ArticlePDF Available
9 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
Spiritual Problems of Women with Breast Cancer in Iran: A Qualitative Study
Received 31 Aug 2019; Accepted 14 Dec 2019
http://dx.doi.org/10.29252/jhsme.7.1.9
Zeinab Ghaempanah1, Parvin Rafieinia1* , Parviz Sabahi1, Shahrokh Makvand Hosseini1
, Nadereh Memaryan2
1 Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran.
2 Spiritual Health Research Center, Mental Health Department, School of Behavioral Sciences and Mental Health (Tehran Institute of
Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
Introduction
breast cancer diagnosis is often
realized as a traumatic and life-
changing event and a stressful
experience (1). Questioning one's
religious/spiritual beliefs and spiritual struggle
is one of the life challenges people face (2).
Being diagnosed with cancer, women feel
severe distress, encounter religious conflicts,
and cannot use meaning-making coping
strategies (3,4). Kamala Devi, M and Karis
Cheng Kin Fong (5) studied the spiritual
experiences of Singaporean women with breast
cancer in the first year of diagnosis. They
reported that spiritual needs are common and
Harrison et al. (6) documented patients
indicated through survey responses that they
had unmet spiritual needs. The spectrum of
spirituality encompassed spiritual despair
(alienation, loss of self, and dissonance),
spiritual practice (forgiveness, self-
exploration, search for balance), and spiritual
well-being (connection, self-actualization,
consonance). According to the World Health
Organization and the US National Quality
Forum, spiritual and religious dimensions of a
patient’s life should be considered in holistic,
multidimensional care (7,8). Based on the
structure of spirituality in Iran, it is defined as
A
Abstract
Background and Objectives: A developing body of evidence has demonstrated the detrimental effects of spirituality and
religion on the well-being of patients with cancer. This necessitates the need to explore the content of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-V (code 62.89). The present study aimed to identify the spiritual problems of Iranian patients
with breast cancer concerning their religious beliefs and cultures.
Methods: A qualitative content analysis with an abductive approach was used and data were gathered using individual semi-
structured interviews. The participants were selected by purposive sampling which continued until data saturation after 12
interviews. Data were analyzed using the Graneheim and Lundman thematic approach.
Results: The themes extracted from the data were “Questioning spiritual values” and “loss or questioning of faith”. The three
categories in the first theme included “Find spiritual cause of illness”, “Question God's justice”, and “Deal with God”. Moreover,
“Lack of intimacy with God”, “Giving up rituals” and “Losing religious faith” were the categories of the second theme.
Conclusion: As evidenced by the obtained results, awareness of religious/spiritual problems of the patients with breast cancer
may be of great help to healthcare professionals to manage the patients who need a referral, further assessment, and appropriate
intervention. In addition, the assessment of spiritual/ religious problems is of paramount importance in designing cultural and
spiritual care and interventions.
Keywords: Spirituality, Religion, DSM-V, Breast cancer.
Original Article Health, Spirituality and Medical Ethics. 2020;7(1):9-15
Please Cite This Article As: Ghaempanah Z, Rafieinia P, Sabahi P, Makvand Hosseini Sh, Memaryan N. Spiritual
Problems of Women with Breast Cancer in Iran: A Qualitative Study. Health Spiritual Med Ethics. 2020;7(1):9-15.
This is an open-access article distributed under the
terms of the Creative Commons Attribution-Non
Commercial 4.0 International License
*Correspondence: Should be addressed to Ms. Parvin
Rafieinia. Email: p_rafieinia@semnan.ac.ir
Ghaempanah Z, et al
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 10
“the noble dimension of human existence
which all humans have been endowed to
follow the path of transcendence that is
proximity to God” (9). There is an increasing
interest in the role of spirituality as a part of
well-being and supportive care of patients with
cancer (10-12). A growing body of evidence
documented that spirituality can play a leading
role in healing and quality of life (4,13) since
spirituality confers inner power, tranquility,
welfare, and wholeness and influence the way
people cope with cancer (13-15). Although
race, culture, and personal experience may
affect the expression of spirituality, everyone
has their unique interpretation of spirituality
(16).
Despite the importance of spirituality in
patients with cancer (17) as a coping strategy
(Whether positive or negative) (18), there is a
paucity of studies on negative spiritual
experiences of women with breast cancer.
Furthermore, women's perception of
spirituality and their cancer experience has
implications for long-term mental health and
coping (19). The majority of studies have
explored cancer patients' spiritual needs or
distress (5, 20), While the content of them is
underestimated. According to the American
Psychiatric Association and Diagnostic and
Statistical Manual of Mental Disorders (DSM
5), recognizing and understanding spirituality
in the cultural texture of society is pivotal to
the provision of culturally appropriate care
(21). To this end, it is of utmost importance to
identify the spiritual problems of patients
according to their religious beliefs and culture
(22). Furthermore, the present study was
targeted at exploring the spiritual problems of
women with breast cancer.
Methods
Qualitative content analysis with an
abductive (combined) approach was used to
identify the spiritual problems of women with
breast cancer (23) under the ethical code:
IR.IUMS.REC.1398.489). Consolidated
criteria for reporting qualitative research
(COREQ): a 32-item checklist was applied to
describe the research methodology (24).
Purposeful Random Sampling was used in
the current study. The inclusion criteria
entailed: 1) taking chemotherapy therapy for at
least 6 months, 2) breast cancer stages of 0-3,
3) age range of 30-65, and 4) ability to speak
and communicate in Persian. On the other
hand, the exclusion criteria included: 1)
psychotic or bipolar disorders, 2) intrusive
suicidal thoughts, and 3) current drug abuse.
Patients were recruited from the Hematology
and Oncology Department of Rasoul-e-Akram
Hospital in Tehran. Audio-recorded interviews
were conducted from August 2018 until
February 2019. Table 1 demonstrates the
demographic characteristics of the participants.
All interviews were conducted by the first
author who was trained in conducting
qualitative studies (items 1-5 in COREQ
checklist). The patients were provided with
research subject, objectives, and identity of the
researchers. Subsequently, the researcher fully
explained the study procedure to all those who
agreed to participate and informed consent was
obtained from all of them (6-8 in COREQ
checklist).
Data were collected by individual semi-
structured with the stance of friendship
interviews. The interview guide was designed
for the study. It was based on reviewing texts
and consulting three spiritual care experts.
Open-ended questions were crafted to gather
the patients’ problems about spirituality and
challenges they face concerning
religious/spiritual values, as well as coping
Table 1. Demographic characteristics of patients
Patient
code
Age
Educational
level
Religion
Employment
status
Marital
status
1
53
Secondary
Islam
Housewife
Married
2
30
Bachelor
Islam
disabled
Single
3
45
Associate
degree
Islam
disabled
Married
4
32
Diploma
Islam
Housewife
Married
5
40
Secondary
Islam
Housewife
Married
6
56
Associate
degree
Islam
Employee
Married
7
51
Diploma
Islam
Housewife
Married
8
39
Associate
degree
Islam
Housewife
Married
9
48
Primary
Islam
Housewife
Married
10
56
Secondary
Islam
Housewife
Married
11
65
Primary
Islam
Hairdresser
Married
12
57
Diploma
Islam
Teacher
Divorced
Spiritual Problems of Women with Breast
11 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
with cancer. Some general questions were
proposed to start the interview process, and the
interview was based on self-response. Sample
questions entailed: “Have you experienced any
change in spiritual/religious issues after being
diagnosed with cancer? “How do you
evaluate yourself on religion/spirituality now?”
“What are the effects of this illness on your
religious/spiritual beliefs?” “Is the cause of
your illness related to spiritual/religious
issues?” “Do you perform religious or spiritual
practices? Are they affected by the illness?”
To ensure that the questions were clear for
patients and study purpose is fulfilled, the
guide was reviewed after the first several
interviews. In this regard, some questions were
added, for instance: “What effect do you think
this disease has on your meaning in life?” “Did
you complain to God during your illness?”
“How is your relationship with God?” More
detailed questions about their feelings and
thoughts along with exploratory ones were also
asked (e.g., "Can you explain more about
this?"). It is worthy to note that given the
stance of friendship interviews, the researchers
expressed empathy for the feelings of patients.
In this respect, if the patient became disturbed
or sad while expressing her experiences, the
interview process ended with positive notes.
For instance, the patient was asked to describe
the advantages of this illness, summarize the
experience of her illness that can be instructive
for others, and describe her plans for recovery
and discharge.
The patients were interviewed in the time and
place convenient to them. The interviews
lasted within 35-70 min, with 50 min being the
average. The sampling continued until data
saturation was achieved when no new data
were emerging. After the conduction of 12
interviews, no new code was developed for
creating categories and themes; however, two
additional interviews were administered (17-22
in COREQ checklist).
All transcribed interviews were reviewed,
coded, and immediately analyzed. A
conventional content analysis, followed by
Graneheim and Lundman's method, was used
for data analysis (23). Firstly, each interview
was thoroughly read to get a sense of the
overall content and an accurate perception of
the statements. Meaning units were extracted
from the interview texts and condensed into a
description of their manifest and literal content
and an interpretation of their latent content.
Subsequently, the meaning units were
condensed and initial codes were generated.
The categories were abstracted based on the
content similarities of codes available in the
descriptions and interpretations.
The researchers of the present study reflected
on the categories and revised them before the
whole text was analyzed. The fifth author read
one-third of the interview texts and checked
the codes and categories. Through a process of
reflection and discussion, the authors agreed
upon a set of themes. On a final note, the
categories were reflected on and seemed
related to DSM-5 which includes a new V
code entitled "Religious or Spiritual Problem":
Given that V code focuses on religious or
spiritual problems, it was considered relevant
headings would unify the categories to themes.
The initial content of interviews and analysis
was not reviewed by the patients; however, the
researcher took her notes and comments into
account after each interview. All processes
were performed by one person who spent an
extensive amount of time on data collection
and analysis. Manual data management was
used and no software was used for data
analysis. Direct quotations of interviews are
provided in the results section to clarify codes,
categories, and themes (items 2332 in the
COREQ checklist).
Lincoln & Guba's trustworthiness criteria
were used to evaluate the credibility,
dependability, conformability, and
transferability of the obtained data (25).
Credibility was realized through sufficient
cooperation and interaction with the patients,
prolonged involvement, and immersion in the
subjects. Transferability and dependability
were insured by correcting any error made by
the external supervisors and arriving at a
consensus. The researchers were provided with
the research details to decide on the
application of the findings. Triangulation of
data resources was performed to review the
opinion of experts (psycho-oncologist,
Ghaempanah Z, et al
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 12
chaplain, and oncologist) through interviews.
In addition, opposed evidence for a
comprehensive description of subjects was
confirmed by purposeful sampling on
individuals with positive spiritual coping
strategies.
Result
The analysis of data revealed that women
with breast cancer lose or question their faith
and spiritual values. The themes are presented
below, and illustrative codes for each can be
found in Table 2.
Theme 1: Questioning spiritual values
Most of the women in the present study
pointed to how spiritual values have been
questioned following the breast cancer
diagnosis. They seek spiritual causes for their
illness and question God's justice.
Patients explain the cause of their cancer
concerning God and seek a spiritual reason,
and check their religious practices to find some
spiritual lapses that led to this illness. Women
asked the question “why me?” and declared
that God’s will or God’s punishment was
effective. They believed that God was testing
their faith or saw their suffering as retribution
for the sins of their past life. In this regard,
participant#1 said: “I used to think that sinners
get cancer; however, I was diagnosed with this
illness and it was a blow to me. I did not hurt a
soul. Why did I get this disease? I am still
wondering why God did this to me”. Not only
did they expect their good deeds to protect
them from illness, but also they were waiting
for rewards, the lack of which has been
challenging to them. They had gone through
hard times in the past and being diagnosed
with breast cancer seemed a miscarriage of
God’s justice. Patient #6 explained: “I
shouldered the responsibility of the whole
family. I cried out to God why he gave this
terminal disease to me and complained to
him”. When their illness-centered prayers are
not answered, they lose their trust in God.
Participant # 7 said in this regard: “I prayed so
much, went on pilgrimage, and pledged for a
negative pathology. However, God liked me
this way”.
Theme 2: loss or questioning of faith
Participants pointed to isolation and
disconnection as the primary result of a
spiritual problem. Lack of intimacy with God,
giving up rituals, and losing religious faith was
reported to be an unmet experience for these
patients.
Having experienced cancer, patients reported
a troubled spiritual relationship and detached
themselves from God. Some were even
annoyed at God, avoided him and even lost
their friendly and intimate spiritual
relationship. Patient #11 asserted: “I had a
close and friendly relationship with God and
constantly remembered him. Nonetheless, this
disease took its toll leading to the breakdown
of our relationship”. Breast cancer sufferers
expressed religious uncertainty and doubt,
challenged their past beliefs and religious
values, and even discontinue the religious
rituals since they were not meaningful to them
Table 2. Themes, categories, and codes
Themes
Categories
codes
Questioning spiritual values
Find the
spiritual
cause of
illness
Question God's purpose of illness
Why me?
Challenge God’s retribution
Non-sinful cause of illness
Test of Faith with cancer
Compensation for sins with illness
Question the
justice of
God
Lack of eligibility for illness
Review the past difficulties in life
Lack of God 's fairness
Being oppressed
Blamed God for the disease
Deal with
God
Safety expected of disease
Pray for health
Waiting for rewards
Health in exchange for prayer
Recovery for worship
loss or questioning of faith
lack of
intimacy with
God
Abandonment by God
Anger at God
Negative image of God
Blaming God for experiencing cancer
Relinquishing
rituals
Leaving religious communities
Regarding religious practices and
worship as ineffective
Reluctance to perform usual religious
practices
Giving up prayer
Failure to observe religious practices
Separation from religious gatherings
Loss of
religious faith
Verbalized inner conflicts about
religious beliefs
Conflicts between religious beliefs
Doubt about religious values
Shaken faith
Question religious values
Nonreligious beliefs
Spiritual Problems of Women with Breast
13 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
anymore. Some even left the religious
community or maintained distance from
religious gatherings they attended before.
Their faith is sometimes shaken to the point
that they give up prayers. Patients #8 reported:
“After this disease, I gave up prayer since I
lost my trust in God”. Participant # 9 claimed
that “There exist no God, Prophet, and Imams
in the world. If they even existed, I would not
believe them.
Discussion
As illustrated by the results of the current
study, questioning spiritual values and losing
or questioning faith are the most
spiritual/religious problems posed to breast
cancer patients. To make matters worse, these
problems get intertwined while being
simultaneously in contact with each other.
These results were in accordance with spiritual
problems in DSM 5 (V code 62.89). The first
theme consisted of three categories, including
the search for a spiritual cause of disease,
questioning divine justice, and dealing with
God. Since breast cancer sufferers held God
responsible for their sufferings, they blame
God by asking why me? Why now? Although
these ‘why’ questions have been addressed in
previous studies (26-28), the content of God-
oriented questions was illustrated in this
research. God's plan for testing patients' faith
or punish them is the sensible answer to most
of these questions. Nonetheless, cancer
sufferers consider this contrary to God's
righteousness and promises. In this regard,
affliction with this disease seemed unfair to
several women with hard times in life. This
problem and such a spiritual perception of the
disease leads to spiritual crisis and discontent
(29) which can be explained by passive
spiritual resources reported by Holt et al. (30).
They indicated that patients consider God's
will as a cause of illness and recovery. They do
not have a specific role, and through this,
attribution adapts to stressful situations.
Another result related to this theme is
contrary to the expected outcomes of religious
practices. Patients expected protection from
daily prayers, reading scriptures, and
attendance at religious services. They used a
variety of religious and spiritual practices in
order to prevent diseases or promote healing;
nonetheless, the desired outcomes were not
bestowed on them by God (31). Taylor et al.
suggested that patients performed religious
rituals with specific purposes, such as health,
and questioned the existence of God after
being diagnosed with cancer (32). In the same
vein, in the study conducted by Jors et al.,
disease-centered prayer was the most common
after the diagnosis of cancer (14). Gall et al.
regarded these challenges as the coping
strategies to find meaning in disease which
ultimately leads to spiritual growth (33).
However, the anger at God and the
simultaneous mobilization of the spiritual and
religious powers for healing leads to internal
conflicts in the patient, which creates more
frustration and spiritual challenges (33).
The second theme of this study is loss or
questioning of faith with three categories,
including lack of intimacy with God,
relinquishment of religious rituals, and losing
religious faith. Being diagnosed with breast
cancer, women in this study lost their inner,
sincere, and friendly relationship with God,
and started blaming him. They were reluctant
to talk to God and lost their hope and trust in
God which was consistent with the argument
of Penson et al. They suggested that the pain of
the disease may take its toll on the patients and
distort the spiritual relationship (26).
Therefore, the patients avoid God since they
regard him as the source of all their sufferings
(34). Having lost their love of God, they feel
isolated and lonely (31,35). In the present
study, the patients stated that they did not
adhere to their past religious beliefs, doubted
the existence of God, and were confronted
with spiritual questions, especially in painful
situations. These findings confirmed the results
of previous studies concerning spiritual
struggles (4,34-36). This change in patients'
attitudes is accompanied by the abandonment
of previous religious and ritual practices.
Cancer poses challenging questions about the
benefits of religious practices which can exert
adverse effects on spiritual beliefs.
Researchers reported that religious struggles
affect rituals and the discontinuity of religious
Ghaempanah Z, et al
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 14
practices might make it more likely (11,37).
The findings of this category were in line with
the research carried out by Salsman et al. In
the mentioned study, the spiritual and religious
dimensions of cancer patients were categorized
as emotional, behavioral, and beliefs which
affect each other (12). Pargament noted that
stressful events in life, such as cancer, could
challenge people's spiritual beliefs and lead to
spiritual disruption (2). Therefore, the negative
attitude to God and spiritual challenges are
considered red flags for these patients and
threaten the quality of life of affected women
(38). It is noteworthy that negative religious
coping is associated with lower life
satisfaction, distress, and depression among
patients with cancer and predicted suicide (37).
Limitations of the study
Every study has some limitations that should
be addressed in the paper. One of the
limitations of this study was the purposeful
sampling method. Therefore, the
generalization of the findings should be carried
out with caution. Since the statistical
population of the present study included
women with breast cancer in Tehran (22), the
generalizations of the research may be affected
by cultural differences among different ethnic
groups in Iran. Despite these limitations, the
results of the present study provide some
promising areas for future research.
Most importantly, longitudinal studies are
required to investigate how various aspects of
spiritual problems affect short- and long-term
quality of life in different stages of breast
cancer among women. Longitudinal research
will be also of great help to determine the
adaptive and maladaptive aspects of these
problems. Finally, based on these results,
health care providers should assess and attend
to the spiritual problems of patients, especially
in a stressful situation, since such factors may
have implications for adjustment.
Conclusion
The findings of the present study highlighted
the spiritual problems posed to women in the
face of breast cancer. They hold God
responsible for their cancer and seek the
spiritual cause of the disease. The tone of their
voice demonstrated that cancer is unfair and
opposed to fairness of God which conflicts
with their religious beliefs. They questioned
their religious values and relinquished
religious practices which were previously
important to them. Researchers and therapists
need to turn their close attention to these
problems from the beginning of the process of
cancer diagnosis and treatment since these
problems may lead to a lower quality of life
and poorer health outcomes. These patients
need emotional support and care from
clinicians and nurses along with their treatment
process and spiritual care providers should
attend to patients’ spiritual problems.
Conflict of interest
The authors declare that they have no conflict
of interest regarding authorship, and/or
publication of the current article.
Acknowledgements
Our deepest appreciation goes to all the
women who kindly participated in the present
study, as well as Spiritual health research
center of Iran University of medical sciences
for supporting this project. In addition, we
extend our gratitude to Shareda Hosein,
Octavio Areas, Peery Brent, and Chenene
Layne for their invaluable scientific support.
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... Spirituality can be viewed as a universal quality by which people search for hope and purpose in their lives, and it can be one factor in determining an individual's health . Spiritual values, including doubting God's justice, thinking that God punishes people in specific ways, thinking that life is pointless, and doubting one's purpose in life are lacking in breast cancer patients (Ghaempanah et al., 2020;Marita et al., 2018). Many studies have shown that people often seek spirituality to deal with the disease. ...
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Introduction: Breast cancer patients frequently experience spiritual discomfort due to the disease, its diagnosis, and its repercussions. When end-of-life patients’ spiritual needs are not adequately served, they are forced to deal with an overall burden of daily distress and anxiety that affects their emotional and spiritual health. Several studies indicate that, when coping with cancer, people frequently turn to spirituality. Spirituality and religiosity have been associated with less depressive symptoms, enhancing well-being throughout cancer treatment and in cancer survivors. This study sought to characterize the spiritual health of breast cancer patients (religious well-being and existential well-being). Methods: A descriptive observational study design was used, and the population of this research was breast cancer patients at the public hospital. The sample total of this research was 104 respondents. The samples were chosen using non-probability sampling with a purposive sampling technique. Spiritual well-being as a variable was measured using the spiritual well-being scale. Data were then analyzed for categorization into less, enough, and good, expressed in frequencies and percentages. Results: The result of this research shows that good religious well-being with a total of 63 (60,6%) and existential well-being enough with a total of 56 (53,8%). Conclusions: This study demonstrates the responder’s good existential and religious well-being categories. Palliative care can be added to medical therapies and programs to promote spiritual well-being, such as spiritual counseling, meditation, and dhikr therapy, which can be helpful for patients with breast cancer. Keywords: breast cancer; existential well-being; religious well-being; spiritual well-being
... Consolidated criteria for reporting qualitative research (COREQ) were applied, which consisted of a 32-item checklist to describe the research methodology (Braun et al., 2019). The interview design was based on reviewing texts, extracting problems from previous research (e.g., Ghaempanah et al., 2020), and consulting three spiritual care experts. Interview topics and questions regarding religious/spiritual problems in women with breast cancer (see Appendix) were formulated based on the researchers' discretion. ...
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Breast cancer may be associated with religious/spiritual problems for women. This multimethod qualitative study aims to show the components of religious/spiritual intervention strategies in breast cancer cases in Iran. The religious/spiritual intervention strategies were arranged according to the patient’s religious/spiritual problems based on the proposed tree diagram. This working model includes answering questions regarding the religious/spiritual cause(s) of the disease; distinguishing between divine justice and getting sick; describing the patient’s attitude toward God and its effect on viewing the disease; explaining the patient’s feelings and emotional relationship with God; identifying weakened religious/spiritual beliefs and replacing them with accepted beliefs; and using daily practices to communicate with God. Implications of the findings and usefulness of this model are discussed. Spiritual care providers can use this model to provide religious/spiritual care services to Iranian Muslim women with breast cancer.
... Some of these studies have been conducted in many years ago or carried out in a limited time period after the diagnosis and treatment of BC [20]. Some other studies have been conducted with different qualitative methods [21,22], either on the positive aspects of life changes [23] or spiritual aspects [24] or facing the feeling of pity [25], or receiving support [25,26] and finally, the problems related to childbearing age in BC survivors [27]. Therefore, given the rapid and significant advances in BC diagnosis and treatment methods in recent years, as well as considering the particular cultural context of Iran, a qualitative study that explores all aspects of BC coping strategies in Iranian women seems necessary. ...
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Background: Breast cancer is the most frequent cancer in Iran. Understanding the coping strategies employed by cancer survivors can provide valuable information for designing interventions to help them adapt to the problems produced by cancer and its treatment. This study aimed to explore the coping strategies of BC survivors in Iran. Methods: This qualitative study was conducted in Mashhad, Northeast Iran, between April and December 2021. Fourteen BC survivors were selected through purposive sampling. The data were collected using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim & Lundman. MAXQDA 12 software was used for data organization. Components of trustworthiness, including credibility, dependability, confirmability, and transferability, were considered. Results: The main categories that emerged from the participants' data analysis were "behavioral coping strategies" and "emotional coping strategies." Behavioral coping strategies included efforts to adopt healthy nutrition, attempts to improve a healthy lifestyle, maintenance of everyday activities, use of specialized cancer support consultation services, and seeking to increase health literacy about BC. The emotional coping strategies consisted of denial as a temporary escape route, positive thinking and focusing on the positive aspects of life, reinforcement of spirituality, and seeking the support of relatives. Conclusion: Our findings provide an in-depth understanding of Iranian women’s strategies for coping with BC. A trained team of oncologists, psychiatrists, mental health professionals, and reproductive health specialists needs to contribute significantly to improving the coping ability of patients with cancer, which could lead to enhanced health promotion and a higher quality of life.
... In Iran, >99% of the population is Muslim; thus, spiritual and religious issues overlap and greatly interact [4]. Spirituality is the search to find the greatest meaning in life and closeness to the source of existence [5]. Religion structures such a search by drawing the place of religious authorities, shaping social networks, certain customs, valuing works, encouraging collective participation, and so on [6]. ...
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ndividuals encounter unprecedented critical conditions globally. The Coro navirus Disease 2019 (COVID-19) has spread worldwide [1]. In addition to biopsychological health, this crisis has affected other areas of human life, like the spiritual health of individuals [2]. This issue can be of great importance because spiritual issues are closely related to general health, and especially mental health among individuals [3]. In Iran, >99% of the population is Muslim; thus, spiritual and religious is sues overlap and greatly interact [4]. Spirituality is the search to find the greatest meaning in life and closeness to the source of existence [5]. Religion structures such a search by drawing the place of religious authorities, shaping social networks, certain customs, valuing works, encouraging collective participation, and so on [6]. Due to this overlap, damaging these structures during the CO VID-19 pandemic may create a kind of spiritual crisis. How did the coronavirus create a spiritual crisis? Some aspects of this crisis include the following: 1. We can consider religious spirituality in the Iranian society as hierarchical; with important holy places and houses of religious leaders at the top; and religious pub lic meetings at the bottom, as well as mosques and Hus seiniyahs1 in the middle. All of them were closed and physical access to them had become impossible during 1. A mosque-like place used for religious meetings and religious rituals public quarantine. These include the places where some Muslims used to visit to strengthen their inner spiritual resources and release daily psychological stress. 2. In Iranian culture, individuals have a very close rela tionship with religious authorities (clerics). Accordingly, in religious affairs and some social issues, and even some daily affairs, the intellectual policy of the society is deter mined by religious leaders. Numerous religious leaders are elderly and among the high-risk group of COVID-19; therefore, this relationship was challenged by the COV ID-19 pandemic and reduced biosocial relationships. 3. The potential of religious communities and psycho social support to each other in reducing psychological stress and preventing mental disorders has been empha sized in various studies [7]. Islamic teachings also place great emphasis on community and participation among religious brothers, while these communities were also banned under quarantine due to illness
... A qualitative study in Iranian patients with cancer found that participants may be questioning the spiritual values and loss, or question their faith. They may experience a lack of intimacy with God or question Gods justice (Ghaempanah et al., 2020). Despite such findings, many studies have been conducted among Iranian patients with chronic disease and have found that a positive role of religion was supportive of their care. ...
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This paper reports on the psychometric properties of the Religious Orientation Scale (ROS) with a sample of 311 Iranian patients who were suffering from cancer between September and December 2020. A cross-sectional study design was used, and convenience sampling was employed. Reliability was evaluated by internal consistency Cronbach’s alpha, McDonald’s omega, and average inter-item correlation. The exploratory factor analysis showed that the ROS had 15 items and two factors (religious identity and personal identity) that explained 43.2% of the total variance of religious orientation in Iranian patients with cancer. Construct validity was assessed by means of confirmatory factor analysis. The internal consistency and composite reliability were acceptable. The results indicate that the ROS can produce reliable and valid data on religious orientation in a sample of Iranian patient with cancer.
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The present study was conducted with the aim of assessing the spiritual needs of female heads of households. This qualitative study was done by phenomenological method. The statistical population included female heads of households referring to positive life centers in Bandar Anzali city. The number of sample sizes continued until data saturation. Finally, after 15 interviews, the data reached saturation. Data were collected, coded and classified into main and subcategories. The results indicated that the most important needs of female heads of households include religious needs, needs related to children, needs related to family, needs related to friends, needs related to society, support and security needs, needs for a healthy and happy life, and personality needs. Also, the most important sufferings of the female heads of the household, the feeling of sadness, the unfair judgment of those around them and their lack of understanding, economic problems, the lustful looks of men, the worry about the current and future condition of the children, and the lack of support and care resources were extracted. The main solution to reduce their suffering; Positive thinking and hope and their main ability; Value preservation and self-esteem were evaluated. It was reported that the most important source of their hope, after God, the infallible imams, and resorting to their recommended prayers, is the existence of their children. Based on this, the importance and attention to the spiritual needs of women heads of households from the society can be effective in reducing their sufferings and pains and improving their conditions.
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The present study was conducted with the aim of assessing the spiritual needs of female heads of households. This qualitative study was done by phenomenological method. The statistical population included female heads of households referring to positive life centers in Bandar Anzali city. The number of sample sizes continued until data saturation. Finally, after 15 interviews, the data reached saturation. Data were collected, coded and classified into main and subcategories. The results indicated that the most important needs of female heads of households include religious needs, needs related to children, needs related to family, needs related to friends, needs related to society, support and security needs, needs for a healthy and happy life, and personality needs. Also, the most important sufferings of the female heads of the household, the feeling of sadness, the unfair judgment of those around them and their lack of understanding, economic problems, the lustful looks of men, the worry about the current and future condition of the children, and the lack of support and care resources were extracted. The main solution to reduce their suffering; Positive thinking and hope and their main ability; Value preservation and self-esteem were evaluated. It was reported that the most important source of their hope, after God, the infallible imams, and resorting to their recommended prayers, is the existence of their children. Based on this, the importance and attention to the spiritual needs of women heads of households from the society can be effective in reducing their sufferings and pains and improving their conditions.
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This study examined the effectiveness of a spiritual/religious intervention on religious coping and eudaimonic psychological well-being in breast cancer survivors. A quasi-experimental design with pre- and post-tests and a control group was used to study 60 Iranian breast cancer patients. The 14-item Brief RCOPE and the Ryff’s 6-Dimensional Psychological Well-Being Scales were administered at baseline and follow-up. An analysis of covariance revealed that spiritual/religious intervention was effective in increasing positive religious coping and reducing negative religious coping but not in increasing psychological well-being. Implications of the findings for the healthcare of women with breast cancer are discussed.
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In light of the high prevalence of breast cancer and the importance of addressing spirituality/religious issues in clinical care, the present study sought to investigate the effectiveness of a spiritual/religious intervention on religious coping and psychological well-being in women with breast cancer. A quasi-experimental with pre-test and post-test design and a control group was conducted in a sample of 60 Iranian breast cancer patients. Pargament’s 14-item Brief RCOPE and 6-dimentional Ryff’s Psychological Well-being Scales were administered at baseline and follow-up. Research data were analyzed using an analysis of covariance. Results indicate that the spiritual/religious intervention was effective in increasing positive religious coping and reducing negative religious coping, although there was no effect on psychological well-being.
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There is a growing body of evidence on the positive effects of religion and spirituality on recovery from cancer and the ability to cope with it. Most spiritual interventions carried out in Iranian research are based on care and support models that have been developed in the West. With the unique cultural and religious features of the Iranian context, a more refined look at spiritual care in the hospital care system of Iran is called for. This paper examines how to implement the spiritual care of cancer patients in hospitals and oncology wards in Iran. A consensus panel of experts was used to develop guidelines for spiritually integrated care consisting of 18 primary areas, which are described in detail in this report. Health care policy makers and managers of health care in Iran and possibly other areas of the Middle East should consider implementing these guidelines. Using indigenous models and programs specific to the religion and the cultural of a region should be considered when providing spiritual care for cancer patients.
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Purpose: Cancer survivors experience significant psychosocial distress even after completion of cancer treatment. The association between cancer coping and cancer recovery is not well established. The present study investigated the cancer-coping profile and cancer outcomes in breast cancer survivors. Methods: A three-wave longitudinal study was conducted. In 2009 (wave 1), 248 breast cancer survivors completed a package of psychological inventories to evaluate cancer copying style, psychological distress, anxiety and depression, and quality of life. They received follow-up survey in 2012 (wave 2) and 2016 (wave 3). A latent profile analysis (LPA) was conducted among participants in wave 1 to identify cancer-coping class. Identified cancer-coping class was used to predict psychological and survival outcomes in waves 2 and 3. Results: Two cancer-coping classes were identified through LPA, namely adaptive cancer coping (class I; 52%) and maladaptive cancer coping (class II; 47.8%). Demographic and clinical factors did not differ significantly between the two classes. Subsequent analyses demonstrated that the cancer-coping style in wave 1 predicted the psychological symptoms and quality of life outcomes at the two follow-ups (waves 2 and 3). Survivors in the adaptive group (class I) exhibited lower cancer distress, anxiety and depression scores, and higher quality of life scores than those in the maladaptive group did. Cancer coping were not found to be significantly associated with cancer survival or recurrence. Conclusions: The identified cancer-coping styles were predictive of the survivors' psychological symptoms, psychological well-being, and health-related quality of life but not cancer survival or recurrence.
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The present paper looks at the influence of culture on Turkish cancer patients’ use of meaning-making coping, paying particular attention to religious, spiritual, and existential coping methods. Data were collected using an interview study (n = 25, 18 women, age range 20–71). Individuals were recruited at an oncology center and a psychiatry clinic in Istanbul. The main focus of the study has been on existential meaning-making coping, which is characterized by finding power inside oneself, altruism, family love, a search for meaning by contemplating philosophical issues, and having a positive life perspective (shukran—thankfulness). In contrast to findings from similar studies conducted in other countries (studies included in the same project), in Turkey religious belief directly determines the coping methods used, including the non-religious methods.
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Purpose: This study describes the prevalence of religious and/or spiritual (R/S) struggle in long-term young adult (YA) survivors following hematopoietic cell transplantation (HCT) as well as existential concerns (EC), social support, and demographic, medical, and emotional correlates of R/S struggle. Methods: Data were collected as part of an annual survey of survivors of HCT aged 18-39 years at survey completion; age at HCT was 1-39 years. Study measures included measures of R/S struggle (defined as any non-zero response on the negative religious coping subscale from Brief RCOPE), quality of life (QOL), and depression. Factors associated with R/S struggle were identified using multivariable logistic regression models. Results: Fifty-two of the 172 respondents (30%), who ranged from less than a year to 33 years after HCT, had some R/S struggle. In bivariate analysis, depression was associated with R/S struggle. In a multivariable logistic regression model, individuals with greater EC were nearly five times more likely to report R/S struggle. R/S struggle was not associated with age at transplant, time since transplant, gender, race, R/S self-identification, or medical variables. Conclusion: R/S struggle is common among YA HCT survivors, even many years after HCT. There is a strong correlation between EC and R/S struggle. Given the prevalence of R/S struggle and its associations with EC, survivors should be screened and referred to professionals with expertise in EC and R/S struggle as appropriate. Further study is needed to determine longitudinal trajectory, impact of struggle intensity, causal relationships, and effects of R/S struggle on health, mood, and QOL for YA HCT survivors.
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Background Spiritual distress is prevalent in advanced disease, but often neglected, resulting in unnecessary suffering. Evidence to inform spiritual care practices in palliative care is limited. Aim To explore spiritual care needs, experiences, preferences and research priorities in an international sample of patients with life-limiting disease and family caregivers. Design Focus group study. Setting/participants Separate patient and caregiver focus groups were conducted at 11 sites in South Africa, Kenya, South Korea, the United States, Canada, the United Kingdom, Belgium, Finland and Poland. Discussions were transcribed, translated into English and analysed thematically. Results A total of 74 patients participated: median age 62 years; 53 had cancer; 48 were women. In total, 71 caregivers participated: median age 61 years; 56 were women. Two-thirds of participants were Christian. Five themes are described: patients’ and caregivers’ spiritual concerns, understanding of spirituality and its role in illness, views and experiences of spiritual care, preferences regarding spiritual care, and research priorities. Participants reported wide-ranging spiritual concerns spanning existential, psychological, religious and social domains. Spirituality supported coping, but could also result in framing illness as punishment. Participants emphasised the need for staff competence in spiritual care. Spiritual care was reportedly lacking, primarily due to staff members’ de-prioritisation and lack of time. Patients’ research priorities included understanding the qualities of human connectedness and fostering these skills in staff. Caregivers’ priorities included staff training, assessment, studying impact, and caregiver’s spiritual care needs. Conclusion To meet patient and caregiver preferences, healthcare providers should be able to address their spiritual concerns. Findings should inform patient- and caregiver-centred spiritual care provision, education and research.
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Background Cancer is one of the leading causes of human death. Besides clinical treatment, cancer patients may need emotional and spiritual counselling to overcome their mental and morale problems. Such counselling sessions have been reported influential by many patients. We aimed to explore the structure of spiritual counselling sessions and their content as one of services provided to patients who experience chemotherapy in Iranian hospitals. Methods Through a qualitative content analysis study, we recorded the discussions between a counsellor, who was a cleric as well, and cancer cases who were undergoing chemotherapy in a hospital in Tehran. The sessions were only recorded if the patient consented to attend at the study. All consideration were taken to avoid release of patients’ identity. The recorded discussions were transcribed verbatim and analyzed thematically after each session, until no new theme was emerged. Result Twenty two sessions were held. The patients aged 53 years old on average. The content of discussions were analyzed along which 165 codes emerged. Four general themes or phases were recognized through counseling as (i) history-Taking (including demographic, disease-related and spiritual history and characteristics), (ii) general advice, (iii) spiritual-religious advice, and (iv) dealing with patients’ spiritual or religious ambiguities and paradoxes. Conclusion Counselling of cancer patients needs special and in depth knowledge on spiritual and religious issues. The counsellor should be able to motivate patients, among whom many are disappointed, to follow the curative instructions well and stay hopeful about their treatment and life. Exploring and understanding what happens during a spiritual counselling session can counselling to the conformity and standardization of such interventions.
Article
Purpose: Investigate change in women’s use of religious/spiritual coping (R/S) in relation to breast cancer. Design: Longitudinal, prospective. Sample: Fifty-six breast cancer and 82 benign diagnosis. Methods: R/S coping and depressed mood were assessed at pre-diagnosis, 3, 6, and 12 months post-diagnosis. Findings: Breast cancer patients increased their use of benevolent reappraisal coping from 3 to 6 months post-diagnosis while women with a benign diagnosis evidenced stability in this coping strategy. Negative R/S coping and depressed mood were associated concurrently and longitudinally for both diagnostic groups. Conclusions: Depressed mood and negative R/S coping are intertwined across time suggesting that women from both diagnostic groups may experience emotional and spiritual struggle in their adjustment to the threat of breast cancer. Implications for Psychosocial Providers: Clinicians need to identify and intervene early to help women address negative R/S coping as it may influence women’s adjustment within the first year post-diagnosis.
Article
Objective: Although there has been increasing emphasis on the importance of spirituality in patients with cancer, few studies have examined the spiritual experiences of an ethnically diverse sample of Asian women with breast cancer. The objective of this study was to examine the spiritual experiences of Singaporean women with breast cancer in the first year of diagnosis. Methods: A qualitative exploratory study design was used and data were gathered using individual semi-structured interviews. Purposive sampling selected the participants and data saturation sample size was reached after interviews with 28 participants. Data were analyzed using Braun and Clarke's thematic approach. Results: The participants were aged between 28 and 64 years and included women from the three major ethnic groups. The three themes that emerged from the data included transcendental experiences, meaning and purpose, and changing perspectives. Conclusions: This study informs that while spiritual needs are common, Singaporean women in their first year of the breast cancer diagnosis express spirituality in culturally specific ways. The clinical implications of the study emphasize the importance of addressing women's spiritual concerns, with attention to cultural differences so as to render holistic patient-centered care. © 2018 Ann & Joshua Medical Publishing Co. Ltd | Published by Wolters Kluwer -Medknow.
Article
Spiritual issues play a prominent role for patients with cancer. Studies have demonstrated a positive connection between a patient's spirituality and health outcomes, including quality of life, depression and anxiety, hopefulness, and the ability to cope with illness. Spiritual or existential distress is prominent in patients with cancer. Models are described that identify ways for clinicians to identify or diagnose spiritual or existential distress, and to attend to that distress. It is critical that all clinicians assess for spiritual distress as part of a routine distress assessment, identify appropriate treatment strategies, and work closely with trained spiritual care professionals.
Article
Purpose of review Because of cancer is generally perceived as a life-threatening illness, patients often develop spiritual needs upon the diagnosis. Spirituality impacts patient quality of life (QoL) and provides a context in which to derive hope and meaning to cope with illness. The goal of this review is to give an overview of the most relevant studies with a focus on the relationship between spiritual well being, QoL and hope in patients with cancer, in addition to exploring the importance of spiritual issues both for patients and healthcare professionals. Recent findings Spiritual well being with its dimensions of faith, meaning, and peace is a central component for the overall QoL. A strong spiritual well being decreases symptom severity, the level of hopelessness and the desire for hastened death in cancer patients. However, in the medical setting the provision of spiritual care remains poor, although patients, especially at the end of life, would like their spiritual needs to be addressed as part of the global care. Summary Care for cancer patients goes beyond just caring for the person's body. The assessment of spiritual/religious needs can be considered the first step in designing needs-tailored interventions.