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The Role of Religion/Spirituality for Cancer Patients and Their Caregivers

Authors:
  • Center for Psychosocial Research

Abstract

Research has shown that religiosity and spirituality significantly contribute to psychosocial adjustment to cancer and its treatments. Religion offers hope to those suffering from cancer, and it has been found to have a positive effect on the quality of life of cancer patients. Numerous studies have found that religion and spirituality also provide effective coping mechanisms for patients as well as family caregivers. Research indicates that cancer patients who rely on spiritual and religious beliefs to cope with their illness are more likely to use an active coping style in which they accept their illness and try to deal with it in a positive and purposeful way. Faith-based communities also offer an essential source of social support to patients, and religious organizations can play a direct and vital role in cancer prevention by providing screening, counseling, and educational programs, especially in minority communities.
Featured CME Topic: Spirituality
The Role of Religion/Spirituality for Cancer
Patients and Their Caregivers
Andrew J. Weaver, MTH,PHD, and Kevin J. Flannelly, PHD
Abstract: Research has shown that religiosity and spirituality sig-
nificantly contribute to psychosocial adjustment to cancer and its
treatments. Religion offers hope to those suffering from cancer, and
it has been found to have a positive effect on the quality of life of
cancer patients. Numerous studies have found that religion and spir-
ituality also provide effective coping mechanisms for patients as
well as family caregivers. Research indicates that cancer patients
who rely on spiritual and religious beliefs to cope with their illness
are more likely to use an active coping style in which they accept
their illness and try to deal with it in a positive and purposeful way.
Faith-based communities also offer an essential source of social
support to patients, and religious organizations can play a direct and
vital role in cancer prevention by providing screening, counseling,
and educational programs, especially in minority communities.
Cancer ranks among the most dreaded of diseases. A di-
agnosis can cause extreme fear, helplessness, and psy-
chologic trauma.
1
The unforeseeable outcome of the treat-
ment compounds the anxiety and leads to patients feeling
powerless. Both cancer patients and their families may be
intimidated and confused by the healthcare delivery system
and the technology of modern treatment.
2
Such a diagnosis
challenges every dimension of a person’s life: physical, emo-
tional, and spiritual.
Cancer is the product of cumulative lifestyle and envi-
ronmental factors that place everyone at risk. In the United
States each year, approximately 1.3 million cancers are diag-
nosed.
3
The 5-year survival rate for all types combined is
62%, and 8.9 million people have a history of cancer. By
2010 approximately 1 in every 250 Americans will be a sur-
vivor of childhood cancer.
4
It is the second leading cause of
death, resulting in more than 550,000 deaths—1 of 4 Americans
who die each year.
3
Many researchers have found a strong re-
lation between patients’ reliance on religious beliefs and prac-
tices and the effectiveness of their coping with cancer.
5–7
Faith can give a suffering person a framework for finding
meaning and perspective through a source greater than self,
8
and it can provide a sense of control over feelings of help-
lessness.
9
Religious practice can provide access to social net-
works and established forms of assistance, including pastoral
care during times of acute distress.
10
The Importance of Hope
Hope is particularly important for those suffering from
cancer,
11–15
and a positive association between various self-
reported measures of hope and religiosity has been found in
quantitative studies specifically designed to examine this re-
lation.
16 –18
For example, in a study of women with gyneco-
logic cancers, 93% said that faith had increased their capacity
to be hopeful.
19
Ebright and Lyon,
20
in research on females
who were recently diagnosed with breast cancer, found that
those who scored higher on the Herth Hope Index reported
less anxiety and fear about their disease. Furthermore, the
more they felt their religious beliefs helped them to deal with
treatment the more positive they felt about their ability to deal
with the situation. Another study of breast cancer patients
found that their level of hope was primarily a function of their
sense of spiritual well-being, as measured by the Spiritual
Well-Being Scale,
21
rather than of demographic, prognostic, or
treatment variables.
22
Qualitative research also indicates that re-
ligion provides hope to oncology patients.
23,24
For example,
Saleh and Brockopp
24
found religious practices and family re-
lationships to be the two most frequently identified sources of
hope among hospitalized patients with bone cancer.
From the HealthCare Chaplaincy, New York, NY.
Reprint requests to Dr. Andrew Weaver, 260 18th Street, New York, NY
11215. E-mail: aweaver747@aol.com
Accepted September 10, 2004.
Copyright © 2004 by The Southern Medical Association
0038-4348/04/9712-1210
Key Points
Faith can give a person suffering from cancer a frame-
work for finding meaning and perspective.
Religious practice offers access to supportive social
networks.
Spiritual well-being in cancer patients has been asso-
ciated with the ability to enjoy life, even when expe-
riencing negative symptoms.
Patients place a high value on interactions with clergy.
Faith-based programs can be useful in promoting reg-
ular screening and educating people about cancer.
1210 © 2004 Southern Medical Association
Most studies indicate that increases in religiosity corre-
late with increases in hopefulness. However, a 1-year study of
women who were newly diagnosed with breast cancer re-
ported a peculiar interaction between hope and religious cop-
ing in their psychologic adjustment.
25
In that study, religious
coping was related to better psychologic adjustment only
among females who were initially rated as being low in hope.
Indeed, among women who were initially high in hope, turn-
ing to religion was associated with poorer adjustment.
Post-White et al
26
used both quantitative and qualitative
methods to examine the relation between spirituality and hope
in hospitalized oncology patients. While the patients’ scores
on the Herth Hope Index were unrelated to their scores on a
spirituality scale developed by the researchers themselves, most
patients said during interviews that “faith or belief in a higher
power helped them feel more
hopeful.” The discrepancy be-
tween the quantitative and quali-
tative findings provides a caution-
ary tale about the use of untested
attitudinal scales in research on
these kinds of concepts.
Spirituality and
Quality of Life
Quality of life (QOL) has
become increasingly important
for patients as treatment ad-
vances extend the length of sur-
vival. Although relatively few
studies have examined the rela-
tionship between religion/spiri-
tuality and QOL, Mytko and
Knight
27
conclude from their re-
view of the research, “... much of
the evidence suggests that religi-
osity and spirituality contribute to
psychosocial adjustment to can-
cer and its treatments.”
Perceived QOL has become a common indicator of ad-
justment, and a variety of scales have been developed to
measure this concept. Most commonly used QOL scales in
cancer research do not include spirituality as a test compo-
nent, but some researchers
7,27
have argued for its inclusion
because of its importance to patients.
7,27–29
A 1999 special
issue of Psycho-Oncology devoted to spirituality contained
two articles that are particularly pertinent.
7,30
The sample
tested in one study consisted of 142 females with breast can-
cer, whereas the sample in the other study consisted of 762
men and 848 women with various kinds of cancer. Both
studies found a significant positive association between QOL
and spirituality, using bivariate statistics, but the smaller study
did not find a significant effect of spirituality when multivar-
iate statistics were used to control for other variables that
might influence QOL.
30
This is not surprising, given the small
sample size. In contrast, the larger study reported that spiri-
tuality had a substantial effect on QOL even when other
factors were controlled for statistically.
7
Moreover, the study
by Brady et al
7
provides evidence that patients’ level of spir-
ituality has clinical implications. When patients were divided
in half according to their levels of pain and fatigue, those who
had higher spirituality scores reported higher QOL than pa-
tients with comparable levels of pain or fatigue who had
lower spirituality scores.
Coping Strategies
People respond to stress differently and a variety of scales
have been developed to assess
how people cope with the stress
of health problems.
31–33
The
various strategies people use to
deal with illness and other stres-
sors have been broadly classi-
fied into two types of styles: (1)
active coping or problem-solv-
ing and (2) passive or avoidant
coping.
34 –38
Freud
38
regarded
religious coping as a kind of de-
fense mechanism and viewed re-
ligious coping as a regressive,
passive, and avoidant psycho-
logic phenomenon.
39
Recent research has found
that religious and spiritual be-
liefs are associated with active
coping, not with avoidant or pas-
sive coping strategies, among
patients with malignant melano-
ma.
5,40
One study was con-
ducted in New York City
5
and
the other in Jerusalem
40
using
identical self-report measures of
coping style (Dealing with Illness-Coping Inventory) and reli-
gious/spiritual beliefs and practices—the Systems of Belief In-
ventory (SBI). In both studies, SBI scores had a significant,
positive correlation with active cognitive-coping methods, even
after controlling for demographic variables and cancer stage.
The results indicated that patients who exhibited greater reliance
on spiritual and religious beliefs were more likely to use an
active-cognitive coping style in which they accepted their illness
and tried to deal with it in a positive and purposeful manner.
These and other studies support the view that religious and spir-
itual beliefs can provide a helpful framework for many individ-
uals who face the existential crises of a cancer diagnosis.
41,42
Prayer can serve as a means of self-soothing and of reduc-
ing such negative emotions as anger, depression, and fear,
43
so
Cancer: A dreaded disease
Cancer is the product of
cumulative lifestyle and
environmental factors that place
everyone at risk.
Cancer is the second leading
cause of death, annually causing
more than 550,000 deaths, or 1
of every 4 Americans who dies.
A cancer diagnosis can cause
extreme fear, helplessness, and
psychologic trauma.
Researchers have found a strong
relation between patients’
reliance on religious beliefs and
practices and their ability to cope
with cancer.
Featured CME Topic: Spirituality
Southern Medical Journal Volume 97, Number 12, December 2004 1211
it may not be surprising that a study by Soderstrom and Mar-
tinson
44
found the most common coping strategy for cancer
patients was praying alone or with others, as well as having
others pray for them. Prayer was also found to be an important
coping mechanism for parents of children with cancer. Among
29 different coping strategies that fathers were asked about,
prayer was the one they said they used most often and was most
helpful to them.
45
Other research indicates that patients also
place a high value on interactions with clergy and that pastoral
visits and prayers help them maintain hope and optimism.
46
The frequent use of spirituality when coping with illness
or caregiver stress should be no surprise, given the impor-
tance of religious community to the majority of Ameri-
cans.
47,48
Moreover, the 353,000 Christian and Jewish clergy
serving congregations in the United States
49
are among the
most trusted professionals in society.
48
Surveys by the Na-
tional Institute of Mental Health found that clergy are more
likely than psychologists and psychiatrists combined to have
a person with a personal problem see them for assistance.
50
More than 10,000 of these clergy serve as chaplains in hos-
pitals and other healthcare institutions working closely with
medical professionals.
51
Faith Helps Caregivers
Family caregivers of cancer
patients often face significant
physical, social, and emotional
hardships and indicate that they
rely heavily on their faith to
cope with these burdens. When
researchers at Johns Hopkins
University surveyed those car-
ing for persons with end-stage
cancer and Alzheimer disease,
52
they discovered that success-
ful coping was primarily associated with two variables: num-
ber of social contacts and support received from religious
faith. When these persons were followed for 2 years to de-
termine the characteristics that predicted faster adjustment to
the caregiver role, again only the number of social contacts
and support received from personal religious faith predicted
better adaptation over time.
53
Having support from one’s re-
ligion appears to be one of the most important factors respon-
sible for successful coping with the stress of caregiving. Other
studies show that family members who are more religious feel
more positively about their role as caregivers
54
and get along
better with those they care for.
55
This may be due in part to the
fact that faith communities foster belief systems of responsibility
and compassion that are likely to help the persons doing the
emotionally difficult work of caring for others.
56
Relationship With God Is Valued
The feeling that one has a positive relationship with God
can give an individual a sense of self-acceptance and belong-
ing as well as provide a source of emotional comfort when
faced with a life-threatening illness.
57
Many of the breast
cancer patients who were interviewed by Johnson and Spilka
46
said they had an active and intimate relationship with God,
that helped them to feel less alone and gave them courage to
deal with their disease. Similarly, many breast cancer patients
who were specifically asked to describe how their religion
and spirituality helped them cope with their illness said that
God was an ever-present support, constant companion, and
confidante who helped buttress their self-esteem and sense of
personal control throughout their illness.
43
Moreover, a pos-
itive relationship with God was associated with greater opti-
mism and hopefulness.
Patients tend to increase their focus on religious issues and
their connection to God as their cancer advances. For example,
in a study of 108 women with various stages of cancer, about
half reported that they had become more religious since they
were diagnosed and none said they were less religious.
19
Simi-
larly, when 231 patients with end-stage cancer were asked what
maintained their quality of life, their “relationship with God”
was the most common response among 28 choices that included
“how well I eat,” “physical con-
tact with those I care about,” and
“pain relief.”
58
According to
these findings, terminal patients
maintained their relationship with
God in spite of severe functional
difficulties and serious physical
symptoms.
Faith-based
Communities Can
Help
Blacks are more likely to have cancer and are 30% less
likely to survive it than are whites. During the period from
1990 to 1996, the incidence rate per 100,000 was 442.9 among
blacks, 402.9 for whites, and 275.4 in Hispanics.
59
Early
detection programs have resulted in a 35% improvement in
5-year survival for colon and for breast cancer patients na-
tionwide.
60,61
Faith communities can play a vital role in pre-
venting deaths by encouraging the use of screening. Research-
ers have found that the participation of clergy and key lay
members in church-based cancer control programs can im-
prove access to and participation in screening for cancer by
blacks and Hispanics.
62
As an example, a recent study pub-
lished in the American Journal of Public Health found that
church-based telephone counseling in ethnic minority com-
munities in Los Angeles significantly increased the regular
use of mammography screening.
63
Such faith-based programs
can have a great impact in promoting regular screening and
educating people about cancer.
64
Their support and imple-
mentation by religious communities will help ensure congre-
gations that are healthy in both body and soul.
The feeling that one has a positive
relationship with God can give an
individual a sense of self-acceptance
and belonging and also provide a
source of emotional comfort when
faced with a life-threatening illness.
Weaver and Flannelly • Role of Spirituality for Cancer Patients and Caregivers
1212 © 2004 Southern Medical Association
Conclusion
Physicians need to be mindful of research showing that
religious beliefs and spiritual practices can be useful to many
patients and their caregivers coping with the impact of can-
cer. Medicine needs to further integrate these scientific find-
ings into clinical practice to promote better patient care.
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The vision must be followed by the venture. It is
not enough to stare up the steps—we must step
up the stairs.
––Vance Havner
Weaver and Flannelly • Role of Spirituality for Cancer Patients and Caregivers
1214 © 2004 Southern Medical Association
... Religion and spirituality is perceived to significantly contribute towards good quality of life. 1 Adherence to religion and spirituality elements has been determined to be a key factor in developing a good coping mechanism among cancer patients. 2 The importance of the religious element is further substantiated by meta-analysis studies showing that the religious belief and practice have a significant effect on the avoidance of criminal behaviour and can significantly improve the values and behaviours of the offenders. 3,4 In addition, parents who have children with disability have found that the reliance on God has given them patience and inner peace to overcome misfortunes in life. ...
... Schools are not familiar with the methods of teaching the Quran to Difficulty Ibadah the deaf and there are not many teachers who are expert in this area. 2 Abdullah & Ali 16 The mastery of prayer among hearing-impaired-student is at a weak level Difficulty Ibadah due to cognitive disability, weak language proficiency and the limitation of communication of hearing-impaired students to the study of religion. 3 Awang et al. 7 Students could not read Al-Quran and the teaching of component in Difficulty Ibadah recitation Al-Quran cannot be conducted due to their difficulty in communication. ...
... For domain 'perception towards obligation' and 'difficulty', the response is rated as (1) 'sangat tidak setuju' (totally disagree), (2) 'tidak setuju' (disagree), (3) 'tidak pasti' (not sure), (4) 'setuju' (agree), to (5) 'sangat setuju' (totally agree). For domain 'practice', the response is rated as (1) 'sangat tidak kerap' (very rarely),(2) 'tidak kerap' (rarely), (3) 'tidak pasti' (not sure), (4) 'kerap' ...
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Objective: This study is a preliminary work to develop a Malay version questionnaire named 'Inventori Persepsi bagi Muslim yang Memiliki Masalah Pendengaran (IPM3P)' to assess the perception on Islamic understanding and practice among Muslim adults with hearing impairment. Methods: The scale development involved three phases: i) generation of domains based on the literature, ii) generation of sub-domains based on literature review and Islamic panel survey, and iii) generation of items. Results: Preliminary version of IPM3P consists of 59 items was produced, representing three domains: Obligation (18 items), Practice (21 items), and Difficulty (20 items), and seven sub-domains ('Ibadah', 'Aqidah', 'Muamalat', 'Tasawwuf', 'Akhlak','Da'wah', and 'Sirah'). Conclusion: The preliminary version of IPM3P needs to be psychometrically tested. This pioneering study may become an impetus towards more research pertaining to understanding the effect of hearing loss towards religious life in the future in Malaysia.
... The social cognitive theory provides a support mechanism that improves patients' overall quality of life [9]. Religious beliefs and spirituality also play a significant role in the treatment process by creating a ray of light among the patients that positively impacts their lives [14]. Religious beliefs act as a coping-up strategy that supports the illness and positively deals with it [15,16]. ...
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Background: Cancer patients are often hesitant to talk about their mental health, religious beliefs regarding the disease, and financial issues that drain them physically and psychologically. But there is a need to break this taboo to understand the perceptions and behaviours of the patients. Previous studies identified many psychological factors that are bothering cancer patients. However, it still requires exploring new elements affecting their mental and physical health and introducing new coping strategies to address patients' concerns. Methods: The current study aims to identify cancer patients' perceived attitudes towards the severity of illness, understand their fears, tend towards religion to overcome the disease, and future financial planning by using a Q-methodological approach. Data were collected in three steps from January-June 2020, and 51 cancer patients participated in the final stage of Q-sorting. Results: The findings of the study are based on the principal component factor analysis that highlighted three essential factors: (1) feelings, (2) religious beliefs about the acceptance of death, and (3) their future personal and financial planning. Further, the analysis shows that the patients differ in their beliefs, causes and support that they received as a coping mechanism. Conclusions: This study explains cancer patients' psychological discomfort and physical pain but cannot relate it to co-morbidities. Q methodology allows the contextualization of their thoughts and future planning in different sets, like acceptance of death, combating religion's help, and sharing experiences through various platforms. This study will help health professionals derive new coping strategies for treating patients and financial managers to design insurance policies that help them to share their financial burdens.
... Much research has associated or discussed the presence of, or the lack of fear of death with the spirituality of the individual(Boscaglia, Clarke, Jobling & Quinn, 2005;Puchalski, 2012;Stefanek, McDonald & Hess, 2005;Weaver & Flannelly, 2004). Early work on spirituality was shown byKübler- Ross (1969) who proposed four quadrants that make up the human life domain (physical, emotional, intellectual and spiritual). ...
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Cancer communication Oesophageal cancer experience Health promotion Health journalism
... Due to unexpected deterioration in the health status of HM patients, some still have hoped to cure or extend their life despite their surrender for death. Hope predominated among all the cancer patients, and it was originally inferred from patients' faith and spiritual power.37,38 Insistence and glimmer hope to survive were frequently reported in the literature.28,29,[32][33][34][35] ...
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... These are all beneficial for cancer patients, who are often unwilling to face their current condition, are victims of negative stigma from society, or face other negative conditions related to their feelings in dealing with the disease (Memaryan et al., 2017). The effectiveness of the spiritual intervention on reducing anxiety in cancer patients has been reported by previous studies (Carvalho et al., 2014;Ghahari et al., 2017;Moeini et al., 2014;Weaver, 2018). Indonesia has Pancasila (Five Principles) as a state of philosophy, which the number one is Belief in the Almighty God. ...
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... In earlier studies a significant relationship had been found between religiosity/spirituality and better physical and functional status, reduced symptoms of psychopathology, greater emotional well-being and improved social support [52][53][54][55] . However, our study did not show such results. ...
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This comprehensive, evidence-informed text provides clinicians, researchers, policy-makers and academicians, with content to inform and enrich the guidelines recommended by the National Consensus Project and the National Quality Forum Preferred Practices. It is designed to meet the needs of health social work professionals who seek to provide culturally sensitive biopsychosocial-spiritual care for patients and families living with life-threatening illness. Edited by two of the leading social work clinician-researchers in the US, this text serves as the definitive resource for practicing clinicians and fulfils the need for social work faculty who wish to complement general health care texts with information specific to palliative and end-of-life care.
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Introduction: Children with cancer expose families, especially mothers, to numerous challenges and cause parents to suffer from a lot of stress. In many cases, the pressures arising from caring for children with cancer tend to grow so intensely that can affect the quality of life of the parents. Objective: This study aims to analyze the impact of Stress Management Training on improving the quality of life of the mothers with leukemic children. Materials and Methods: The present study is an experimental research with a pre-test/post-test control group design. The statistical population of the study comprised of all mothers of leukemic children between 4 and 6 years of age living in Rasht, Iran, in the school year 2014-2015. 30 mothers with the inclusion criteria were randomly selected as the sample and were randomly placed into experimental and control groups. The researchers administered the short-form 36 (SF-36) questionnaire (Warosherbon, 1992) among the two groups at both pre-test and post-test stages. The experimental group received ten 70-minute sessions of Stress Management Training, whereas the control group did not receive any such an intervention. Results: Data analysis indicates a significant difference between the experimental and the control group in terms of mean scores of life quality (p<0.01). Thus, Stress Management Training has improved the quality of life of the experimental group. Conclusion: The results of this study suggest that, besides instrumental and informational empowerment strategies such as the funding of treatment and education, mothers of children with cancer also need emotional support and psychological intervention in order to enjoy improvement in quality of life.
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Context: Cancer diagnosis and its therapeutic methods can lead to considerable psychological problems and decrease the levels of hope in patients. Due to the considerably important multidimensional effects of hope on the life of patients with cancer, this study aimed to assess the effect of psycho-socio-spiritual strategies on the hope level of patients with cancer. Evidence Acquisition: In this narrative review, electronic databases were searched including Google Scholar, Scientific Information Database, Magiran, PubMed, ScienceDirect, Web of Science (ISI), Ovid, and Scopus. Those articles published between 1978 and 2020 were retrieved and assessed through the abstract and full-text appraisal. Finally, 74 articles were included in this study. Results: Psycho-socio-spiritual strategies for affecting the hope level of patients with cancer were classified as follows: (1) psychological interventions (psychotherapy, counseling, coping skills training, stress management training, crisis management, individual or group supporting therapy, hope therapy, and psychoeducational interventions); (2) social interventions (social and family support intervention); and (3) spiritual interventions (logotherapy, religion therapy, and praying). Conclusions: Due to the chronic nature of cancer disease, in addition to the important role of pharmacological treatment such as chemotherapy and radiotherapy, considering non-pharmacological approaches such as hope-fostering interventions for these patients is essential and can lead to a better quality of life.
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The World Health Organization (WHO) is developing an international quality of life assessment instrument (WHOQOL) which will allow an enquiry into the perception of individuals of their own position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns. The WHOQOL will measure quality of life related to health and health care. It is being developed in the framework of a collaborative project involving numerous centres in different cultural settings. In addition it will have proven psychometric properties of validity, reliability and responsiveness to change and will be sensitive to the cultural setting in which it is applied, while maintaining comparability of scores across different cultural settings. This chapter outlines the methodology for the development of the instrument and sets out the characteristics and uses of the WHOQOL.
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