The global burden of colorectal cancer continues to grow. According to the International Agency for Research on Cancer (IARC), 1.9 million new cases will be diagnosed worldwide in 2020, leading to about 935,000 deaths, and this places the mortality rate at second globally1. The International Center for Cancer Research predicts that by 2030, the number of new cases worldwide will reach 2.2 million, with deaths totaling 1.1 million2.
In Europe and the United States, the incidence of colorectal cancer has been increasing over the last two decades. In contrast, China has seen a gradual increase in both incidence and mortality rates3. By 2030, new cases are expected to reach 2.2 million, with 1.1 million deaths4.
Colorectal cancer is a life-threatening disease with low cure rates, high relapse rates, and high mortality. Patients face various degrees of physical, psychological, social, and spiritual challenges during diagnosis, treatment, and recovery5. In addition to physical symptoms like pain, dyspnea, fatigue, vomiting, loss of appetite, and sleep disorders, patients also struggle with changes in body image and financial burdens. They must cope with emotional distress, including despair and anxiety6.
These challenges extend to spiritual needs, such as feelings of despair, anxiety, depressive disorders, and existential concerns like a lack of purpose and fear of death. As a result, both the spiritual health and quality of life of these patients are severely impacted7,8. This study builds upon the concept proposed by Field et al.9 and incorporates ideas from various scholars10. It aims to summarize spiritual needs as the needs and expectations of individuals—regardless of their religious beliefs—to find meaning, purpose, and value in life.
Currently, the main treatment methods for colorectal cancer include surgery, immunotherapy, and targeted therapy. Single or multiple combinations of diagnostic and treatment programs often have unavoidable side effects, leading to various discomforts in patients. As a result, patients with colorectal cancer experience severe physical and mental pain during both treatment and recovery11. Some patients have reported that spirituality helps them find hope and gratitude, enabling them to face the disease positively. They perceive spirituality as a source of strength, key to hope, and essential for a sense of purpose in their lives12. Studies have shown that meeting patients' spiritual needs positively impacts their quality of life and psychosocial well-being13,14.
Taiwanese scholar Hsiao et al. conducted qualitative interviews with 33 cancer patients during their treatment. They found that spiritual needs were mainly manifested in four aspects: enhancing hope, maintaining a peaceful state of mind, experiencing interpersonal love, and receiving dignified care. Almost all participants expressed the need to maintain dignity, realize the meaning of life, and face death with serenity15. Research on the spiritual needs of cancer patients in China is limited. However, Shihui Zhang has shown a positive correlation between spiritual health and the need for spiritual care among cancer patients. The more pronounced the need for spiritual sustenance, the better the spiritual health16.
Overall, there is a growing emphasis on the relationship between spiritual needs and health. Investigating the impact of key risk factors on the long-term recovery of colorectal cancer patients is crucial, especially for developing countries. Previous research has often focused on isolated regression analyses of spiritual needs, overlooking potential interconnections17. Additionally, spiritual needs are frequently trivialized in healthcare settings, even in end-of-life care18. While much work remains to fully integrate spiritual care into healthcare practices, it is encouraging to see a growing national emphasis and active promotion of spiritual care in hospice settings.
In cross-sectional studies, various positive psychological qualities such as mental toughness19, benefit findings20, Positive Mindfulness Stress Reduction21, self-esteem22, and optimism23 have been shown to help colorectal cancer patients reduce negative emotions, maintain inner peace, and experience more positive emotions. These qualities positively impact patients' spiritual needs. Conversely, negative emotions like anxiety and depression can negatively affect their spiritual needs24, 25.
Zhang Y's study26 on patients with advanced kidney disease indicated that psychological factors mediate the effect of spiritual needs on quality of life. Although international scholars have explored the influence of spiritual needs on health outcomes, their findings generally suggest that psychological factors play a crucial role. However, only a few studies have consistently considered these variables in structural equation modeling. Therefore, the first hypothesis of this study is that while anxiety and depression may negatively impact the spiritual needs of colorectal cancer patients, psychological resilience may have a positive effect. Supporting this hypothesis, Rose's study of 142 cancer patients found that psychological resilience significantly impacts patients' spiritual needs27.
Additionally, numerous studies have shown that colorectal cancer patients require social support, including emotional support from close family members and healthcare professionals28. Ciria-Suarez et al. found that positive social support could account for 19.3% of spiritual needs, suggesting that social support impacts the spiritual needs of colorectal cancer patients29. Buck's study also revealed a significant correlation between social support and cancer patients' spiritual needs30.
The spiritual dimension of health is also crucial for colorectal cancer patients, emphasizing the need to improve their mental, physical, spiritual, and social well-being31. Previous research has shown that addressing spiritual needs is fundamental for providing spiritual care and improving patients' spiritual health32. Riklikien et al.33 found a significant positive relationship between the absence of spiritual needs and patients' mental health. Therefore, the third hypothesis of this study is that spiritual health will positively affect the spiritual needs of colorectal cancer patients. Supporting this hypothesis, Asgeirsdottir et al. found a strong link between the spiritual health of advanced cancer patients and their spiritual needs34.
There is a growing body of literature on the spiritual needs of colorectal cancer patients and increasing evidence that these needs positively impact their prognosis29,35,36. Various factors determine patients' spiritual needs, and most existing studies focus on single influencing factors37,38,39,40. Therefore, a comprehensive survey is needed to understand the current situation and the factors influencing the spiritual needs of colorectal cancer patients.
The main objective of this paper is to understand the status of spiritual needs and the associated factors in patients with colorectal cancer. Additionally, this study aims to develop a structural equation model to investigate the influence of targeted spiritual care interventions on the spiritual needs of these patients, focusing on the mechanisms of action of different elements. This study examines the current predictive relationships between psychological resilience, social support, spiritual health, anxiety, and depression in a hospital setting and their impact on the spiritual needs of patients with colorectal cancer. In summary, the following hypotheses were developed:
Hypothesis 1
Anxiety and depression have a negative impact on spiritual needs, and psychological resilience has a positive impact on spiritual needs in colorectal cancer patients.
Hypothesis 2
Social support can help meet the emotional needs of colorectal cancer patients.
Hypothesis 3
The spiritual needs of colorectal cancer patients are positively influenced by spiritual health.