Spirituality and spiritual care are gaining increasing attention but their potential contribution to palliative care remains unclear. The aim of this study was to synthesize qualitative literature on spirituality and spiritual care at the end of life using a systematic ('meta-study') review. Eleven patient articles and eight with healthcare providers were included, incorporating data from 178 patients and 116 healthcare providers, mainly from elderly White and Judaeo-Christian origin patients with cancer. Spirituality principally focused on relationships, rather than just meaning making, and was given as a relationship. Spirituality was a broader term that may or may not encompass religion. A 'spirit to spirit' framework for spiritual care-giving respects individual personhood. This was achieved in the way physical care was given, by focusing on presence, journeying together, listening, connecting, creating openings, and engaging in reciprocal sharing. Affirmative relationships supported patients, enabling them to respond to their spiritual needs. The engagement of family caregivers in spiritual care appears underutilized. Relationships formed an integral part of spirituality as they were a spiritual need, caused spiritual distress when broken and were the way spiritual care was given. Barriers to spiritual care include lack of time, personal, cultural or institutional factors, and professional educational needs. By addressing these, we may make an important contribution to the improvement of patient care towards the end of life.

To investigate the dimensions and determinants of posttraumatic growth among Chinese cancer survivors, 188 participants were asked to complete a Chinese posttraumatic growth inventory, translated from the Posttraumatic Growth Inventory (PTGI; J Trauma Stress 1996; 9: 455-471), together with the Chinese versions of the Hospital Anxiety and Depression scale, the Mini-Mental Adjustment to Cancer scale, and the General Health Questionnaire. Confirmatory factor analysis showed a different factor structure than the original English-language version of the PTGI. The dimensions of growth could also be broadly dichotomized into an Interpersonal and an Intrapersonal dimension in our Chinese sample. Multiple regression analysis showed that positive coping was the most important determinant of posttraumatic growth when compared with negative coping and psychological symptoms. A Chinese Posttraumatic Growth Inventory was developed to facilitate future research.

In rural China, family intervention should focus on improving the relatives' recognition of illness, the caring attitude towards the patients, treatment compliance, relapse prevention, and the training of the patients' social functioning. This trial, one of the largest in the literature, has shown that psychoeducational family intervention is effective and suitable for psychiatric rehabilitation in Chinese rural communities.

The benefits of economic growth, such as higher employment and more educational opportunities for the rural population in particular, may have contributed to the reduced suicide rate in China. However, the recent rapid changes in socioeconomic conditions could have increased stress levels and resulted in more suicides, especially among the elderly. Despite the significant reduction reported here, the latest figures suggest the declining trend is reversing. It will be important to continue monitoring the situation and to examine how urbanization and economic changes affect the well-being of 1.3 billion Chinese.

The psychometric properties of a Chinese version of the Mini-Mental Adjustment to Cancer scale (Mini-MAC) were examined among 115 Chinese cancer patients in Hong Kong. The five subscales from the original Mini-MAC (Anxious Preoccupation, Helpless-Hopeless, Fighting Spirit, Fatalism, Cognitive Avoidance) had acceptable internal reliabilities (Cronbach's alpha ranged from 0.65 to 0.88) and construct validities in our sample. Factor analysis suggested three factors: (1) Negative Emotion (alpha=0.91) contained items of the Anxious Preoccupation and the Helpless-Hopeless subscales of the original Mini-MAC, (2) Positive Attitude (alpha=0.77) combined the Fighting Spirit and the Fatalism subscales of the original version, and (3) Cognitive Avoidance (alpha=0.65) which was identical to the Cognitive Avoidance subscale of the original Mini-MAC. Construct validities of the novel factors were shown by their correlations with HADS Anxiety and Depression scores in the predicted directions. It was concluded that both the 5-factor model from the original Mini-MAC and the 3-factor model from the present study were valid in Hong Kong Chinese cancer patients. The results were discussed in terms of the meaning of the original Mini-MAC factors and cultural differences in coping functions between Chinese and UK cancer patients.

This study provides further confirmation of the potential harmful consequences of sensational and excessive reporting of celebrity deaths.

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