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November 2009 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.


Wagle, A. M., Champion, V. L., Russell, K. M. and Rawl, S. M. "Development of Wagle Health-Specific Religiousness Scale." Cancer Nursing 32, no. 5 (September/October 2009): 418-425.


SUMMARY and COMMENT: This month's article presents a new scale for spirituality & health research that is unusual in explicitly asking patients to draw connections between their theological understanding and the care of their bodies. This approach is distinct from that of the most popular measures in spirituality & health research (e.g., the Brief RCOPE or FACIT-Sp), which query patients quite generally about their spirituality in the context of illness. The strength of the Wagle scale lies in its potential to draw out very specific theological constructs that may affect health and provide insight for providers, but the theological scope of the questions may limit its flexibility with different populations.

This scale revolves around the concept of "health-specific religiousness," defined as "a set of religious beliefs that centers on a higher presence and guides health beliefs and health behaviors" [p. 419]. The authors, all nurses, hold that while others "have examined various aspects of religion, the wide variety of conceptual and operational definitions of religiousness have failed to yield a clear understanding of the role that religiousness plays in influencing health behaviors," and " studies were identified that examined the relationship between health-specific religiousness and particular health behaviors" [p. 419]. The measure was developed for the study of mammography adherence among African Americans, and psychometric testing was done with a sample of 344 low-income African Americans participating in a community-based trial of an intervention to increase mammography screening.

The measure was written to reflect eight themes found in concept analysis of the literature:

  • Subjective religious beliefs related to health beliefs and health behaviors
  • Manner in which religious beliefs foster awareness and concern for others and self
  • Presence of God-given meaning and enjoyment in life
  • Means for moving through guilt, anger, and anxiety
  • Commitment to a greater purpose
  • Means for personal adjustment and/or coping
  • Distinction between passive vs. active locus of control
  • Acceptance of social norms relative to religion
    --see p. 420
The nineteen items of the Wagle Health-Specific Religiousness Scale (WHSR) are as follows:
  1.   I believe that God wants me to be concerned about the health of my family and friends.
  2.   I believe that God wants me to take care of my body so that I can enjoy life.
  3.   Because of my religious beliefs, I feel guilty when I donít take care of my body.
  4.   If I take care of my body, I am better able to do Godís will.
  5.   I believe that God will be with me if something happens to my health.
  6.   I believe God has given me some control of my health.
  7.   My religious community shares my beliefs about taking care of my body.
  8.   I believe that God expects me to take care of my body.
  9.   I believe that God wants me to be concerned about my health.
  10.   I believe that God has complete control of my health.
  11.   I believe that God has given us doctors to help us take care of our bodies.
  12.   I believe that God will take care of my body.
  13.   I believe that God wants me to take care of my body to help me enjoy life.
  14.   Taking care of my body is necessary to do Godís work.
  15.   I believe that God will provide others to help me if something happens to my health.
  16.   The women in my religious community encourage me to take care of my body.
  17.   I believe that God wants me to visit my doctor regularly.
  18.   I believe that God wants me to take care of my own health as part of my responsibility to my family.
  19.   I believe that by taking care of my body, God will give me peace.
[--See p. 422. Items reprinted here with permission of the author.]

In addition to presenting the measure itself, the article goes on to report results from its use in the study of mammography adherence among low-income African American women. Among the findings: "...cancer fatalism and perceived self-efficacy to get a mammogram were significant predictors of health-specific religious beliefs...," and "...religious behavior [was] significantly related to mammography adherence": "Women with higher levels of religious behaviors were more likely to be adherent to mammography guidelines" [p. 423]. Moreover, "higher levels of health-specific religious beliefs result in more religious behavior (prayer, attendance at worship and other religious meetings, and scripture reading)" [p. 423].

Limits in this study--and in the testing of the WHSR scale--include the lack of diversity among the participants: an older African American population that was mostly of "fundamental Christian faith"; and the authors caution against generalization to other religious groups. The need for further research is duly noted, not only with different populations, but with attention to the dynamics of mediation in the relation of religion to health. [See p. 424.]

The theological picture behind the WHSR scale is one of a personal and involved God who "wants" and "expects" people to take care for their physical bodies and utilize medical professionals, so as to be able better to do "God's work" in the world and "enjoy life." All of the items are worded in a single, positive direction, and the last item draws a connection between taking care of one's body and feeling God's peace. As such, even patients of "fundamental Christian faith" who are experiencing anguish over failing health would seem to find their feelings cutting against the grain of this questionnaire. That may not have been a methodological problem in the present research, but it suggests the challenge of using highly theology-specific measures in circumstances where patients' beliefs as well as their bodies may be stressed by illness.


Suggestions for the Use of the Article for Discussion in CPE: 

This article offers another opportunity for students to think carefully about the dynamics of questionnaires and about the trade-offs between tailoring them to certain populations and making them broadly useful across different populations. A review of the JCOPE measure vis-a-vis the Brief RCOPE, as explored in our July 2009 Article-of-the-Month page (--see especially the side-by-side comparison) may help students think about how particular questionnaire items connect more or less to the theology and social/cultural traditions of different religious groups. What items on the Wagle scale stand out as potentially well-suited to the Christian population in the current study, and how might these same items be out of sync with non-Christian populations? Students should be aware of the complexity of instrument development and should also be reminded that every time a questionnaire is used, the data collected is as much a referendum on the measure itself as it is an insight into the subject matter being researched. (Another resource for students on this point may be Problems with Questions: Thinking Critically about Questionnaire Items, noted in our Winter 2002 Newsletter.)

Other approaches to discussing the article would be to focus on the connections between 1) Self-Efficacy and Cancer Fatalism, 2) Health-Specific Religious Beliefs, and 3) Religious Behaviors. See especially the Conceptual Framework and Discussion sections [pp. 419 and 423]. Of course, students may be interested in exploring the particular topic of mammography adherence and possibly the wider topic of breast cancer in light of spirituality [--see Related Items of Interest, §II & §III, below].


Related Items of Interest:

I. For another recent measure that asks about religious attitudes and beliefs in the explicit context of cancer, see:

Bowman, E. S., Beitman, J. A., Palesh, O., Perez, J. E. and Koopman, C. "The cancer and deity questionnaire: a new religion and cancer measure." Journal of Psychosocial Oncology 27, no. 4 (2009): 435-453. [The article reports testing of a new 12-item measure with 61 participants, 52 of which took the questionnaire at baseline and again at follow-up. The scale is constructed of two subscales: Abandonment and Benevolence. Five of the items address beliefs about God in explicit relation to cancer (i.e., "Before I had cancer, God treated me better than God does now," "I trust God with the outcome of my cancer," "Before I had cancer, God felt more powerful than God does now," "Before I had cancer, God listened to me more than God does now," and "Before I had cancer, I felt closer to God than now." (From the abstract:) Internal consistency was excellent for the Benevolence scale (alpha = .97) and good for the Abandonment scale (alpha = .80). Moderate correlations with the Spiritual Well-Being Scale support divergent validity. Correlations between CDQ scales and the Styles of Religious Coping scales support convergent validity. The CDQ is brief, easily scored, practical for psycho-oncology research, and adaptable for use with other illnesses.]

II. For more on the subject of spirituality and breast cancer screening, see the following recent articles:

Florez, K. R., Aguirre, A. N., Viladrich, A., Cespedes, A., De La Cruz, A. A. and Abraido-Lanza, A. F. "Fatalism or destiny? A qualitative study and interpretative framework on Dominican women's breast cancer beliefs." Journal of Immigrant and Minority Health 11, no. 4 (August 2009): 291-301. [(Abstract:) BACKGROUND: A growing literature on Latino's beliefs about cancer focuses on the concept of fatalismo ("fatalism"), despite numerous conceptual ambiguities concerning its meaning, definition, and measurement. This study explored Latina women's views on breast cancer and screening within a cultural framework of destino ("destiny"), or the notion that both personal agency and external forces can influence health and life events. METHODS: Semi-structured interviews were conducted with 25 Latinas from the Dominican Republic aged 40 or over. RESULTS: Respondents reported complex notions of health locus of control that encompassed both internal (e.g., individual action) and external (e.g., the will of God) forces shaping breast cancer prevention efforts. Furthermore, women actively participated in screening because they believed that cancer could become a death sentence if diagnosed late or left untreated. DISCUSSION: In contrast to simplistic notions of "fatalism", our analysis suggests complex strategies and beliefs regarding breast cancer and cancer screening that speak of resiliency rather than hopelessness.]

Holt, C. L., Lee, C. and Wright, K. "A spiritually based approach to breast cancer awareness: cognitive response analysis of communication effectiveness." Health Communication 23, no. 1 (January-February 2009): 13-22. [(Abstract:) The purpose of this study was to compare the communication effectiveness of a spiritually based approach to breast cancer early detection education with a secular approach, among African American women, by conducting a cognitive response analysis. A total of 108 women from 6 Alabama churches were randomly assigned by church to receive a spiritually based or secular educational booklet discussing breast cancer early detection. Based on the elaboration likelihood model (Petty & Cacioppo, 1981), after reading the booklets participants were asked to complete a thought-listing task, writing down any thoughts they experienced and rating them as positive, negative, or neutral. Two independent coders then used 5 dimensions to code participants' thoughts. Compared with the secular booklet, the spiritually based booklet resulted in significantly more thoughts involving personal connection, self-assessment, and spiritually based responses. These results suggest that a spiritually based approach to breast cancer awareness may be more effective than the secular approach because it caused women to more actively process the message, stimulating central route processing. The incorporation of spiritually based content into church-based breast cancer education could be a promising health communication approach for African American women.]

III. For articles addressing broadly the connections between spirituality and breast cancer, see:

Astrow, A. B., Wexler, A., Texeira, K., He, M. K. and Sulmasy, D. P. "Is failure to meet spiritual needs associated with cancer patients' perceptions of quality of care and their satisfaction with care?" Journal of Clinical Oncology 25, no. 36 (December 20, 2007): 5753-5757. [(Abstract:) PURPOSE: Few studies regarding patients' views about spirituality and health care have included patients with cancer who reside in the urban, northeastern United States. Even fewer have investigated the relationship between patients' spiritual needs and perceptions of quality and satisfaction with care. PATIENTS AND METHODS: Outpatients (N = 369) completed a questionnaire at the Saint Vincent's Comprehensive Cancer Center in New York, NY. The instrument included the Quality of End-of-Life Care and Satisfaction with Treatment quality-of-care scale and questions about spiritual and religious beliefs and needs. RESULTS: The participants' mean age was 58 years; 65% were female; 67% were white; 65% were college educated; and 32% had breast cancer. Forty-seven percent were Catholic; 19% were Jewish; 16% were Protestant; and 6% were atheist or agnostic. Sixty-six percent reported that they were spiritual but not religious. Only 29% attended religious services at least once per week. Seventy-three percent reported at least one spiritual need; 58% thought it appropriate for physicians to inquire about their spiritual needs. Eighteen percent reported that their spiritual needs were not being met. Only 6% reported that any staff members had inquired about their spiritual needs (0.9% of inquiries by physicians). Patients who reported that their spiritual needs were not being met gave lower ratings of the quality of care (P = .009) and reported lower satisfaction with care (P = .006). CONCLUSION: Most patients had spiritual needs. A slight majority thought it appropriate to be asked about these needs, although fewer thought this compared with reports in other settings. Few had their spiritual needs addressed by the staff. Patients whose spiritual needs were not met reported lower ratings of quality and satisfaction with care.]

Gall, T. L., Guirguis-Younger, M., Charbonneau, C. and Florack, P. "The trajectory of religious coping across time in response to the diagnosis of breast cancer." Psycho-Oncology 18, no. 11 (November 2009): 1165-1178. [(Abstract:) OBJECTIVES: This study investigates the mobilization of religious coping in women's response to breast cancer. METHODS: Ninety-three breast cancer patients and 160 women with a benign diagnosis participated. Breast cancer patients were assessed on their use of religious coping strategies and their level of emotional distress and well-being at pre-diagnosis, 1 week pre-surgery, and 1 month, 6 months, 1 year, and 2 years post-surgery. RESULTS: In general, breast cancer patients used religious strategies more frequently than women with a benign diagnosis; however, the patterns of use were similar across time for the majority of strategies. Results showed that religious coping strategies are mobilized early on in the process of adjustment to breast cancer. Breast cancer patients' use of support or comfort-related strategies peaked around surgery and then declined, while the use of strategies that reflected more a process of meaning-making remained elevated or increased into the long-term. Positive and negative forms of religious coping were predictive of concurrent distress and emotional well-being. As well, there was evidence that the mobilization of religious coping was predictive of changes in distress and well-being across time. For example, women's increased use of active surrender coping from 1 to 6 months post-surgery was related to a concomitant decrease in emotional distress and increase in emotional well-being. CONCLUSIONS: Notably the nature of the relationship between religious coping and emotional adjustment depended on the type of religious coping strategy as well as the specific time of assessment. Specificity of information in the use of religious coping can allow health-care professionals to better identify resources and address potential points of difficulty during the process of women's adjustment to breast cancer.]

Gall, T. L., Kristjansson, E., Charbonneau, C. and Florack, P. "A longitudinal study on the role of spirituality in response to the diagnosis and treatment of breast cancer." Journal of Behavioral Medicine 32, no. 2 (April 2009): 174-186. [(Abstract:) This longitudinal study addressed the role of spirituality in women's response to breast cancer. Ninety-three women diagnosed with breast cancer were assessed on various measures of image of God, positive attitude, social well-being and emotional distress at pre-diagnosis, 6 months post-surgery and 1 year post-surgery. As compared to women who dropped out of the study, this sample reported religion to be less important in their daily lives. Path analyses showed evidence of direct and indirect effects of positive and negative images of God on emotional distress in cross-sectional but not longitudinal data. A positive image of God was related to greater concurrent distress while a negative image of God was indirectly related to greater distress through the pathways of social well-being and positive attitude. In the longitudinal path model, a pre-diagnosis measure of religious salience was the only aspect of spirituality that predicted an increase in distress at 1 year post-surgery. The cross-sectional analyses provided limited support for the "religious/spiritual mobilization" hypothesis as put forth by Pargament (The psychology of religion and coping. New York: Guilford Press, 1997). There was also limited support for the mediator variables of positive attitude and social well-being as mechanisms through which spirituality influences adjustment. Finally, there was no support that spirituality acted in a protective manner rather the negative elements of spirituality were more prominent in relation to various aspects of women's adjustment to breast cancer. Such results suggest that women who were less spiritually/religiously involved prior to the onset of breast cancer and who attempt to mobilize these resources under the stress of diagnosis may experience a negative process of spiritual struggle and doubt that, in turn, has implications for their long-term adjustment.]

Gibson, L. M. and Hendricks, C. S. "Integrative review of spirituality in African American breast cancer survivors." ABNF [Association of Black Nursing Faculty] Journal 17, no. 2 (2006): 67-72. [(Abstract:) This paper reports findings of an integrative review of the literature on spirituality in AA breast cancer survivors, isolates key spiritual themes, and recommends future research. Inclusion criteria are 1994 to 2004 research studies that included AA breast cancer survivors 18 years old and older. Content analysis was used to isolate spiritual themes and spiritual domains/dimensions. Seven studies resulted that used qualitative, quantitative, and mixed methods. Themes identified were spirituality provided the strength to cope; the need to care for others and receive care; beliefs that God is the healer and in control; God assists in decision-making; and closeness to God. Spiritual domains were beliefs, functions, and social support. Future research should explore the domains/dimensions and meanings of spirituality experienced by diverse groups of AA breast cancer survivors. Culturally appropriate, evidence-based nursing care should include spiritually based interventions that acknowledge the significance of God.]

Gillum, F. and Williams, C. "Associations between breast cancer risk factors and religiousness in American women in a national health survey." Journal of Religion and Health 48, no. 2 (June 2009): 178-188. [(Abstract:) Breast cancer is a leading cause of death in American women. Data are lacking from representative samples of total populations on the association of risk factors for breast cancer and religiousness. The sixth cycle of the National Survey of Family Growth (NSFG VI) included 3,766 women aged 30-44 years with complete data on self-reported religiousness, and selected breast cancer risk factors. Of women in the analysis, 1,008 reported having four or more breast cancer risk factors. Women who never attended services were over seven times more likely to report having four or more risk factors than those who attended more than weekly (P < 0.0001). After adjusting for age, race, Hispanic ethnicity, nativity, education and marital status by logistic regression, women who never attended services were still over six times more likely to report having four or more risk factors (P < 0.0001). The combination of frequent attendance at religious services, very high importance of religion in daily life, and self-identification as a Protestant evangelical was particularly protective. Multiple dimensions of religiousness are independently associated with multiple breast cancer risk factors.]

Gould, J., Wilson, S. and Grassau, P. "Reflecting on spirituality in the context of breast cancer diagnosis and treatment." Canadian Oncology Nursing Journal 18, no. 1 (2008): 34-46. [(Abstract:) In this first part of a longitudinal study, women were asked to reflect on the meaning of spirituality in the first year following diagnosis of breast cancer. Twenty-two women were interviewed at approximately one year post-diagnosis. This paper reports on a thematic analysis of these interviews. Participants' responses reflected three higher-order themes: relationship with a higher power, a deepening sense of self, and spiritual connection with others. The findings provide an enhanced understanding of how spirituality frames and impacts (both positively and negatively) the experience of breast cancer immediately following diagnosis and treatment. Most participants in this study found strength and support in their experiences of spirituality. They also spoke at times of feeling disconnected from or abandoned by God. The paper concludes with a discussion of how cancer health professionals might respond to the spiritual needs expressed by women living with cancer.]

Hebert, R., Zdaniuk, B., Schulz, R. and Scheier, M. "Positive and negative religious coping and well-being in women with breast cancer." Journal of Palliative Medicine 12, no. 6 (June 2009): 537-545. [(Abstract:) BACKGROUND: Although religions is important to many people with cancer, few studies have explored the relationship between religious coping and well-being in a prospective manner, using validated measures, while controlling for important covariates. METHODS: One hundred ninety-eight women with stage I or II and 86 women with stage IV stage breast cancer were recruited. Standardized assessment instruments and structured questions were used to collect data at study entry and 8 to 12 months later. Religious coping was measured with validated measures of positive and negative religious coping. Linear regression models were used to explore the relationships between positive and negative religious coping and overall physical and mental well-being, depression, and life satisfaction. RESULTS: The percentage of women who used positive religious coping (i.e., partnering with God or looking to God for strength, support, or guidance) "a moderate amount" or "a lot" was 76%. Negative religious coping (i.e., feeling abandoned by or anger at God) was much less prevalent; 15% of women reported feeling abandoned by or angry at God at least "a little." Positive religious coping was not associated with any measures of well-being. Negative religious coping predicted worse overall mental health, depressive symptoms, and lower life satisfaction after controlling for sociodemographics and other covariates. In addition, changes in negative religious coping from study entry to follow-up predicted changes in these well-being measures over the same time period. Cancer stage did not moderate the relationships between religious coping and well-being. CONCLUSIONS: Negative religious coping methods predict worse mental heath and life satisfaction in women with breast cancer.]

Holt, C. L., Caplan, L., Schulz, E., Blake, V., Southward, P., Buckner, A. and Lawrence, H. "Role of religion in cancer coping among African Americans: a qualitative examination." Journal of Psychosocial Oncology 27, no. 2 (2009): 248-273. [(Abstract:) The present study used qualitative methods to examine if and how African Americans with cancer use religiosity in coping. Patients (N = 23) were recruited from physician offices and completed 1-1(1/2) hour interviews. Themes that emerged included but were not limited to control over one's illness, emotional response, importance of social support, role of God as a healer, relying on God, importance of faith for recovery, prayer and scripture study, and making sense of the illness. Participants had a great deal to say about the role of religion in coping. These themes may have utility for development of support interventions if they can be operationalized and intervened upon.]

Leak, A., Hu, J. and King, C. R ."Symptom distress, spirituality, and quality of life in African American breast cancer survivors." Cancer Nursing 31, no. 1 (January-February 2008): E15-21. [(Abstact:) This study examined the relationships among the demographic characteristics, symptom distress, spirituality, and quality of life (QOL) of African American breast cancer survivors. A convenience sample of 30 survivors with a mean age of 56 years and a mean survival of 6 years was recruited from African American breast cancer support groups and churches in the Southeastern United States. Data were collected through face-to-face interviews using a demographic questionnaire, the Quality of Life Index-Cancer Version, the Symptom Distress Scale, and the Spiritual Perspective Scale. Statistically significant relationships were found between symptoms and QOL (r = -0.62, P < .05) and between spirituality and QOL (r = 0.70, P < .05). No statistically significant relationships were found between age at diagnosis, income, or education and QOL. This research suggests that symptoms and spirituality are associated with QOL. Culturally appropriate care should be provided to these women to reduce health disparities and to improve their QOL.]

Levine, E. G., Aviv, C., Yoo, G., Ewing, C. and Au, A. "The benefits of prayer on mood and well-being of breast cancer survivors." Supportive Care in Cancer 17, no. 3 (March 2009): 295-306. [(Abstract:) OBJECTIVES: Prayer is becoming more widely acknowledged as a way to cope with cancer. The goal of this study was to compare differences in use of prayer between breast cancer survivors from different ethnic groups and examine how use of prayer is related to mood and quality of life. METHODS: This study used a mixed methods design. One hundred and seventy-five breast cancer survivors participated in a longitudinal study of survivorship. Women completed in-depth qualitative interviews and a battery of measures including quality of life, spirituality, social support, and mood. RESULTS: Eighty-one percent of the women prayed. There were no significant differences between the groups for any of the psychological, social support, or quality of life variables with the exception of higher benefit finding and spiritual well-being among those who prayed. The data did show that women who prayed were able to find more positive contributions from their cancer experience than women who did not pray. The interviews showed that those who prayed tended to be African American or Asian, Catholic or Protestant. The prayers were for petitioning, comfort, or praise. Some of the women stated that they had difficulty praying for themselves. CONCLUSIONS: While there seems to be few differences in terms of standardized measures of quality of life, social support, and mood between those who prayed and those who did not, the interviews showed that certain ethnic minority groups seem to find more comfort in prayer, felt closer to God, and felt more compassion and forgiveness than Caucasian women.]

Levine, E. G., Yoo, G., Aviv, C., Ewing, C. and Au, A. "Ethnicity and spirituality in breast cancer survivors." Journal of Cancer Survivorship 1, no. 3 (September 2007): 212-225. [(Abstract:) INTRODUCTION: Many women are incorporating spirituality as a way of coping with cancer. However, few studies have examined the role of spirituality in mood and quality of life among breast cancer survivors from different ethnic groups. METHODS: One hundred and seventy-five women who had completed treatment for breast cancer participated in in-depth interviews about their experiences. Transcripts were available for 161 women. RESULTS: The majority (83%) of the women talked about their spirituality. The main themes were: (1) God as a Comforting Presence; (2) Questioning Faith; (3) Anger at God; (4) Spiritual Transformation of Self and Attitude Towards Others/Recognition of Own Mortality; (5) Deepening of Faith; (6) Acceptance; and (7) Prayer by Self. A higher percentage of African-Americans, Latinas, and Christians felt comforted by God than the other groups. CONCLUSIONS: These results are consistent with the common assumption that more African-American and Latinas engage in spiritual activities and that African-Americans are more fatalistic than the other groups. Implications for Cancer Survivors: The present findings suggest that there are several dimensions of spirituality experienced among cancer survivors. For many the trauma of a cancer diagnosis might deepen their faith and appreciation of life as well as changing the way they view at themselves, their lives, and how they relate to those around them, including God.]

Manning-Walsh, J. "Spiritual struggle: effect on quality of life and life satisfaction in women with breast cancer." Journal of Holistic Nursing 23, no. 2 (June 2005): 120-140, with discussion on pp. 141-144. [(Abstract:) BACKGROUND: Women with breast cancer experience stressors affecting quality of life (QOL) and life satisfaction. Little is known about effects of spiritual struggle as a coping strategy on QOL and life satisfaction. PURPOSE: Examine relationships between spiritual struggle, QOL, and life satisfaction. METHOD: Nonprobablility sample of 100 participants recruited from an Internet Web site with mailed questionnaires. Three instruments were used: breast cancer-specific version of Functional Assessment of Cancer Therapy Scale (FACT-B), Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp-12) combined for QOL, Negative Coping subscale of Religious Coping (RCOPE) for spiritual struggle, and a single-item measuring life satisfaction. FINDINGS: Small inverse relationships between spiritual struggle, QOL (r = -.36, p < .001), and life satisfaction (r = -.31, p < .001) existed. CONCLUSIONS: Spiritual struggle gives voice to women's questionings implying lower QOL and life satisfaction. Implications: Assessment of and assistance with managing spiritual struggle are necessary to promote QOL and life satisfaction among those facing difficult health problems.]

Nidich, S. I., Fields, J. Z., Rainforth, M. V., Pomerantz, R., Cella, D., Kristeller, J., Salerno, J. W. and Schneider, R. H. "A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients." Integrative Cancer Therapies 8, no. 3 (September 2009): 228-234. [(Abstract:) This single-blind, randomized controlled trial evaluated the impact of the Transcendental Meditation program plus standard care as compared with standard care alone on the quality of life (QOL) of older women (>or=55 years) with stage II to IV breast cancer. One hundred and thirty women (mean age = 63.8) were randomly assigned to either experimental (n = 64) or control (n = 66) groups. Functional Assessment of Cancer Therapy-Breast (FACT-B), Functional Assessment of Chronic Illness Therapy- Spiritual Well-Being (FACIT-SP), and Short-Form (SF)-36 mental health and vitality scales were administered every 6 months over an average 18-month intervention period. Significant improvements were found in the Transcendental Meditation group compared with controls in overall QOL, measured by the FACT-B total score (P = .037), emotional well-being (P = .046), and social well-being (P = .003) subscales, and SF-36 mental health ( P = .017). RESULTS: It is recommended that this stress reduction program, with its ease of implementation and home practice, be adopted in public health programs.]

Ross, L. E., Hall, I. J., Fairley, T. L., Taylor, Y. J. and Howard, D. L."Prayer and self-reported health among cancer survivors in the United States, National Health Interview Survey, 2002." Journal of Alternative and Complementary Medicine 14, no. 8 (October 2008): 931-938. [(Abstract:) OBJECTIVES: At least 10.8 million living Americans have been diagnosed with cancer, and about 1.5 million new cancer cases are expected to be diagnosed in 2008. The purpose of this study was to examine prayer for health and self-reported health among a sample of men and women with a personal history of cancer. METHODS: We used data from the 2002 National Health Interview Survey, which collected information on complementary and alternative medicine practices. RESULTS: Among 2262 men and women with a history of cancer, 68.5% reported having prayed for their own health and 72% reported good or better health status. Among cancer survivors, praying for one's own health was associated with several sociodemographic variables including being female, non-Hispanic black, and married. Compared to persons with a history of skin cancer, persons with a history of breast cancer, colorectal cancer, a cancer with a short survival period (e.g., pancreatic cancer), or other cancers were more likely to pray for their health. Persons who reported good or better health were more likely to be female, younger, have higher levels of education and income, and have no history of additional chronic disease. Overall, praying for one's own health was inversely associated with good or better health status. CONCLUSIONS: Data from this nationally representative sample indicate that prayer for health is commonly used among people with a history of cancer and that use of prayer varies by cancer site. The findings should add to the current body of literature that debates issues around spirituality, decision-making about treatment, and physician care.]

Weathers, B., Kessler, L., Collier, A., Stopfer, J. E., Domchek, S. and Halbert, C. H."Utilization of religious coping strategies among African American women at increased risk for hereditary breast and ovarian cancer." Family and Community Health 32, no. 3 (July-September 2009): 218-227. [(Abstract:) This observational study evaluated utilization of religious coping strategies among 95 African American women who were at increased risk for having a BRCA1/BRCA2 (BRCA1/2) mutation. Overall, women reported high levels of collaborative coping; however, women with fewer than 2 affected relatives (beta = -1.97, P = 0.04) and those who had a lower perceived risk of having a BRCA1/2 mutation (beta = -2.72, P = 0.01) reported significantly greater collaborative coping. These results suggest that African American women may be likely to use collaborative strategies to cope with cancer-related stressors. It may be important to discuss utilization of religious coping efforts during genetic counseling with African American women.]

Yanez, B., Edmondson, D., Stanton, A. L., Park, C. L., Kwan, L., Ganz, P. A. and Blank, T. O. "Facets of spirituality as predictors of adjustment to cancer: relative contributions of having faith and finding meaning." Journal of Consulting and Clinical Psychology 77, no. 4 (August 2009): 730-741. [(Abstract:) Spirituality is a multidimensional construct, and little is known about how its distinct dimensions jointly affect well-being. In longitudinal studies (Study 1, n = 418 breast cancer patients; Study 2, n = 165 cancer survivors), the authors examined 2 components of spiritual well-being (i.e., meaning/peace and faith) and their interaction, as well as change scores on those variables, as predictors of psychological adjustment. In Study 1, higher baseline meaning/peace, as well as an increase in meaning/peace over 6 months, predicted a decline in depressive symptoms and an increase in vitality across 12 months in breast cancer patients. Baseline faith predicted an increase in perceived cancer-related growth. Study 2 revealed that an increase in meaning/peace was related to improved mental health and lower cancer-related distress. An increase in faith was related to increased cancer-related growth. Both studies revealed significant interactions between meaning/peace and faith in predicting adjustment. Findings suggest that the ability to find meaning and peace in life is the more influential contributor to favorable adjustment during cancer survivorship, although faith appears to be uniquely related to perceived cancer-related growth.]


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