic use of the PC-NAT on quality of life, unmet needs and service utilisation of patients and caregivers are underway.

Assessing the biopsychosociospiritual model in primary care: development of the biopsychosociospiritual inventory (BioPSSI)

OBJECTIVE

There is growing evidence in support of the Biopsychosociospiritual Model. However, a cohesive instrument to measure each dimension in terms of its dimension-specific symptoms and functional status does not exist, serving as an obstacle to future research in this area. The purpose of this study was to develop and validate an instrument to measure each dimension in terms of its dimension-specific symptoms, appraisals, and functional status in an unselected group of primary care patients.

METHOD

An instrument that assessed biopsychosociospiritual symptoms and function and health outcomes was administered to 289 patients attending two primary care clinics. Responses were analyzed using principal component factor analysis with Equimax rotation. This led to the development of five Biopsychosociospiritual Inventory scales (impaired functional status, physical symptoms, psychological symptoms, social symptoms, and spiritual symptoms). Demographic differences in mean scale scores were sought. In addition to internal consistency, construct validity was assessed based upon dimension-specific health care utilization, life satisfaction, and perceived health status.

RESULTS

All five scales had excellent internal consistency (alpha > 0.8) and construct validity. Differences were strongly related to income, marital status, and employment in a manner consistent with previous research.

CONCLUSIONS

This study developed and validated the Biopsychosociospiritual Inventory which could potentially provide a holistic estimate of the impact of disease and its treatment, support research in this area, and lead to the expansion of classification systems that include spirituality. Further validation of this instrument in other primary care sites using diverse patient populations as well as its function over time is needed.

A clinical interview assessing cancer patients' spiritual needs and preferences

We conducted a phase-I study to test the practicability and usefulness of a short (15-30 min) clinical interview for the assessment of cancer patients' spiritual needs and preferences. Physicians assessed the spirituality of their patients using the semi-structured interview SPIR. The interview focuses on the meaning and effect of spirituality in the patient's life and coping system. Visual Analogue Scales (VAS) and Questionnaires were completed following the interview for rating whether SPIR had been helpful or distressing, and to what extent spirituality seemed important in the patient's life and in coping with cancer disease. Thirty oncological outpatients who all agreed to participate were included. The majority wanted their doctor to be interested in their spiritual orientation. Patients and interviewing physicians evaluated the SPIR interview as helpful (patients mean 6.76 +/- 2.5, physicians 7.31 +/- 1.9, scale from 0 to 10) and non-distressing (patients 1.29 +/- 2.5, physicians 1.15 +/- 1.3, scale from 0 to 10). Following the interview, doctors were able to correctly gauge the importance of spirituality for their patients. Patients who considered the interview as very helpful (VAS > 7) were more often female (P = 0.002). There were no differences between patients who evaluated the SPIR as very helpful and those who did not, as far as diagnosis, educational level or belonging to a religious community were concerned. The present study shows that a short clinical assessment of cancer patients' spirituality is well received by both patients and physicians. The SPIR interview may be a helpful tool for addressing the spiritual domain, planning referrals and ultimately strengthening the patient-physician relationship.

Religion and Spirituality in Coping with Breast Cancer: Perspectives of Chilean Women

This study examined the roles of religion and spirituality in relation to coping with breast cancer in Chilean women. Specifically, the purpose of the study was to examine how these patients used religion and spirituality to cope with their illness; how their illness changed the roles of religion and spirituality in their lives; and their views regarding whether, and if so how, spiritual faith can help patients recuperate from breast cancer. Twenty-seven women with breast cancer who were patients at a clinic in Santiago, Chile were recruited to participate in one-on-one interviews. The transcribed interviews were analyzed using the "constant comparative method" to seek patterns and organize the content into specific themes. Women viewed religion and spirituality as primary resources for themselves and others to use in coping with breast cancer. Women's use of religion and spirituality was manifested in praying, in their perceived dependence on God to intercede and guide them through their illness, and in obtaining social support from other persons in their faith community. Half (13/26) of the women reported that their cancer prompted an increased emphasis on religion and spirituality in their lives by deepening their faith in God. Almost all (26/27) participants endorsed the belief that spiritual faith can help cancer patients to recuperate. These findings suggest that health care providers working should be aware of the culturally dependent roles that religion and spirituality play in women's coping with breast cancer.

Active coping mediates the association between religion/spirituality and quality of life in ovarian cancer

OBJECTIVES

This study investigated the role of religion/spirituality (R/S) and coping in quality of life (QOL) in 129 women immediately prior to a course of adjuvant chemotherapy for ovarian cancer.

METHODS

Participants completed the COPE, the Functional Assessment of Cancer Therapy-Ovarian (FACT-O), and the Systems of Belief Inventory-15R (SBI-15R). Women averaged 58.9 years of age (SD = 11.5) and were primarily Caucasian (86%), married (74%), and had received at least some college education (67%). Eighty-five percent of the participants had stage III or IV ovarian cancer at study entry.

RESULTS

Correlational analyses revealed that R/S was associated with active coping (r = 0.23, P = 0.022), overall QOL (r = 0.25, P = 0.012), emotional and functional well-being (r = 0.24, P = 0.014 and r = 0.28, P = 0.004), and fewer ovarian cancer-specific concerns (r = 0.27, P = 0.006). In addition, active coping was related to overall QOL (r = 0.22, P = 0.029) and social and functional well-being (r = 0.20, P = 0.042 and r = 0.33, P = 0.001). Tests of mediation between these variables suggested that the positive associations between R/S and functional well-being and R/S and overall QOL were mediated through the use of active coping.

CONCLUSION

Future studies are needed to better understand the complex relationships between R/S, coping, and QOL throughout the ovarian cancer treatment experience.

The contribution of spirituality and spiritual coping to anxiety and depression in women with a recent diagnosis of gynecological cancer

The objective of this study was to determine whether, after accounting for illness and demographic variables, spiritual involvement and beliefs and positive and negative spiritual coping could account for any of the variation in anxiety and depression among women within 1 year's diagnosis of gynecological cancer (GC). One hundred patients from outpatient GC clinics at two Melbourne-based hospitals completed a brief structured interview and self-report measures of anxiety, depression, spirituality, and spiritual coping. Using two sequential regression analyses, we found that younger women with more advanced disease, who used more negative spiritual coping, had a greater tendency towards depression and that the use of negative spiritual coping was associated with greater anxiety scores. Although not statistically significant, patients with lower levels of generalized spirituality also tended to be more depressed. The site of disease and phase of treatment were not predictive of either anxiety or depression. We conclude that spirituality and spiritual coping are important to women with GC and that health professionals in the area should consider these issues.