Background In recent years, spiritual well-being has gradually gained the attention of health care providers in China, especially those in oncology departments, who have recognized the importance of improving spiritual well-being in cancer patients. Since most of the current research on spiritual well-being has been carried out in areas with religious beliefs, this study was conducted in the context of no development of formal religion. The purpose of this study was to explore the relationship between death anxiety and spiritual well-being and the related factors of spiritual well-being among gynecological cancer patients. Methods This cross-section study was conducted among 586 gynecological cancer patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-spiritual well-being32 (EORTC QLQ-SWB32) and Templer's Death Anxiety Scale (T-DAS) were used to measure spiritual well-being and death anxiety. The Multiple Linear Regression Model was used to determine the relationship between spiritual well-being and death anxiety. Results For all participants, the highest QLQ-SWB32 centesimal score was 75.13 on the Relationship with Other scale, and the lowest was 60.33 on the Relationship with Someone or Something Greater Scale. The mean Death Anxiety score was 5.31 (SD 3.18). We found that Relationship with Someone or Something Greater was the only scale not associated with death anxiety. Overall, patients with lower death anxiety have a higher level of spiritual well-being. Besides, a high Relationship with Other score was associated with living with a partner (B = 2.471, P < 0.001) and married (B = -6.475, P = 0.001). Patients with higher Global-SWB were retired (B = 0.387, P = 0.019). Conclusions Our study found that the spiritual well-being of patients with gynecological cancer in China was no worse than in other countries with religious beliefs and patients with lower death anxiety have a higher level of spiritual well-being. Clinical staff should pay attention to the spiritual health of cancer patients, and spiritual care should be regarded as an essential element in cancer care.

PurposeThe purpose of this study was to explore the relationship between post-traumatic growth (PTG), spiritual well-being (SWB), and perceived social support (PSS) ,and the related factors of post-traumatic growth among gynecological cancer patients.MethodsWe conducted a cross-section study among 586 gynecological cancer patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-spiritual well-being32 (EORTC QLQ-SWB32), Post-traumatic Growth Inventory (PTGI), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to measure spiritual well-being, PTG, and PSS. The Multiple Linear Regression Model was used to determine the relationship between post-traumatic growth , spiritual well-being , and perceived social support .ResultsFor all participants, the highest PTGI score was 51.07 on the Appreciation of life scale, and the lowest was 32.84 on the New possibilities Scale.The highest QLQ-SWB32 centesimal score was 75.13 on the Relationship with Other scale, and the lowest was 60.33 on the Relationship with Someone or Something Greater Scale.The highest MSPSS centesimal score was 24.31 on the Family support scale, and the lowest was 20.54 on the Friend Support Scale.We found that Relationship with Self of QLQ-SWB32 was the only scale not associated with post-traumatic growth. Overall, patients with higher level of spiritual well-being and perceived social support have a higher level of post-traumatic growth.Besides, a high Personal strength score was associated with Religious belief (B= 1.615, P< 0.05) and Education background (senior middle school,B= 1.268, P=0.05，college and above，B= 1.450, P<0.05). Patients with higher Global-SWB of EORTC QLQ-SWB32 were retired (B= 0.387, P= 0.019).ConclusionsOur study revealed that patients with gynecological cancer who perceived higher levels of social support would experience greater post-traumatic growth, and spiritual well-being can mediate this effect.Implications for Cancer SurvivorsIncreasing social support and spiritual well-being might be scientific intervention techniques for improving post-traumatic growth in gynecological cancer survivors.