Background
Whereas religion/spirituality (R/S) is important in its own right for many cancer patients, a large body of research has examined whether R/S is also associated with better physical health outcomes. This literature has been characterized by heterogeneity in sample composition, measures of R/S, and measures of physical health. In an effort to synthesize previous findings, we conducted a meta-analysis of the relationship between R/S and patient-reported physical health in cancer patients.
Methods
A search of PubMed, PsycInfo, CINAHL, and Cochrane Library yielded 2,073 abstracts, which were independently evaluated by pairs of raters. Meta-analysis was conducted on 497 effect sizes from 101 unique samples encompassing over 32,000 adult cancer patients. R/S measures were categorized into affective, behavioral, cognitive, and ‘other’ dimensions. Physical health measures were categorized into physical well-being, functional well-being, and physical symptoms. Average estimated correlations (Fisher's z) were calculated using generalized estimating equations with robust variance estimation.
Results
Overall R/S was associated with overall physical health (z=.153, p<.001); this relationship was not moderated by sociodemographic or clinical variables. Affective R/S was associated with physical well-being (z=.167, p<.001), functional well-being (z=.343, p<.001), and physical symptoms (z=.282, p<.001). Cognitive R/S was associated with physical well-being (z=.079, p<.05) and functional well-being (z=.090, p<.01). ‘Other’ R/S was associated with functional well-being (z=.100, p<.05).
Conclusions
Results of the current meta-analysis suggest that greater R/S is associated with better patient-reported physical health. These results underscore the importance of attending to patients’ religious and spiritual needs as part of comprehensive cancer care.
Introduction-The Cancer Behavior Inventory-Brief Version (CBI-B), a 12-item measure of self-efficacy for coping with cancer derived from the longer 33-item version (CBI-L), was subjected to psychometric analysis.
Purpose
Religion and spirituality (R/S) are patient-centered factors and often resources for managing the emotional sequelae of the cancer experience. Studies investigating the relationship between R/S (e.g., beliefs, experiences, coping) and mental health (e.g., depression, anxiety, well-being) in cancer have used very heterogeneous measures, with correspondingly inconsistent results. A meaningful synthesis of these findings has been lacking; thus, the purpose of this study was to conduct a meta-analysis of the research on R/S and mental health.
Methods
Four electronic databases were systematically reviewed and 2,073 abstracts met initial selection criteria. Reviewer pairs applied standardized coding schemes to extract correlational indices of the relationship between R/S and mental health. A total of 617 effect sizes from 148 eligible studies were synthesized using meta-analytic generalized estimating equations; subgroup analyses were performed to examine moderators of effects.
Results
The estimated mean correlation (Fisher z) was 0.19 (95% CI 0.16–0.23), which varied as a function of R/S dimension: affective, z=0.38 (95% CI 0.33-0.43); behavioral, z=0.03 (95% CI -0.02-0.08); cognitive, z=0.10 (95% CI 0.06-0.14); and ‘other,’ z=0.08 (95% CI 0.03-0.13). Aggregate, study-level demographic and clinical factors were not predictive of the relationship between R/S and mental health. There was little indication of publication or reporting biases.
Conclusions
The relationship between R/S and mental health is generally a positive one. The strength of that relationship is modest and varies as a function of R/S dimensions and mental health domains assessed. Identification of optimal R/S measures and more sophisticated methodological approaches are needed to advance research.
This article reports the development of a measure of self-efficacy for coping with cancer. Items culled from a variety of sources were chosen for inclusion in the Cancer Behavior Inventory (CBI) based on the psychometric properties of the items and the fit of the items in a factor structure. Factor analysis on a group of 502 persons with cancer yielded 6 factors: (a) Maintenance of Activity and Independence (alpha = .89), (b) Coping With Treatment-Related Side Effects (alpha = .88), (c) Accepting Cancer/Maintaining Positive Attitude (alpha = .87), (d) Seeking and Understanding Medical Information (alpha = .88), (e) Affective Regulation (alpha = .75), and (f) Seeking Support (alpha = .77). Cronbach's alpha for the entire measure was .96, and correlations with other measures supported its validity. The CBI may be useful for research and clinical practice.
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