Although we as healthcare providers want to be cautious and not provide a sense of false hope, we can also acknowledge that for individuals who are deeply religious and spiritual, terminal illness that results in death may not be viewed as negative.
Jill B. Hamilton, PhD, RN, FAAN
Jill B. Hamilton, PhD, RN, FAAN
Associate Professor in the Department of Community-Public Health
Johns Hopkins School of Nursing
Although we as healthcare providers want to be cautious and not provide a sense of false hope, we can also acknowledge that for individuals who are deeply religious and spiritual, terminal illness that results in death may not be viewed as negative. Whatever our own beliefs, such an acknowledgment can build cross-cultural bridges of trust. And research suggests that it may indeed help ease the worry and suffering of patients and families touched by such a frightening experience.
A cancer diagnosis comes with psychological distress. Patients worry about disruptions in work and social roles, have body image concerns, and fear progressively worsening disease associated with pain, weight loss, and eventual death. When psychological distress is high, both patients and family members have a decreased ability to communicate needs for information and support and to process information received about the illness.
Patients with cancer and their family members often rely on their spirituality and religious beliefs to overcome fears and anxieties, for strength to endure prescribed treatment, and to find meaning in the experience. Although it is generally accepted that spirituality and religious beliefs are important to the cancer experience, little is known of how they could be used to positively influence adherence to treatment and improve outcomes.
In our research conducted with 31 African American cancer survivors, a frequently expressed religious belief (n = 11) was that God had the ability to cure cancer. This belief and hope for continued life motivated participants to seek treatment in spite of advanced illness and even when healthcare providers had delivered news that their illness was terminal.1
A closely related religious belief was that God was in control over life and death (n = 11). For these survivors, God was given credit for whether they survived cancer, for providing healthcare professionals with knowledge to treat them, for sending the social support they needed, and for giving them the strength to overcome negative comments and stories of others who had died from cancer.
The belief that God had a plan for their lives (n = 8) enabled survivors to accept the diagnosis and face it as they would any other stressful life event. For these survivors, the cancer served some purpose in their lives or could have been God’s way of communicating to them that they needed to make a change. And, there was the belief that if life were to end in this world, then God must want them in heaven, and that was also a good outcome.
Survivors also discussed the positive influences of singing religious songs and reading Bible verses. Survivors used them as a form of communication with God, a way of requesting help, and expressing gratitude. Hymns and Bible verses were a distraction from depressed moods and physical pain.
Although we cannot assume that patients with cancer are monolithic, a shared experience among a majority of US populations is the certainty that God exists and that religion is very important to their lives.2 Among African American populations, religion is especially important. Scholars who have traced and examined the religious expressions of African Americans report a belief that God is an all-powerful being, a protector capable of delivering those who believe in Him from the pain and suffering that come with this worldly existence.3,4
The pressing question for healthcare providers is how these research findings might be useful to support patients and family members through a cancer diagnosis and treatment. One suggestion would be to encourage the expression of religious beliefs during patient encounters and incorporate religious beliefs into cancer care.
For example, to decrease patients’ and family members’ anxieties and fear of death, remind patients to use their spirituality, as this could be calming, enabling them to better process the information we are giving them. Encourage the use of a favorite religious song or Bible verse to decrease fear and anxiety. Asking about spirituality might be a nonthreatening and culturally sensitive way to begin conversations related to the psychological distress associated with a cancer diagnosis. The 23rd Psalm is a favored and widely used part of scripture, as are the hymns “Amazing Grace” and “I Will Trust in the Lord.”
We do not need to have similar beliefs to provide patients and families with spiritual support. Our patients want us to acknowledge and understand that God is real, tangible, and central to every aspect of their lives. Being respectful of this can assist patients and their family members in overcoming their fears and anxieties and facilitating a sense of trust and hopefulness, as we attempt to provide optimal cancer care.