Skip to main content

Advertisement

SpringerLink
Log in

The mediating role of spirituality (meaning, peace, faith) between psychological distress and mental adjustment in cancer patients

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Objective

The objectives of this study were (a) to determine the psychometric properties of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale and (b) to provide that FACIT scores behave one-dimensional to establish the mediating role of spiritual well-being in psychological distress and mental adjustment in a sample of patients with non-metastatic, resected cancer.

Method

A total of 504 consecutive patients completed the FACIT-Sp, Brief Symptom Inventory, and Mini-Mental Adjustment to Cancer scales. The dimensionality and structure of the scale were assessed by semi-confirmatory factor analysis; the reliability of the derived scale scores was evaluated using the omega coefficient, and regression analysis appraised the FACIT-Sp’s mediating role between psychological distress and mental adjustment.

Results

A clear and theoretically interpretable solution in two factors that agreed generally with solutions reported in other languages was obtained for the FACIT item scores and omega reliabilities of the derived Meaning/Peace (0.85) and Faith (0.86) scales were acceptable. The oblique solution in two factors was compatible with an essentially unidimensional solution of general well-being and associated strongly with psychological distress and mental adjustment. Spiritual well-being acted as a partial mediator between psychological distress and mental adjustment strategies, such as fighting spirit, hope, and cognitive avoidance.

Conclusions

The Spanish version of the FACIT-Sp scale is a reliable and valid clinical evaluation tool, and further highlights the potential clinical implications of spirituality for improving quality of life and adjustment to cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Bovero A, Leombruni P, Miniotti M et al (2016) Spirituality, quality of life, psychological adjustment in terminal cancer patients in hospice. Eur J Cancer Care (Engl) 25(6):961–969. https://doi.org/10.1111/ecc.12360

    Article  CAS  Google Scholar 

  2. Scott-Ladd B, Chan CCA (2004) Emotional intelligence and participation in decision-making: strategies for promoting organizational learning and change. Strateg Chang 13(2):95–105. https://doi.org/10.1002/jsc.668

    Article  Google Scholar 

  3. Peterman AH, Fitchett G, Brady MJ et al (2002) Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy— Well-being Scale (FACIT-Sp). Ann Behav Med 24(1):49–58. https://doi.org/10.1207/S15324796ABM2401_06

    Article  PubMed  Google Scholar 

  4. Mitchell AJ, Chan M, Bhatti H et al (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12(2):160–174. https://doi.org/10.1016/S1470-2045(11)70002-X

    Article  PubMed  Google Scholar 

  5. Munoz AR, Salsman JM, Stein KD, Cella D (2015) Reference values of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being: a report from the American Cancer Society’s studies of cancer survivors. Cancer 121(11):1838–1844. https://doi.org/10.1002/cncr.29286

    Article  PubMed  PubMed Central  Google Scholar 

  6. Nejat N, Whitehead L, Crowe M (2017) The use of spirituality and religiosity in coping with colorectal cancer. Contemp Nurse 53(1):48–59. https://doi.org/10.1080/10376178.2016.1276401

    Article  PubMed  Google Scholar 

  7. Schnipper LE, Davidson NE, Wollins DS et al (2015) American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options. J Clin Oncol 33(23):2563–2577. https://doi.org/10.1200/JCO.2015.61.6706

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bai M, Lazenby M (2015) A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer. J Palliat Med 18(3):286–298. https://doi.org/10.1089/jpm.2014.0189

    Article  PubMed  PubMed Central  Google Scholar 

  9. McDermott DF, Regan MM, Clark JI et al (2005) Randomized phase III trial of high-dose interleukin-2 versus subcutaneous interleukin-2 and interferon in patients with metastatic renal cell carcinoma. J Clin Oncol 23(1):133–141. https://doi.org/10.1200/JCO.2005.03.206

    Article  CAS  PubMed  Google Scholar 

  10. Yeung NCY, Lu Q (2014) Affect as a mediator between self-efficacy and quality of life among Chinese cancer survivors in China. Eur J Cancer Care (Engl) 23(1):149–155. https://doi.org/10.1111/ecc.12123

    Article  CAS  Google Scholar 

  11. Whitford HS, Olver IN (2012) The multidimensionality of spiritual wellbeing: peace, meaning, and faith and their association with quality of life and coping in oncology. Psycho-Oncology 21(6):602–610. https://doi.org/10.1002/pon.1937

    Article  PubMed  Google Scholar 

  12. Koenig HG (2009) Research on religion, spirituality, and mental health: a review. Can J Psychiatr 54(5):283–291. https://doi.org/10.1177/070674370905400502

    Article  Google Scholar 

  13. Peterman AH, Reeve CL, Winford EC et al (2014) Measuring meaning and peace with the FACIT–Spiritual Well-Being Scale: distinction without a difference? Psychol Assess 26(1):127–137. https://doi.org/10.1037/a0034805

    Article  PubMed  Google Scholar 

  14. Canada AL, Murphy PE, Fitchett G et al (2008) A 3-factor model for the FACIT-Sp. Psychooncology 17(9):908–916. https://doi.org/10.1002/pon.1307

    Article  PubMed  Google Scholar 

  15. Murphy PE, Canada AL, Fitchett G et al (2010) An examination of the 3-factor model and structural invariance across racial/ethnic groups for the FACIT-Sp: a report from the American Cancer Society’s Study of Cancer Survivors-II (SCS-II). Psychooncology 19(3):264–272. https://doi.org/10.1002/pon.1559

    Article  PubMed  Google Scholar 

  16. Peterman AH, Fitchett G, Brady MJ et al (2002) Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy—Spiritual Well-being Scale (FACIT-Sp). Ann Behav Med 24(1):49–58. https://doi.org/10.1207/S15324796ABM2401_06

    Article  PubMed  Google Scholar 

  17. Derogatis LR (2001) BSI 18, Brief Symptom Inventory 18: administration, scoring and procedures manual. NCS Pearson, Incorporated

  18. Watson M, Law MG, Santos MD et al (1994) The Mini-MAC: further development of the mental adjustment to cancer scale. J Psychosoc Oncol 12(3):33–46. https://doi.org/10.1300/J077V12N03_03

    Article  Google Scholar 

  19. Bredal IS (2010) The Norwegian version of the Mini-Mental Adjustment to Cancer Scale: factor structure and psychometric properties. Psycho-Oncology 19(2):216–221. https://doi.org/10.1002/pon.1564

    Article  PubMed  Google Scholar 

  20. Kriston L, Scholl I, Hölzel L et al (2010) The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Educ Couns 80(1):94–99. https://doi.org/10.1016/j.pec.2009.09.034

    Article  PubMed  Google Scholar 

  21. De las Cuevas C, Perestelo-Perez L, Rivero-Santana A et al (2015) Validation of the Spanish version of the 9-item Shared Decision-Making Questionnaire. Health Expect 18(6):2143–2153. https://doi.org/10.1111/hex.12183

    Article  Google Scholar 

  22. Lorenzo-Seva U, Ferrando PJ (2013) FACTOR 9.2: a comprehensive program for fitting exploratory and semiconfirmatory factor analysis and IRT models. Appl Psychol Meas 37(6):497–498. https://doi.org/10.1177/0146621613487794

    Article  Google Scholar 

  23. Hair JF, Black WC, Babin BJ (2010) RE Anderson multivariate data analysis: a global perspective

  24. Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model A Multidiscip J 6(1):1–55. https://doi.org/10.1080/10705519909540118

    Article  Google Scholar 

  25. Schermelleh-Engel K, Moosbrugger H, Müller H (2003) Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods Psychol Res Online 23–74

  26. McDonald RP (1999) Test theory: a unified treatment. L. Erlbaum Associates, Mahwah

    Google Scholar 

  27. ten Berge JMF, Kiers HAL (1991) A numerical approach to the approximate and the exact minimum rank of a covariance matrix. Psychometrika 56(2):309–315. https://doi.org/10.1007/BF02294464

    Article  Google Scholar 

  28. Jose PE (2003) MedGraph-I: a programme to graphically depict mediation among three variables: the internet version, version 2.0. Victoria Univesity Wellington, Wellington, New Zealand Retrieved Dec 31:2009

  29. Baron RM, Kenny DA (1986) The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182. https://doi.org/10.1037/0022-3514.51.6.1173

    Article  CAS  PubMed  Google Scholar 

  30. Ferrando PJ, Lorenzo-Seva U (2013) Unrestricted item factor analysis and some relations with Item Response Theory. Technical Report. Department of Psychology, Universitat Rovira i Virgili, Tarragona. http://psico.fcep.urv.es/utilitats/factor

  31. Breitbart W, Rosenfeld B, Gibson C et al (2010) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology 19(1):21–28. https://doi.org/10.1002/pon.1556

    Article  PubMed  PubMed Central  Google Scholar 

  32. Park CL, Chmielewski J, Blank TO (2010) Post-traumatic growth: finding positive meaning in cancer survivorship moderates the impact of intrusive thoughts on adjustment in younger adults. Psychooncology 19(11):1139–1147. https://doi.org/10.1002/pon.1680

    Article  PubMed  Google Scholar 

  33. Visser A, Garssen B, Vingerhoets A (2010) Spirituality and well-being in cancer patients: a review. Psycho-Oncology 19(6):565–572. https://doi.org/10.1002/pon.1626

    Article  PubMed  Google Scholar 

  34. Fradelos E, Tzavella F, Koukia E et al (2016) The translation, validation and cultural adaptation of functional assessment of chronic illness therapy—Spiritual Well-being 12 (facit-sp12) Scale in Greek language. Mater Socio Medica 28(3):229–234. https://doi.org/10.5455/msm.2016.28.229-234

    Article  Google Scholar 

  35. Noguchi W, Ohno T, Morita S et al (2004) Reliability and validity of the Functional Assessment of Chronic Illness Therapy–Spiritual (FACIT–Sp) for Japanese patients with cancer. Support Care Cancer 12(4):240–245. https://doi.org/10.1007/s00520-003-0582-1

    Article  PubMed  Google Scholar 

  36. Lazenby M, Khatib J, Al-Khair F, Neamat M (2013) Psychometric properties of the Functional Assessment of Chronic Illness Therapy—Spiritual Well-being (FACIT-Sp) in an Arabic-speaking, predominantly Muslim population. Psycho-Oncology 22(1):220–227. https://doi.org/10.1002/pon.2062

    Article  PubMed  Google Scholar 

  37. Laidsaar-Powell RC, Butow PN, Bu S et al (2013) Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations. Patient Educ Couns 91(1):3–13. https://doi.org/10.1016/j.pec.2012.11.007

    Article  CAS  PubMed  Google Scholar 

  38. Scholl I, Kriston L, Dirmaier J, Härter M (2015) Comparing the nine-item Shared Decision-Making Questionnaire to the OPTION Scale—an attempt to establish convergent validity. Health Expect 18(1):137–150. https://doi.org/10.1111/hex.12022

    Article  PubMed  Google Scholar 

  39. Bench S, Day T (2010) The user experience of critical care discharge: a meta-synthesis of qualitative research. Int J Nurs Stud 47(4):487–499. https://doi.org/10.1016/j.ijnurstu.2009.11.013

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by FSEOM-Onvida for Projects on Long Survivors and Quality of Life. SEOM (Spanish Society of medical Oncology) 2015. The sponsor of this research has not participated in the collection, analysis, or interpretation of the data, in the writing of the report, or in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Hospital Universitario Central de Asturias, Oviedo, Spain

    Paula Jimenez-Fonseca

  2. Faculty of Psychology, Rovira and Virgili University, Tarragona, Spain

    Urbano Lorenzo-Seva & Pere Joan Ferrando

  3. Hospital Universitario Morales Meseguer, Murcia, Spain

    Alberto Carmona-Bayonas & Teresa García

  4. Grupo Hospitalario Quirón, Sevilla, Spain

    Carmen Beato

  5. Hospital Virgen de La Luz, Cuenca, Spain

    María del Mar Muñoz

  6. Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain

    Avinash Ramchandani

  7. Hospital Universitario La Paz, Madrid, Spain

    Ismael Ghanem

  8. Hospital Universitario de Canarias, Tenerife, Spain

    Alejandra Rodríguez-Capote

  9. Hospital Universitario Fundación Alcorcón—Universidad Rey Juan Carlos, Madrid, Spain

    Carlos Jara

  10. Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de la Vall d’Hebron, 171, 08035, Barcelona, Spain

    Caterina Calderon

Authors
  1. Paula Jimenez-Fonseca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Urbano Lorenzo-Seva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pere Joan Ferrando
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alberto Carmona-Bayonas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carmen Beato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Teresa García
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. María del Mar Muñoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Avinash Ramchandani
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ismael Ghanem
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alejandra Rodríguez-Capote
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Carlos Jara
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Caterina Calderon
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors meet the appropriate authorship criteria and no author has been omitted from the list. All authors contributed to the concept and design of the manuscript, and critically reviewed and approved the final version.

Corresponding author

Correspondence to Caterina Calderon.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

The study has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments. This study is an observational trial without intervention.

Informed consent statement

Signed informed consent was obtained from all patients.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jimenez-Fonseca, P., Lorenzo-Seva, U., Ferrando, P.J. et al. The mediating role of spirituality (meaning, peace, faith) between psychological distress and mental adjustment in cancer patients. Support Care Cancer 26, 1411–1418 (2018). https://doi.org/10.1007/s00520-017-3969-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-017-3969-0

Keywords

Search

Navigation