Evidence suggests that cancer patients commonly experience spiritual pain or distress but believe that their spiritual needs are not being adequately addressed by healthcare providers. At the 38th Annual Congress of the Oncology Nursing Society, Jill Burleson, MSN, ANP, spiritual care coordinator at Duke Medical Care in Durham, North Carolina, and Anne Belcher, PhD, RN, AOCN, associate professor at Johns Hopkins University School of Nursing in Baltimore, Maryland, discussed spirituality, religion, and the strategies nurses can use to help patients find meaning in their cancer experience.
Burleson made a distinction between spirituality and religion. “There are many definitions, but spirituality refers to a connection with something greater than oneself, personally meaningful experiences, or a deep sense of purpose and meaning in life. Some of these aspects overlap with religiosity, but in general, organized religion is associated with a specific set of beliefs and language that is based on a search for transcendent meaning in a personal way,” she explained.
“Terminally ill patients will seek a connection with a higher power, whether or not they consider themselves religious prior to this time and they may not adapt a spiritual practice.”
Cancer patients may ask themselves, “Why me?” This existential questioning usually occurs within 100 days of diagnosis, recurs at relapse and terminal diagnosis, and leads to a search for meaning, said Burleson. “Spirituality is for everyone, whether very religious, somewhat, or not at all. It is what drives a person. The search for meaning can lead to a return to childhood faith, turmoil with questioning, and peace with the diagnosis and outcome.”
Several coping mechanisms are associated with spirituality. These can include direct action (such as prayer), denial/fatalism, seizing control (for type A personalities), information seeking, role reversal to childlike behavior, and depression.
Patients who consider themselves survivors have different needs from those who are terminally ill. Survivors will need to readjust their thinking and learn to live once more.
“They have to learn to dream again. They may feel guilty for surviving. Hope is considered to be a very effective strategy and helps to create meaning in life as well as dignity in death,” Burleson said. “Hope can be better than expectations. Maintaining hope is important for patients. There are different types of hope: hope for a good day, hope for a cure.”
Belcher discussed tools for nurses to use when assessing spirituality. Choice of a tool should encompass the patient’s age, culture, religious beliefs, and gender. Spiritual assessment should be performed for terminally ill patients and those who face existential crises, she said.
Some useful instruments include the Spiritual Perspective Scale (a 10-item self-questionnaire developed by Pamela G. Reed in 1986), the FICA (Faith/Importance/Community/Address) Spiritual Assessment Tool (developed by Christina Puchalski in 1999), and the Spiritual Life Map (for more information, see Hodge DR. Soc Work. 2005;50:77-87).
“The Spiritual Life Map is one of the most clinically useful tools I have come across. This is a way for patients to express concerns nonverbally,” Belcher explained.
Nurses can ask patients what gives their life meaning, what brings them a sense of joy, what they hope for, what gives them strength, and who they love. Open-ended statements can also be used to elicit their responses; for example, Recently my spirits have been…; I would like help in boosting my spirits from….
Patients want to be asked about their spirituality, she continued. Some questions are: What can a nurse do to help nurture your spirits? What would you like your nurse to know about your spiritual practices and beliefs? “People want to be touched, called by name, listened to when they talk, and be able to see a chaplain when needed,” Belcher noted.
“Let patients know you care and that you won’t forget them. Never underestimate the power of touch. Journey with your patient to find meaning. Understand beliefs that may help and ones that may hurt. I have come up with REST as an acronym for how nurses can help: R for respect, E for encouragement, S for support, T for trust—trust your own instincts and build trust between you and your patient,” Burleson said.
Burleson J, Belcher A. Spirituality versus religion. Presented at: 38th
Annual Congress of the Oncology Nursing Society; April 25, 2013; Washington, DC.