Nurse-Led Meaning-Centered Spiritual Care, Anxiety, and Illness Acceptance in Breast Cancer: A Quasi-Experimental Study
https://doi.org/10.53770/medica.v8i10.1277
Keywords
Breast Cancer Meaning-Centered Spiritual Care Anxiety Illness Acceptance Oncology NursingAbstract
Breast cancer frequently causes anxiety and difficulties with illness acceptance, potentially affecting psychological well-being, treatment engagement, and adaptation to cancer-related challenges. This study evaluated changes in anxiety and illness acceptance following nurse-led meaning-centered spiritual care compared with routine oncology care. A quasi-experimental, non-equivalent control group pretest–posttest study was conducted at two hospitals in Palembang, Indonesia, from May 2025 to April 2026. Using consecutive sampling, 172 women with stage I–III breast cancer were recruited into intervention (n = 86) and control (n = 86) groups according to hospital, without randomization. The intervention involved four individualized nurse-led sessions lasting 45–60 minutes each, delivered twice weekly over two weeks. Sessions integrated spiritual assessment, meaning-centered reflection, adaptive spiritual coping, and reinforcement of hope and illness acceptance, supported by an educational booklet and daily reflective exercises. Both groups received routine oncology care. Anxiety was assessed using the Hospital Anxiety and Depression Scale–Anxiety subscale (HADS-A), and illness acceptance using the Acceptance of Illness Scale (AIS). Between-group differences in pretest–posttest change scores were compared to characterize short-term comparative intervention-related psychological outcome differences. Relative to controls, the intervention group had a greater reduction in HADS-A scores (between-group difference in change: −4.94 points; 95% CI: −5.79 to −4.09; p < 0.001; Cohen’s d = 1.76) and a greater increase in AIS scores (6.57 points; 95% CI: 5.41–7.73; p < 0.001; Cohen’s d = 1.70). Nurse-led meaning-centered spiritual care was associated with greater short-term improvements in both outcomes, although nonrandomized hospital-based allocation limits causal inference.
Downloads
References
American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
Applebaum, A. J., Kulikowski, J. R., & Breitbart, W. (2022). Meaning-centered psychotherapy for cancer patients: Current evidence and future directions. Current Opinion in Supportive and Palliative Care, 16(3), 150–156. https://doi.org/10.1097/SPC.0000000000000604
Arch, J. J., Mitchell, J. L., & Genung, S. R. (2023). Acceptance- and mindfulness-based interventions for cancer survivors: A systematic review and meta-analysis. Psycho-Oncology, 32(5), 685–699. https://doi.org/10.1002/pon.6105
Balboni, T. A., Puchalski, C. M., & Peteet, J. R. (2022). The relationship between spirituality and serious illness care. JAMA, 328(2), 184–197. https://doi.org/10.1001/jama.2022.11086
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77. https://doi.org/10.1016/S0022-3999(01)00296-3
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834
Breitbart, W., Poppito, S. R., Rosenfeld, B., Vickers, A. J., Li, Y., Abbey, J., Olden, M., & Nelson, C. J. (2022). Individual meaning-centered psychotherapy for patients with advanced cancer: A randomized clinical trial. Psycho-Oncology, 31(5), 713–722. https://doi.org/10.1002/pon.5857
Breitbart, W., Poppito, S. R., Rosenfeld, B., & Gibson, C. (2018). Meaning-centered psychotherapy in the cancer setting: Finding meaning and hope in the face of suffering. Oxford University Press.
Büssing, A., Recchia, D. R., Surzykiewicz, J., Baumann, K., & Hvidt, N. C. (2022). Spiritual needs and illness acceptance in patients with chronic diseases: A systematic review. Journal of Religion and Health, 61(5), 3700–3722. https://doi.org/10.1007/s10943-022-01556-3
Caldeira, S., Timmins, F., Carvalho, E. C., & Vieira, M. (2023). Spiritual care interventions in oncology nursing: An integrative review. Supportive Care in Cancer, 31, 421. https://doi.org/10.1007/s00520-023-07863-7
Caruso, R., Nanni, M. G., Riba, M. B., Sabato, S., & Grassi, L. (2022). Depressive spectrum disorders in cancer: Diagnostic issues and intervention. Current Psychiatry Reports, 24(3), 147–159. https://doi.org/10.1007/s11920-022-01318-9
Cavers, D., Hacking, B., Erridge, S. C., Kendall, M., Morris, P. G., & Murray, S. A. (2021). Social, psychological and existential well-being in cancer survivorship: A longitudinal qualitative study. Psycho-Oncology, 30(8), 1326–1334. https://doi.org/10.1002/pon.5695
Chan, R. J., Howell, D., & Armes, J. (2023). Future directions for supportive cancer care: Expanding the role of oncology nurses in person-centered care. Seminars in Oncology Nursing, 39(5), 151566. https://doi.org/10.1016/j.soncn.2023.151566
Charalambous, A., Wells, M., Oldenmenger, W., & Kearney, N. (2021). A systematic review of nurse-led interventions to manage symptoms in patients with cancer. Supportive Care in Cancer, 29(8), 4281–4298. https://doi.org/10.1007/s00520-021-06046-8
Costa, G., Marôco, J., & Pais-Ribeiro, J. L. (2024). Illness acceptance and psychological adjustment among people living with cancer: A systematic review. Supportive Care in Cancer, 32, 114. https://doi.org/10.1007/s00520-024-08341-z
Des Jarlais, D. C., Lyles, C., Crepaz, N., & the TREND Group. (2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. American Journal of Public Health, 94(3), 361–366. https://doi.org/10.2105/AJPH.94.3.361
European Oncology Nursing Society. (2024). Cancer nursing education framework and recommendations for supportive care. European Oncology Nursing Society.
Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
Felton, B. J., Revenson, T. A., & Hinrichsen, G. A. (1984). Stress and coping in the explanation of psychological adjustment among chronically ill adults. Social Science & Medicine, 18(10), 889–898. https://doi.org/10.1016/0277-9536(84)90158-8
Ferrell, B. R., Paice, J. A., Koczywas, M., & Malloy, P. (2023). National Consensus Project Clinical Practice Guidelines for Quality Palliative Care: Implications for oncology nursing. Seminars in Oncology Nursing, 39(2), 151394. https://doi.org/10.1016/j.soncn.2023.151394
Ferrell, B. R., & Temel, J. S. (2022). Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology, 40(9), 965–984. https://doi.org/10.1200/JCO.21.02641
Fegg, M. J., Kögler, M., Brandstätter, M., Jox, R. J., Anneser, J., Haarmann-Doetkotte, S., & Borasio, G. D. (2023). Meaning-centered interventions in oncology and palliative care: An updated systematic review. Palliative & Supportive Care, 21(2), 285–296. https://doi.org/10.1017/S1478951522000600
Greer, J. A., Jacobs, J. M., El-Jawahri, A., Nipp, R. D., Gallagher, E. R., Pirl, W. F., Park, E. R., & Temel, J. S. (2022). Role of psychological flexibility and acceptance in patients with advanced cancer. Psycho-Oncology, 31(2), 254–262. https://doi.org/10.1002/pon.5810
Howell, D., Keshavarz, H., Broadfield, L., Hack, T., Hamel, M., Harth, T., Jones, J., & Olson, K. (2024). Evidence-based psychosocial care for adults with cancer: Updated clinical practice recommendations. Current Oncology, 31(2), 1124–1147. https://doi.org/10.3390/curroncol31020078
Howell, D., Keshavarz, H., Broadfield, L., Hack, T., Hamel, M., Harth, T., Jones, J., & Olson, K. (2023). A pan-Canadian practice guideline for screening, assessment, and management of anxiety in adults with cancer. Current Oncology, 30(5), 4473–4493. https://doi.org/10.3390/curroncol30050340
Hulbert-Williams, N. J., Beatty, L., & Dhillon, H. M. (2021). Psychological support for patients with cancer: Current state of the evidence and future directions. CA: A Cancer Journal for Clinicians, 71(3), 200–218. https://doi.org/10.3322/caac.21662
International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use. (2023). ICH harmonised guideline E6(R3): Guideline for good clinical practice. International Council for Harmonisation.
International Council of Nurses. (2021). The ICN code of ethics for nurses. International Council of Nurses.
Leuteritz, K., Mehnert-Theuerkauf, A., Koch, U., & Herschbach, P. (2023). Nurse-led psychosocial interventions in oncology: Effects on emotional distress and quality of life. Supportive Care in Cancer, 31, 534. https://doi.org/10.1007/s00520-023-07942-9
National Cancer Institute. (2024). Adjustment to cancer: Anxiety and distress (PDQ®)–Health professional version. U.S. Department of Health and Human Services.
National Comprehensive Cancer Network. (2025). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Distress management (Version 1.2025). National Comprehensive Cancer Network.
Phillips, S. M., Alfano, C. M., Perna, F. M., Glasgow, R. E., & Demark-Wahnefried, W. (2024). Psychosocial adaptation and illness acceptance among cancer survivors: Current evidence and future directions. Cancer, 130(4), 623–635. https://doi.org/10.1002/cncr.35071
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Puchalski, C. M., Vitillo, R., Hull, S. K., & Reller, N. (2023). Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine, 26(3), 357–366. https://doi.org/10.1089/jpm.2022.0428
Rodin, G., Lo, C., Rydall, A., Zimmermann, C., & Hales, S. (2021). Managing cancer and living meaningfully (CALM): A randomized controlled trial of a psychological intervention for patients with advanced cancer. Journal of Clinical Oncology, 39(14), 1519–1531. https://doi.org/10.1200/JCO.20.02564
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2024). Global cancer statistics 2024: GLOBOCAN estimates of incidence and mortality worldwide. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834
Warth, M., Kessler, J., Koehler, F., Aguilar-Raab, C., & Ditzen, B. (2023). Effects of spiritual care and meaning-centered interventions in cancer patients: A systematic review and meta-analysis. Psycho-Oncology, 32(6), 847–860. https://doi.org/10.1002/pon.6148
Watson, J., & Woodward, T. K. (2020). Watson's caring science and human caring theory: Transforming personal and professional practices of nursing and health care. University Press of Colorado
World Health Organization. (2024). Cancer fact sheet. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/cancer
World Medical Association. (2025). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human participants. JAMA, 333(1), 71–74. https://doi.org/10.1001/jama.2024.21972
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 MEDICA (International Medical Scientific Journal)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
