Prevalence, Predictors and Correlates of Religious and Spiritual Struggles in Palliative Cancer Patients

Annelieke Damen*, Julie Exline, Kenneth Pargament, Yingwei Yao, Harvey Chochinov, Linda Emanuel, George Handzo, Diana J. Wilkie, George Fitchett

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Context: Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. This concise measure allows for the assessment of multiple types of r/s struggles for people from different religious backgrounds or none. Objectives: The aim of the present study was to examine the prevalence, predictors and correlates of r/s struggles as measured by the RSS-14 and its subdomains in a cancer population receiving palliative care. Methods: Data were collected from six outpatient palliative care services across the US. Inclusion criteria for patients were age 55 or older with a cancer diagnosis. In addition to demographic and r/s characteristics, study measures included the Edmonton Symptom Assessment Scale (ESAS), the Patient Dignity Inventory (PDI) and the Quality of Life at the End of Life (QUAL-E). Results: The study included 331 participants. Some r/s struggle was reported by 66%, moderate to high struggle for at least one item was reported by 20% of the patients. In bivariate analyses, r/s struggle was associated with greater symptom burden, greater dignity-related problems and poorer quality of life; in multivariable analyses, dignity-related problems remained a predictor of total r/s struggle. Conclusion: R/S struggles may compromise well-being for cancer patients receiving palliative care. Clinicians should consider periodic screening for r/s struggles and referrals for spiritual care if indicated.

Original languageEnglish (US)
Pages (from-to)e139-e147
JournalJournal of Pain and Symptom Management
Issue number3
StatePublished - Sep 2021


  • Religion
  • cancer
  • negative religious coping
  • palliative care
  • religious/spiritual struggles
  • spirituality

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • General Nursing


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