What is Spiritual Life?

When we talk about spiritual life, we usually mean a connection to something beyond ourselves—the higher power that 90 percent of Americans believe in. You can be spiritual whether or not you are also religious, belong to a faith group, or follow specific principles and beliefs. Spirituality and religion both help us answer the big questions of existence: Why am I here? What is the meaning of life? What matters?

Cancer and other serious illnesses tend to draw our attention to these questions. They focus our life. For that reason, many people with cancer say spirituality and religion—or faith—are particularly important during illness and treatment. Many studies show that having a spiritual or religious practice helps people with cancer cope with challenges from depression and anxiety to pain management and recovery. ³

A deepened connection to ourselves, whether through religion, spirituality or mindfulness will help in navigating a serious medical trauma, such as cancer. Here are a few definitions to consider when we are talking about spirituality:

• Mindfulness: Presence in the here and now and acceptance of one’s illness within the context of the world we live in physically.
• Spirituality: Existential concerns about life after death, what happens to one’s soul, or will one see their loved ones again, etc.
• Religious: Social-cultural systems of designated beliefs, behaviors, morals, and practices that relate humanity to supernatural, transcendental, and spiritual elements.

How does spiritual care help in cancer treatment?

Cancer and its management can open new spiritual support—addressing needs you may have never been aware of before. Raymond Wadlow, MD, is a medical oncologist at the Inova Schar Cancer Care Center in Fairfax, Virginia. In Dr. Wadlow’s experience, common questions include:

• Why me?
• Is cancer my fault?
• Is God or the universe punishing or testing me?

Did this happen because I smoked, drank alcohol, ate certain foods, or did something bad in the past?

• Will I die soon?
• What will happen to my spirit after I die?
• Has my life mattered?

Worrying about these questions can have a negative effect on one’s physical, social, and emotional quality of life. On the other hand, spiritual care has been found to positively ⁴ impact quality of life and be especially helpful at the end of life. ⁵ Honoring and accommodating each person’s belief system and spiritual practices is important. ⁶

A spiritual care plan is designed to help people do the following things and more:

• Understand how they are struggling and talk about their needs.
• Cope with anxiety, worry, grief, and anger.
• Talk about change, loss, and death and dying when appropriate.
• Gain acceptance of their situation and develop a sense of peace and hope.
• Die with dignity, in a chosen manner (when possible). ⁷

Talking with your care team about spiritual care

In whole person care, we often refer to three dimensions: body, mind, and spirit. But if you rely on your oncologist as the main source of treatment resources, finding spiritual care may take some extra effort.

“Physicians are not taught to discuss spirituality,” explains Dr. Wadlow. He says that talking about spiritual life and religion is still “somewhat taboo, and often delegated to other team members.” Your cancer care team may be hesitant to bring up spiritual life because they don’t want to intrude on your personal beliefs. They may even believe it is not ethical to talk about these issues with you. However, most are willing to talk with you if you ask.

Your doctor or another person on your cancer team may also be willing to talk with your pastor, faith healer, or spiritual leader, especially if they understand the importance of spirituality and religion in cancer care. They can also help you find spiritual care by connecting you with a chaplain, a therapist, a support group, or meditation class at the hospital or cancer center.

Requesting a spiritual assessment

A spiritual assessment is another way to include spirituality and religion in your cancer care plan. An assessment is a tool, similar to an outline or list, that allows you or your health-care provider to consider spiritual beliefs, concerns, and desires. While the tools listed below were designed for used by chaplains and other providers, you can use them for yourself or a loved one, changing “the patient” to “you.”

Spiritual assessment tools include:

The Joint Commission Spiritual Beliefs and Preferences questions

• You may use this whether you are receiving treatment, acting as someone’s caregiver, or treating patients with cancer.

The FICA Spiritual History Tool

• Developed for providers to assess spiritual or religious preferences of a patient and how they may apply to mental well-being and medical care. Patients with cancer and their families may find it helpful

The HOPE Questions for Mind and Spirit

• Questions that address a patient’s reason for living—their purpose in life. These questions are designed to reveal what the patient finds meaningful, what motivates them, and what provides them with a sense of joy. Here are a few examples:– What brings you joy?
  – How has your illness impacted your life?
  – Why do you seek healing?
  – What are your plans and aspirations in life?

Personal Health Inventory

• Based on work developed by the Veterans Health Administration, the personal health inventory (PHI) (PDF) establishes what matters to the patient and examines the personal determinants of health. This assessment helps a person to uncover where they are in their personal health and where they would like to be.

Drawing on many types of care

Ask any three people with cancer what “spiritual care” means, and you’re likely to receive different answers. These may include:

• “Praying with the hospital chaplain and having people at my church pray for me.”
• “Using traditional herbs and having a sweat lodge ceremony.”
• “Meditating more often and going to therapy.”

Not all spiritual interventions look the same. For example, a study conducted at the Kyoto University Graduate School of Agriculture found that a set of treatments based on time in nature, or “green space,” were beneficial and considered spiritual. The treatments included gardening, “forest-bathing,” yoga, and meditation. ⁸ Although the study was small, the people who took part clearly showed benefit, including an increase in immune cell activity.

Talking with a therapist is another way to address spiritual needs. Having cancer may lead people to explore cognitive behavioral therapy with a counselor available through the cancer treatment center or the patient’s workplace. Spiritual care for cancer may also include meditation or mindfulness-based stress-reduction techniques. Art and music therapy are other helpful therapeutic tools.

The Inova Life with Cancer Center, where Dr. Wadlow practices, has courses in mindfulness and related practices and is even beginning to require that physicians and other providers taking advanced specialty training to participate in the courses. Many cancer centers have similar programs, and training providers to participate is becoming more common.

How chaplains can help

A chaplain is a trained spiritual leader who works at a hospital or for another organization such as a branch of the military service. Most service members are familiar with chaplains, who may come from any faith and are generally trained to help people of all faiths or none.

Your hospital or cancer center may have a chaplain who can support you. They can:

• Read spiritual material to you.
• Talk with you about your concerns and about making healthcare decisions.
• Help family members with spiritual needs.
• Support members of the health-care team and providers at the hospital or clinic.
• Help you, your family, and your health-care team communicate with each other. ⁹

Spiritual care beyond the hospital

Chaplains are generally available in the hospital. For support when you (or your loved ones) are at home, you may want to contact your spiritual community, even if you have not been active recently or ever. You may feel awkward at first, but nearly every organization will welcome a request to talk about essential life questions or provide help.

A hospital chaplain can also help you connect with a local organization for spiritual care, including organizations for those with no specific religious faith such as the American Humanist Association.

Here are some ways to ask for spiritual support:

• I have cancer, and I’d like to talk to someone.
• My family is looking for a supportive community during cancer care.
• We used to attend [church, temple, mosque, dojo]. We’d like to get involved again, especially since [I, a family member, my partner] am/is having cancer treatment.
• I would like to be added to a prayer group.

Other health-care team members who can connect you with a spiritual or religious organization include social workers, nurses, and therapists.

Tips for finding spiritual care

Based on his experience caring for people with cancer, Dr. Wadlow suggests:

• Being open to exploring your questions about faith and spirituality.
• Recognizing that taking care of your spiritual side can help you heal as a whole person, whether the cancer is cured or not.
• Introducing your physician and other team members to your spiritual leaders or mentors if they visit or are involved in your care.
• Knowing that you can still discuss fears, worries, and questions of meaning and purpose if you do not have a spiritual bent or aren’t religious. You may find hope or peace in nature, movement, meditation, art, or a support group.

“Most health-care providers are extremely dedicated and looking for ways to help you,” says Dr. Wadlow. “But they may also feel sensitive because spirituality can be so private, so don’t hesitate to ask if you are looking for guidance in this area.” When you are seeking help to support and mend your spirit, it’s important to ask—and be open to receiving the help and support you need.

Resources

Online articles

• “Cancer: Religion and Spirituality” from Stanford University
• “Feed Your Faith, Not Your Fears,” article from Cancer Treatment Centers of America
• “My Wife Susan’s Response to Cancer,” from www.drwaynejonas.com

Books

• When Things Fall Apart by Pema Chodron
• Picture Your Life After Cancer, edited by Karen Barrow
• Finding a Cancer Support Group from the National Cancer Institute
• Kitchen Table Wisdom by Rachel Naomi Remen, MD
• Spirituality in Healthcare edited by Mark Cobb, Christina Puchalski, Bruce Rumbold
• Healing Words: The Power of Prayer and the Practice of Medicine by Larry Dosse

References

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