Spirituality in African-American Breast Cancer Patients: Implications for Clinical and Psychosocial Care
Spirituality has been shown to be important to many individuals dealing with a cancer diagnosis. While African-American breast cancer survivors have been reported to have higher levels of spirituality compared to White women, little is known about how levels of spirituality may vary among African-American breast cancer survivors. The aims of this study were to examine factors associated with spirituality among African-American survivors and test whether spirituality levels were associated with women’s attitudes about treatment or health care. The primary outcome, spirituality, was nine-item scale (Cronbach’s α = .99). Participants completed standardized telephone interviews that captured sociocultural, healthcare process, and treatment attitudes. Medical records were abstracted post-adjuvant therapy for treatment and clinical information. In bivariate analysis, age was not correlated with spirituality (p = .40). Married/living as married women had higher levels of spirituality (m = 32.1) than single women (m = 30.1). Contextual factors that were associated with higher levels spirituality were: collectivism (r = .44; p < 0.0001, Afrocentric worldview (r = .185; p = .01), and self-efficacy scale (r = .17; p = .02). In multivariable analysis, sociodemographic factors were not significant. Collectivism remained a robust predictor (p < 0.0001). Attitudes about the efficacy of cancer treatment were not associated with spirituality. The high levels of spirituality in African-American survivors suggest consideration of integrating spiritual care within the delivery of cancer treatment. Future studies should consider how spirituality may contribute to positive coping and/or behaviors in African-American women with high levels of spirituality.
KeywordsSpirituality African-American Breast cancer Psychosocial care Religiosity
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Allen, J. D., Leyva, B., Torres, M. I., Ospino, H., Tom, L., Rustan, S., et al. (2014). Religious beliefs and cancer screening behaviors among Catholic Latinos: Implications for faith-based interventions. Journal of Health Care for the Poor and Underserved, 25(2), 503.CrossRefPubMedPubMedCentralGoogle Scholar
- American Cancer Society. (2015). Breast cancer facts & figures 2015–2016. Atlanta: American Cancer Society.Google Scholar
- Boyd-Franklin, N. (2010). Incorporating spirituality and religion into the treatment of African American clients. The Counseling Psychologist.Google Scholar
- Charlson, M. E., Loizzo, J., Moadel, A., Neale, M., Newman, C., Olivo, E., et al. (2014). Contemplative self healing in women breast cancer survivors: A pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complementary and Alternative Medicine, 14, 349.CrossRefPubMedPubMedCentralGoogle Scholar
- Douglas, A. N., Jimenez, S., Lin, H. J., & Frisman, L. K. (2008). Ethnic differences in the effects of spiritual well-being on long-term psychological and behavioral outcomes within a sample of homeless women. Cultural Diversity and Ethnic Minority Psychology, 14(4), 344.CrossRefPubMedGoogle Scholar
- Hamilton, J. B., Sandelowski, M., Moore, L. A. D., Agarwal, M., & Koenig, H. G. (2012). “You need a song to bring you through”: The use of religious songs to manage stressful life events. The Gerontologist, gns064.Google Scholar
- Holt, C. L., Wynn, T. A., Southward, P., Litaker, M. S., Jeames, S., & Schulz, E. (2009). Development of a spiritually based educational intervention to increase informed decision making for prostate cancer screening among church-attending African American men. Journal of Health Communication, 14(6), 590–604.CrossRefPubMedPubMedCentralGoogle Scholar
- Kinney, A. Y., Emery, G., Dudley, W. N., & Croyle, R. T. (2002, June). Screening behaviors among African American women at high risk for breast cancer: do beliefs about god matter?. In Oncology nursing forum (Vol. 29, No. 5, pp. 835–844). ONCOLOGY NURSING SOCIETY.Google Scholar
- Koenig, H. G. (2012). Religion, spirituality, and health: The research and clinical implications. ISRN psychiatry, 2012.Google Scholar
- Mandelblatt, J. S., Sheppard, V. B., Hurria, A., Kimmick, G., Isaacs, C., Taylor, K. L., et al. (2010). Breast cancer adjuvant chemotherapy decisions in older women: the role of patient preference and interactions with physicians. Journal of Clinical Oncology, 28(19), 3146–3153.CrossRefPubMedPubMedCentralGoogle Scholar
- Mofidi, S. (2014). The electoral function of religion in contemporary India. International Journal of Contemporary Issues, 1(4), 18–33.Google Scholar
- Moore, A. D., Hamilton, J. B., Knafl, G. J., Godley, P. A., Carpenter, W. R., Bensen, J. T., et al. (2013a). The influence of mistrust, racism, religious participation, and access to care on patient satisfaction for African American men: the North Carolina-Louisiana Prostate Cancer Project. Journal of the National Medical Association, 105(1), 59–68.CrossRefPubMedGoogle Scholar
- Moore, A. D., Hamilton, J. B., Knafl, G. J., Godley, P. A., Carpenter, W. R., Bensen, J. T., et al. (2013b). The influence of mistrust, racism, religious participation, and access to care on patient satisfaction for African American men: the North Carolina-Louisiana Prostate Cancer Project. Journal of the National Medical Association, 105(1), 59–68.CrossRefPubMedGoogle Scholar
- Pew Forum on Religion and Public Life. (2007). Changing faiths: Latinos and the transformation of American religion.Google Scholar
- Royal College of Nursing. Spirituality in nursing care: A pocket guide. 2011. https://www2.rcn.org.uk/__data/assets/pdf_file/0008/372995/003887.pdf
- Sheppard, V. B., Faul, L. A., Luta, G., Clapp, J. D., Yung, R. L., Wang, J. H. Y.,… & Pitcher, B. N. (2014). Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB protocol 369901. Journal of Clinical Oncology, JCO-2013.Google Scholar
- Sheppard, V. B., Isaacs, C., Luta, G., Willey, S. C., Boisvert, M., Harper, F. W., et al. (2013). Narrowing racial gaps in breast cancer chemotherapy initiation: the role of the patient–provider relationship. Breast Cancer Research and Treatment, 139(1), 207–216.CrossRefPubMedPubMedCentralGoogle Scholar
- Spiritual Care. Dana Faber Cancer Institute Website. http://www.dana-farber.org/For-Adult-Cancer-Survivors/Caring-For-Yourself-After-Cancer/Finding-Meaning.aspx. Published 2016. Accessed Sept 13 2016.
- Spirituality in Cancer Care. National Cancer Institute Website. http://www.cancer.gov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-pdq. Published May 18, 2015. Accessed Sept 13 2016.
- Weiss, S., & Groda, J. (2011). Spiritual care assessment: Measurable goals and outcomes. Proceedings of the MHPCO Annual Conference, 2011, 1–28.Google Scholar
- Winett, R. A., Anderson, E. S., Whiteley, J. A., Wojcik, J. R., Rovniak, L. S., Graves, K. D., et al. (1999). Church-based health behavior programs: Using social cognitive theory to formulate interventions for at-risk populations. Applied and Preventive Psychology, 8(2), 129–142.CrossRefGoogle Scholar