Screening for religious/spiritual struggle in blood and marrow transplant patients

Support Care Cancer. 2013 Apr;21(4):993-1001. doi: 10.1007/s00520-012-1618-1. Epub 2012 Oct 11.


Purpose: A growing body of research documents the harmful effects of religious/spiritual (R/S) struggle (e.g., feeling abandoned or punished by God) among patients with a wide variety of diagnoses. Documented effects include poorer quality of life, greater emotional distress, poorer recovery, and increased disability. This study reports the use of a screening protocol that identified patients who may have been experiencing R/S struggle. We also examined the prevalence and correlates of possible R/S struggle, its association with quality of life, pain, and depressive symptoms and compared the results from the screening protocol with social workers' assessments.

Methods: One hundred seventy-eight blood and marrow transplant patients completed the Electronic Self-Report Assessment--Cancer (ESRA-C) which included the Rush Religious Struggle Screening Protocol and other measures of quality of life, pain, and depressive symptoms prior to transplant therapy. All participants were assessed by a social worker, 90 % within 2 weeks of the ESRA-C assessment.

Results: Using the Rush Protocol, 18 % of the patients were identified as potentially experiencing R/S struggle. R/S struggle was not reported in any social work assessments. In a multivariable model, potential R/S struggle was more likely in patients who were more recently diagnosed, male, and Asian/Pacific Islanders. There were no significant associations between potential R/S struggle and quality of life, pain, or depressive symptoms.

Conclusions: Early identification of patients with R/S struggle will facilitate their referral for further assessment and appropriate intervention. Further research is needed to identify the best methods of screening patients for R/S struggle.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Blood Transfusion*
  • Bone Marrow Transplantation*
  • Female
  • Humans
  • Interview, Psychological / methods*
  • Logistic Models
  • Male
  • Middle Aged
  • Neoplasms / psychology
  • Neoplasms / therapy
  • Quality of Life / psychology
  • Sex Distribution
  • Social Work
  • Spirituality*
  • Surveys and Questionnaires
  • Washington