Cancer is a leading cause of death worldwide, with nearly 10 million (or nearly one in sixth) deaths due to cancer in 2020 (unknown, 2022). As China is the world's most populous country, the number of cancer cases in China is far ahead in the world rankings. According to the latest global cancer burden data for 2020 released by the WHO International Agency for Research on Cancer (IARC), China had 3 million cancer deaths in 2020, ranking first in the world (Cancer, 2020). Cancer poses a serious threat to people's health, and also brings a heavy burden to the economy and society (Sun et al., 2020).
Patients with terminal cancer have a life expectancy of less than 6 months and often face many comorbidities and systemic symptoms (Ko et al., 2023). Pain is one of the most common and intractable symptoms of terminal cancer, with an incidence rate of 66.4% (Yang et al., 2021). It is also one of the most feared and burdened problems for cancer patients, and interferes with important aspects of their lives, including daily activities, social functioning, sleep quality, and cognitive function. Therefore, the main purpose of the treatment of terminal cancer patients is no longer to prolong survival, but to control symptoms, reduce pain, and improve the quality of life (Currow et al., 2020). In the past, due to humanity concerted efforts, spiritual needs of have been integrated the into a person's overall health care (Bradford, 2023). Hospice care is an effective form to achieve this goal, providing comprehensive physical, psychological, social and spiritual care for patients with terminal cancer (unknown, 2017). A systematic review by Hindmarch, et al. (Hindmarch et al., 2022) found that spiritual care may help cope with cancer pain. Amini et al. (Amini & Tahrekhani, 2022)randomized 145 cancer patients and found that after 3 days of spiritual care, the fatigue and pain scores in the experimental group were significantly lower than those in the control group.
According to the National Consensus Project for Quality Palliative Care (NCP), Spirituality is a way for people to find and express the meaning and purpose of life, It is also a way to experience the connection between the self and the present, others, oneself, the supreme person (such as God, etc.), the natural environment and faith (unknown, 2019). In the Oriental cultural tradition, "Tao", "virtue", "benevolence", "righteousness", "manners", "wisdom" and "credit" are also the embodiment of spiritual connotation(Xiaohua, 2022) .
Spiritual needs are an important element of holistic care and an intrinsic human need, that unlike religion and has received increasing attention in recent years. Many previous review(Petersen, 2020; Yang et al., 2021) results consistently suggest that patients with life-limiting diseases have spiritual needs. It seems that life-threatening diseases make people aware of the often suppressed reality in the hustle and bustle of everyday life. Terminal cancer is often associated with death, so many patients become more tuned to their inner spirituality(Mamier et al., 2021). When patients, realize that their health is gradually deteriorating, most people begin to think about the meaning and purpose of life, and the problem of death. Mesquita et al. (Mesquita et al., 2017) conducted a comprehensive review to identify the spiritual needs of cancer patients receiving palliative care. They included 10 quantitative and 6 qualitative studies for a total of 1469 subjects. Their thematic analysis reveals the following types of spiritual needs: living with illness and finding meaning; having connections with others, God and nature; engaging in religious or spiritual beliefs and practice; knowing the spiritual needs related to the overall (bio-psychological-social spiritual existence); being able to discuss death; dealing with "unfinished things" and using the remaining time; wanting to be respected and maintain dignity. Although there may be ample evidence for the intensity and type of psychiatric needs experienced by patients with terminal cancer, information on these psychiatric needs and which personal factors are associated with increased psychiatric needs remains limited. Understanding the nature of spiritual needs and their associated factors can guide clinical care efforts.
Scholars have already explored this issue. Riklikienė et al. found that female cancer patients showed stronger spiritual needs than men, and pain was also one of the important factors affecting spiritual needs (Riklikienė et al., 2020). However, there seems to be a different view on the relevance of cancer pain to spiritual needs. According to Hindmarch et al. reaserch (Hindmarch et al., 2022) that the intensity of cancer pain is not necessarily related to meeting spiritual needs. In addition, Mamier, et al. (Mamier et al., 2021) compared the influencing factors of the spiritual needs of patients with chronic diseases in different cultural backgrounds in Korea and the United States, and religious beliefs can affect the degree and content of patients' spiritual needs. For patients with a specific religious belief, religious needs are an important component of their spiritual needs. However, China is a multi-religious country, Chinese citizens enjoy freedom of religious belief, and there is a large proportion of Chinese people not religious (unknown, 2018). In such a diverse social culture, the spiritual needs of patients with cancer may be very different from those of patients with specific religious backgrounds. Although the factors influencing spiritual needs have been examined in many parts of the world, the results vary.As far as know, almost no scholars have made in-depth exploration of the factors influencing different types of spiritual needs. Is it possible to find the difference in spiritual needs of people with different cultural backgrounds?
In conclusion, the aim of this study is to investigate the spiritual needs and influencing factors in patients with terminal cancer. Clarify the extent to which cancer pain affects spiritual needs. To provide the basis for the improvement of the spiritual care program, so as to promote the spiritual health of patients with terminal cancer, reduce the pain of patients, reduce the burden of caregivers, and help patients to die with comfort, serenity and dignity. Therefore, the specific research questions of this study are as follows: (1) the degree and type of spiritual needs of patients with terminal cancer in southern China?(2) What are the main factors affecting their spiritual needs? Does pain affect their spiritual needs?(3) Can more detailed nursing work according to the classification of spiritual needs?