Psycho-spiritual well-being in patients with advanced cancer: an integrative review of the literature


  • Hung-Ru Lin PhD RN,

    1. Assistant Professor and Head of Planning Division, Research and Development Center, National Taipei College of Nursing, Taipei, Taiwan
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  • Susan M. Bauer-Wu DNSc RN

    1. Director, The Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts; and Instructor of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Susan M. Bauer-Wu, Dana-Farber Cancer Institute, 44 Binney Street, G220, Boston, MA 02115-6084, USA.


Purpose. An integrative literature review was undertaken to examine the research on psycho-spiritual well-being in terminally ill people, specifically patients with advanced cancer.

Method. A comprehensive search of MEDLINE, CINAHL, CancerLit and PsycINFO using relevant keywords produced 43 primary research studies that investigated psycho-spiritual well-being in patients with advanced cancer. Each report was read, critiqued and systematically assessed for purpose statement or research questions, study design, sample size, characteristics of the subjects, measurement of independent and dependent variables, sample attrition, method of data analysis and results. Major themes and findings were identified for each of the studies.

Findings. Psycho-spiritual well-being is an area of interest to researchers all over the world. Retrieved studies had been conducted in 14 countries by researchers in a variety of disciplines, including nursing, medicine, psychology and theology. Six major themes repeatedly emerged as essential components of psycho-spiritual well-being: self-awareness, coping and adjusting effectively with stress, relationships and connectedness with others, sense of faith, sense of empowerment and confidence, and living with meaning and hope.

Conclusion. Patients with an enhanced sense of psycho-spiritual well-being are able to cope more effectively with the process of terminal illness and find meaning in the experience. Prognostic awareness, family and social support, autonomy, hope and meaning in life all contribute to positive psycho-spiritual well-being. Emotional distress, anxiety, helplessness, hopelessness and fear of death all detract from psycho-spiritual well-being. The research indicated that health professionals can play an important role in enhancing psycho-spiritual well-being, but further research is needed to understand specific interventions that are effective and contribute to positive patient outcomes.