Evaluation of the psychology of quality of life includes the study of how patients adjust to, and cope with, their illness, and of strategies they may use to optimize their quality of life.
One such strategy, response shift, is the redefinition of what is important life. Patients with serious illnesses sometimes adopt a new framework in which to live in and experience their changed world.1
Spiritual well-being is an important quality-of-life dimension. The Quality of Life Group of the European Organisation for Research and Treatment of Cancer has defined spiritual well-being (SWB) according to three dimensions: relationship with self and others, existential issues, and specific religious or spiritual beliefs and practices.2
Spirituality from a functional perspective focuses on how a person finds meaning and purpose in life and how that person’s behavior relates to his or her spiritual beliefs. A study by Rodhe evaluated at the ways in which patients receiving early palliative care for colorectal cancer coped with their illness in relation to spiritual well-being.3
Rodhe et al chose a qualitative approach using an in-depth interview with the 20 participants, who were 34 to 75 years old, had been referred for first- or second-line noncurative chemotherapy, and had a life expectancy greater than 6 months.
Through empirical analysis, subthemes were identified according to the three SWB dimensions.
Relationship with self and others
—Strategies for inner harmony
Participants reported the importance of acknowledging painful thoughts about their incurable disease. There was fluctuation between psychologically painful thoughts and positive feelings, and the patients then attempted to find balance. They adjusted long-term goals and tended to focus on achievable short-term goals. The participants observed that they valued small, positive everyday experiences. Most of them underwent a response shift. Factors that may interfere with a response shift include having a negative or depressed personality, limited experience in managing resistance, or a fragile relationship with one’s family.
—Sharing feelings with significant others
After they became ill, some participants spoke more openly about their inner thoughts, and said this change had enriched their lives. The quality of the relationship between participants and their families and friends became more prominent. Those with good relationships observed that these the relationships improved. Participants with complicated family relationships did not experience an improvement when they became ill. Some made a conscious decision not to tell their families the entire truth about their disease, as a protective strategy when coping with problems and challenges.
—Coping with thoughts about the end of life
Rodhe et al noted that most participants were not afraid of death and were aware of their incurable disease.
Religious /Spiritual Beliefs and Practices
—Seeking faith as a means of self-support
Patients who had faith in God or a greater power continued to maintain their faith after they became ill. They reported that they considered the strength provided by God or a greater power to be a supplement to whatever benefits medical treatment and care could provide. God or a greater power was used as a collaborator and supporter. In their study, Rodhe et al did not identify a correlation between being without a faith in God or a greater power and difficult or frightening thoughts about death. Participants with a faith in God or a greater power found their faith to be a consolation. The participants’ belief system did not change after they became ill. Participants reported that they did not expect healthcare providers to begin conversations about these existential issues, although they said they would have welcomed this.
Knowledge about cancer patients’ use of different strategies to increase spiritual well-being may provide healthcare providers with a deeper understanding of patients’ concerns and coping mechanisms at different points in the cancer trajectory, and may, in turn, enable them to better support patients through difficult periods.
Participants identified a trusting relationship with the healthcare provider as important in helping them to feel more comfortable verbalizing their feelings about existential issues. Rodhe et al suggest that healthcare providers, while maintaining an unobtrusive manner, identify vulnerable patients and allow them time and an opportunity to acknowledge their faith. The healthcare provider may act as a facilitator to arrange meetings between patients and their families in order to promote communication.
The findings of Rohde et al provide a deeper understanding of how colorectal cancer patients in the palliative phase adjust to cope with their illness. Healthcare providers can play a supportive role by encouraging communication and helping patients to improve their coping skills and sense of spiritual well-being.
1. 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.
2. Vivat B. Measures of spiritual issues for palliative care patients: a literature review. Palliat Med. 2008:22:859-68.
3. Rohde G, Kersten C, Vistad I, Mesel T. Spiritual well-being in patients with metastatic colorectal cancer receiving noncurative therapy: a qualitative study. Cancer Nursing. 2017;40:209-16.