Spiritual needs and their associated psychosocial factors among women with breast cancer: A cross‐sectional study

Abstract

Aims: Guided by the biopsychosocial-spiritual model, this study aimed to evaluate the spiritual needs of Chinese women with breast cancer and explored factors associated with those spiritual needs. Design: This study has a cross-sectional design. Methods: This cross-sectional study involved 228 breast cancer patients in China, between May 2019 and July 2019. Data were collected using the general information form, the Spiritual Needs Scale, the Perceived Social Support Scale and the Hospital Anxiety and Depression Scale. Data were analysed by Spearman correlation analysis, univariate analysis and multiple linear regression, and a structural equation model (SEM) was constructed by maximum likelihood estimation.Results: There was a slightly higher average score for spiritual needs. Of the five dimensions of spiritual needs, those with the highest and lowest levels were 'meaning and purpose' and 'relationship with transcendence' respectively. Religion, time since confirmed diagnosis and education level were related to spiritual needs. The proposed model linking spiritual needs perceived social support, anxiety, and depression revealed a satisfactory fit to the data. Specifically, a higher level of social support predicted lower levels of anxiety and depression, which in turn predicted stronger spiritual needs. Conclusions: The spiritual needs of breast cancer patients were associated with individual characteristics and psychosocial elements. Patients' spiritual needs should therefore be effectively evaluated, especially the needs of those who are not religious. Furthermore, comprehensive, needs-tailored interventions that incorporate spiritual, biological, psychological and social support should be formulated. Impact: Nurses should become more aware of the spiritual needs of breast cancer patients, incorporate a spiritual focus into their care and develop comprehensive needs tailored to their characteristics as well as interventions based on biopsychosocial factors.

The concept of spirituality in the context of Chinese patients with cancer: A scoping review

“…Twenty‐six studies were quantitative designs and were conducted in mainland China ( n = 18), Taiwan ( n = 6), and the USA ( n = 2). Among them, five studies explored spiritual needs (Cheng et al, 2018; Deng et al, 2015; Du et al, 2022), spiritual state (Cheng et al, 2019), and spiritual nursing needs (Li et al, 2017); 11 studies examined the correlation between spiritual aspects and other variables (Chang et al, 2022; Cho & Lu, 2017; Feng et al, 2021; Guo et al, 2022; Kao et al, 2013; Li et al, 2012, 2022; Tao et al, 2022; Wang & Lin, 2016; Yang et al, 2021; Yeung et al, 2014); seven studies were conducted to translate spirituality‐related instruments originally developed in Western countries into Chinese for use with Chinese people with cancer (Astrow et al, 2012; Lin et al, 2015; Liu et al, 2016; Lo et al, 2016; Tang & Kao, 2017; Xie et al, 2019; Zhao et al, 2019); and three studies aimed to examine the effects of interventions on the spirituality of Chinese people with cancer (Chen et al, 2021; Sun et al, 2021; Xiao et al, 2022). One study with a mixed methods design was conducted in mainland China to explore the quality of life (including a spiritual dimension) of breast cancer survivors (Cheng et al, 2016).…”

“…As for the term ‘spirituality’, which is unfamiliar to many Chinese, the phrase ‘writing about my spirituality’ was modified to ‘writing down the spiritual world in my brain’, and specific examples of spiritual resources such as ‘temple’, ‘church’ or ‘other religious sites’ were added (Guo et al, 2022; Li et al, 2017; Xie et al, 2019). Items/questions that were determined to be detrimental to construct validity, based on the results of validity testing/factor analysis, were deleted (Chang et al, 2022; Cheng et al, 2018; Du et al, 2022; Guo et al, 2022; Li et al, 2017; Lin et al, 2015; Tao et al, 2022; Xie et al, 2019; Zhao et al, 2019).…”

“…were added (Cheng et al, 2018;Du et al, 2022;Zhao et al, 2019), and the term was paraphrased as 'heaven or deities' (Tao et al, 2022).…”

“…or 'other religious sites' were added (Guo et al, 2022;Li et al, 2017;Xie et al, 2019). Items/questions that were determined to be detrimental to construct validity, based on the results of validity testing/ factor analysis, were deleted (Chang et al, 2022;Cheng et al, 2018;Du et al, 2022;Guo et al, 2022;Li et al, 2017;Lin et al, 2015;Tao et al, 2022;Xie et al, 2019;Zhao et al, 2019). Restructuring life perspectives (a subtheme of the theme 'creating meaning') Chiu et al (2000) Restructuring an alternative life perspective (a subtheme of the theme 'meaning making') Leung and Chan (2010) Construing benefits in the experience (a subtheme of the theme 'meaning making') Leung and Chan (2010) Attributing a cause to the occurrence of cancer (a subtheme of the theme 'creating meaning') Leung and Chan (2010) Learning meaning of life and fulfilling them (a subcategory of the category 'need to fulfil meaning of life and preserve one's dignity') Chinese support groups (a theme about 'spiritual resources') Chiu (2001) Relationship with others (a subtheme of the theme 'connectedness') Leung and Chan (2010) and Chiu et al (2000) Being empowered through encouragements from family members, friends and/or other people with cancer (a theme of the domain 'healing') Chio et al (2008) Love-spirituality is caring relationship but not over-attachment to others (a theme of the pattern 'communion with others') Chao et al (2002) Power (a subtheme of the theme 'connectedness') Chiu et al (2000) Seeking others' love and caring others (a subcategory of the category 'the need to experience more reciprocal human love') Hsiao et al (2011) Reconciliation-spirituality is to forgive and to be forgiven (a theme of the pattern 'communion with others') Chao et al (2002) Offering forgiveness (a subcategory of the category 'the need to experience more reciprocal human love') Hsiao et al (2011) Being self-transcendent through helping other people with cancer (a theme of the domain 'healing') Chio et al (2008) Nurturing compassion: engaging in efforts beyond egoistic concern (a subtheme of the theme 'transcendence')…”

“…For religious activities, some religious terms were replaced with culturally appropriate concepts such as from 'scripture reading' to 'positive reading' (Cheng et al, 2018;Du et al, 2022;Guo et al, 2022;Li et al, 2017;Xie et al, 2019), 'prayer' was supplemented with terms 'chanting', 'worshipping deities', 'burning incense' and 'offering tribute' (Tao et al, 2022), specific examples such as 'chanting scriptures', 'praying', 'morning ceremony' were added (Guo et al, 2022;Li et al, 2022;Xie et al, 2019), and 'sacrament', 'mass', and other rituals not commonly performed by Chinese people were removed (Cheng et al, 2018;Du et al, 2022). As for the term 'spirituality', which is unfamiliar to many Chinese, the phrase 'writing about my spirituality' was modified to 'writing down the spiritual world in my brain',…”