Status Of Spirituality And Its Impact On Quality Of Life In Patients With Advanced Cancer

ObjectiveTo translate Spiritual Attitude and Involvement List(SAIL)into Chinese and evaluate the reliability and validity when applied to the patients with advanced cancer.Then,describe the prevalence of spirituality among patients with advanced cancer and explore its influence to these patients' quality of life,and moderating effect of the sense of coherence in this association.MethodsThis study was divided into two parts.The first part is translate and evaluation of C-SAIL.SAIL was translated into Chinese through the procedure of translation,back-translation.Then,SAIL was revised by expert consultation,cognitive interview and pre-survey combined with Chinese cultural background.After that,C-SAIL scale was used to investigate patients with advanced cancer.In the first stage,258 patients were selected for item analysis and exploratory factor analysis(EFA),meanwhile content validity,internal consistency,and retest reliability were evaluated.In the second phase,397 patients with advanced cancer were investigated for confirmatory factor analysis(CFA).The second part is the influence of spirituality on the quality of life of patients with advanced cancer.Spirituality,sense of coherence and quality of life was measured in a cross-sectional study involving 534 patients with advanced cancer.Correlation analysis was used to analyze the relationship among the three variables and structural equation model was used to explore the mechanism of how spirituality impact on quality of life.ResultsFor the first part,The Chinese version of the Spiritual Attitude And Involvement List consisted of 25 items arranged in 3 subscales with 6 dimensions:Connectedness to oneself(meaningfulness,trust,acceptance);to the environment/others(caring for others,connectedness with nature);to the transcendent(spiritual experiences),Cronbach's alpha coefficient of the C-SAIL was 0.911,test-retest reliability was 0.809,and the item-CVI of all items was 1.000.Six factors were extracted explaining 64.045%of the total sample variance.The findings from CFA revealed that the C-SAIL showed an acceptable model fit(?2/df=1.937,GFI=0.910,CFI=0.948,IFI=0.949,NFI=0.901,TLI=0.939,RMSEA=0.049).For the second part,the mean score of C-SAIL was(4.04±0.75)and the items in other dimensions are scored at least 4 points on average except the Spiritual Involvement.The score of C-SAIL was related to the age,educational level,religious/cultural belief and the degree of informed diagnosis.Spirituality,sense of coherence and quality of life are positively correlated(r=0.320?0.538,P<0.01).Results indicated that spirituality predicted quality of life and sense of coherence mediated these associations,two variablesexplained 46.6%of the total score of the quality of life together.The findings showed the mediation model with acceptable fit indices(?2/df=2.656,GFI=0.932,NFI=0.926,IFI=0.953,TLI=0.934,CFI=0.952,RESEA=0.072).In addition,we examined how distinct aspects of spirituality impact on quality of life.Results indicated that Trust predicted all the dimensions of quality of life directly and it can also indirectly affect the quality of life through sense of coherence.Meaningfulness had both direct and indirect influence on emotional well-being and functional well-being.Caring for Others predicted social well-being and emotional well-being directly.Conclusion(1)The Chinese version of the Spiritual Attitude and Involvement List had good reliability and validity,and can be used to measure the spirituality of advanced cancer patients in China.(2)Spirituality of patients with advanced cancer is at a good level and scored differently depends on patients' demographic variables such as age,education level,religion/cultural belief,and the degree of informed diagnosis.(3)Spirituality was positively associated with higher quality of life and sense of coherence partially mediated the relationship between spirituality and quality of life in advanced cancer patients.(4)SAIL sub-scales of Trust,Meaningfulness and Caring for Others play a major role in the quality of life of patients with advanced cancer,which indicates that we should focus on these aspects of spirituality.Our findings lay the foundation for the integrated intervention consist of improving patients' spirituality,enhancing sense of coherence as well as improving quality of life in patients with advanced cancer,which patients can gain maximized benefit from it.