Capstone Project Framework

PART I

Impact of Spiritual Intervention on Depression among Cancer Patients

Introduction

When patients are faced with serious health conditions such as cancer, the first thing that comes into their mind is death. Cancer not only affects the patients’ physical health but also their ability to work and engage in income-generating, as well as social activities. Cancer treatment is a costly process to both the patients and their families. Additionally, cancer, its treatment, and related procedures such as surgeries bring physical pain to the patient. All these factors have been blamed for the high prevalence of mental illnesses among patients suffering from cancer ("Social & Emotional Impacts of Cancer", 2020). One of the most prevalent mental health conditions among cancer patients is depression. However, most healthcare providers do not focus on the mental health and comfort of the patients. Instead, they solely focus on the conventional treatment of the cancer and pain management while overlooking the mental wellness of the patients (McFarland & Holland, 2016).

One intervention that can be employed in the ensuring that the patients remain mentally stable and psychologically prepared to fight the cancer is the provision of spiritual care. Spiritual intervention enables patients to be comfortable, hopeful, embrace self-acceptance, cope appropriately with treatment, and increase their faith in the treatment process. Therefore, integrating spiritual interventions in the cancer treatment process will enable the patients to focus more, be hopeful, remain resilient, and determined to fight cancer without giving up (National Cancer Institute, 2020). Studying the impact of spiritual interventions in the management of depression among cancer patients will enable healthcare providers to understand different spiritual approaches to depression and their effectiveness in improving the psychological and mental preparedness of the patients during the cancer treatment process.

Problem Overview

Cancer treatment is an emotionally taxing process to both the patients and their families. Despite healthcare providers trying their best to provide safe and high-quality interventions to help patients manage cancer, mental health of the patients and their families is mostly overlooked during the care process. Different factors such as adverse effects of medications and therapies, financial burden of treatment modalities and stigma associated with cancer might trigger depression among cancer patients. In a study conducted by Khalil et al. (2016) to determine the prevalence of depression and anxiety among cancer patients, it was found out that 48.7% of patients suffering from cancer were suffering from depression and anxiety. Depression greatly affects the quality of life of the patients and their health outcomes. Depression can affect a patient’s adherence to medications and their motivation to achieve the set care goals. Among chronically-ill adults, depression has direct association with readmissions, hospitalization, and mortalities (Goldstein et al., 2017).

Considering the negative impact that depression has on the health outcomes of cancer patients, there is a need to explore spiritual interventions and approaches that can be applied in the management of depression. Studying the impact of spiritual therapy on depressed cancer patients will enable care providers to create functional models and frameworks of integrating spiritual therapy into cancer management processes. People suffering from terminal illness such as cancer need a holistic approach to care other than just concentrating on the management of the symptoms and pain management. They need comfort, hope, motivation, and encouragement. According to National Cancer Institute (2020), most cancer patients and survivors turn to religion and spiritual beliefs as a way of coping with cancer treatment. Therefore, identifying and developing evidence-based and patient-centered spiritual approaches to depression among cancer patients will provide an effective method of not only dealing with depression but also improving the health outcomes and their will to remain focused on the treatment process.

References

Goldstein, C., Gathright, E., & Garcia, S. (2017). Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team. Patient Preference And Adherence, Volume 11, 547-559. https://doi.org/10.2147/ppa.s127277

Khalil, A., Faheem, M., Fahim, A., Innocent, H., Mansoor, Z., Rizvi, S., & Farrukh, H. (2016). Prevalence of Depression and Anxiety amongst Cancer Patients in a Hospital Setting: A Cross-Sectional Study. Psychiatry Journal, 2016, 1-6. https://doi.org/10.1155/2016/3964806

McFarland, D., & Holland, J. (2016). The Management of Psychological Issues in Oncology. Clinical Advances In Hematology & Oncology, 14(12). Retrieved 21 September 2020, from.

National Cancer Institute. (2020). Spirituality in Cancer Care. National Cancer Institute. Retrieved 21 September 2020, from https://www.cancer.gov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-pdq.

Social & Emotional Impacts of Cancer. MD Anderson Cancer Center. (2020). Retrieved 21 September 2020, from https://www.mdanderson.org/patients-family/life-after-cancer/social-emotional-impacts.html#:~:text=Body%20image%3A%20Cancer%20survivors%20who,ones%20can%20minimize%20negative%20feelings.

PART II

Spirituality Improves Depression among Cancer Patients

Cancer patients are likely to suffer from depression due to several factors such as the financial burden of the disease, the impact of the disease on the patients’ health, the stigma that comes with cancer, and the fact that cancer is a terminal illness (Feelings and Cancer, 2020). As a result, some patients turn to spirituality and religiosity to cope with the depression that comes with cancer. Spirituality and religiosity give patients suffering from depression a sense of comfort and hope. Therefore, this project will assess the impact of spiritual support on patients suffering from depression and compare the patient outcomes with their condition prior to receiving spiritual interventions.

PICOt question:

Population—50-70 year-old patients with cancer

Intervention—provision of spiritual support

Comparison—to their level of depression prior to receiving spiritual interventions

Outcome—decreased level of depression by 5% as per the PHQ9 depression scale

Time—Three months

Significance

Depression is quite common among patients suffering from cancer. In a study conducted by Nikbakhsh, Moudi, Abbasian, and Khafri (2014), it was found out that only 20.5% of patients suffering from breast cancer and had no depression at all. This means that out of all the breast cancer patients that took part in this study, 79.5% of them either had mild or symptomatic depression. Out of the 150 patients suffering from different types of cancer that were studied, 48% of them had either mild or symptomatic depression. This makes depression a matter of concern among this group of patients. depression affects the mental wellness of cancer patients. The patients are already suffering from a terminal illness. Therefore, a depression diagnosis means that they have to deal with an additional condition that deserves equal attention as cancer they are already suffering from. cancer treatment requires patience, motivation, and ultimate focus. Therefore, if a cancer patient develops depression during the care and cancer management process, he/she might lose the motivation to remain focused on completing and pursuing the treatment (Gu, Xu, Zhu, and Zhong, 2017). Additionally, considering that depression is a mental disorder that affects the patients’ cognition, the patient might fail to adhere to basic health instructions such as medication instructions, physician appointments, and lifestyle modification guidelines. Therefore, if these basic factors of care are not adhered to, mortalities among cancer patients will keep on increasing. It is estimated that depression increases the mortality rate among cancer patients by 39% (Rosenstein, 2011). Therefore, it is important to address the issue of depression among cancer patients with the urgency it deserves to ensure that the quality of life of the patients improves and better outcomes are realized.

One important approach to depression among cancer patients is spirituality and religiosity. Patients suffering from cancer and depression encounter dilemmas of different types. They are confused between taking medications or praying to receive healing. Others view depression as a punishment from God. A combination of cancer and depression is characterized by hopelessness, self-pity, pessimism, emptiness, and doubts in the existence of God (Bener, Alsulaiman, Doodson, and Agathangelou, 2017). On the other hand, Religiosity and spirituality give patients some sense of fulfillment and emotional comfort. Despite being put through the conventional psychiatric care, cancer patients suffering from depression need to find a balance between conventional care and their spirituality. Apart from depression, these patients are also suffering from terminal illnesses. Therefore, they need answers whose questions cannot be answered by the psychiatric care.

To ensure that patients find a consensus between conventional cancer and psychiatric care and their spiritual wellness, spirituality and religiosity should be properly integrated into the care process. Different religious affiliations are structured in a manner that will give their followers hope and resilience to conquer different challenges that they face in their lives. Different studies have been conducted to ascertain the impact of spirituality and religiosity on patients suffering from depression. According to a study conducted by Vitorino et al. (2018), there was a close relationship between low depression scores and spirituality. The study also established a correlation between high depression scores and lack of spirituality among patients suffering from depression. Using the linear regression model, the study found out that negative spiritual and religious coping was positively correlated with depressive symptoms. Cancer patients who had depressive symptoms were positively correlated with negative spiritual and religious coping at 16.1%. However, cancer patients who had positive spiritual and religious coping did not show any depressive symptoms during the study.

In another study conducted by Santos et al. (2017), 27.3% of the participants had depression. The study further found out that patients with higher spiritual and religious coping had a negative correlation with symptomatic depression. There was a negative correlation coefficient of -0.200 between depression and spiritual and religious coping among patients with high spiritual and religious coping. Additionally, this study established a negative correlation between negative religious and spiritual coping scores and the social health of the patients. furthermore, a negative correlation of r=0.214 was identified between religious and spiritual coping and mental health. This shows that religious and spiritual coping not only improves the depression among cancer patients but also improves other health domains of the patients such as their social skills.

Finally, a study conducted by Safavi, Yahyavi, Narab, and Yahyavi (2019) to investigate the association between spiritual intelligence and depression coping among cancer patients, there was an inverse correlation between spiritual intelligence and depression. According to the study, the correlation coefficient between depression and spiritual intelligence was -0.307. These studies show the close relationship between religious and spiritual coping and the wellbeing of patients suffering from depression resulting from cancer. However, spiritual and religious coping not only apply to cancer patients with depression. Coupling psychotherapy with spiritual interventions will ensure that cancer patients suffering from both mild or symptomatic depression find comfort, consolation, and hope beyond the therapy sessions. Through this intervention, patients can gain self-esteem, confidence, and improve their self-control. Furthermore, they can navigate grieving and suffering through different motivating aspects of spirituality and religiosity. Also, they can establish a better relationship with God and fellow humans hence eliminating negative factors such as hopelessness and doubts (Cassella, 2019).

References

Bener, A., Alsulaiman, R., Doodson, L., and Agathangelou, T., 2017. Depression, Hopelessness, and Social Support among Breast Cancer Patients: in Highly Endogamous Population. Asian Pac J Cancer Prev, 18(7).

Cassella, C., 2019. Spiritual Beliefs Are Linked To A 'Protective' Effect Against Depression In The Brain. [online] ScienceAlert. Available at: <https://www.sciencealert.com/spiritual-or-religious-beliefs-may-act-like-a-buffer-against-depression-in-the-brain> [Accessed 30 September 2020].

Gu, W., Xu, Y., Zhu, J. and Zhong, B., 2017. Depression and its impact on health-related quality of life among Chinese in patients with lung cancer. Gu, W., Xu, Y. M., Zhu, J. H., & Zhong, B. L. (2017). Depression and its impact on health-related quality of life among Chinese inpatients with lung cancer. Oncotarget, 8(62), 104806–104812. https://doi.org/10.18632/oncotarget.21001, 8(62).

National Cancer Institute. 2020. Feelings And Cancer. [online] Available at: <https://www.cancer.gov/about-cancer/coping/feelings> [Accessed 30 September 2020].

Nikbakhsh, N., Moudi, S., Abbasian, S. and Khafri, S., 2014. Prevalence of depression and anxiety among cancer patients. Caspian Journal of Internal Medicine, 5(3).

Rosenstein, D., 2011. Depression and end-of-life care for patients with cancer. Dialogues in Clinical Neuroscience, 13(1).

Safavi, M., Yahyavi, S., Narab, H. and Yahyavi, S., 2019. Association between spiritual intelligence and stress, anxiety, and depression coping styles in patients with cancer receiving chemotherapy in university hospitals of Tehran University of medical science. Journal of Cancer Research and Therapeutics, 15(5).

Santos, P., Capote Júnior, J., Filho, J., Ferreira, T., Filho, J. and Oliveira, S., 2017. Religious coping methods predict depression and quality of life among end-stage renal disease patients undergoing hemodialysis: a cross-sectional study. BMC Nephrol, 18(127).

Vitorino, L., Lopes-Júnior, L., Oliveira, G., Tenaglia, M., Brunheroto, A., Cortez, P. and Lucchetti, G., 2018. Spiritual and religious coping and depression among family caregivers of pediatric cancer patients in Latin America. Psychooncology, 27(8).