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Relation of Religion and Spirituality to Adjustment, Quality of Life, and Health Indices

    continued...

    Engaging in prayer is often cited as an adaptive tool,[23] but qualitative research [24] found that for about one third of cancer patients interviewed, concerns about how to pray effectively or the questions raised about the effectiveness of prayer also caused inner conflict and mild distress. In a study of reported use of spiritual healing and prayer by a sample of 123 patients hospitalized on a palliative care unit, 26.8% reported having used spiritual healing and prayer for curative purposes, 35% for improving survival, and 36.6% for improving symptoms (note: these percentages overlap). Higher levels of faith on the FACIT-Sp were associated with greater use of complementary and alternative medicine techniques in general and with interest in future use, whereas the level of meaning/peace was not. The study also looked at the general use of complementary therapies.[25] A useful discussion of how prayer is used by cancer patients and how clinicians might conceptualize prayer has been published.[26]

    Ethnicity and spirituality were investigated in a qualitative study of 161 breast cancer survivors. In individual interviews, most participants (83%) spoke about some aspect of their spirituality. Seven themes were identified: "God as a Comforting Presence," "Questioning Faith," "Anger at God," "Spiritual Transformation of Self and Attitude Towards Others/Recognition of Own Mortality," "Deepening of Faith," "Acceptance," and "Prayer by Self." A higher percentage of African Americans, Latinas, and persons identified as Christians were more likely to feel comforted by God than were other groups.[27]

    Positive religious involvement and spirituality appear to be associated with better health and longer life expectancy, even after controlling for other variables such as health behaviors and social support, as shown in one meta-analysis.[28] Although little of this research is specific to cancer patients, one study of 230 patients with advanced cancer (expected prognosis <1 year) investigated a variety of associations between religiousness and spiritual support.[29] Most study participants (88%) considered religion either very important (68%) or somewhat important (20%); more African Americans and Hispanics than whites reported religion to be very important. Spiritual support by religious communities or the medical system was associated with better patient quality of life. Age was not associated with religiousness. At the time of recruitment to participate in the study, increasing self-reported distress was associated with increasing religiousness, and private religious or spiritual activities were performed by a larger percentage of patients after their diagnosis (61%) than before (47%). Regarding spiritual support, 38% reported that their spiritual needs were supported by a religious community "to a large extent or completely," while 47% reported receiving support from a religious community "to a small extent or not at all." Finally, religiousness was also associated with the end-of-life treatment preference of "wanting all measures taken to extend life." Another study [30] found that helper and cytotoxic T-cell counts were higher among women with metastatic breast cancer who reported greater importance of spirituality. Other investigators [31] found that attendance at religious services was associated with better immune system functioning. Other research [32,33] suggests that religious distress negatively affects health status. These associations, however, have been criticized as weak and inconsistent.[34]

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