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Citation: ˙
Zołnierz, Joanna, and
Jarosław Sak. 2023. Coping and
Religiosity of Polish Breast Cancer
Patients. Religions 14: 682. https://
doi.org/10.3390/rel14050682
Academic Editor: John P. Bartkowski
Received: 28 April 2023
Revised: 6 May 2023
Accepted: 16 May 2023
Published: 19 May 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
religions
Article
Coping and Religiosity of Polish Breast Cancer Patients
Joanna ˙
Zołnierz * and Jarosław Sak
Department of Humanities and Social Medicine, Medical University of Lublin, Chod´zki Street 7,
20-093 Lublin, Poland
*Correspondence: joanna.zolnierz@umlub.pl
Abstract:
Religiosity can support a patient in coping with a stressful situation such as breast cancer.
In this study, the authors aimed to explain the relationships between the religiosity of the respondents
and the religious crises they experienced and coping strategies, as well as between coping strategies
and the disease duration. The research method used is the method of diagnostic survey, and the
tools: a questionnaire of our own, making it possible to determine sociodemographic variables and
standardized scales: the Inventory for Measuring Coping with Stress—Mini-COPE (the brief COPE),
the Polish Centrality of Religiosity Scale (CRS) and the Religious Crisis Scale by W. Pr˛e˙
zyna (RCS).
With approval from the Bioethics Committee at the Medical University of Lublin (KE-0254/133/2015),
69 female subjects with breast cancer were studied. The results showed statistically significant
positive correlations between the centrality of religiosity and selected components of religiosity
and action-oriented coping strategies. RCS scores correlate negatively with more adaptive coping
strategies and positively with ineffective ones. Additionally, patients suffering from breast cancer for
more than five years, are statistically significantly different from those with shorter disease duration
only in their scores for the CRS “public practice” subscale. Mature religiosity promotes the adoption
of constructive coping strategies, while religious crisis hinders the process of coping with stressful
situations. It appears necessary to integrate spiritual care into the treatment process of cancer patients.
Keywords:
Mini-COPE; spiritual care; CRS; religious crisis; coping; stress; centrality of religiosity;
breast cancer
1. Introduction
In Poland, 19,620 women were diagnosed with breast cancer in 2019, according to
data collected from the National Cancer Registry (Krajowy Rejestr Nowotworów 2019). In
the following year, breast cancer was also the most commonly diagnosed type of cancer
among women (23.8% of all cancers registered in women in Poland) (Wojciechowska et al.
2022). Although the prognosis of cancer diagnosis has improved significantly over the
past few decades and it currently has the status of a chronic disease, it is still associated
with severe stress for the patient. Among patients in Poland, the oncological disease is still
associated with a high mortality rate, onerous, painful, and prolonged treatment, and a
significant deterioration in socioeconomic status as a result of having to give up previously
fulfilled social and professional roles (Gołota et al. 2017;Dro˙
zd˙
z 2016). Studies prove
that patients diagnosed with cancer experience not only strong negative emotions, but
as many as 15–80% of them experience the signs of post-traumatic stress (Ogi´nska-Bulik
2015;Rybarski 2018). Polish researchers indicate that individuals with cancer experience
anxiety much more often than patients with other chronic diseases, not only at the time
of diagnosis. Furthermore, anxiety in cancer patients is higher and can more often take a
pathological form, as it is intense and lasts for a long time (Gołota et al. 2017;Dryhinicz and
Rzepa 2018;Komendarek-Kowalska 2018;Rogala and Dombrowska-Pali 2018;˙
Zołnierz
2019). Reactions are particularly pronounced in patients suffering from cancers of the
reproductive organs, breast, or genitourinary system. Then, in addition, anxiety reactions
resulting from a life-threatening disease are strongly associated with feelings of shame
Religions 2023,14, 682. https://doi.org/10.3390/rel14050682 https://www.mdpi.com/journal/religions
Religions 2023,14, 682 2 of 15
and loss of one’s own performance abilities or self-attractiveness. In this light, the effects
of chemotherapy or surgical treatment for breast cancer remain extremely traumatic for
women, often permanently altering their body image, forcing them to confront difficult
questions, even about their sense of their own gender identity (Cie´slak and Golusi´nski
2018). This, in turn, secondarily affects patients functionally in other dimensions of their
lives, which creates further problems and heightens feelings of hopelessness, loneliness,
and depression (Bober et al. 2016;Jabło´nski et al. 2018;Jarz ˛abek-Bielecka 2018;Kulpa et al.
2017;O´smiałowska et al. 2018). It can also trigger a “spiral of loss” and loss of resources,
according to Hobfoll’s concept, intensifying anxiety and insecurity resulting from the
disease (Dro˙
zd˙
z 2016;˙
Zołnierz 2019).
The presented patient’s reactions to the situation of their cancer problem remain in
the area of intensive scientific research of the relatively young psychological field—psycho-
oncology, but they are explainable and can be described with the help of well-known
and already well-established psychological concepts of stress and coping. The dominant
concept is Lazarus and Folkman’s transactional theory of stress (Lazarus and Folkman
1984), and tools for studying coping strategies are questionnaires, including Lazarus and
Folkman’s WCQ, Endler and Parker’s CISS, Moos’ HDL-CS, and the COPE (an abbreviated
version of which was used in the study, described in this article) by Carver et al. (Juczy ´nski
1999). Coping involves adapting to the disease and functioning optimally in all areas
of life, in spite of the whole cancer experience. Researchers have divided strategies into
constructive ones, i.e., those that promote adaptation to the stressful situation of the disease
(positive reevaluation and fighting spirit) and destructive ones (helplessness and anxiety
preoccupation) (Dro˙
zd˙
z 2016;Watson et al. 1988,1999). In this context, it is also important
to recall the concept of religious coping and mention the functions that religion plays in
human life. Researchers distinguish, among other things, the meaning-producing role of
religion, which allows one to ascribe value to life, especially in the face of problems or
traumatic events. Being a source of hope, religion allows one to look at difficulties from
a different perspective, which is an opportunity to positively reevaluate difficulties and
to better cope with them (Piskozub 2010;Juczy´nski 2016). From this function of religion,
there stems the concept of religious coping (Pargament et al. 2000,2011;Cummings and
Pargament 2010;Arbinaga et al. 2021). Moreover, religion provides a sense of security, and
thus forms a basis for the proper construction of the personality and a sense of self-dignity,
if, of course, the relationship with God is based on trust and the individual presents a
positive image of Him (Piskozub 2010;Chlewi´nski 1982;Kirkpatrick 1992;Kulesz 2013;
Matys and Bartczuk 2011;Renz et al. 2018;˙
Zołnierz and Sak 2017). This is because thanks to
religion, man has the opportunity to find his place in the world, in relation to God, the other
person, and himself. In this way, religion also performs an auto-identification function,
which is particularly important in the formation of healthy interpersonal relationships,
and a sense of identification with the group and affects adaptation to life in society, which
secondarily allows the individual to avoid rejection and negative emotions as a result
of transgressing group norms (Chlewi´nski 1982;Sadło´n 2017). Religion triggers self-
therapeutic functions, helping a person understand the limits of self-responsibility and
cope with guilt and tensions arising from crises, especially the crisis connected with the
meaning of life ( ˙
Zołnierz 2019;Chlewi ´nski 1982;Kulesz 2013;Bejda et al. 2019;Pawlikowski
2013). The presented functions of religion are intensively studied by researchers in various
fields, as they form the basis of numerous concepts useful in explaining the positive
relationship between religiosity and quality of life, well-being, or the health status of
patients (Koenig 2008,2009). However, researchers interested in the issue of religiosity also
pay attention to the negative impact of religiosity on patients’ functioning that occurs, such
as in the case of religious or personality immaturity, a negative image of God, which is
currently most often addressed in research on the concept of religious struggle/religious
crisis (Ogi´nska-Bulik 2015;˙
Zołnierz 2019;Pargament et al. 2000;Wilt et al. 2016;Zarzycka
2018;Zarzycka and Puchalska-Wasyl 2020;Zarzycka and Zietek 2019).
Religions 2023,14, 682 3 of 15
The purpose of the research conducted and described in this article was to identify the
relationship between the level of patients’ religiosity, the religious crises they experienced,
and the coping strategies they presented, as well as to obtain information on the relationship
between the duration of the disease and the patients’ coping strategies. The authors
hypothesized that higher patients’ religiosity would be positively correlated with more
constructive coping strategies (Hypothesis 1), that the greater the severity of the religious
crisis, the more frequently used and more preferred destructive coping styles (Hypothesis
2), and that patients with shorter diseases would manifest less adaptive coping strategies
(Hypothesis 3).
2. Results
The study included 69 women with breast cancer treated at the St. John of Dukla
Oncology Center of Lublin Voivodeship in Lublin. Most of the studied patients lived
in rural areas constituting 37.68%. The remaining 42 subjects lived in small cities (up
to 100,000 residents) (N = 21) and large cities (over 100,000 residents) (N = 21). The
largest group among the subjects was married women (81.16%), while the smallest group
was unmarried women (N = 3). Most of the female patients surveyed had secondary or
vocational education (N = 35). On the other hand, 44.93% of all subjects had a college or
incomplete college education. Thirty of the surveyed women were economically active,
while nearly half of the surveyed (47.83%) remained on pension or retirement. When asked
about surgical treatment, 47 patients answered affirmatively, while 2 did not answer this
question. 28.99% of the respondents were not operated on. During treatment, 37 patients
received radiation therapy and 61 received chemotherapy (Table 1).
Table 1. Characteristics of respondents by sociodemographic data.
Analysed Variable N %
Dwelling place
rural area 26 37.68
city up to 100 K 21 30.43
city over 100 K 21 30.43
absence of data 1 1.45
Marital status
single 3 4.35
married 56 81.16
divorced 4 5.80
widow 6 8.70
Education
elementary 3 4.35
secondary or
vocational 35 50.72
licenciate or higher 31 44.93
Professional activity
active 30 43.48
ubemployed 4 5.80
retired/pension 33 47.83
absence of data 2 2.90
Surgery
no 20 28.99
yes 47 68.12
absence 2 2.90
Radiotherapy
no 27 39.13
yes 37 53.62
absence of data 5 7.25
Chemotherapy
no 4 5.80
yes 61 88.41
absence of data 4 5.80
The study included a group of female patients between the ages of 30 and 78. The
average age of the women studied was 53.3 years (SD = 10.6). The shortest time since
Religions 2023,14, 682 4 of 15
surgery was 2 weeks, and the longest was 22 years. The average time since surgery, on
the other hand, is 189.1 weeks (SD = 279.45). The shortest duration of the disease is 1
month, and the longest is 34 years. The mean duration of the disease, on the other hand, is
51.1 months (SD = 74.8) (Table 2).
Table 2. Characteristics of the subjects by age, disease duration, and time since surgery.
Analysed Variable N M Me Min Max Q1 Q3 SD
Age 69 53.3 54 30 78 45 62 10.6
Disease duration [in months] 66 51.1 14.5 1 408 6 84 74.8
Time from surgery [in weeks] 42 189.1 46 2 1056 20 240 279.5
In the studied sample, religiosity played a marginal role for 1 person. 31 respondents
were characterized by subordinated religiosity, while more than half: 53.62% presented
high religiosity (N = 37) (Table 3).
Table 3. Level of religiosity of the respondents according to the results obtained on the CRS scale.
Religiosity N %
marginal 1 1.45
subordinated 31 44.93
central 37 53.62
Analysis of the results obtained by the patients on the Religious Crisis Scale, presented
in quartiles, allows us to conclude the presence of a religious crisis in 20 of the subjects,
while 13 did not experience a crisis (N = 13). In the majority, the crisis occurs temporarily
(52.17%) (Table 4).
Table 4. Intensity of religious crisis—RCS scores in quartiles.
Intensity of Religious Crisis N %
absence of religious crisis 13 18.84
transient crisis 36 52.17
religious crisis 20 29.00
Descriptive statistics of the variables: centrality of religiosity, religious crisis, and stress
coping strategies are shown in Table 5.
In the following analyses, Spearman’s rank correlation coefficient was used to verify
Hypothesis 1 and Hypothesis 2. Statistically significant results at p< 0.050 are marked in
red in the table (Table 6). Based on the analyses, there was a statistically significant positive
correlation between the overall score on the CRS scale and the three problem-focused coping
strategies “active coping”, “positive reframing”, and “seeking instrumental support”, as
well as the emotion-focused strategy “turning to religion”. It was also found that the
higher the centrality of religiosity in each of the CRS subscales, the more frequently the
stress coping strategy used: “turning to religion”, but also “seeking instrumental support”.
It was further observed that the higher the scores on the CRS subscales “intellectual”,
“private practice”, “religious experience”, and “public practice”, the more frequently the
strategy of “active coping” used. Higher scores on the “private practice” subscale also
correlate positively with other constructive stress coping strategies: “positive reframing”
and “planning”. In addition, the “planning” strategy is more frequently used by patients
scoring higher on the CRS “public practice” subscale. “Sense of humor”, in turn, positively
correlates with “religious experience” and “intellectual” dimension. In contrast, analysis
of the results obtained for the Religious Crisis Scale revealed that the higher the intensity
of the crisis, the less frequently the “turning to religion” and constructive stress coping
Religions 2023,14, 682 5 of 15
strategies used: “active coping”, “positive reframing” and “planning”. In addition, those
scoring higher on the RCS are more likely to blame themselves for the situation and are
also more likely to use the “behavioral disengagement” strategy (Table 6).
Table 5. Descriptive statistics of CRS, RCS, and Mini-COPE scores in the total group.
Analysed Variable M Me Min Max Q1 Q3 SD
CRS Intellectual 9.9 11 3 15 8 12 2.8
CRS Ideological 12.9 14 4 15 12 15 2.4
CRS Private practice 12.7 14 3 15 11 15 2.8
CRS Religious experience 10.5 10 3 15 9 12 2.8
CRS Public practice 11.7 13 3 15 10 14 3.2
CRS Centrality in general 57.8 60 16 75 53 66 11.9
RCS in general 17.1 16 7 35 13 21 5.2
M-COPE.1. Active coping 3.2 3 1 4 3 3.5 0.7
M-COPE.2.Planning 3.1 3 1 4 2 3.5 0.7
M-COPE.3. Positive reframing 2.8 3 1 4 2.5 3 0.8
M-COPE.4. Acceptance 3.2 3.5 1 4 3 3.5 0.6
M-COPE.5. Sense of humor 1.9 2 1 4 1.5 2.5 0.6
M-COPE.6. Turning to religion 3.1 3 1 4 2.5 4 0.9
M-COPE.7. Seeking emotional support 3.1 3 1 4 2.5 4 0.8
M-COPE.8. Seeking instrumental support 2.9 3 1 4 2.5 3.5 0.7
M-COPE.9. Self-distraction 3.1 3 1 4 3 3.5 0.7
M-COPE.10. Denial 2.2 2 1 4 1.5 2.5 0.7
M-COPE.11. Venting 2.4 2.5 1 4 2 3 0.7
M-COPE.12. Substance use 1.1 1 1 2.5 1 1 0.3
M-COPE.13. Behavioral disengagement 1.8 1.5 1 4 1 2.5 0.7
M-COPE.14. Self-blame 1.9 2 1 4 1.5 2.5 0.7
Table 6.
Relationship of religious centrality and religious crisis scores with stress coping strategy
scores.
Strategies of Dealing
with Stress
CRS
Intellectual
CRS
Ideological
CRS
Private
Practice
CRS
Religious
Experience
CRS
Public
Practice
CRS
Centrality in
General
RCS in
General
1. Active coping 0.289 0.203 0.351 0.261 0.323 0.358 −0.290
2. Planning −0.019 0.123 0.249 0.142 0.270 0.177 −0.266
3. Positive reframing 0.270 0.241 0.243 0.224 0.224 0.259 −0.276
4. Acceptance 0.114 −0.015 0.109 0.056 0.0319 0.057 −0.106
5. Sense of humor 0.270 0.151 0.139 0.254 0.173 0.214 −0.094
6. Turning to religion 0.579 0.554 0.556 0.603 0.549 0.672 −0.295
7. Seeking emotional support 0.155 0.137 0.202 0.229 0.104 0.166 −0.187
8. Seeking instrumental support
0.259 0.283 0.292 0.295 0.298 0.317 −0.221
9. Self-distraction 0.041 −0.089 −0.043 0.025 −0.027 −0.0211 −0.027
10. Denial 0.128 −0.053 0.067 0.195 0.047 0.098 0.074
11. Venting −0.015 0.001 −0.048 0.152 0.027 0.011 −0.012
12. Substances use −0.208 −0.127 −0.069 −0.211 −0.210 −0.178 0.018
13. Behavioral disengagement 0.029 −0.054 −0.198 −0.037 −0.041 −0.063 0.244
14. Self-blame −0.066 −0.197 −0.182 −0.045 −0.055 −0.083 0.296
To verify Hypothesis 3, analyses were carried out for the variables: coping strategies
and duration of disease (Table 7). In addition, analyses were carried out for the variables:
the centrality of religiosity and religious crisis (Tables 8and 9). The authors also checked for
correlations between the age of female patients and the variables: stress coping strategies,
the centrality of religiosity, and religious crisis (Tables 7–9). In the analysis of the variables:
coping strategies, the centrality of religiosity and religious crisis, the division into two
subgroups of the subjects was taken into account: those ill up to five years of duration and
those with more than five years of duration (Tables 10 and 11).
Religions 2023,14, 682 6 of 15
Table 7. Correlation of stress coping strategies scores with patients’ age and duration of disease.
Strategies for Coping with Stress Correlations with Age Correlations with Duration of an Disease
RpRp
1. Active coping −0.087 0.477 −0.050 0.693
2. Planning −0.096 0.432 −0.008 0.948
3. Positive reframing −0.020 0.871 −0.158 0.204
4. Acceptance 0.143 0.241 0.005 0.968
5. Sense of humour −0.179 0.141 0.070 0.575
6. Turning to religion 0.333 0.005 0.142 0.255
7. Seeking emotional support 0.081 0.509 −0.078 0.536
8. Seeking instrumental support 0.169 0.165 0.152 0.223
9. Self-distraction −0.041 0.738 −0.149 0.232
10. Denial 0.257 0.033 −0.003 0.979
11. Venting −0.096 0.433 0.052 0.680
12. Substance use −0.295 0.014 −0.110 0.378
13. Behavioral disengagement 0.005 0.966 −0.018 0.888
14. Self-blame 0.089 0.469 0.152 0.222
Table 8. Relationship of religiosity centrality scores with patient age and disease duration.
The Centrality of Religiosity Correlations with Age Correlations with Duration of an Disease
RpRp
1. Intellectual 0.270 0.025 0.069 0.583
2. Ideological 0.167 0.170 0.061 0.626
3. Private practice 0.327 0.006 0.161 0.196
4. Religious experience 0.317 0.007 0.199 0.108
5. Public practice 0.239 0.048 0.340 0.005
6. Centrality in general 0.304 0.011 0.233 0.060
Table 9. Relationship of religious crisis scores with age of patients and duration of disease.
Religious Crisis Correlations with Age Correlations with Duration of an Disease
RpRp
Religious crisis in
general 0.048 0.695 −0.180 0.149
Table 10. Subgroupdivision as for the duration of disease.
Groups N %
Up to 5 years of disease duration 48 69.57
Over 5 years of disease duration 18 26.09
Absence 3 4.35
There was a statistically significant correlation between disease duration and the CRS
“public practice” score (R = 0.340, p= 0.005). Higher disease duration scores correspond
to higher scores on the CRS “public practice” measure—thus, the longer the disease lasts,
the more often the patients attend religious services and are more likely to pursue this
form of practicing their religiosity (Table 8). Other than this one, there were no statistically
significant correlations of disease duration with other CRS scores, nor RCS and mini-COPE
(Tables 7–9). However, a correlation was found, at the level of statistical tendency (p= 0.06)
between overall religiosity centrality and disease duration.
Religions 2023,14, 682 7 of 15
Table 11. Comparison of results of subjects with shorter and longer disease duration.
Analysed Variable Duration of an
Disease M Me Min Max Q1 Q3 SD U
p
CRS Intellectual up to 5 years 9.8 10 3 15 8 12 3 U = 401.0
p= 0.663
over 5 years 10.7 11 6 14 9 12 2.15
CRS Ideological up to 5 years 12.8 13.5 4 15 12 15 2.6 U = 391.0
p= 0.563
over 5 years 13.3 14 9 15 13 15 1.9
CRS Private practice up to 5 years 12.4 14 3 15 10.5 15 3.1 U = 396.0
p= 0.612
over 5 years 13.4 14 7 15 13 15 1.9
CRS Religious experience up to 5 years 10.1 10 3 15 8.5 12 2.9 U = 323.5
p= 0.120
over 5 years 11.3 11.5 7 15 9 13 2.5
CRS Public practice up to 5 years 11 12 3 15 8 14 3.4 U = 262.0
p= 0.014
over 5 years 13.2 14 6 15 13 15 2.6
CRS Centrality in general up to 5 years 56.1 58.5 16 75 50.5 65 12.9 U = 310.5
p= 0.080
over 5 years 61.4 64.5 37 72 56 67 9.2
RCS in general up to 5 years 17.6 17 7 35 14 21.5 5.4 U = 345.0
p= 0.215
over 5 years 15.8 14.5 11 23 11 20 4.8
M-COPE
1. Active coping
up to 5 years 3.1 3 1 4 3 3.5 0.7 U = 402.0
p= 0.674
over 5 years 3.3 3 2 4 3 4 0.6
M-COPE
2. Planning
up to 5 years 3.1 3 1 4 2.8 3.5 0.7 U = 424.5
p= 0.915
over 5 years 3 3 1 4 2.5 4 0.9
M-COPE
3. Positive reframing
up to 5 years 2.9 3 1 4 2.5 3.3 0.8 U = 341.0
p= 0.194
over 5 years 2.6 2.5 1 4 2.5 3 0.7
M-COPE
4. Acceptance
up to 5 years 3.2 3.3 1 4 3 3.5 0.6 U = 405.5
p= 0.705
over 5 years 3.1 3 1.5 4 2.5 4 0.7
M-COPE
5. Sense of humor
up to 5 years 1.9 2 1 4 1.5 2.5 0.7 U = 429.0
p= 0.972
over 5 years 1.9 2 1 3 1.5 2 0.6
M-COPE
6. Turning to religion
up to 5 years 3 3 1 4 2.5 3.5 0.8 U = 380.5
p= 0.462
over 5 years 3.1 3 1 4 3 4 0.9
M-COPE
7. Seeking emotional support
up to 5 years 3.2 3 1 4 2.8 4 0.7 U = 333.5
p= 0.157
over 5 years 2.9 3 1.5 4 2.5 3.5 0.8
M-COPE
8. Seeking instrumental support
up to 5 years 2.8 3 1 4 2.5 3.5 0.7 U = 411.5
p= 0.770
over 5 years 2.9 3 1.5 4 2.5 3 0.7
M-COPE
9. Self-distraction
up to 5 years 3.1 3 1.5 4 3 3.5 0.7 U = 346.0
p= 0.221
over 5 years 2.8 3 1 4 2.5 3.5 0.9
M-COPE
10. Denial
up to 5 years 2.2 2 1 4 1.5 2.8 0.8 U = 414.0
p= 0.803
over 5 years 2.1 2 1 3 2 2.5 0.6
M-COPE
11. Venting
up to 5 years 2.3 2.5 1 4 2 3 0.7 U = 409.0
p= 0.748
over 5 years 2.4 2.5 1 4 2 2.5 0.6
M-COPE
12. Substances use
up to 5 years 1.1 1 1 2 1 1 0.3 U = 413.5
p= 0.792
over 5 years 1.1 1 1 2.5 1 1 0.6
M-COPE
13. Behavioral disengagement
up to 5 years 1.8 1.5 1 4 1 2.5 0.8 U = 389.0
p= 0.544
over 5 years 1.8 1.8 1 3 1.5 2.5 0.7
M-COPE
14. Self-blame
up to 5 years 1.8 1.8 1 4 1.5 2 0.7 U = 316.0
p= 0.097
over 5 years 2.2 2 1 3 1.5 2.5 0.8
As for statistically significant correlations of patients’ age to stress coping strategies,
such were detected for three strategies: “turning to religion”, “denial”, and “substance
use”. As patients get older, they are more willing and more likely to use their religiosity
as a method of coping with stress, and they are also more likely, although this is a weak
relationship, to deny the stressful situation. The older they are, the less often they use
Religions 2023,14, 682 8 of 15
psychoactive substances to cope with stress (Table 7). Almost all subscales of the CRS and
the overall score of this scale also correlate positively with the age of the patients. The
strongest of the detected correlations are with the subscales “private practice”, “religious
experience”, and the total score. The age of the subjects does not correlate in a statistically
significant way only with the CRS scores for the subscale “ideological”. There were also
no statistically significant correlations between the patients’ age with the results of the
Religious Crisis Scale (Tables 8and 9).
The analysis of the literature prompted the authors to carry out a comparison of the
results obtained by female patients with diseases up to five years with the results of female
patients with diseases above that time. This is because it has been pointed out that the
limit of five years from diagnosis is a turning point in the perception of the chances of
survival, and may therefore differentiate patients in terms of the coping strategies used
(Cie´slak and Golusi´nski 2018). In our study, respondents were therefore divided into two
subgroups. The first included women with a disease duration of up to five years, while
the second subgroup included women who had been ill for more than five years. The first
group represents the majority, 69.57% of all respondents. Three people did not answer the
question about the duration of the disease (Table 10).
Analyses comparing the results of the subgroup of patients ill up to five years with
those of patients ill longer than that, found a statistically significant relationship only for
the CRS “public practice” score, as well as a difference at the level of statistical trend
(p= 0.08) with regard to the overall centrality of religiosity. It turns out that women who
have been ill for more than five years are more likely to practice their faith in public and
participation in worship services is an important dimension of their functioning. In terms
of other outcomes, the two subgroups are not statistically significantly different (Table 11).
The revealed correlations between RCS and mini-COPE scores encouraged the authors
to also test whether it would be possible to predict the risk of a religious crisis based on
mini-COPE scores. To this end, they divided all respondents based on their overall RCS
score. Based on the analysis of the RCS total score, two subgroups were distinguished:
those not experiencing a crisis or experiencing it temporarily, sporadically (RCS scores
lower than 21), and those experiencing a religious crisis (scores equal to or higher than
21). The first subgroup included 49 people (71.01%), while the second group accounted for
20 people, or 28.99% of all respondents.
For the resulting distribution, a univariate logistic regression analysis was performed.
Logistic regression analysis was performed only for those stress-coping strategies for which
there were statistically significant correlations with the RCS score (Table 7). Only three of
the strategies analyzed were found to be statistically significant in univariate regression
analysis, these were “active coping” (OR = 0.254, 95% CI 0.102–0.629, p= 0.003), “planning”
(OR = 0.433, 95% CI 0.203–0.924, p= 0.030) and “positive reframing” (OR = 0.453, 95% CI
0.217–0.950, p= 0.036). In all cases, higher scores on these coping strategies reduced the
risk of religious crisis (Table 12).
Table 12. Analysis of logistic regression results for stress coping strategies.
Strategies for Coping with Stress Statistical Significance of the
Reliability Quotient Test OR 95% CI p
1. Active coping 0.001 0.254 0.102–0.629 0.003
2. Planning 0.024 0.433 0.203–0.924 0.030
3. Positive reframing 0.029 0.453 0.217–0.950 0.036
6. Turning to religion 0.278 0.717 0.393–1.308 0.278
13. Behavioral disengagement 0.393 1.362 0.671–2.764 0.393
14. Self-blame 0.075 1.903 0.927–3.906 0.079
3. Discussion
The results of the statistical analyses presented above confirmed Hypothesis 1. The
authors hypothesized that higher religiosity of female patients would be positively cor-
Religions 2023,14, 682 9 of 15
related with more constructive coping strategies. The results confirmed that the more
autonomous, i.e., high, mature religiosity of female patients is, the more frequently most of
the adaptive coping strategies, i.e., proble4.m-focused strategies, which include “positive
reframing”, “active coping”, or “seeking instrumental support” are utilized (Carver et al.
2012b). This finding is completely consistent with the results of other studies on religiosity
and coping strategies, which indicate that internal religious orientation is strongly related
to problem-focused strategies, while external orientation is based on the cognitive functions
of avoidance strategies (Arbinaga et al. 2021;Pargament et al. 1992). It is noteworthy, how-
ever, that the strategy of seeking instrumental support, in particular, remains important
for strengthening cognitive processes (Juczy´nski 2016;Janowski et al. 2016), and it is this
strategy that, in the study group of female patients scoring high on the CRS, is one strategy
that correlates positively with all measured aspects of religiosity, as well as with the overall
religiosity centrality score.
The second strategy that correlates strongly positively with all components of CRS
and also with the overall score of the centrality of religiosity in the studied group of
female patients is “turning to religion”. This result, too, does not differ from previous
observations made by other researchers. Moreover, it fits perfectly into the discussion of
whether religious coping is an independent strategy or rather mediates other “secular”
strategies for coping with stress (Pargament et al. 2000,2011;Arbinaga et al. 2021;Holtmaat
et al. 2019;Fradelos et al. 2018). In this context, the research conducted only allows us
to conclude that the use of the strategy “turning to religion” is in a strong relationship
with the high religiosity of the respondents. It is also worth noting that the higher the
centrality of religiosity in the two components: “religious experience” and “intellectual”,
the more frequently the strategy “sense of humor” is used. Additionally, although this
strategy is categorized as an evasive strategy that, when used over a long period of time,
can prove destructive, Juczynski points out that in certain circumstances this strategy can
prove extremely useful. This happens when the problem encountered seems impossible to
overcome with any active action. In the face of one’s own helplessness and immense stress,
an evasive strategy in the form of humor can prove effective ( ˙
Zołnierz 2019;Juczy´nski
2016;Carver et al. 2012a,2012b;Juczy´nski and Chrystowska-Jabło ´nska 1999;Kalembrik
and Juczy´nski 2001;Sosnowski et al. 2017). Previous scientific studies have provided
information on the existence of positive relationships between individual and collective
religious practices and the patient’s functioning in various dimensions of his life (Koenig
2008,2009,2012;Jim et al. 2015;Koenig et al. 2001).
Our own research partially confirms these scientific reports. Indeed, participation in
religious services as a component of the CRS tool correlates positively with the strategies
“planning”, “active coping” and “seeking instrumental support”, and prayer additionally
further with “positive reframing”. As evidenced by scientific research, these strategies
in particular help the patient to accept the disease, regain control and hope, strengthen
self-esteem, and thus are not without impact on his quality of life ( ˙
Zołnierz 2019;Cie´slak
and Golusi´nski 2018;Piskozub 2010;Juczy ´nski 2016;Janowski et al. 2016;Koenig 2012;
Wnuk et al. 2010;Büssing et al. 2016). This is particularly important in the context of the
statistically significant correlations detected in our study between the duration of disease
and the CRS “public practice” subscale. The longer the duration of the disease, the more
important and more frequent the participation in worship. In addition, “public practice”
is the only one of the variables that statistically significantly differentiates the subgroup
of patients with diseases up to five years from those with longer diseases (falsifying
Hypothesis 3, as no statistically significant differences in stress coping strategies were
detected between the groups). This seems to be consistent with the results of the studies
cited above.
Analysis of the results of the study revealed that more than half of the surveyed people
are characterized by a high religiosity. Additionally, a large proportion, as many as 31
people, are characterized by a moderate level of religiosity. Such a high rate of religiosity
among the respondents can be explained by their specific life situations. An attempt to
Religions 2023,14, 682 10 of 15
explain this phenomenon, also observed in their research among Polish oncology patients,
was made by Walczak et al. They indicated that the observed greater intensity of religious
attitudes may be related to a sense of danger and an attempt to find support in a Higher
Being (Walczak et al. 2018). The assumption of greater religiosity/spirituality of people
with cancer, compared to healthy people, was also made by Arbinaga’s team, conducting a
study among Spanish patients (Arbinaga et al. 2021).
The authors also assumed that the greater the severity of the religious crisis, the more
frequently used and more preferred destructive coping styles (Hypothesis 2). The analyses
conducted also helped confirm this hypothesis. Religious crisis is positively correlated with
blaming oneself and stopping action, and these are categorized as evasive strategies, and
although they can be useful in some situations, especially disease exacerbation, researchers
question their effectiveness, especially when used for a long time (Carver et al. 2012a,2012b).
Analysis of the research results further revealed that as the intensity of the religious
crisis increases, action-focused coping strategies are less frequently undertaken. The re-
search confirmed the existence of this relationship between RCS scores and the strategies
“active coping”, “positive reframing” and “planning”. These are disturbing observations,
especially since, of the female patients included in the study, nearly one-third were experi-
encing a religious crisis. This leads to the conclusion that medical care for cancer patients
should also include spiritual care, especially in terms of the religious crises they experience.
The literature lists numerous negative effects of the experienced religious crisis, ranging
from unpleasant emotions, psychological tensions, depressive states, ending with personal-
ity disintegration and suicide attempts, symptoms of post-traumatic stress disorder and
somatic symptoms, i.e., pain symptoms, impaired immune system function and increased
mortality (Zarzycka and Zietek 2019;Nowosielski and Bartczuk 2011;Pargament and
Exline 2023;Tomczyk 2007;Sherman et al. 2015). Properly helping a patient cope with a
religious crisis can provide an opportunity for the revision of life goals and the patient’s
personal and post-traumatic growth (Ogi´nska-Bulik 2015;˙
Zołnierz 2019;Nowosielski and
Bartczuk 2011;Tomczyk 2007).
4. Materials and Methods
In the study, stress coping strategies, religious centrality, and religious crisis were
taken as interchangeable dependent variables. The age of the patients and the duration
of the disease are independent variables. The research method used is the diagnostic
survey method, and the research technique is the survey technique. The tools used are:
a questionnaire of our own making it possible to determine sociodemographic variables
(gender, age, marital status, place of residence, living with someone or alone, religion,
education, duration and type of disease, type of treatment used—surgery, chemotherapy,
radiation therapy) and standardized scales for the study of dependent variables: the
Inventory for Measuring Coping with Stress (Mini-COPE) (Carver et al. 2012b), the Polish
adaptation of S. Huber’s Centrality of Religiosity Scale (CRS) (Zarzycka 2011), and the
Religious Crisis Scale by W. Pr˛e˙
zyna (RCS) (Nowosielski and Bartczuk 2011).
The choice of specific research tools was preceded by deep reflection and literature re-
search. The indicated scales for the study of religiosity—the Polish Centrality of Religiosity
Scale (CRS) and the Religious Crisis Scale by W. Pr˛e˙
zyna (RCS) are popular tools in Poland,
allowing a comprehensive and multifaceted study of religiosity and remain culturally
sensitive, meeting the needs of Polish respondents. The Inventory for Measuring Coping
with Stress—Mini-COPE (the brief COPE) is also a popular research tool, making it easier
to compare survey results and present more accurate interpretations. The questionnaires
of the indicated tools are also short, which is of considerable importance for the comfort
of inpatients or outpatients, too. The study using the indicated scales took place with the
permission of the authors of the tools and with respect to their copyright.
The Inventory for Measuring Coping with Stress—Mini-COPE (the brief COPE) is
used to examine typical reactions to a stressful situation and is an abbreviated version of a
60-item popular tool by (Carver et al. 1989,2012a;Carver and Scheier 1994). Adaptation
Religions 2023,14, 682 11 of 15
to Polish conditions of the abbreviated version of the scale was made by Juczynski and
Oginska-Bulik (Carver et al. 2012b). The Mini-COPE allows the examination of 14 stress-
coping strategies. The study is carried out by assigning a certain number of points from 0
to 3 on the scale next to each of the 28 statements. The number of points obtained in the two
statements assigned to a particular strategy is then summed. Juczynski and Oginska-Bulik,
in their commentary on the tool’s description, point out that all 14 strategies can be divided
into three main categories—problem-focused strategies, emotion-focused strategies, and
avoidance strategies. In the first category, they included “seeking instrumental support”
and “planning”, in the second such strategy as “denial” or “turning to religion”, for
example, while in the third—evasive: “substance use” or “sense of humor” ( ˙
Zołnierz 2019;
Arbinaga et al. 2021;Carver et al. 2012b).
The Polish Centrality of Religiosity Scale (CRS), made by Zarzycka, consists of 15
statements (Zarzycka 2011;Huber and Huber 2012). This short tool makes it possible to
determine the centrality of religiosity in the personality, as a whole (the sum of all the
points obtained for each of the 15 statements) or the centrality of religiosity in five specific
content aspects, i.e., religious beliefs (“ideological”), prayer (“private practice”), interest in
religious issues (“intellectual”), worship (“public practice”), and religious experience. The
higher the score, the greater the centrality of religiosity in the personality, and therefore the
greater its impact on the individual’s life. The global number of points obtained in all of
the 15 statements makes it possible to determine whether the respondent’s religiosity is
autonomous (high religiosity/central religiosity) or subordinated (moderate religiosity), or
at a marginal level ( ˙
Zołnierz 2019;Zarzycka 2011;˙
Zołnierz et al. 2017).
The Religious Crisis Scale by W. Pr˛e ˙
zyna (RCS) is a very short tool, as it consists of five
statements that can be answered using a 7-point Likert scale (Nowosielski and Bartczuk
2011). The sum of the scores given for each of the five questions informs about the intensity
of the religious crisis—low scores inform about the absence of a crisis, high scores inform
about the presence of a crisis, while moderate scores are interpreted as psychological
tensions of temporary, temporary difficulties in the relationship with God, but without the
signs of a crisis. The author of the tool is Pr˛e ˙
zyna, but before his death, he did not manage
to complete the work on the scale, hence its continuation was handled by Nowosielski and
Bartczuk ( ˙
Zołnierz 2019;Nowosielski and Bartczuk 2011;˙
Zołnierz et al. 2017).
The study was initiated after obtaining approval from the Bioethics Committee at
the Medical University of Lublin (KE-0254/133/2015). The study was conducted from
November 2017 to March 2019 among inpatients and outpatients at the St. John of Dukla
Cancer Center of Lublin Voivodeship and the Chemotherapy Outpatient Clinic of the
Specialized Outpatient Clinic Complex of the St. John of Dukla Cancer Center of Lublin
Voivodeship. The survey was completed anonymously after providing information about
the study and obtaining the patient’s consent of participation. The inclusion criterion for
the study was: patient’s age above 18 years of age, gender—female, diagnosis—breast
cancer, ability to participate in the study—completion of the questionnaire. The exclusion
criteria were: minors, lack of consent to complete the questionnaire, and time since surgery
of less than 2 days. Sixty-nine completely completed survey questionnaires were qualified
for statistical analysis.
The results obtained were subjected to statistical analysis. The values of the quantita-
tive variables analyzed were presented using mean, median, lower and upper quartiles,
minimum and maximum values, and standard deviation, and the qualitative variables
were presented using count and percentage. Spearman’s rank correlations were used to
assess the correlation of the analyzed variables, and the Mann–Whitney U test was used to
assess the differences between groups. Logistic regression analysis was used to estimate
the risk of religious crisis due to the results of stress coping strategies. A significance level
of p< 0.05 was adopted, indicating the existence of statistically significant relationships.
Statistical analysis was performed using Statistica 9.1 and PQStat 1.8.2 software.
Religions 2023,14, 682 12 of 15
5. Limitations
Limitations of our study include the heterogeneity of the study group in terms of
treatment methods and stage of cancer, as well as the method of selecting the study group.
The inclusion of these variables in the selection of study participants in future research
work would allow for more accurate analyses and facilitate the interpretation of the data
obtained on patients’ stress-coping strategies and religiosity.
6. Conclusions
1.
More than half of the breast cancer patients included in the study present a high level
of religiosity. The study confirmed that the higher the centrality of religiosity, the
more frequently the stress-coping strategy: “turning to religion” was used. Thus, for
some patients, religiosity is an important resource used in coping with the disease
situation.
2.
Our own research confirmed other scientific reports—mature religiosity is conducive
to undertaking constructive coping strategies, while religious crisis hinders the process
of coping with a stressful situation.
3.
Nearly 1/3 of the patients included in the study experience a religious crisis. Thus, in
order to provide comprehensive medical care to the cancer patient, it is necessary to
pay attention to and take care of their religiosity/spirituality.
4.
Female oncology patients using problem-oriented stress-coping strategies were found
to be less likely to experience a religious crisis. Thus, in caring for patients, it is
important to pay attention to how they cope with disease in order to prevent religious
crisis, which destructively affects patient functioning.
Author Contributions:
Conceptualization, J. ˙
Z. and J.S.; methodology, J. ˙
Z.; software, J.S.; validation,
J. ˙
Z and J.S.; formal analysis, J. ˙
Z. and J.S.; investigation, J. ˙
Z.; resources, J. ˙
Z.; data curation, J. ˙
Z.; writing—
original draft preparation, J. ˙
Z.; writing—review and editing, J.S.; visualization, J. ˙
Z.; supervision,
J.S.; project administration, J. ˙
Z.; funding acquisition, J.S. All authors have read and agreed to the
published version of the manuscript.
Funding:
This research was funded by a donation from the Medical University of Lublin, Street: al.
Racławickie 1, Lublin City, Zip-code: 20-059, Poland, Grant no DS741/2023.
Institutional Review Board Statement:
The study was conducted in accordance with the Declaration
of Helsinki and approved by the Bioethics Committee at the Medical University of Lublin (KE-
0254/133/2015).
Informed Consent Statement:
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: Data are available on reasonable request.
Conflicts of Interest:
The authors declare no conflict of interest. The funders had no role in the
design, execution, interpretation, or writing of the study.
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