Source: Dissertation Abstracts International, Volume: 75-09(E), Section: A.

Adviser: Ruth McCorkle.

The purpose of this study was to examine spiritual well-being and its relationship with quality of life (QOL) among people diagnosed with cancer. This dissertation was completed in three manuscripts examining spiritual well-being in people with cancer from different methodological approaches.

The first manuscript entitled "The relationship between spiritual well-being and quality of life: a systematic review in the cancer literature" synthesized 36 studies screened from 566 citations identified in the PubMed and CINAHL databases from year 1960 to 2013. This review examined bivariate and multivariate associations between spiritual well-being and QOL for people diagnosed with cancer. Results provided evidence based on the majority of studies that overall spiritual well-being as well as the Meaning and Peace factors were positively associated with QOL outcomes for people diagnosed with cancer; these associations remained significant after controlling for various demographic, clinical and psychosocial variables; however Faith factor inconsistently related to QOL and tended to vary with sample characteristics.

The second manuscript entitled "Exploratory factor analysis of the 12-item Functional Assessment of Chronic Illness Therapy--Spiritual Well-being Scale (FACIT-Sp-12) in people newly diagnosed with advanced cancer" examined the factor pattern of the FACIT-Sp-12 using exploratory factor analysis in 118 patients newly diagnosed with advanced cancer undergoing treatment. The original FACIT-Sp-12 was developed as a 2-factor scale using principal components analysis (PCA): peace/meaning and faith. Subsequent confirmatory factor analysis suggested a 3-factor model improves psychometric property if peace and meaning items were scored separately. This manuscript explored the factor pattern of the FACIT-Sp-12 using both PCA and common factor analysis procedures. Results empirically supported a 3-factor model indicated by peace, meaning and faith factors. The congruence of exploratory and confirmatory factor analysis cast doubt on the two-dimensional construct of spiritual well-being and lent further support to the three-factor model of the FACIT-Sp-12.

The third manuscript entitled "Exploring the relationship between spiritual well-being and quality of life in people newly diagnosed with advanced cancer during existential plight" examined spiritual well-being and QOL as well as their relationship over two occasions during the existential plight. The study was designed as a secondary data analysis of a NIH funded cluster randomized clinical trial with patients newly diagnosed with advanced cancer undergoing treatment. The sample represented 52 participants assigned to the control group at one and three months post-baseline. Findings of this study provide empirical evidence that spiritual well-being cannot be reduced to psychological well-being for patients during existential plight, which in our sample, extends as far as 180 days after cancer diagnosis. Peace, Meaning and Faith are important during the initial crisis period, but over time the effect of Faith may wane. Future longitudinal studies are needed to verify the dynamic pattern of associations among factors of spiritual well-being with QOL. The unique contribution of Peace to QOL enhances our understanding of crucial integrants of spiritual well-being, and may inform future interventions intended to improve QOL for people newly diagnosed with advanced cancer. Taken together, these three methodological approaches have helped to advance an understanding of spiritual well-being in people with cancer.