Prevalence, defining characteristics, and predictors of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy: A longitudinal study

J Nurs Scholarsh. 2023 Jul;55(4):782-791. doi: 10.1111/jnu.12862. Epub 2022 Dec 12.


Introduction: Cancer patients are exposed to several types of treatments, including chemotherapy. In this context, patients experience several nursing diagnoses, including spiritual distress. The definition of the diagnosis of spiritual distress is grounded in lack of meaning and purpose in life, a sense of suffering, and a feeling of disconnected.

Purpose: The aim of this study was to determine the prevalence, sensitivity, specificity, and predictors of the nursing diagnosis of spiritual distress of cancer patients undergoing chemotherapy.

Designs: The study used a longitudinal questionnaire design with quarterly data collection points over a 12-month period. Participants were recruited through random sampling, in an outpatients' setting in one oncology day unit in Portugal.

Findings: The highest prevalence of spiritual distress was found at 3 months after patients started chemotherapy. The highest value of specificity was lack of meaning in life and express suffering, and the highest values of sensitivity concerned spiritual distress diagnosis. The predictors of spiritual distress were express suffering, alienation, questioning meaning in life, lack of serenity, questioning the meaning of suffering, hopelessness, and lack of meaning in life.

Conclusions: Spiritual distress is a human response that is current in patients undergoing chemotherapy, and the highest prevalence seems to occur at 3 months after commencing chemotherapy. Express suffering and lack of meaning in life play the role not only of defining characteristics (DC) in this study, but also of predictors in the diagnosis of spiritual distress.

Clinical relevance: The identification of the prevalence, predictors, sensitivity, and specificity of the DC of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy may facilitate nurses' clinical reasoning and improve the planning of nursing care in clinical practice in order to improve spiritual well-being in cancer patients.

Keywords: defining characteristic; nursing diagnosis; predictors; prevalence; spiritual distress.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Longitudinal Studies
  • Neoplasms* / drug therapy
  • Nursing Diagnosis*
  • Prevalence
  • Spirituality
  • Stress, Psychological