Sinicization And Revision Of The Spiritual Coping Questionnaire And Its Application In Advanced Cancer Patients

1 BackgroundThe International Agency for Research on Cancer（IARC）has issued the latest statistics,showing that the high incidence and mortality of cancer,which seriously affecting the quality of human life.Compared with other countries,the incidence and mortality rate of cancer in our country rank first in the world.Patients with advanced cancer are suffering from the overall distress of body,mind,society,and spirit,so spiritual care cannot be ignored.Spiritual coping is a unique coping mechanism.Cancer is a source of stress for patients,and spirituality serves as the stress buffering function to help patients cope with the disease and relieve their physical and psychological symptoms.At present,the spiritual coping scale developed in China does not take into account the negative aspect,and our country still lacks localized and comprehensive spiritual coping assessment tools.Therefore,it is necessary to introduce and revise foreign scales with complete structure and content.2 PurposeTo explore spiritual coping strategies of advanced cancer patients in depth through conducting qualitative interviews,simultaneously providing a basis for cultural adjustment and item revision of the scale;To introduce the spiritual coping questionnaire into our country through translation,back translation,expert comment,and cultural adaptation,and to test its reliability and validity in advanced cancer patients,verifying its applicability and scientificity;To understand the current status of spiritual coping for patients with advanced cancer,and to analyze its influencing factors,with applying the revised Chinese version of the Spiritual Coping Questionnaire to patients with advanced cancer,providing references for spiritual care.3 method3.1 Qualitative researchBased on the descriptive phenomenological method,28 patients with advanced cancer in the oncology department of a third-class hospital in Guangzhou were selected for semi-structured interviews by using purpose sampling.Analysing the data through the Colaizzi analysis method to deeply understand and explore the spiritual coping strategies of patients with advanced cancer.3.2 Sinicization and Revision of scaleAuthorized by the original author,based on the Brislin translation principle,the translation and back translation scales were conducted by two researchers respectively,and the differences were unified and determined by a third party.An expert compared the back-translated version with the original scale,and then fed it back to the original author.Finally,the scale was culturally adjusted and revised based on qualitative interviews and traditional Chinese culture,and the final items were determined by expert comment.3.3 Cross-sectional surveyConvenience sampling was used to select 442 patients with advanced cancer from three third-class hospitals in Guangzhou to test applicability of the Chinese version of the Spiritual Coping Questionnaire,through adopting these methods,such as project analysis,exploratory factor analysis,confirmatory factor analysis,internal consistency reliability,and retest reliability,etc.Finally,the official Chinese version of the spiritual coping questionnaire was applied to patients with advanced cancer,to understand the patient’s spiritual coping status,and to explore its influencing factors.4 results4.1 Spiritual Coping Strategies for Patients with Advanced CancerFour themes were refined:embodying self-worth（personal responsibility,maintaining roles）,cognitive appraisal and attitude（diseases cognitive,life attitude,and thinking about life and death）,seeking peace from the outside world（transcendental behavior,getting close to nature）,and obtaining hope and support（medical science,religion/faith,feel love and encouragement）.4.2 The Sinicization,Revision,Reliability and Validity of the Spiritual Coping QuestionnaireWith cultural adjustment and revision,the scale has 26 items,7 dimensions,and 2 subscales:positive spiritual coping（personal,social,environmental,transcendence）and negative spiritual coping（personal,social,transcendence）.The content validity is 0.933,and the cumulative variance contribution rate of the 7 common factors is 73.251%.The confirmatory factor analysis shows that x2=580.510,df=281,x2/df=2.066（P<0.05）,GFI=0.840,CFI=0.916,IFI=0.917,TLI=0.903,RMSEA=0.070,SRMR=0.080;The internal consistency of the subscale was 0.884 and 0.908,and the test-retest reliability was 0.933 and 0.938.4.3 The Status and influencing factors of spiritual coping in patients with advanced cancerThe positive spiritual coping score of advanced cancer patients was 3.80（3.47,4.18）points,and the negative spiritual coping score was 1.33（1.00,2.00）points.Positive spiritual coping is negatively correlated with anxiety and depression（r=-0.250/-0.388,P<0.01）,and positively correlated with social support（r=0.243,P<0.01）;negative spiritual coping is positively correlated with anxiety and depression（r=0.269/0.314,P<0.01）,and negatively correlated with social support（r=-0.282,P<0.01）.Religious beliefs and high social support are contributing factors to positive spiritual coping,and anxiety is its hindering factor;women,low education,low social support,and high anxiety and depression patients are more likely to adopt negative spiritual coping.5 Conclusion5.1 Advanced cancer patients present spiritual coping styles from the connection of personal,social,natural and transcending.It is reminded that medical staff should fully understand the characteristics of spiritual coping and provide targeted spiritual care in the future.5.2 The Chinese version of the spiritual coping questionnaire has good reliability and validity.It can be used to measure the spiritual coping styles of patients with advanced cancer in our country and provide a good assessment tool for clinical spiritual care.5.3 Patients with advanced cancer are more likely to use positive spiritual coping and less use of negative spiritual coping,which are affected by many factors.This is conducive to medical staff to propose individualized spiritual care measures based on the status of spiritual coping,promoting the development of spiritual care.