The purpose of this integrative review was to synthesize the research on the psychosocial-spiritual outcomes of psychotherapeutic interventions in Muslim patients undergoing treatment for cancer. Psychotherapeutic interventions are nonpharmacological strategies to address psychosocial-spiritual distress associated with cancer. Throughout this review, we noted a myriad of psychotherapeutic interventions under study in caring for Muslim patients with cancer that target various psychosocial-spiritual outcomes, including promoting patients’ mental health and quality of life, which were the most common outcomes in the studies included for review. Reviewed studies have shown that CBT-based interventions are promising strategies to improve psychosocial-spiritual outcomes in Muslim patients with cancer. The reviewed studies are also informative in building a base for the effectiveness of psychotherapeutic techniques in the psycho-oncologic treatment of Muslim patients.
This review confirms the positive outcomes of various psychotherapeutic interventions on improving mental health, such as improving symptoms of depression and anxiety and stress [10, 17, 18, 19, 21, 24, 26, 31]. Consulting sessions [19, 21] provide patients with practical and educational information and resources that are related to emotions such as depression, anxiety, and fear associated with cancer. Mindfulness-based cognitive therapy [24, 26] increases patients’ awareness of their feelings; throughout this therapy, patients acquire cognitive skills that promote metacognitive awareness, acceptance of negative thoughts, and an ability to effectively cope with psychological distress. Aromatherapy  entails using volatile essential oils of plants to enhance mental health. These oils stimulate the olfactory nerves which connect to long-term memories that involve long-forgotten memories and their emotional links to one’s life. These emotions can enhance sleep quality and relieve stress. Laughter yoga  includes various techniques, such as clapping and chanting, as well as deep breathing, which prepare the mind for happiness and improve a sense of optimism and hopefulness.
The results of this review also suggest that different psychotherapeutic interventions can enhance Muslim cancer patients’ quality of life. A diagnosis of cancer and its associated treatment leads to emotional distress because of deteriorating health and impending death, which can result in reduced quality of life. The hopelessness  that is associated with poor quality of life can also be a predictor of depressive symptoms among patients with cancer. Seven of the studies included in this review suggest that psychotherapeutic strategies can improve patients’ quality of life [20, 21, 22, 23, 25, 27, 31].
Mindfulness-based cognitive therapy  helps patients by incorporating principles of cognitive therapy and meditative practice to consciously attract attention to thoughts and feelings without prejudging. This can help patients to improve mood and combat depressive symptoms such as hopelessness, and in turn, enhance quality of life. While yoga sessions  and psychoeducation  may stimulate brain pleasure centers, spiritual therapy  works on promoting illness perception through patients’ cultural beliefs and psychological needs. Zamaniyan and colleagues  indicate how spiritual therapy that includes education about the psychological aspects of patients undergoing chemotherapy contributes to improving symptoms of depression and anxiety, ultimately enhancing patients’ quality of life.
Some authors discussed the role of spiritual counseling and therapy [15, 16, 29, 30, 31] in improving spiritual well-being. These approaches help patients to increase self-awareness and broaden inner strengths and resources through addressing their spiritual questions, reciting Qur’an, and practicing relaxation exercises and meditation. Rassouli and colleagues  used these approaches to support patients coping with cancer and its related problems. Patients’ religious beliefs and some practices may conflict with therapists’ interpretations of patients’ experience. Therefore, these spiritual counseling approaches may help patients with cancer to find meaning in the cancer experience and resolve these conflicts [16, 30]. Finally, Jafari and colleagues  demonstrate how a spiritual therapy intervention can assist patients in identifying and shifting negative thoughts and validating positive ones.
The majority of Muslim patients with cancer believe that God has the power to control their lives and circumstances and God alone can cure disease [16, 22, 29]. These beliefs may help observant Muslims cope with negative feelings and experiences that may be associated with cancer. Patients acknowledged the significance of their absolute belief in God’s forgiveness and mercy as religious practices and spiritual resources support the process of changing feelings of powerlessness into feelings of power.
Implications for Research
The psychotherapeutic approaches of psychotherapy in the included studies were not all described with the specificity necessary for replication. Psychotherapeutic approaches already established as efficacious in cancer patients need to be adapted to be culturally and spiritually sensitive to Muslims undergoing treatment for cancer and then tested to determine the benefits of these adaptations in this understudied population. And rigorous research designs, such as sufficiently powered randomized control trials, with well-structured control groups, are necessary. Measuring the effects of extant efficacious psychotherapeutic interventions using a common set of standardized mental health, quality of life, and spiritual well-being outcome measures will facilitate comparing and synthesizing results of different studies across populations.
In addition, we need further qualitative studies to explore the psychosocial-spiritual needs of cancer patients of different ages, cancer stages, and ethnicity groups. As well, none of the included studies reported cost or examine cost-effectiveness analysis, which is a crucial matter that should be considered in developing countries.
There is a paucity of studies conducted in the Middle East, the sub-continent of Asia, and the Asia-Pacific region, where most Muslims live. In some countries, psychotherapeutic interventions may not be seen as beneficial due to the main focus on psychotropic medications as they act fast in their effects and there is pervasive doubt in the effectiveness of psychotherapeutic techniques. Testing interventions in rigorous trials may help to change this perception. There is also a paucity of studies conducted among Muslim cancer patients who live in Canada, Europe, the United Kingdom, and the United States. As Muslim populations grow in these areas, psychotherapeutic studies in Muslims undergoing treatment for cancer in these regions will be necessary.
Implication for Practice
Patients and healthcare providers should work together to evaluate the psychosocial-spiritual distress associated with cancer and provide culturally and spiritually sensitive cancer care. Since non-Muslim healthcare providers are not fully aware of how to offer culturally and spiritually sensitive cancer care to Muslims, this may result in misunderstandings of their religious beliefs and practices . Thus, culturally and spiritually sensitive psycho-oncologic interventions are likely to improve the psychosocial-spiritual outcomes of Muslim patients with cancer. Cultural and spiritual diversity is a variant that needs to be considered when teaching non-Muslim providers. Since psychotherapeutic approaches differ in their contents, durations, and goals, manuals of interventions adapted for, and tested in, Muslims would enable non-Muslim providers to deliver culturally and spiritually sensitive psycho-oncologic care.
Seeking medical help or disclosure about psychosocial-spiritual distress because of mental illness stigma may be a matter of great concern among patients . Stigma faced by patients in their daily lives may interfere with seeking psycho-oncologic help to improve their mental health, quality of life, and spiritual well-begin. Culturally and spiritually sensitive interventions may help to reduce this stigma.
Limitations and Strengths
Our findings should be considered in the context of their methodological shortcomings and potential limitations in generalizability. The scientific rigor of the studies included varies. The majority of reviewed studies recruited relatively small sample sizes, which resulted in being underpowered to detect the effects of psychotherapeutic interventions. The experimental studies included in this review did not indicate whether intervention fidelity was applied in their protocol, and some lacked randomization, blindness techniques, and control groups. Most reviewed studies did not examine long-term effects, but rather focused on effects 3–12 weeks post-intervention. Only one study examined intervention effects at 10 weeks , and two studies at 12 weeks [23, 31]. Since the included studies used various controls, outcome measures, and intervention modalities, this rendered synthesis across studies challenging. This diversity makes it difficult to draw conclusions about any specific modality for a certain cancer stage or type. Our review highlights the importance of future studies sufficiently powered and with long-term follow-up.
Several studies included participants with a range of cancer types and stages simultaneously, instead of focusing on a specific type, stage, or treatment phase. This is a challenge in conducting cancer studies, except at major academic cancer centers where it is possible to conduct studies in patients of only a certain cancer type, stage, or treatment phase. Some studies included in this review did not specify the cancer stage or treatment phase, nor did they specify what the participants in the control group received. These limitations can act as threats to the validity of these studies or mask the real effect of the interventions implemented. Thus, in addition to well-powered studies with long-term follow-up, future studies in homogenous populations are needed.