Spirituality in Cancer Care (PDQ®)
General Information About Spirituality
Studies have shown that religious and spiritual values are important to Americans. Most American adults say that they believe in God and that their religious beliefs affect how they live their lives. However, people have different ideas about life after death, belief in miracles, and other religious beliefs. Such beliefs may be based on gender, education, and ethnic background.
Many patients with cancer rely on spiritual or religious beliefs and practices to help them cope with their disease. This is called spiritual coping. Many caregivers also rely on spiritual coping. Each person may have different spiritual needs, depending on cultural and religious traditions. For some seriously ill patients, spiritual well-being may affect how much anxiety they feel about death. For others, it may affect what they decide about end-of-life treatments. Some patients and their family caregivers may want doctors to talk about spiritual concerns, but may feel unsure about how to bring up the subject.
Some studies show that doctors' support of spiritual well-being in very ill patients helps improve their quality of life. Health care providers who treat patients coping with cancer are looking at new ways to help them with religious and spiritual concerns. Doctors may ask patients which spiritual issues are important to them during treatment as well as near the end of life. When patients with advanced cancer receive spiritual support from the medical team, they may be more likely to choose hospice care and less aggressive treatment at the end of life. (See the PDQ summary on Last Days of Life for information on end-of-life issues.)
The terms spirituality and religion are often used in place of each other, but for many people they have different meanings. Religion may be defined as a specific set of beliefs and practices, usually within an organized group. Spirituality may be defined as an individual's sense of peace, purpose, and connection to others, and beliefs about the meaning of life. Spirituality may be found and expressed through an organized religion or in other ways. Patients may think of themselves as spiritual or religious or both.
Serious illnesses like cancer may cause patients or family caregivers to have doubts about their beliefs or religious values and cause much spiritual distress. Some studies show that patients with cancer may feel that they are being punished by God or may have a loss of faith after being diagnosed. Other patients may have mild feelings of spiritual distress when coping with cancer.
Spirituality and Quality of Life
It is not known for sure how spirituality and religion are related to health. Some studies show that spiritual or religious beliefs and practices create a positive mental attitude that may help a patient feel better and improve the well-being of family caregivers. Spiritual and religious well-being may help improve health and quality of life in the following ways:
- Decrease anxiety, depression, anger, and discomfort.
- Decrease the sense of isolation (feeling alone) and the risk of suicide.
- Decrease alcohol and drug abuse.
- Lower blood pressure and the risk of heart disease.
- Help the patient adjust to the effects of cancer and its treatment.
- Increase the ability to enjoy life during cancer treatment.
- Give a feeling of personal growth as a result of living with cancer.
- Increase positive feelings, including:
- Hope and optimism.
- Freedom from regret.
- Satisfaction with life.
- A sense of inner peace.
Spiritual and religious well-being may also help a patient live longer.
Spiritual distress may make it harder for patients to cope with cancer and cancer treatment. Health care providers may encourage patients to meet with experienced spiritual or religious leaders to help deal with their spiritual issues. This may improve their health, quality of life, and ability to cope.
A spiritual assessment is a method or tool used by doctors to understand the role that religious and spiritual beliefs have in the patient's life. This may help the doctor understand how these beliefs affect the way the patient responds to the cancer diagnosis and decisions about cancer treatment. Some doctors or caregivers may wait for the patient to bring up spiritual concerns. Others may use an interview or a questionnaire.
A spiritual assessment may include questions about the following:
- Religious denomination, if any.
- Beliefs or philosophy of life.
- Important spiritual practices or rituals.
- Using spirituality or religion as a source of strength.
- Being part of a community of support.
- Using prayer or meditation.
- Loss of faith.
- Conflicts between spiritual or religious beliefs and cancer treatments.
- Ways that health care providers and caregivers may help with the patient's spiritual needs.
- Concerns about death and afterlife.
- Planning for the end of life. (See the PDQ summary on Last Days of Life for information on end-of-life planning).
The health care team may not ask about every issue the patient feels is important. Patients should bring up other spiritual or religious issues that they think may affect their cancer care.
Meeting the Patient's Spiritual and Religious Needs
Spirituality and religion are very personal issues. Patients should expect doctors and caregivers to respect their religious and spiritual beliefs and concerns. Patients with cancer who rely on spirituality to cope with the disease should be able to count on the health care team to give them support. This may include giving patients information about people or groups that can help with spiritual or religious needs. Most hospitals have chaplains, but not all outpatient settings do. Patients who do not want to discuss spirituality during cancer care should also be able to count on the health care team to respect their wishes.
Doctors and caregivers will try to respond to their patients' concerns, but may not take part in patients' religious practices or discuss specific religious beliefs.
The health care team may help with a patient's spiritual needs in the following ways:
- Suggest goals and options for care that honor the patient's spiritual and/or religious views.
- Support the patient's use of spiritual coping during the illness.
- Encourage the patient to speak with his/her religious or spiritual leader.
- Refer the patient to a hospital chaplain or support group that can help with spiritual issues during illness.
- Refer the patient to other therapies that have been shown to increase spiritual well-being. These include mindfulness relaxation, such as yoga or meditation, or creative arts programs, such as writing, drawing, or music therapy.