Images of God and attitudes towards death in relation to spiritual wellbeing: an exploratory side study of the EORTC QLQ-SWB32 validation study in palliative cancer patients

Abstract

BackgroundWhen patients are facing the ends of their lives, spiritual concerns often become more important. It is argued that effective, integrated palliative care should include addressing patients’ spiritual wellbeing. In 2002 the EORTC Quality of Life Group began an international study to develop an spiritual wellbeing measure for palliative patients (SWB). Spiritual wellbeing is a complex construct, which comprises multiple contributory components. While conducting the EORTC SWB validation study with Dutch palliative cancer patients we also conducted an exploratory side study to examine the relationship between their spiritual wellbeing, images of God, and attitudes towards death.MethodsPatients with incurable cancer who were able to understand Dutch and were well enough to participate, completed the provisional SWB measure and two scales assessing “Images of God” and “attitudes towards death and afterlife”. Linear stepwise regression analysis was conducted to assess the relation between SWB and other factors.ResultsFifty two Dutch patients, 28 females and 24 males, participated. The whole SWB measure validation identified four scoring scales: Existential (EX), Relationship with Self (RS), Relationships with Others (RO), Relationship with Something Greater (RSG) and Relationship with God (RG, for believers only). Adherence to an image of an Unknowable God and a worse WHO performance status were negatively associated with the EX scale. The image of an Unknowable God was also found to be negatively associated with the RS scale. Higher education correlated positively with the RO scale. Adherence to a Personal or Non-Personal Image of God was not found to be positively influencing any of the domains of SWB.ConclusionsFor our participants, an Unknowable Image of God had a negative relationship with their SWB. Furthermore, specific images of God (Personal or Non Personal) are not associated with domains of SWB. Together, these findings suggest that spiritual wellbeing surpasses traditional religious views. The development of a new language which more naturally expresses different images of a higher being amongst patients in western late-modern societies may further aid our understanding and subsequently lead to an improvement in patients’ spiritual wellbeing.

Association between spiritual well-being, quality of life, anxiety and depression in patients with gynaecological cancer in China

“…The World Health Organization states that palliative care should integrate the psychological and spiritual aspects of patient care to improve quality of life. [ 8 , 9 ] Moreover, spirituality seems to be associated with physical and psychological health, especially in patients with cancer. [ 10 ] Spirituality is defined as “a person's experience of connectedness with the essence of life, search for connectedness to oneself, others, nature, and sacredness”.…”

Living with advanced cancer: Rich Pictures as a means for health care providers to explore the experiences of advanced cancer patients

“…Contingency refers to the randomness of life, that everything could have been different . When life goals are jeopardized, questions like “why me” and “why now” may arise . Patients need to make meaning of their life with cancer and incorporate diagnosis and prognosis in their life story .…”

“…Integrating advanced cancer in one's narrative of life, however, is challenging, and feelings of hopelessness, depression, and even the desire for a hastened death were found to be common among patients with advanced cancer . Therefore, care for patients with advanced cancer needs to address psychosocial, spiritual and existential health in addition to physical health . Despite improvements in cancer care in developed countries, these nonphysical domains remain largely unattended …”

“…[3][4][5][6] When life goals are jeopardized, questions like "why me" and "why now" may arise. 1,4,5,7 Patients need to make meaning of their life with cancer and incorporate diagnosis and prognosis in their life story. 5 Integrating advanced cancer in one's narrative of life, however, is challenging, and feelings of hopelessness, depression, and even the desire for a hastened death were found to be common among patients with advanced cancer.…”

“…1,2 Therefore, care for patients with advanced cancer needs to address psychosocial, spiritual and existential health in addition to physical health. 3,[7][8][9][10] Despite improvements in cancer care in developed countries, these nonphysical domains remain largely unattended. [10][11][12] The experience of contingency can be conceptualized as an interpretation crisis, and people may not be able to find words to express what is happening to them, that is, words may be insufficient in capturing intense experiences.…”