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Spirituality and Cancer Collection Development
by Sharon A. Lezotte, MHE, MLIS
"Religion without science is blind,
Science without religion is lame."
- Albert Einstein
A. Brief Discussion
Spirituality - a therapeutic modality? A question being raised more and more often in the area of health and wellness. There is strong indication that materials relevant to spirituality or inspirational thought might be appropriate for inclusion in a cancer/consumer health library collection. Spirituality has cross-cultural implications that may or may not included organized religion for the individual patient. Spirituality is being seen as one of the mind-body concepts, many of which have been proven useful for relaxation and stress management, pain control and an over all better quality of life. . Health care personnel by weaving together the concepts of spirituality, such as prayer, visualization, meditation, concept of hope, with good end-of-life care, grief support, compassion add a warmer blanket of care for the cancer community.
Research is revealing that a rich spiritual life may actually improve patient outcomes.
Cancer patients who seek support from friends and fellow patients, and who share an element of spirituality appear to improve their quality of life. "Social conceitedness and a faith dimension are two relatively consistent characteristics among some long-term survivors of cancer," says oncologist Dr. Edward Creagan of the Mayo Clinic in Rochester, Minnesota
In the medical community, there is the general recognition of the interactions between the body and mind or spirit, known as psychoneuroimmunology. Stress physiology has knowledge about the cellular and molecular events that turn emotional events in the outside world into a cardiovascular, and/or immune system response. Coping skills are VERY important. Relaxation response, meditation, inspired thoughts, quiet time, or prayer enables individual's inner resources to be activated
The Harvard Mind Body Institute on Spirituality & Health states that religion is widespread and deeply influences our society, culture, and health practices. Recent Gallup surveys indicate that 96% of Americans believe in God or a universal spirit, 90% pray, and 43% attend church weekly or more often. The Institute believes that these various religious or spiritual practices can have an impact on physical and mental health, on the meaning that illness has for persons, and on decisions that people make about seeking health care. They also have found that religion is commonly used as a way of coping with stress caused by health problems. Their studies indicate that 40% or more of those with serious medical illness report their religion is the most important factor that keeps them going. So strong is this trend becoming that currently 83 of the 112 medical schools are now offering a spirituality and medicine course.
On March 25th 2000, a conference held in Washington D.C. with representatives from 50 medical schools and hospital centers, dealt with issues of cross culture / multi cultural and spirituality issues in the health care field. The conference called, "Spirituality, Cross-cultural Issues and End of Life Care: Curricular Development." explored such areas as skills in taking spiritual histories, the data on spirituality and health, and the creative use of diversity, and the end of life decision-making. The conference was well received.
In collection development of this area, as with all consumer health materials, evaluation criteria should be employed. A multicultural attitude, a balanced, natural approach should be looked for in the expression of these ideas. Collection resources should avoid delving into a single, extreme, dogmatic approach or direction as the only means of attaining a spiritual existence. Personal experience has led me to believe that supporting patients with inspirational materials can provide a positive benefit.
B. Web Sites
C. Collection Development
1. Videos
Healing/Dying: An Interview with Stephen Levine is divided into two parts. The first part deals with healing from illness and healing grief. The second part deals with caring for the dying person, and dealing with process of losing someone you love
CANCER: A Turning Point - An Interview with Dr. Lawrence LeShan Classic psychotherapy is daunting and ineffective at helping people survive cancer, but Lawrence LeShan pioneered a more pleasant therapeutic adventure aimed at rediscovering what brings you satisfaction in life which can result in awaking our immune systems. His approach has had remarkable results even for many patients with terminal cancer.
CANCER: Increasing Your Odds for Survival (Documentary Series) This guide does not break down cancers into subspecialties of individual cancers. It is a general resource guide aimed at empowering the cancer patient and family, and it will help you choose your path to healing. I have included excerpts from interviews with cancer treatment and healing specialists. There are experts to represent the full spectrum of healing approaches. The interviews address theories and philosophies of the physical, emotional, spiritual, and psychological aspects of coping with cancer and finding a path to healing
2. Books
Alexander DS: Spiritual Abundance: Meditations and Affirmations on Prosperity for Every Day of the Year; JP Tarcher; 1997.
Bass DC, editor; Practicing Our Faith; Josse-Bass Inc; 1997.
Batchelor S; Buddhism Without Beliefs: a Contemporary Guide to Awakening; Riverhead books; 1997.
Becton, Randy: Everyday Strength: A Cancer Patient's Guide to Spiritual Survival; Baker Book House; 1989.
Becvar DS; Soul Healing; Basic Books; 1997.
Berrin S; A Heart of Wisdom: Making the Jewish Journey from Midlife: Jewish Lights Publishing; 1997.
Burgard S; Hallowed Ground: Rediscovering Our Spiritual Roots; Plenum Publishing Corp.; 1997.
Carse JP; The Silence of God; HarperCollins Publishers; 1995.
Casey K; Daily Meditations for Practicing the Course; HarperCollins Publishers; 1995.
Chodron. P; When things Fall Apart: Heart Advice for Difficult times; Random House, 1997.
Dayton T; The Quiet Voice of Soul; Health Communications, Inc.; 1995.
Dean A; Peace of Mind: Daily Meditations for Easing Stress; Bantam Books; 1995.
Dosick WD; When Life Hurts; Harper; 1998.
Dossey L; Healing Words: the Power of Prayer and the Practice of Medicine; Harper 1993.
Dossey L; The Power of Meditation and Prayer; Hay House; 1997.
Elahi B; Foundations of Natural Spirituality: a Scientific Approach to the Nature of the Spiritual Self; Element; 1997
Fleischman PH; Cultivating Inner Peace; G.P. Putman's Sons; 1997.
Foster RJ; Prayer: Finding the Heart's True Home; Harper; 1992.
Fowler JW; Stages of Faith: the Psychology of Human Development and the Quest for Meaning; Harper; 1981.
Gawain S; The Four Levels of Healing; a Guide to Balancing the Spiritual, Mental, Emotional and Physical Aspects of Life; Nataraj Publishing; 1997.
Goldstein J; Insight Meditation; Random House; 1994.
Guiley RE; Wellness; Prayers for Comfort and Healing; Pocket Books; 1998.
Hanh TN; Be Still and Know: Reflections From Living Buddha, Living Christ; The Berkley Publishing Group; 1996.
Johnson W; The Posture of Meditations of All Traditions; Random House; 1996.
Kotge CS; The Spirited Walker: Fitness Walking for Clarity, Balance, and Spiritual Connection; HarperCollins; 1998.
Lawlis GF; Transpersonal Medicine: the New Approach to Healing Body-Mind-Spirit; Shambhala Publications; 1996.
Lewis C; Readings for Meditation and Reflection; Harper; 1996.
Markway BG; Illuminating the Heart; New Harbinger; 1996
Matthews DA; The Faith Factor; Viking; 1998.
McDonald K; How to Meditate: a Practical Guide; Wisdom Publishing: 1984.
Mullins T; Vitamins for Your Soul; 200 Ways to Nurture Your Spiritual Life; Doubleday; 1997.
Rapgay L; The Tibetan Book of Healing; Morson Publishing; 1997
RavenWing J; The Return of Spirit: a Woman's Call to Spiritual Action; Health Communications, Inc.; 1996.
Richardson PT; Four Spiritualities: Expressions of Self, Expressions of Spirit; Psychology of Contemporary Spiritual Choice; Bavies-Black Publishing; 1996.
Schwartz DI; Finding Joy: a Practical Spiritual Guide to Happiness; Jewish Lights Publishing; 1996.
Smith J; Breath Sweeps Mind: First Guide to Meditation Practice; Riverhead Books; 1998.
Somogyi R; Inner Peace in a 9 to 5 World; Citadel Press; 1996.
Stratton EK; Seeds of Light; Simon & Schuster; 1997.
Wright LM; Beliefs; Basic Books; 1996.
D. Literature Review:
- Psychooncology 1999 Sep-Oct;8(5):439-50; Body, mind and spirit: towards the integration of religiosity and spirituality in cancer quality of life research; Mytko JJ, Knight SJ;VA Chicago Healthcare System, Lakeside, Health Services Research and Development, Department of Psychiatry and Behavioral; Sciences, Northwestern University Medical School, Chicago, IL, USA.
The importance of religion and spirituality to the American public has been highlighted by recent opinion polls, media attention and empirical studies. Psychosocial researchers are incorporating these variables into studies of emotional and physical illness. A number of studies have found that, for cancer patients, religious, spiritual and quality of life concerns are paramount. This paper reviews the literature relating religion and spirituality to physical and emotional health and quality of life. Definitions and measurement issues related to religiosity/spirituality and quality of life are discussed. The paper provides a rationale and methodological suggestions for future studies assessing religious and spiritual beliefs of cancer patients in relation to quality of life. The authors conclude that regular inclusion of religiosity and spirituality measures in quality of life studies is needed in order to understand the integration of mind, body and spirit in cancer care.
- Psychooncology 1999 Sep-Oct;8(5): 417-28; A case for including spirituality in quality of life measurement in oncology; Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D; Institute for Health Services Research and Policy Studies, Northwestern University.
Most of the commonly used quality of life (QOL) instruments in oncology do not include spirituality as a core domain. However, previous research suggests that spirituality might be an important aspect of QOL for cancer patients and that it may, in fact, be especially salient in the context of life-threatening illness. This study used a large (n=1610) and ethnically diverse sample to address three questions relevant to including spirituality in QOL measurement: (1) Does spirituality demonstrate a positive association with QOL?; (2) Is this association unique?; and (3) Is there clinical utility in including spirituality in QOL measurement? Spirituality, as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), was found to be associated with QOL to the same degree as physical well-being, a domain unquestioned in its importance to QOL. The significant association between spirituality and QOL was unique, remaining after controlling for core QOL domains as well as other possible confounding variables. Furthermore, spiritual well-being was found to be related to the ability to enjoy life even in the midst of symptoms, making this domain a potentially important clinical target. It is concluded that these results support the move to the bio- psycho-social-spiritual model for QOL measurement in oncology.
- Psychooncology 1999 Sep-Oct;8(5):395-407 Re-creating your life: a spiritual/psychotherapeutic intervention for people diagnosed with cancer.
Cole B, Pargament K Department of Psychology, Bowling Green State University, Bowling Green, OH, USA.
This paper describes a pilot psychotherapy program for people who have experienced cancer that integrates spiritual issues and resources. The name of the program is: Re-Creating Your Life: During and After Cancer. The literature suggests that people experiencing cancer wrestle with existential concerns related to control, identity, relationships, and meaning. For spiritually oriented people, religious and spiritual issues are likely to be embedded in these existential concerns. Moreover, spiritual resources are likely to play a role in resolving these issues. This seems even more likely given the body of research suggesting that spirituality and religion play a helpful role when people face a traumatic life event. The few studies that have examined the importance of religious variables for people experiencing cancer have found that this is also true for this population. Thus, a psychotherapeutic program for persons diagnosed with cancer might be more efficacious if it integrated spiritual issues and resources. This paper describes a treatment program oriented towards this goal and presents rationales for the interventions that are included in the therapy process. The program addresses the four existential concerns listed above, in ways that integrate spiritual issues and assist participants in drawing on spiritual resources. An outcome study is currently underway to evaluate the effectiveness of this intervention. Ten participants have participated, results are promising, and will be published when data collection is completed.
- Cancer Nurs 1996 Feb;19(1):1-7; Long-term female cancer survivors: quality of life issues and clinical implications; Wyatt G, Friedman LL; College of Nursing, Michigan State University, East Lansing 44824 USA.
The purpose of this research was to identify concerns and issues related to quality of life in long-term female cancer survivors and to discuss the implications of these issues for nursing. Data were collected by mailed questionnaire to 188 female long-term cancer survivors whose mean age was 61 years. Respondents were recruited through a Michigan tumor registry. The newly developed Long-Term Quality of Life (LTQL) instrument was used to measure quality of life in four domains: physical, psychological, social, and spiritual. We hypothesized that physical concerns would be minimal, whereas psychological, social, and spiritual areas would encompass salient issues. Our hypotheses were supported, with the lowest levels of quality of life found in the areas of spiritual philosophical views, diet and exercise habits, and social/emotional support; the highest area of quality of life was physical, i.e., the absence of somatic concerns. Long-term survivors have resolved many of the physical concerns resulting from their illness and treatment. However, nursing interventions can still improve quality of life in the psychological, social, and spiritual areas. A multipurpose support group for survivors is recommended, including "exercise partners" to support regular exercise, group discussions of spirituality and philosophical views of life, and community service activities with women's organizations and/or newly diagnosed women.
- Support Care Cancer 2000 Mar;8(2):110-4; Faith among patients with advanced cancer. A pilot study on patients offered "no more than" palliation; Norum J, Risberg T, Solberg E; Department of Oncology, University Hospital of Tromso, Norway.
Spiritual well being is an important topic in cancer care. Being religious is reported by patients facing dilemmas concerning the quality and meaning of life to be potentially helpful. However, the fear of death may be close to the surface and easily stimulated. The aim of this study was to clarify patients' attitudes to faith. Between February 1998 and February 1999, 20 patients aged 37-74 years and suffering from ten different incurable cancers were enrolled in the study. An interview technique focusing on the topic by way of an open question about faith was employed. The topic was only continued if the patient signaled a clear wish for this. Half the patients had a close relative present during the conversation, and an oncology nurse was present in all cases. Most patients (18, or 90%) intimated that the topic was of interest: 85% responded by saying they believed in God, and 75% reported that they prayed. A quarter (25%) mentioned that they had visited their local Lutheran pastor before their admission to hospital. One patient reported being a Jehovah's Witness and one, a member of the Norwegian Humanistically Ethical Association (HEA). Following the conversation, 4 patients requested a visit from the hospital chaplain, 1 asked for contact with the Salvation Army to be arranged, and 1 wanted to talk to the local leader of HEA. Following the conversation all patients were observed by a nurse, and no raised level of anxiety was reported. Sixteen of the patients died within a median of 18 (1-180) days after the conversation. In conclusion, most patients responded positively to a question about faith. The topic should be addressed in the treatment of patients with advanced disease. However, care must be taken to avoid frightening the patients. Patients' attitudes with regard to what death brings deserve respect.
- Int J Nurs Stud 1995 Oct; 32(5):457-68; The spiritual dimension: its importance to patients' health, well-being and quality of life and its implications for nursing practice, Ross L; Department of Management and Social Sciences, Queen Margaret College, Edinburgh, U.K.
The spiritual dimension is described and is interpreted as the need for: meaning, purpose and fulfillment in life; hope/will to live; belief and faith. As the spiritual dimension is important for the attainment of an overall sense of health, well-being and quality of life (referred to as the health potential) and as illness and hospitalization can precipitate spiritual distress, patients' spiritual needs should be addressed. The nurse's role in spiritual care is discussed with reference to the nursing literature.
- Psychooncology 2000 Jan-Feb;9(1):89; Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer; Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E; Breast Cancer Personal Support and Lifestyle Intervention Trial, California Pacific Medical Center, San Francisco, CA, USA and University of California, San Francisco, CA, USA.
This study examined the relationships among spiritual well-being, quality of life, and psychological adjustment in 142 women diagnosed with breast cancer who were participating in a larger study designed to compare the efficacy of two psychosocial support programs. Participants were given a set of questionnaires that measured spiritual well-being, quality of life, and adjustment to cancer. Results revealed a positive correlation between spiritual well-being and quality of life, as well as significant correlations between spiritual well-being and specific adjustment styles (e.g. fighting spirit). There was also a negative correlation between quality of life and use of a helpless/hopeless adjustment style, and a positive correlation between quality of life and fatalism. In regression analyses, after controlling for demographic variables and adjustment styles, spiritual well-being contributed very little additional variance in quality of life. These findings suggest that while spiritual well-being is correlated with both quality of life and psychological adjustment, the relationships among these variables are more complex and perhaps indirect than previously considered.
- Heart Lung 2000 May-Jun;29(3):180-95; Research on the quality of life of lung transplant candidates and recipients: an integrative review; Lanuza DM, Lefaiver CA, Farcas GA; Niehoff School of Nursing, Loyola University of Chicago, and Loyola University Medical Center, Maywood, IL 60153, USA.
Although lung transplantation is one of the most rapidly growing areas of solid organ transplantation, there has been little research on the quality of life of lung transplant candidates or recipients. This review critiques and synthesizes the quality-of-life reports concerning these patients that have been published between January 1980 and January 1999. The purposes of this review of the literature were to (1) examine both the conceptual and operational definitions of quality of life used; (2) identify and list the instruments used to measure quality of life; (3) investigate methodological issues; and (4) determine the state-of-the-art of research in this area. On the basis of this review, suggestions are made for future studies.
- 1: Psychooncology 1999 Sep-Oct;8(5):378-85; Seeking meaning and hope: self-reported spiritual and existential needs among an ethnically-diverse cancer patient population; Moadel A, Morgan C, Fatone A, Grennan J, Carter J, Laruffa G, Skummy A, Dutcher J; Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, USA.
Spiritual beliefs and practices are believed to promote adjustment to cancer through their effect on existential concerns, including one's personal search for the meaning of life and death, and hope. This study sought to identify the nature, prevalence, and correlates of spiritual/existential needs among an ethnically-diverse, urban sample of cancer patients (n=248). Patients indicated wanting help with: overcoming my fears (51%), finding hope (42%), finding meaning in life (40%), finding spiritual resources (39%); or someone to talk to about: finding peace of mind (43%), the meaning of life (28%), and dying and death (25%). Patients (n=71) reporting five or more spiritual/existential needs were more likely to be of Hispanic (61%) or African-American (41%) ethnicity (vs. 25% White; p<0.001), more recently diagnosed (mean=25.6 vs. 43.7 months; p<0.02), and unmarried (49% vs. 34%; p<0.05), compared with those (n=123) reporting two or fewer needs. Treatment status, cancer site, education, gender, age, and religion were not associated with level of needs endorsement. Discriminant analysis found minority status to be the best predictor of high needs endorsement, providing 65% correct classification, p<0.001. Implications for the development and delivery of spiritual/existential interventions in a multi-ethnic oncology setting are discussed.
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