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 Table of Contents  
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 101-103

Spiritual Care for Cancer Patients

College of Nursing and Health, Wright State University-Miami Valley, Dayton, Ohio, USA

Date of Submission12-Oct-2018
Date of Acceptance16-Oct-2018
Date of Web Publication31-Jan-2019

Correspondence Address:
Yi-Hui Lee
College of Nursing and Health, Wright State University-Miami Valley, Dayton, Ohio
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/apjon.apjon_65_18

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How to cite this article:
Lee YH. Spiritual Care for Cancer Patients. Asia Pac J Oncol Nurs 2019;6:101-3

How to cite this URL:
Lee YH. Spiritual Care for Cancer Patients. Asia Pac J Oncol Nurs [serial online] 2019 [cited 2021 Dec 2];6:101-3. Available from: https://www.apjon.org/text.asp?2019/6/2/101/251292

Cancer is the second leading cause of death worldwide; about 1 in 6 deaths is due to cancer.[1] Diagnosis and medical treatment for cancer usually cause great physical and emotional distress and add stress to cancer patients' lives.[2] Spirituality and religious beliefs have been found, especially important for patients who suffer from severe illness and/or are facing life-threatening health problems.[3] Spirituality is an aspect of one's life regarding seeking meaning, purpose, and connection to a higher power, and it allows the individual to effectively function toward his/her life goal.[4] It is believed that spirituality is one essential factor providing a context for cancer patients to derive hope and meaning to cope with their illness from the diagnosis through treatment, survival, recurrence, and dying, and it could serve as a protector buffers the deteriorating impacts of life stress and illness.[2],[5] Individuals who are living with a life-threatening illness such as cancer may be most vulnerable to spiritual distress and are more aware and sensitive to their spiritual selves and spiritual needs.[3],[5],[6] Addressing spiritual needs could help patients cope with the challenges associated with illness.[7] As spirituality is a critical component of holistic and person-centered care, spiritual interventions should be considered and incorporated into the plan of care for each cancer patient.[2],[5]

During the past decade, there has been a considerable increase in the number of studies in spiritual and religious coping in adjustment to severe illness such as cancer.[8] Spirituality is one essential indicator of quality of life,[4],[9] and spiritual well-being is found to be positively associated with spirituality and health outcomes in patients diagnosed with cancer.[5],[10] Cancer patients who had high levels of spiritual well-being reported better quality of life, a lower level of depression, less anxiety about death, and a lower level of distress.[5],[8] Cancer patients reported that spirituality is a source of strength that helps them cope with their cancer experiences, define wellness during treatment and survivorship, find meaning in their lives, find a sense of health, and make sense of their cancer experiences during illness.[5] Consistent associations between spirituality, spiritual well-being, and health outcomes found in published studies highlight the importance of providing spiritual care to enhance cancer patients' spiritual well-being and address their spiritual needs.

Experiencing spiritual distress is not uncommon among cancer patients.[8] Unfulfilled spiritual needs could be a contributor causing distress.[2] Spiritual distress and suffering may influence a person's experiences and symptoms associated with illness and contribute to poorer health and psychosocial outcomes.[2],[8] Cancer patients' spiritual needs should be assessed and addressed when planning and providing care to them, and the assessment for spiritual wellness and distress is vital in addressing cancer patients' needs,[10],[11] Health-care providers have responsibilities to provide holistic care to patients with cancer and to acknowledge and encourage exploration of their spiritual issues and needs.[3] Nurses and other health-care professionals should be educated and trained to be competent in assessing and addressing cancer patients' spiritual needs.

The impacts of culture should be taken into account to provide holistic and culturally competent spiritual care to provide each cancer patient with appropriate spiritual care and to address each cancer patient's spiritual needs.[12],[13] The connections between spirituality, culture, and religion are dynamical and reciprocal.[14] Culture could influence a person's spiritual belief, spiritual well-being, and spiritual practices since spirituality is experienced through daily lived experience.[13] Reciprocally, spiritual and religious beliefs may contribute to an individual's interpretation and management of physical and psychological distress as well as play an imperative role in shaping one's cultural understandings of life, death, and living a meaningful life.[7],[14],[15] For example, cancer patients' perceptions and interpretations of pain could be influenced by a combination of various social, cultural, and spiritual factors.[15] Patients from some cultures may believe that pain is a part of God's plan or is a sign of progress toward recovery, while other patients from different cultural groups may review pain as the result of an imbalance between yin and yang.[15] A spiritual intervention may be as effective as a medical intervention in pain management for cancer patients.[2] Assessing cancer patients' spiritual, cultural, and social beliefs is important, and it could help health-care providers to more accurately assess cancer patients' perceptions of physical and psychological distress and adequately provide interventions and medications to cancer patients. While individuals with the same cultural background or within the same religious group most likely share a set of common beliefs, it should be acknowledged that there is variance in beliefs and spiritual needs among different individuals and situations. The mixture of spirituality, religion, culture, and the beliefs of individuals, families, communities, and other social structures powerfully influence patients' decision-making, care delivery, and views about death and illness.[14],[16] It is crucial that health-care providers acknowledge and adapt culturally appropriate and patient-centered care to fulfill the diverse spiritual needs of patients.

As spiritual care for cancer patients needs to be interdisciplinary and culturally appropriate, using valid and reliable instruments and tools that are culturally appropriate for assessing spiritual needs and evaluating outcomes of spiritual care becomes extremely important.[13] A culturally appropriate and responsive spiritual assessment is the initial step to address the spiritual needs of patients.[13] Uses of culturally appropriate tools could aid in integrating culturally specific spiritual beliefs and practices into the plan of spiritual care and allow health-care providers to respond better to cancer patients' spiritual needs. Although many assessment tools are available and applicable to perform a religious and spiritual assessment, it is unclear whether these tools originally developed for Western populations are equally reliable and valid for the use in Asian populations. Appropriate tools and instruments for assessing patients' spiritual needs, spiritual distress, and spiritual well-being in Asian populations which are influenced by their unique and diverse spiritual, religious, and cultural beliefs may be absent or scarce. The lack of valid and reliable tools that are culturally appropriate and sensitive could be a barrier that limits nurses and health professionals' capabilities to deliver appropriate spiritual care to address Asian cancer patients' spiritual needs and to evaluate the outcomes of spiritual care. Further efforts to develop appropriate assessment tools for the Asian populations require researchers' attentions. Although responding to diverse spiritual needs may be challenging, this process can be rewarding for health-care providers, patients, and patients' family members since it provides chances for reciprocal spiritual and religious growth during the exchange of new understandings and meanings.[3]

Even if the integral role of providing spiritual care as part of a holistic approach to cancer patients and the necessity for spiritual assessment is generally recognized, cancer patients reported their spiritual needs were not recognized, addressed, or supported.[5],[8],[17] Multiple complex barriers have been reported in literature such as spiritual and religious differences between patients and providers, a lack of understanding of spirituality, a lack of education and preparedness, and a lack of time and experience to adequately address patients' spiritual needs and deliver spiritual care.[2],[18],[19] The barriers to providing spiritual care must be overcome so that appropriate and comprehensive care can be delivered to address cancer patients' needs.

Given the fact that the significance of providing spiritual care to cancer patients has become increasingly more evident, nurses and other health-care professionals have responsibilities to assess cancer patients' spiritual needs as well as to plan and deliver culturally appropriate spiritual care to them. More studies investigating spiritual well-being, spiritual needs, and culturally appropriate spiritual care for cancer patients with Asian cultural backgrounds are urgently needed to overcome barriers preventing the delivery of proper and competent spiritual care to all cancer patients. It is necessary to ensure nurses become familiarized with the aspects of spirituality, understand cultural influences on cancer patients' spirituality and spiritual well-being, and overcome the barriers to providing spiritual care to properly deliver appropriate and comprehensive care to each cancer patient.

A growing number of studies have investigated the linkages between spirituality and health outcomes in cancer patients and emphasized the importance of spiritual care and spiritual well-being in cancer patients worldwide; however, the majority of these studies were carried out in Western countries. Research that explored and provided evidence regarding spirituality and spiritual care among cancer patients in Asian countries is scarce. The lack of information causes a knowledge gap that limits health-care providers' capabilities to deliver appropriate spiritual care to oncology patients with Asian cultural backgrounds. Studies to investigate barriers and facilitators to the delivery of culturally appropriate and sensitive spiritual care among cancer patients with diverse cultural and social backgrounds in Asian countries require further attentions and efforts.

The aim of this special issue is to provide a platform for health professionals, researchers, educators, politicians, nongovernment agencies, and interested others to share knowledge and experiences on developing and providing spiritual care for cancer patients in Asian countries. It is our intent to create a dialog to gain a deeper understanding about developing and providing spiritual care in Asia and for the future collaboration and support of each other to improve spiritual care in this region. The papers in this issue contribute to enhancing our knowledge and capabilities in assessing and addressing spiritual needs as well as developing and delivering culturally appropriate and patient-centered spiritual care to all cancer patients. It is a great privilege to write the editorial for this special issue, and I appreciate all the authors who contributed their excellent work to this special issue.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. Cancer. World Health Organization; 2018. Available from: http://www.who.int/news-room/fact-sheets/detail/cancer. [Last accessed on 2018 Aug 12].  Back to cited text no. 1
Puchalski CM, King SD, Ferrell BR. Spiritual considerations. Hematol Oncol Clin North Am 2018;32:505-17.  Back to cited text no. 2
Conway J. Integrating spiritual care as part of comprehensive cancer treatment. Oncol Nurse Advis 2010;1:24-7.  Back to cited text no. 3
Lee YH, Salman A. The mediating effect of spiritual well-being on depressive symptoms and health-related quality of life among elders. Arch Psychiatr Nurs 2018;32:418-24.  Back to cited text no. 4
Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol 2012;23 Suppl 3:49-55.  Back to cited text no. 5
Cheng Q, Xu X, Liu X, Mao T, Chen Y. Spiritual needs and their associated factors among cancer patients in China: A cross-sectional study. Support Care Cancer 2018;26:3405-12.  Back to cited text no. 6
Hodge DR, Sun F, Wolosin RJ. Hospitalized Asian patients and their spiritual needs: Developing a model of spiritual care. J Aging Health 2014;26:380-400.  Back to cited text no. 7
National Institutes of Health. Spirituality in Cancer Care (PDQ®): Health Professional Version; 2017. Available from: https://www.cancer.gov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-hp-pdq. [Last accessed on 2018 Aug 16].  Back to cited text no. 8
Amoah CF. The central importance of spirituality in palliative care. Int J Palliat Nurs 2011;17:353-8.  Back to cited text no. 9
Bai M, Lazenby M. A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer. J Palliat Med 2015;18:286-98.  Back to cited text no. 10
Hui D, de la Cruz M, Thorney S, Parsons HA, Delgado-Guay M, Bruera E, et al. The frequency and correlates of spiritual distress among patients with advanced cancer admitted to an acute palliative care unit. Am J Hosp Palliat Care 2011;28:264-70.  Back to cited text no. 11
Cockell N, McSherry W. Spiritual care in nursing: An overview of published international research. J Nurs Manag 2012;20:958-69.  Back to cited text no. 12
Lee YH, Salman A. Evaluation of using the Chinese version of the spirituality index of well-being (SIWB) scale in Taiwanese elders. Appl Nurs Res 2016;32:206-11.  Back to cited text no. 13
Surbone A, Baider L. The spiritual dimension of cancer care. Crit Rev Oncol Hematol 2010;73:228-35.  Back to cited text no. 14
Martin EM, Barkley TW Jr. Improving cultural competence in end-of-life pain management. Home Healthc Now 2017;35:96-104.  Back to cited text no. 15
Fang ML, Sixsmith J, Sinclair S, Horst G. A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: Findings from a scoping review. BMC Geriatr 2016;16:107.  Back to cited text no. 16
Richardson P. Spirituality, religion and palliative care. Ann Palliat Med 2014;3:150-9.  Back to cited text no. 17
Zakaria Kiaei M, Salehi A, Moosazadeh Nasrabadi A, Whitehead D, Azmal M, Kalhor R, et al. Spirituality and spiritual care in Iran: Nurses' perceptions and barriers. Int Nurs Rev 2015;62:584-92.  Back to cited text no. 18
Saguil A, Phelps K. The spiritual assessment. Am Fam Physician 2012;86:546-50.  Back to cited text no. 19

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