Despite innovations in supportive care, people with cancer experience significant symptoms such as pain, fatigue, depression and sleep disturbance  which can contribute to substantial distress . Previous research has revealed that people with cancer generally experience multiple symptoms concurrently, with patients reporting an average of eight [3-5]. These cancer-related symptoms can adversely impact functional status and quality of life [6, 7], and can result in treatment delays and stoppages , making symptom management a top priority. Since symptom experiences are complex and multidimensional, addressing spirituality may be one route to support symptom management .
Interest in examining spirituality’s effects on physical and mental health is expanding, with growing evidence that higher self-reported spirituality is associated with positive physical and psychological outcomes . Spirituality is defined as a dynamic process whereby humans experience connection with self, others, nature and/or higher power and a sense of meaning [11-13]. Spirituality is often operationalized as spiritual well-being, including dimensions of peace, faith and meaning . Spirituality and religion are separate and distinct concepts, yet they can have overlap for some patients. Religion is generally practiced within an organized structure and is focused on prayers, rituals and communal services, where spirituality involves recognizing sacredness of every human activity . Spirituality can be meaningful at any stage of life, but often becomes especially important when faced with a life-threatening illness such as cancer . Prior research suggests that connection to spirituality offers a route to supportive thoughts and emotions, such as a sense of safety and comfort, when facing difficult circumstances , and that spirituality can serve as a positive coping resource to support adjustment to cancer and cancer-related symptoms [9, 17]. Spirituality may also be associated with greater uptake of self-management strategies among people with cancer . Based on this premise, supporting spirituality could be especially helpful when facing a range of cancer-related symptoms.
Prior research on spirituality and cancer-related symptoms has primarily focused on single-symptom outcomes such as pain  and depression , and findings have been mixed [21, 22]. Yet recent work examining coordinated symptom management across multiple cancer-related symptoms has highlighted the value of assessing and addressing co-occurring or clustered symptoms concurrently . Cancer-related symptoms, such as the pain, fatigue, and sleep disturbance cluster, have complex biopsychosocial underpinnings [4, 24]. Supporting spirituality is an under-explored area which could yield future advancements in the simultaneous management of co-occurring symptoms.
Conceptually, this work is grounded in the Dynamic Symptoms Model [25, 26]. This theoretical foundation illustrates the complex nature of symptoms, and symptom trajectories. The Dynamic Symptoms Model describes how various antecedents give rise to multidimensional symptom experiences, and how symptom experiences have consequences across different areas of patients’ lives. For the current research, our application of the model focuses on the role of spirituality as an antecedent to the experience of symptom severity, distress, and interference across four common cancer-related symptoms, pain, fatigue, depression, and sleep disturbance. Based on prior literature and on the Dynamic Symptoms Model, the current study explores the potential for spirituality to play a role in the way adults with cancer experience symptoms.
The purpose of this research is to explore how spirituality relates to common cancer-related symptoms (pain, fatigue, depression, sleep disturbance) among a sample of adults with cancer. Aims include examining…
1) The relationship between spirituality and symptom severity (for pain, fatigue, depression, sleep disturbance).
2) The relationship between spirituality and symptom-related distress (for pain, fatigue, depression, sleep disturbance).
3) The relationship between spirituality and overall symptom interference with daily life.
Is it hypothesized that higher levels of spirituality will be related to lower symptom severity, lower symptom-related distress and lower levels of overall symptom interference among this sample of people with cancer.