Christina M. Puchalski, MD, MS.

Patients who are spiritual may utilize their beliefs in coping with illness, pain, and life stresses. Some studies indicate that those who are spiritual tend to have a more positive outlook and a better quality of life. For example, patients with advanced cancer who found comfort from their religious and spiritual beliefs were more satisfied with their lives, were happier, and had less pain (1).

Spirituality is an essential part of the “existential domain” measured in quality-of-life scores. Positive reports on those measures—a meaningful personal existence, fulfillment of life goals, and a feeling that life to that point had been worthwhile— correlated with a good quality of life for patients with advanced disease (2)

Some studies have also looked at the role of spirituality regarding pain. One study showed that spiritual well-being was related to the ability to enjoy life even in the midst of symptoms, including pain. This suggests that spirituality may be an important clinical target (3). Results of a pain questionnaire distributed by the American Pain Society to hospitalized patients showed that personal prayer was the most commonly used non drug method of controlling pain: 76% of the patients made use of it (4).

In this study, prayer as a method of pain management was used more frequently than intravenous pain medication (66%), pain injections (62%), relaxation (33%), touch (19%), and massage (9%). Pain medication is very important and should be used, but it is worthwhile to consider other ways to deal with pain as well.

Spiritual beliefs can help patients cope with disease and face death. When asked what helped them cope with their gynecologic cancer, 93% of 108 women cited spiritual beliefs. In addition, 75% of these patients stated that religion had a significant place in their lives, and 49% said they had become more spiritual after their diagnosis (5). Among 90 HIV-positive patients, those who were spiritually active had less fear of death and less guilt (6).

A random Gallup poll asked people what concerns they would have if they were dying. Their top issues were finding companionship and spiritual comfort—chosen over such things as advance directives, economic/financial concerns, and social concerns.

Those who were surveyed cited several spiritual reassurances that would give them comfort. The most common spiritual reassurances cited were beliefs that they would be in the loving presence of God or a higher power, that death was not the end but a passage, and that they would live on through their children and descendants (7).

Bereavement is one of life’s greatest stresses. A study of 145 parents whose children had died of cancer found that 80% received comfort from their religious beliefs 1 year after their child’s death. Those parents had better physiologic and emotional adjustment. In addition, 40% of those parents reported a strengthening of their own religious commitment over the course of the year prior to their child’s death (8).

These findings are not surprising. We hear them repeated in focus groups, in patients’ writings and stories: When people are challenged by something like a serious illness or loss, they frequently turn to spiritual values to help them cope with or understand their illness or loss.

End Notes

1. Yates JW, Chalmer BJ, St James P, Follansbee M, McKegney FP. Religion in patients with advanced cancer. Med Pediatr Oncol. 1981;9:121–128.[PubMed]
2. Cohen SR, Mount BM, Strobel MG, Bui F. The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliat Med. 1995;9:207–219.[PubMed]
3. Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psychooncology. 1999;8:417–428.[PubMed]
4. McNeill JA, Sherwood GD, Starck PL, Thompson CJ. Assessing clinical outcomes: patient satisfaction with pain management. J Pain Symptom Manage. 1998;16:29–40.[PubMed]
5. Roberts JA, Brown D, Elkins T, Larson DB. Factors influencing views of patients with gynecologic cancer about end-of-life decisions. Am J Obstet Gynecol. 1997;176(1 Pt 1):166–172.[PubMed]
6. Kaldjian LC, Jekel JF, Friedland G. End-of-life decisions in HIV-positive patients: the role of spiritual beliefs. AIDS. 1998;12:103–107.[PubMed]
7. George H. Spiritual Beliefs and the Dying Process: A Report on a National Survey. Conducted by Gallup International Institute for the Nathan Cummings Foundation and the Fetzer Institute, 1997. Available at http://www.ncf.org/ reports/rpt_fetzer_contents.html(accessed July 2001).

8.Cook JA, Wimberly DW. If I should die before I wake: religious commitment and adjustment to death of a child. Journal of the Scientific Study of Religion. 1983;22:222–238.