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Spiritual Factors Impacting a Patient’s Ability to Cope with Uncertainty (Part 3)

A pilot study examines the impact of religion and social support on patients and caregivers facing death and dying.
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To address how patients and caregivers manage uncertainty when facing death and dying, the authors examined the role of spirituality through a series of research papers. Part 1 focused on clear practitioner-patient communication as a means of offering patients who are dying the best chance of achieving a “good death.”1 Part 2 discussed coping efficacy and its relation to the Theory of Motivated Information Management (TMIM).2 In this third and final paper, the authors share the results of a pilot study seeking to identify correlations between religiosity/spirituality, social support, coping efficacy, and information-seeking among patients facing the end of life and the impact on their family caregivers.

As presented in Part 2, information stimulates an individual’s environment in order to add to his/her knowledge base.2-4 Information-seeking is a strategy used to evaluate the outcome and efficacy of a certain situation.3 Obtaining information that increases or decreases uncertainty, for example, may offer hope.3-5 In times of uncertainty, such as when facing dying or death, a person may choose to seek information after positively assessing the outcome of receiving information and after believing he/she can effectively attain the information actively, passively, or interpersonally.3

Active information-seeking is defined as researching or manipulating the environment to obtain a target response.3 Interpersonal information-seeking is the most effective of the three types and involves communicating directly with the target.3 This type can be especially useful when the patient is able to ask specific questions of a doctor or family member. This study examined active and interpersonal direct information-seeking.  

Following TMIM’s framework, the more a patient or caregiver thinks he/she can cope with talking about death, the more willing the patient or caregiver may be to seek information about death and dying, which can decrease uncertainty discrepancy and any associated emotion.6 Uncertainty discrepancy is the difference between the actual amount of uncertainty that surrounds a topic and the desired amount of uncertainty. A large discrepancy can lead to feelings of anxiety, fear, or even relief.

Discussing difficult topics with one another and with a pain practitioner, in the context of religion, may also decrease distress levels by creating stronger relationships.7 For example, a Swedish research group asked nursing students about their perceptions and feelings of death. Some used religion to view death as a natural part of life and to help them talk about death and their feelings about an afterlife, which made them feel more comfortable with the idea of dying.8 According to TMIM, if coping efficacy is high, a person is more likely to seek out information (eg, communicate with others).3,9

The authors sought to prove multiple hypotheses:

  • Hypothesis 1 predicted that religion/spirituality and coping efficacy would be positively correlated for both patients and informal caregivers.
  • Hypothesis 2 declared that the same relationship would exist between social support and coping efficacy for both patients and informal caregivers.
  • Hypothesis 3 asserted that a higher coping efficacy for dying patients would be positively related to information-seeking behaviors around death and dying, and, in turn, that the higher the coping efficacy, the more an informal family caregiver would be able to discuss the topics of death and dying with the patient.

Study Methods

Patients and caregivers of Stage III or IV cancer were initially enrolled in the study. However, due to difficulty in accessing this target population, the study was expanded to include those who had or cared for those with any stage of cancer, including those in remission. Patients and caregivers included in the study were over age 18. Caregivers were family members with no formal caregiving training. There was no request for verification of the patient’s cancer diagnosis; instead, patients were given a survey to list their diagnosis as well as to assess their religiosity, spirituality, social support, coping efficacy, and information-seeking behaviors. (See Appendices A-D.)

Participants were recruited by the authors via social media and email. In the first round of data collection, the survey link and standardized script were posted on social media sites (eg, Facebook, Instagram, and LinkedIn), encouraging readers to pass the survey along to others. In the second phase, student investigators called and emailed leaders of cancer and caregiver support groups in the Orange County, California area. Those who thought the research was appropriate for their group sent the survey to their respective groups via email.

In total, 75 subjects took the survey. However, because of missing answers or ineligibility, 34 surveys were inapplicable, resulting in 41 valid participants. About 87.8% of participants identified as female (9.8% male) and reported an age range of 18 to 79 years old, with the mean ranging from 30-39 years old. The largest ethnicity reported was Caucasian/White (68.3%). Asian/Pacific Islander made up 17.1% and approximately 9.8% of participants identified as Latino/Hispanic. One person reported as Native American.

There was a range of reported religion/spirituality beliefs. A majority identified with a Christian denomination (65.9%), including 22% percent identifying as Roman Catholic. Also, 7.3% of the participants identified as Jewish; 4.9% as Buddhist; 2.4% as atheist; and 12.2% as being spiritual but not religious. Another 4.9% stated they were neither spiritual nor religious.

Last updated on: November 14, 2017
Continue Reading:
The Effects of Religion and Spirituality on Coping Efficacy for Death and Dying