Abstract
Introduction
A diagnosis of cancer is a life-changing event for most people. The trauma and uncertainties of a breast cancer diagnosis can affect survivors’ psychological well-being. Religion and/or spirituality can provide a means of support for many women as they live with the realities of a diagnosis of cancer. The purpose of this focused review is to critically analyze and synthesize relationships among psychological well-being, religion, and spirituality among women with breast cancer.
Methods
MEDLINE, CINAHL, Web of Science, Cambridge Scientific Abstracts, Cochrane CENTRAL, and PsycINFO databases were searched: January 1985–March 2010. The search terms religi*(religious/religion), spiritu*(spiritual/spirituality), breast cancer, psychological adjustment, psychological outcomes, psychological distress, psychological well-being, and outcomes were searched for separately and in combination.
Results
Eighteen quantitative studies were analyzed in order to examine associations among religion, spirituality, and psychological well-being for women diagnosed with breast cancer. These three variables were operationally defined as follows: (a) religious practice, religious coping, and perception of God; (b) spiritual distress, spiritual reframing, spiritual well-being, and spiritual integration; and (c) combined measure of both the religion and spirituality constructs.
Discussion/conclusions
Results of this review suggest that within this population, limited relationships exist among religion, spirituality, and psychological well-being. Given the various definitions used for the three variables, the strength and clarity of relationships are not clear. In addition, the time of assessment along the course of the disease varies greatly and in some instances is not reported. Diagnosis and/or prognosis, factors that could influence psychological well-being, are frequently not factored into results. There does, however, appear to be sufficient evidence to include a brief, clinically focused assessment of women diagnosed with breast cancer regarding the importance of a given belief system as they face the diagnosis and treatment of their disease.
Implications for cancer survivors
The implications for cancer survivors are as follows: (a) Psychological well-being of women diagnosed with breast cancer may depend to some extent on their belief system. (b) Coping through “turning to God” for women without a significant prior relationship with God, or minimal spiritual behaviors, may experience diminished well-being. (c) Longitudinal studies suggest that struggling with, or questioning, one’s belief system in early survivorship may also be associated with lower levels of well-being. This diminished well-being often resolves over time.
Similar content being viewed by others
References
Rowland JH, Bellizzi KM. Cancer survivors and survivorship research: a reflection on today’s successes and tomorrow’s challenges. Hematol Oncol Clin N. 2008;22:181–200.
Boyle P, Levin B. World Cancer Report 2008. In Edition Lyon, France: International Agency for Research on Cancer 2008.
Ferrell B, Paice J, Koczywas M. New standards and implications for improving the quality of supportive oncology practice. J Clin Oncol. 2008;26:3824–31.
Lin HR, Bauer-Wu SM. Psycho-spiritual well-being in patients with advanced cancer: an integrative review of the literature. J Adv Nurs. 2003;44:69–80.
Carone Jr DA, Barone DF. A social cognitive perspective on religious beliefs: their functions and impact on coping and psychotherapy. Clin Psychol Rev. 2001;21:989–1003.
Ano GG, Vasconcelles EB. Religious coping and psychological adjustment to stress: a meta-analysis. J Clin Psychol. 2005;61:461–80.
Gibson LM, Hendricks CS. Integrative review of spirituality in African American breast cancer survivors. ABNF J. 2006;17:67–72.
McCabe MS, Jacobs L. Survivorship care: models and programs. Semin Oncol Nurs. 2008;24:202–7.
Gall TL, Grant K. Spiritual disposition and understanding illness. Pastoral Psychol. 2005;53:515–33.
Ferrell BR, Dow KH, Leigh S, et al. Quality of life in long-term cancer survivors. Oncol Nurs Forum. 1995;22:915–22.
Zwingmann C, Wirtz M, Müller C, et al. Positive and negative religious coping in German breast cancer patients. J Behav Med. 2006;29:533–47.
Albaugh JA. Spirituality and life-threatening illness: a phenomenologic study. Oncol Nurs Forum. 2003;30:593–8.
Feher S, Maly RC. Coping with breast cancer in later life: the role of religious faith. Psycho-Oncol. 1999;8:408–16.
Jim HS, Richardson SA, Golden-Kreutz DM, Andersen BL. Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychol. 2006;25:753–61.
Meraviglia M. Effects of spirituality in breast cancer survivors. Oncol Nurs Forum. 2006;33:E1–7.
Efficace F, Marrone R. Spiritual issues and quality of life assessment in cancer care. Death Stud. 2002;26:743–56.
Institute of Medicine. Cancer care for the whole patient: meeting psychosocial health needs. Washington, DC: Institute of Medicine; 2007.
Zinnbauer BJ, Pargament KI, Cole B, et al. Religion and spirituality: unfuzzying the fuzzy. J Sci Stud Relig. 1997;36:549–64.
White A, Schmidt K. Systematic literature reviews. Complement Ther Med. 2005;13:54–60.
National Health Service. Appraisal Tools. 2009 [cited 2009 April 28]; Available from: http://www.phru.nhs.uk/Pages/PHD/resources.htm.
Galvan JL. General guidelines for analyzing literature. In Writing Literature Reviews. 3rd ed. Glendale: Pyrczak Publishing; 2006. p. 31–42.
Targ EF, Levine EG. The efficacy of a mind–body–spirit group for women with breast cancer: a randomized controlled trial. Gen Hosp Psychiat. 2002;24:238–48.
Cotton SP, Levine EG, Fitzpatrick CM, et al. Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psycho-oncol. 1999;8:429–38.
Gall T, Kristjansson E, Charbonneau C, Florack P. A longitudinal study on the role of spirituality in response to the diagnosis and treatment of breast cancer. J Behav Med. 2009;32:174–86.
Gall TL, de Renart RMM, Boonstra B. Religious resources in long-term adjustment to breast cancer. J Psychosoc Oncol. 2000;18:21–37.
Gall TL, Guirguis-Younger M, Charbonneau C, Florack P. The trajectory of religious coping across time in response to the diagnosis of breast cancer. Psycho-Oncol. 2009;18:1165–78.
Manning-Walsh J. Social support as a mediator between symptom distress and quality of life in women with breast cancer. JOGNN. 2005;34:482–93.
Purnell JQ, Andersen BL, Wilmot JP. Religious practice and spirituality in the psychological adjustment of survivors of breast cancer. Couns Values. 2009;53:165–82.
Romero C, Friedman LC, Kalidas M, et al. Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer. J Behav Med. 2006;29:29–36.
Bauer-Wu S, Farran CJ. Meaning in life and psycho-spiritual functioning: a comparison of breast cancer survivors and healthy women. J Holistic Nurs. 2005;23:172–90.
Friedman LC, Barber CR, Chang J, et al. Self-blame, self-forgiveness, and spirituality in breast cancer survivors in a public sector setting. J Cancer Educ. 2010;25:343–8.
Wildes KA, Miller AR, San Miguel de Majors S, Ramirez AG. The religiousity/spirituality of Latina breast cancer survivors and influence on health-related quality of life. Psycho-Oncol. 2009;18(8):831–40.
Schreiber JA. Image of god: effect on coping and psychospiritual outcomes in early breast cancer survivors. Oncol Nurs Forum. 2011;38:293–301.
Bussell VA, Naus MJ. A longitudinal investigation of coping and posttraumatic growth in breast cancer survivors. J Psychosoc Oncol. 2010;28:61–78.
Hebert R, Zdaniuk B, Schulz R, Scheier M. Positive and negative religious coping and well-being in women with breast cancer. J Palliat Med. 2009;12:537–45.
Stanton AL, Danoff-Burg S, Huggins ME. The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment. Psycho-oncol. 2002;11:93–102.
Yanez B, Edmondson D, Stanton AL, et al. Facets of spirituality as predictors of adjustment to cancer: relative contributions of having faith and finding meaning. J Consult Clin Psychol. 2009;77:730–41.
Sears SR, Stanton AL, Danoff-Burg S. The yellow brick road and the emerald city: benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychol. 2003;22:487–97.
Schlehofer MM, Omoto AM, Adelman JR. How do “religion” and “spirituality” differ? Lay definitions among older adults. J Sci Stud Relig. 2008;47:411–25.
Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. J Palliat Med. 2009;12:885–904.
Delgado C. A discussion of the concept of spirituality. Nurs Sci Q. 2005;18:157–62.
Kapuscinski AN, Masters KS. The current status of measures of spirituality: a critical review of scale development. Psychol Relig Spirituality. 2010;2:191–205.
Hyman C, Handal P. Definitions and evaluation of religion and spirituality items by religious professionals: a pilot study. J Relig Health. 2006;45:264–82.
King JE, Crowther MR. The measurement of religiosity and spirituality: examples and issues from psychology. J Organ Chang Manag. 2004;17:83.
Miller WR, Thoresen CE. Spirituality, religion, and health. An emerging research field. Am Psychol. 2003;58:24–35.
Hill PC, Pargament KI, Hood RW, McCoullough ME, Swyers JP, Larson DB, et al. Conceptualizing religion and spirituality: points of commonality, points of departure. J Theor Soc Behav. 2000;30:51–77.
Zinnbauer BJ, Pargament KI, Scott AB. The emerging meaning of religiousness and spirituality: problems and prospects. J Personal. 1999;67:889–919.
Harold GK. Religion and medicine II: religion, mental health, and related behaviors. Int J Psychiat Med. 2001;31:97–109.
Hummer RA, Ellison CG, Rogers RG, et al. Religious involvement and adult mortality in the United States: review and perspective. Southern Med J. 2004;97:1223–30.
Hall DE, Koenig HG, Meador KG. Hitting the target: why existing measures of “religiousness” are really reverse-scored measures of “secularism”. Explore. 2008;4:368–72.
Audi R. Belief, faith, and acceptance. Int J Philos Relig. 2008;63:87–102.
Bader C, Froese P. Images of God: the effect of personal theologies on moral attitudes, political affiliations, and religious behavior. Interdisc J Reseach Relig. 2005;1:1–24.
Maynard EA, Gorsuch RL, Bjorck JP. Religious coping style, concept of God, and personal religious variables in threat, loss, and challenge situations. J Sci Stud Relig. 2001;40:65–74.
Wong-McDonald A, Gorsuch RL. A multivariate theory of God concept, religious motivation, locus of control, coping, and spiritual well-being. J Psychol Theol. 2004;32:318–34.
Ryff CD. Happiness is everything, or is it—explorations on the meaning of psychological well-being. J Personal Soc Psychol. 1989;57:1069–81.
Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol. 1995;69:719–27.
McCoubrie RC, Davies AN. Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer? Support Care Cancer. 2006;14:379–85.
Stanton AL, Danoff-Burg S, Cameron CL, et al. Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. J Consult Clin Psychol. 2000;68:875–82.
Buck T, Baldwin CM, Schwartz GE. Influence of worldview on health care choices among persons with chronic pain. J Altern Complement Med. 2005;11:561–8.
Kagee A, Dixon DN. Worldview and health promoting behavior: a causal model. J Behav Med. 2000;23:163–79.
Koltko-Rivera ME. The psychology of worldviews. Rev Gen Psychol. 2004;8:3–58.
McSherry W, Cash K. The language of spirituality: an emerging taxonomy. Int J Nurs Stud. 2004;41:151–61.
Vidal C. What is a worldview? Nieuwheid denken. De wetenschappen enhet creatieve aspect van de werkelijkheid, Edition Acco, NL: Leuven 2008; 71–85.
Ellison C, Lee J. Spiritual struggles and psychological distress: is there a dark side of religion? Soc Ind Research. 2010;98:501–17.
Funding
This research, as part of a doctoral study, was funded by the American Cancer Society—Doctoral Scholarship in Cancer Nursing Grant (DSCN 05-186-01), Pre-doctoral Fellow—Kentucky Cancer Prevention Training Grant (grant no.—5 R25 CA098220 04)—National Cancer Institute, and Beta Epsilon Chapter, Sigma Theta Tau.
Author contributions
Both authors contributed to the study conception and design and data analysis. JS was responsible for data collection and drafting the manuscript. DB made critical revisions to the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schreiber, J.A., Brockopp, D.Y. Twenty-five years later—what do we know about religion/spirituality and psychological well-being among breast cancer survivors? A systematic review. J Cancer Surviv 6, 82–94 (2012). https://doi.org/10.1007/s11764-011-0193-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11764-011-0193-7