Human beings are the unity of biology, psychology, society and spirituality, the quality of life can not ignore spirituality, especially for cancer patients.Our study used the FACIT-sp-12 scale to access the spirituality, and its total score was 33.3±10.35, which was lower than the results of Munoz [15, 34–36], but higher than Lewis[37, 21]. The differences may be affected by the cultural background and religious beliefs of the subjects. The faith domain includes religious contents, thus, having religious affiliations may increase the total FACIT-Sp-12 scores, while 97.2% of the patients in our study had no religious beliefs.In this study,the level of spiritual well-being was moderate. It may be that 88.79% of the patients have spouses, and 86.87% are taken care by relatives. As the core of family support, spouse and their relatives can provide support and understanding when cancer patients are helpless or negative, thus increasing self-affirmation and confidence.At the same time, 77.41% of patients extroverted, they could adjust themselves to feel the meaning of life and have a peaceful heart.
Studies have shown that higher education is a protective factor for spiritual health. Our hospital is responsible for cancer prevention and treatment of 8,064,628 population in 11 districts and counties in northeast Chongqing, where the regional economic level is low and the rural population is in the majority,and the education is low. It is the only third-class hospital in this area with advanced cancer treatment equipment such as linear accelerators and PET-CT. In this study, 89.32% had a primary school education and 71.98% had a family income below 3000.In the face of diseases with high recurrence and high cost, it is difficult to accept the guidance of positive energy to seek spiritual sustenance, and the overall level of spirituality not high and lower than that of patients with chronic diseases.Chronic diseases with a long survival and high quality of life,as it through healthy lifestyles and dietary interventions can control the progression. Cancer belongs to the category of chronic diseases, but because of its rapid progression, high recurrence and death, once diagnosed and known to the patient, the spirit has become a serious burden, suggesting that the spirituality of cancer patients needs to be improved. Previous studies [39–40] have shown that cancer patients have higher spiritual needs, and meeting spiritual needs is the focus of nursing. Timely intervention should be conducted to make them face the disease with peaceful and strength.
From the perspective of dimensions and items, the lowest score were the peace domain and item 9 "I find comfort in my faith or spiritual beliefs", which was consistent with another study . It may be that cancer patients with varying degrees of anorexia, pain and other symptoms, and coupled with financial pressure that lead they are easy to anxiety and depression, the mood is difficult to calm and ease. Related studies have shown that spiritual care affects the clinical outcomes, relieves pain and contributes to health promotion, so that patients can feel content and enjoy peace in mind[42–43]. Therefore, under the condition of solving the economic pressure and using treatment methods to alleviate discomfort symptoms, it is necessary to meet their spiritual needs as the premise and provide appropriate measures of spiritual care.
Spiritual well-being was related to gender,character,and emotional with spouse from the ANOVA test or t test,and the results of multiple regression analysis showed that gender and character jointly affected it. Male and extroverted cancer patients had a higher level of spirituality.The differences can be explained as follows. First, gender.The score of male was higher than that of female.which may be due to the fact that 78.07% of male patients are migrant workers and farmers, have rich experience and profound inner experience. They are brave, strong and unrestrained,and they are better able to see through the world and understand the essence of life.On the contrary, female patients are mainly emotional and focusing on family,and rooted in traditional Chinese thoughts. Once they suffer from cancer, their physiological functions are impaired and the ability to perform family duties is lacking,the physical and mental symptoms interact and shows more serious spiritual impairment.Therefore, female patients need targeted supportive care, maximize the guidance to appreciate the meaning of life, relax family responsibilities to reduce their ideological burden.Second, character.The extrovert had a higher score than the introvert. It may be an optimistic and open-minded personality trait, is easier to form a harmonious, long-term and stable interpersonal relationship, accept the guidance of positive energy to seek spiritual sustenance and appreciate life.They show a scene of calm and serene, full of strength in the heart, it prompts that more spiritual care should be given to patients with introverted cancer. Third,
emotional with spouse. It was related to the score of the meaning dimension. It is possible that the support, understanding and tolerance of the spouse can provide patients with rich emotional interaction and spiritual support, which can alleviate loneliness and helplessness, facilitate the integration with the outside,and deepen the understanding of the meaning of life.Therefore, medical staff should be good at communicating with patients to create a harmonious doctor-patient environment. For patients without a spouse or have a poor relationship with spouse, relatives and friends should be encouraged to actively participate in disease care, and carry out family-centered health education to increase the social support for patients.Because of the influence of religion and culture, western countries have matured spiritual care and with a higher level of spiritual well-being than that in China. In recent years, through the continuous exploration and efforts of scholars, tranquility treatment and end-of-life education are gradually developing. How to improve the spiritual well-being of cancer patients? The model should be suitable for the regional characteristics and rooted in Confucianism, Taoism, Legalism and other historical culture, customs, and medical systems, and pay attention to the subjects of focus.
Our study did have some limitations. Due to the time and resources, only recruited one medical institution and collected the basic demographic characteristics information. While the informations about cancer staging, psychological characteristics, quality of life, etc. were not included, at the same time, the cross-sectional study was unable to find changes the trends. In the future, a multi-center longitudinal study can be carried out to comprehensively explore the influencing factors and dynamic changes of spirituality.