Images of God and attitudes towards death in relation to spiritual wellbeing: an exploratory side study of the EORTC QLQ-SWB32 validation study in palliative cancer patients

Teresa Young,Renske Kruizinga,Johannes B A M Schilderman,Mariëtte Weterman,Hanneke W M Van Laarhoven,Michael Scherer-Rath

doi:10.1186/s12904-017-0251-7

Abstract

BackgroundWhen patients are facing the ends of their lives, spiritual concerns often become more important. It is argued that effective, integrated palliative care should include addressing patients’ spiritual wellbeing. In 2002 the EORTC Quality of Life Group began an international study to develop an spiritual wellbeing measure for palliative patients (SWB). Spiritual wellbeing is a complex construct, which comprises multiple contributory components. While conducting the EORTC SWB validation study with Dutch palliative cancer patients we also conducted an exploratory side study to examine the relationship between their spiritual wellbeing, images of God, and attitudes towards death.MethodsPatients with incurable cancer who were able to understand Dutch and were well enough to participate, completed the provisional SWB measure and two scales assessing “Images of God” and “attitudes towards death and afterlife”. Linear stepwise regression analysis was conducted to assess the relation between SWB and other factors.ResultsFifty two Dutch patients, 28 females and 24 males, participated. The whole SWB measure validation identified four scoring scales: Existential (EX), Relationship with Self (RS), Relationships with Others (RO), Relationship with Something Greater (RSG) and Relationship with God (RG, for believers only). Adherence to an image of an Unknowable God and a worse WHO performance status were negatively associated with the EX scale. The image of an Unknowable God was also found to be negatively associated with the RS scale. Higher education correlated positively with the RO scale. Adherence to a Personal or Non-Personal Image of God was not found to be positively influencing any of the domains of SWB.ConclusionsFor our participants, an Unknowable Image of God had a negative relationship with their SWB. Furthermore, specific images of God (Personal or Non Personal) are not associated with domains of SWB. Together, these findings suggest that spiritual wellbeing surpasses traditional religious views. The development of a new language which more naturally expresses different images of a higher being amongst patients in western late-modern societies may further aid our understanding and subsequently lead to an improvement in patients’ spiritual wellbeing.

Highlights

When patients are facing the ends of their lives, spiritual concerns often become more important
In 2009 a Consensus Conference with the aim to improve the quality of spiritual care agreed on the following definition: ‘Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred’ [8]
In 2002, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group began an international study to develop a measure of spiritual wellbeing measure for palliative patients (SWB) for palliative patients

Summary

Introduction

When patients are facing the ends of their lives, spiritual concerns often become more important. It is argued that effective, integrated palliative care should include addressing patients’ spiritual wellbeing. In 2002 the EORTC Quality of Life Group began an international study to develop an spiritual wellbeing measure for palliative patients (SWB). Saunders, the founder of the modern hospice movement, argued that dying people experienced “total pain” - physical, social, emotional and spiritual; and the World Health Organization states that palliative care should integrate psychological and spiritual aspects of patient care and aim at enhancing quality of life [3,4,5]. In 2002, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group began an international study to develop a measure of SWB for palliative patients. Pilot-testing was conducted in 6 European countries and Japan [12], and validation field-testing was completed in 2014, with the EORTC QLQ-SWB32 validated in 14 countries, including the Netherlands [12]

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