The role of religion and spirituality in cancer care: An umbrella review of the literature

Highlights

• Religion &Spirituality had a positive impact on cancer care.

• Variation in methodological approaches to Religion & Spirituality were identified.

• Religion & Spirituality may be important in patient cancer care.

• Integration of Religion & Spirituality may result in more patient-centered care.

Abstract

Although some studies have suggested a strong relationship between religion and spirituality (R&S) and patient outcomes in cancer care, other data have been mixed or even noted adverse effects associated with R&S in the healthcare setting. We sought to perform an umbrella review to systematically appraise and synthesize the current body of literature on the role of patient R&S in cancer care. A systematic search of the literature was conducted that focused on “cancer” (neoplasm, malignant neoplasm, malignancy), “spirituality” (beliefs, divine), and “religion” (specific practices like Christianity, faith, faith healing, prayer, Theology). A total of 41 review articles published from 1995 to 2019 were included: 8 systematic reviews, 6 meta-analyses, 4 systematic reviews and meta-analysis, and 23 other general reviews. The number of studies included in each review ranged from 7 to 148, while 10 studies did not indicate sample size. Most articles did not focus on a specific cancer diagnosis (n = 36), stage of cancer (n = 32), or patient population (n = 34). Many articles noted that R&S had a positive impact on cancer care, yet some reviews reported inconclusive or negative results. Marked variation in methodological approaches to studying R&S among cancer patients, including operational definitions and measurement, were identified. Resolving these issues will be an important step to understanding how patients seek to have R&S integrated into their patient-centered cancer care experience.

Introduction

Within the field of healthcare, preferences regarding the integration of religion and spirituality (R&S) into patient care have varied over time. The earliest providers were “healers” that were embedded in traditional religious and spiritual practices (e.g., Shaman) [1,2]. Conversely, the disease-centered, cure-oriented model of care that has dominated the field of medicine over the last century has conceptualized R&S and medical care as distinct, separate entities. More recently, however, the shift to patient-, relationship-, and family-centered models of care have brought R&S back into the healthcare context [[3], [4], [5], [6]]. This trend has been reflected in the scholarly literature as publications on the topic of ‘spirituality and health’ and ‘religion and health’ have increased 600% and 47%, respectfully, between the late 1990s and early 2000s, highlighting the growing interest in the relationship between R&S and health [7].

In distressing situations, such as receiving a serious or terminal diagnosis, R&S issues may become more important for both patients and healthcare professionals [8]. For cancer survivors, R&S may be particularly important due to the uncertainties surrounding diagnosis and prognosis, treatment‐related decisions, as well as consideration of prolonged, challenging therapies that may not result in symptom improvement or cure [9,10]. After being diagnosed, survivors are charged with making significant, life-altering decisions regarding their treatment and care, with each decision having their own biological, psychological, social, and spiritual consequences. Cancer survivors often consider their R&S values and practices as an important aspect related to hope, comfort, and meaning during their cancer care [11,12]. Additionally, professional organizations such as the American College of Physicians, American Medical Association and World Psychiatric Association recognize that high-quality patient-centered care (PCC) includes integrating and supporting the R&S needs of survivors across the cancer care continuum [[13], [14], [15]].

Although some studies have suggested a strong, positive relationship between R&S and patient outcomes in cancer care, other data have been mixed or even noted adverse effects associated with R&S in the healthcare setting. Additionally, there are inconsistencies with the application of R&S concepts, including how R&S is assessed and implemented in the patient-provider relationship. We sought to address this gap by performing a comprehensive synthesis of the literature. In particular, umbrella reviews are often referred to as a “review of reviews” and can help summarize the findings across a broad topic, including comparing and contrasting the reported findings [16]. Therefore, the aim of this study was to perform an umbrella review approach to systematically appraise and synthesize the current body of literature on the role of patient R&S in cancer care across all fields and specialties to guide future research, intervention development, and clinical practice.