Measuring Spirituality as a Universal Human Experience: A Review of Spirituality Questionnaires

Spirituality is an important theme in health research, since a spiritual orientation can help people to cope with the consequences of a serious disease. Knowledge on the role of spirituality is, however, limited, as most research is based on measures of religiosity rather than spirituality. A questionnaire that transcends specific beliefs is a prerequisite for quantifying the importance of spirituality among people who adhere to a religion or none at all. In this review, we discuss ten questionnaires that address spirituality as a universal human experience. Questionnaires are evaluated with regard to psychometric properties, item formulation and confusion with well-being and distress. Although none of the questionnaires fulfilled all the criteria, the multidimensional Spiritual Well-Being Questionnaire is promising

Does spirituality reduce the impact of somatic symptoms on distress in cancer patients? Cross-sectional and longitudinal findings

Rationale: When diagnosed with cancer, a patient has to cope with stressors such as pain, fatigue, and the experience of life-threat that can cause great distress. Spirituality may be a resource for coping with these problems, thereby reducing distress. Objective: Two questionnaire studies the first a cross-sectional (Study 1; N = 216) and the second a one-year longitudinal (Study 2; N = 383) investigated among Dutch cancer patients whether spirituality lessens the impact of pain, fatigue, and perceived life-threat on distress. Method: Data for Study 1 were gathered in 2006-2007 and for Study 2 in 2009-2010. Spirituality was measured with the Spiritual Attitude and Involvement List, which assesses six distinct but related aspects of spirituality. Linear regression analysis and marginal effect plots were applied. Results: Limited evidence appeared for the hypothesis that spirituality reduces the impact of pain, fatigue, or perceived life threat on distress. Meaningfulness and acceptance might reduce a negative impact of increases in fatigue during the rust year after the start of cancer treatment. In contrast, spirituality might enhance a negative impact of increases in perceived life threat. Conclusions: Processes of appraisal might explain the findings. Experiences of meaningfulness and acceptance might help to reappraise fatigue in a less threatening way, thereby reducing distress. Conversely, appraising the cancer as life-threatening might conflict with spiritual experiences of meaning, acceptance, and awe about life. Future studies should focus on the processes by which the various aspects of spirituality influence the adjustment of cancer patients and use other outcome variables than non-specific distress. Such studies may provide further clues as to how the spirituality of patients can be harnessed to help them adjust to a serious life event such as the occurrence of cancer

Web-based individual Mindfulness-Based Cognitive Therapy for cancer-related fatigue — A pilot study

Background: Severe fatigue may persist for many years in cancer survivors and has a considerable impact on a patient's life. This condition is called cancer-related fatigue (CRF). Mindfulness-Based Cognitive Therapy has shown to significantly reduce CRF in cancer survivors. Internet-delivered interventions can be valuable for fatigued patients who are not able to travel to a healthcare institute because of the lack of energy and/or physical limitations. Therefore, we have developed a web-based, therapist guided individual 9-week Mindfulness-Based Cognitive Therapy (eMBCT) aimed at diminishing CRF. Objective: The aim of this study was to evaluate the efficacy of eMBCT in a clinical setting in reducing fatigue severity and distress in cancer survivors. Methods: This pilot study was based on data from severely fatigued cancer survivors who applied for eMBCT between 2009 and 2013. Our primary outcome measure was the change in self-reported web-assessed fatigue severity, measured with the Fatigue severity subscale of the Checklist Individual Strength before (baseline) and one month after (post-assessment) eMBCT. The secondary outcome was distress (HADS) and the proportion of participants that showed clinically relevant improvement on fatigue severity. Patients' satisfaction with using eMBCT and reasons for non-adherence were studied. Intention-to-treat analyses were performed using multiple imputations to deal with data loss at post-assessment. All patients had to be severely fatigued at baseline (≥35 on the fatigue severity subscale of the Checklist Individual Strength), were >18 years old, had no history of psychosis or current Major Depressive Disorder, finished their last cancer treatment at least six months ago (mixed cancer types), and were not in the terminal phase of illness. Patients were recruited offline as well as online. Results: Two-hundred fifty-seven patients (age range 22–79 (M = 50.2, SD = 10.7), 76% women, 44% breast cancer, most had had surgery, chemo- and/or radiotherapy) met our inclusion criteria. Paired samples t-tests showed that fatigue severity was significantly reduced post-assessment (t(18) = 13.27, p < .001, Cohen's d: 1.45 as well as distress (t(46) = 7.66, p < .001, Cohen's d: 0.71). Thirty-five percent (n = 89) was clinically relevant improved at post-assessment and 62% (n = 159) adhered to treatment. This study had a completion rate of 1.5 and a registration rate of 2.3. Conclusion: These findings suggest that individual eMBCT may be effective in reducing fatigue in cancer survivors. A randomized controlled study with a large sample and longer follow up is needed to demonstrate the effectiveness of eMBCT for CRF