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Spirituality in Cancer Care (PDQ®)

  • Last Modified: 09/20/2012

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Overview

National surveys consistently support the idea that religion and spirituality are important to most individuals in the general population. More than 90% of adults express a belief in God, and slightly more than 70% of individuals surveyed identified religion as one of the most important influences in their lives.[1] Yet even widely held beliefs, such as survival of the soul after death or a belief in miracles, vary substantially by gender, education, and ethnicity.[2]

Research indicates that both patients and family caregivers [3,4] commonly rely on spirituality and religion to help them deal with serious physical illnesses, expressing a desire to have specific spiritual and religious needs and concerns acknowledged or addressed by medical staff; these needs, although widespread, may take different forms between and within cultural and religious traditions.[5-7]

A survey of hospital inpatients found that 77% of patients reported that physicians should take patients' spiritual needs into consideration, and 37% wanted physicians to address religious beliefs more frequently.[8] A large survey of cancer outpatients in New York City found that a slight majority felt it was appropriate for a physician to inquire about their religious beliefs and spiritual needs, although only 1% reported that this had occurred. Those who reported that spiritual needs were not being met gave lower ratings to quality of care (P < .01) and reported lower satisfaction with care (P < .01).[7] A pilot study of 14 African American men with a history of prostate cancer found that most had discussed spirituality and religious beliefs with their physicians; they expressed a desire for their doctors and clergy to be in contact with each other.[9]

Sixty-one percent of 57 inpatients with advanced cancer receiving end-of-life care in a hospital supported by the Catholic archdiocese reported spiritual distress when interviewed by hospital chaplains. Intensity of spiritual distress correlated with self-reports of depression but not with physical pain or with perceived severity of illness.[10] Another study [11] of advanced cancer patients (N = 230) in New England and Texas assessed their spiritual needs. Almost half (47%) reported that their spiritual needs were not being met by a religious community, and 72% reported that these needs were not supported by the medical system. When such support existed, it was positively related to improved quality of life. Furthermore, having spiritual issues addressed by the medical care team had more impact on increasing the use of hospice and decreasing aggressive end-of-life measures than did pastoral counseling.[12]

This summary will review the following topics:

  • How religion and spirituality can be usefully conceptualized within the medical setting.

  • The empirical evidence for the importance of religious and spiritual factors in adjustment to illness in general and to cancer in particular, throughout the course of illness and at the end of life, for both patients and family caregivers.[3]

  • The range of assessment approaches that may be useful in a clinical environment.

  • Various models for management and intervention.

  • Resources for clinical care.

Paying attention to the religious or spiritual beliefs of seriously ill patients has a long tradition within inpatient medical environments. Addressing such issues has been viewed as the domain of hospital chaplains or a patient’s own religious leader. In this context, systematic assessment has usually been limited to identifying a patient’s religious preference; responsibility for management of apparent spiritual distress has been focused on referring patients to the chaplain service.[13-15] Although health care providers may address such concerns themselves, they are generally very ambivalent about doing so,[16] and there has been relatively little systematic investigation addressing the physician’s role. These issues, however, are being increasingly addressed in medical training.[17] Acknowledging the role of all health care professionals in spirituality, a multidisciplinary group from one cancer center developed a four-stage model that allows health care professionals to deliver spiritual care consistent with their knowledge, skills, and actions at one of four skill levels.[18]

Interest in and recognition of the function of religious and spiritual coping in adjustment to serious illness, including cancer, has been growing.[19-23] New ways to assess and address religious and spiritual concerns as part of overall quality of life are being developed and tested. Limited data support the possibility that spiritual coping is one of the most powerful means by which patients draw on their own resources to deal with a serious illness such as cancer; however, patients and their family-member caregivers may be reluctant to raise religious and spiritual concerns with their professional health care providers.[24-26] Increased spiritual well-being in a seriously ill population may be linked with lower anxiety about death,[27] but greater religious involvement may also be linked to an increased likelihood of desire for extreme measures at the end of life.[28] Given the importance of religion and spirituality to patients, integrating systematic assessment of such needs into medical care, including outpatient care, is crucial. The development of better assessment tools will make it easier to discern which aspects of religious and spiritual coping may be important in a particular patient's adjustment to illness.

Of equal importance is the consideration of how and when to address religion and spirituality with patients and the best ways to do so in different medical environments.[29-31] Although addressing spiritual concerns is often considered an end-of-life issue, such concerns may arise at any time after diagnosis.[24] Acknowledging the importance of these concerns and addressing them, even briefly, at diagnosis may facilitate better adjustment throughout the course of treatment and create a context for richer dialogue later in the illness. One study of 118 patients seen in follow-up by one of four oncologists suggests that a semistructured inquiry into spiritual concerns related to coping with cancer is well accepted by patients and oncologists and is associated with positive perceptions of care and well-being.[32]

In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. The evidence and application to practice related to children may differ significantly from information related to adults. When specific information about the care of children is available, it is summarized under its own heading.

References
  1. Gallup GH Jr: Religion In America 1996: Will the Vitality of the Church Be the Surprise of the 21st Century? Princeton, NJ: Princeton Religion Research Center, 1996. 

  2. Taylor H: The Religious and Other Beliefs of Americans 2003. The Harris Poll #11, February 26, 2003. Rochester, NY: Harris Interactive Inc., 2003. Available online. Last accessed April 16, 2014. 

  3. Kim Y, Wellisch DK, Spillers RL, et al.: Psychological distress of female cancer caregivers: effects of type of cancer and caregivers' spirituality. Support Care Cancer 15 (12): 1367-74, 2007.  [PUBMED Abstract]

  4. Whitford HS, Olver IN, Peterson MJ: Spirituality as a core domain in the assessment of quality of life in oncology. Psychooncology 17 (11): 1121-8, 2008.  [PUBMED Abstract]

  5. Taleghani F, Yekta ZP, Nasrabadi AN: Coping with breast cancer in newly diagnosed Iranian women. J Adv Nurs 54 (3): 265-72; discussion 272-3, 2006.  [PUBMED Abstract]

  6. Blocker DE, Romocki LS, Thomas KB, et al.: Knowledge, beliefs and barriers associated with prostate cancer prevention and screening behaviors among African-American men. J Natl Med Assoc 98 (8): 1286-95, 2006.  [PUBMED Abstract]

  7. Astrow AB, Wexler A, Texeira K, et al.: Is failure to meet spiritual needs associated with cancer patients' perceptions of quality of care and their satisfaction with care? J Clin Oncol 25 (36): 5753-7, 2007.  [PUBMED Abstract]

  8. King DE, Bushwick B: Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract 39 (4): 349-52, 1994.  [PUBMED Abstract]

  9. Bowie J, Sydnor KD, Granot M: Spirituality and care of prostate cancer patients: a pilot study. J Natl Med Assoc 95 (10): 951-4, 2003.  [PUBMED Abstract]

  10. Mako C, Galek K, Poppito SR: Spiritual pain among patients with advanced cancer in palliative care. J Palliat Med 9 (5): 1106-13, 2006.  [PUBMED Abstract]

  11. Balboni TA, Vanderwerker LC, Block SD, et al.: Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol 25 (5): 555-60, 2007.  [PUBMED Abstract]

  12. Balboni TA, Paulk ME, Balboni MJ, et al.: Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol 28 (3): 445-52, 2010.  [PUBMED Abstract]

  13. Zabora J, Blanchard CG, Smith ED, et al.: Prevalence of psychological distress among cancer patients across the disease continuum. Journal of Psychosocial Oncology 15 (2): 73-87, 1997. 

  14. Fitchett G, Meyer PM, Burton LA: Spiritual care in the hospital: who requests it? Who needs it? J Pastoral Care 54 (2): 173-86, 2000 Summer.  [PUBMED Abstract]

  15. Handzo G: Where do chaplains fit in the world of cancer care? J Health Care Chaplain 4 (1-2): 29-44, 1992.  [PUBMED Abstract]

  16. Kristeller JL, Zumbrun CS, Schilling RF: 'I would if I could': how oncologists and oncology nurses address spiritual distress in cancer patients. Psychooncology 8 (5): 451-8, 1999 Sep-Oct.  [PUBMED Abstract]

  17. Puchalski C, Romer AL: Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med 3(1): 129-137, 2000. 

  18. Gordon T, Mitchell D: A competency model for the assessment and delivery of spiritual care. Palliat Med 18 (7): 646-51, 2004.  [PUBMED Abstract]

  19. Pargament KI: The Psychology of Religion and Coping: Theory, Research, Practice. New York, NY: Guilford Press, 1997. 

  20. Koenig HG: Spirituality in Patient Care: Why, How, When, and What. Philadelphia, Pa: Templeton Foundation Press, 2002. 

  21. Koenig HG, McCullough ME, Larson DB: Handbook of Religion and Health. New York, NY: Oxford University Press, 2001. 

  22. Tarakeshwar N, Vanderwerker LC, Paulk E, et al.: Religious coping is associated with the quality of life of patients with advanced cancer. J Palliat Med 9 (3): 646-57, 2006.  [PUBMED Abstract]

  23. Yanez B, Edmondson D, Stanton AL, et al.: Facets of spirituality as predictors of adjustment to cancer: relative contributions of having faith and finding meaning. J Consult Clin Psychol 77 (4): 730-41, 2009.  [PUBMED Abstract]

  24. Murray SA, Kendall M, Boyd K, et al.: Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliat Med 18 (1): 39-45, 2004.  [PUBMED Abstract]

  25. McCullough ME, Hoyt WT, Larson DB, et al.: Religious involvement and mortality: a meta-analytic review. Health Psychol 19 (3): 211-22, 2000.  [PUBMED Abstract]

  26. Jenkins RA, Pargament KI: Religion and spirituality as resources for coping with cancer. Journal of Psychosocial Oncology 13 (1/2): 51-74, 1995. 

  27. Chibnall JT, Videen SD, Duckro PN, et al.: Psychosocial-spiritual correlates of death distress in patients with life-threatening medical conditions. Palliat Med 16 (4): 331-8, 2002.  [PUBMED Abstract]

  28. Phelps AC, Maciejewski PK, Nilsson M, et al.: Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. JAMA 301 (11): 1140-7, 2009.  [PUBMED Abstract]

  29. Post SG, Puchalski CM, Larson DB: Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med 132 (7): 578-83, 2000.  [PUBMED Abstract]

  30. Sloan RP, Bagiella E, VandeCreek L, et al.: Should physicians prescribe religious activities? N Engl J Med 342 (25): 1913-6, 2000.  [PUBMED Abstract]

  31. Dagi TF: Prayer, piety and professional propriety: limits on religious expression in hospitals. J Clin Ethics 6 (3): 274-9, 1995 Fall.  [PUBMED Abstract]

  32. Kristeller JL, Rhodes M, Cripe LD, et al.: Oncologist Assisted Spiritual Intervention Study (OASIS): patient acceptability and initial evidence of effects. Int J Psychiatry Med 35 (4): 329-47, 2005.  [PUBMED Abstract]