“If God Wanted Me Yesterday, I Wouldn't Be Here Today”: Religious and Spiritual Themes in Patients' Experiences of Advanced Cancer

Abstract

Background: This study sought to inductively derive core themes of religion and=or spirituality (R=S) active in patients' experiences of advanced cancer to inform the development of spiritual care interventions in the terminally ill cancer setting. Methods: This is a multisite, cross-sectional, mixed-methods study of randomly-selected patients with advanced cancer (n ¼ 68). Scripted interviews assessed the role of R=S and R=S concerns encountered in the advanced cancer experience. Qualitative and quantitative data were analyzed. Theme extraction was performed with interdisciplinary input (sociology of religion, medicine, theology), utilizing grounded theory. Spearman correlations determined the degree of association between R=S themes. Predictors of R=S concerns were assessed using linear regression and analysis of variance. Results: Most participants (n ¼ 53, 78%) stated that R=S had been important to the cancer experience. In descriptions of how R=S was related to the cancer experience, five primary R=S themes emerged: coping, practices, beliefs, transformation, and community. Most interviews (75%) contained two or more R=S themes, with 45% mentioning three or more R=S themes. Multiple significant subtheme interrelationships were noted between the primary R=S themes. Most participants (85%) identified 1 or more R=S concerns, with types of R=S concerns spanning the five R=S themes. Younger, more religious, and more spiritual patients identified R=S concerns more frequently (b ¼ À0.11, p < 0.001; b ¼ 0.83, p ¼ 0.03; and b ¼ 0.89, p ¼ 0.04, respectively). Conclusions: R=S plays a variety of important and inter-related roles for most advanced cancer patients. Future research is needed to determine how spiritual care can incorporate these five themes and address R=S concerns.

Making sense of a diagnosis of incurable cancer: The importance of communication

“…advanced cancer is contrary to the results of studies which suggest that existential concerns and religious/spiritual activities play a prominent role for many patients in coping with incurable malignancy. 5,7,14,15 Our results are similar to a study of patients newly diagnosed with advanced gastrointestinal cancer where almost half expressed a belief in God, a higher power or a divine power 27 , and in contrast with studies in patients with more advanced disease from other settings in the USA and UK. [14][15][16][17] Despite the conflicting research results as to whether appraised meaning, and the results of meaning-making, change over time, it is possible that the role of spirituality and/or religion will become a more relevant influence in our patients as they become more symptomatic and progress towards a terminal state.…”

Why Is Spiritual Care Infrequent at the End of Life? Spiritual Care Perceptions Among Patients, Nurses, and Physicians and the Role of Training

“…Religion and spirituality (R/S) are important dimensions of most patients' experiences of advanced illness 1,2 and are associated with medical outcomes including improved quality of life (QOL) 3,4 and greater preferences and receipt of aggressive end-oflife (EOL) care. 5,67 Spiritual care (SC)-recognition and support of the R/S dimensions of illness-is considered by patients to be an important aspect of EOL care [8][9][10][11] and is also associated with key patient outcomes, including patient QOL, 12 satisfaction with hospital care, 13,14 increased hospice use, 12 decreased aggressive medical interventions, 12 and medical costs.…”

Psychological utility of art therapy for patients with advanced cancer

“…Particularly in cases of advanced cancer or recurrence, patients are confronted with the reality of death. Religion and spirituality are important dimensions of most patients' experiences of advanced illness [3].…”