Despite considerable progress within wilderness and adventure therapy research over the last decade, researchers are still unable to precisely answer why, how, and for whom this treatment modality works. There is also a need for more knowledge regarding the circumstances under which the treatment does not appear to be effective. In this realist synthesis, we attempt to unpack this "black box" of wilderness therapy more specifically, defined as a specialized approach to mental health treatment for adolescents. Through a focused review of the primary qualitative wilderness therapy studies, empirical findings are used to test and refine a key program theory. The synthesis results in a proposed wilderness therapy clinical model and offers informed implications for future theory development, research, and practice.

Background:Spiritual well-being (SWB) is an important quality-of-life dimension for cancer patients in the palliative phase. Therefore, it is important for healthcare professionals to recognize the concept of SWB from the patient’s point of view. A deeper understanding of how patients experience and reflect upon these issues might influence patient care.Objectives:The aim of this study was to explore SWB in colorectal cancer patients receiving chemotherapy in the palliative phase.Methods:We used a qualitative method of in-depth interviews and a hermeneutic editing approach for the analyses and interpretations.Results:Twenty colorectal cancer patients in the palliative phase, aged 34 to 75 years, were included: 12 patients were receiving first-line chemotherapy, and 8 patients were receiving second-line chemotherapy. Through empirical analyses, we identified subthemes according to the SWB dimensions defined by the European Organisation for Research and Treatment of Cancer quality-of-life group. Under the SWB dimension, (i) relationships with self and others, we identified the subthemes: (a) strategies for inner harmony and (b) sharing feelings with significant others. Under the dimension, (ii) existential issues, we identified the subtheme (c) coping with end-of-life thoughts. Under the dimension, (iii) specifically religious and/or spiritual beliefs and practices, we identified the subtheme (d) seeking faith as inner support.Conclusion:Knowledge about cancer patients’ use of different strategies to increase their SWB may help healthcare professionals to guide patients through this vulnerable phase.Implication for Practice:Healthcare professionals need sufficient courage and willingness to share their patients’ thoughts, beliefs, and grief to be able to guide patients toward improving their SWB.

No abstract