Psychospiritual Well-Being and Symptom Distress in Women With Breast Cancer

Juanita K. Manning-Walsh

ONF 2005, 32(3), E56-E62. DOI: 10.1188/05.ONF.E56-E62

Purpose/Objectives: To examine the relationship between symptom distress and psychospiritual well-being in women with breast cancer.

Design: Descriptive, cross-sectional, correlational study.

Setting: Secondary analysis of data collected in 2000 from the Breast Cancer Support Web site at

Sample: 100 women were invited to participate in the study after posting an entry in the Web site guest book. Most had stage I or II breast cancer, were nearly 46 years old, and were 10.25 months post-diagnosis.

Methods: Mailed questionnaires. Women were required to meet the following inclusion criteria: a confirmed breast cancer diagnosis, first cancer experience, fewer than two years postsurgery for breast cancer, 18 years of age or older, and the ability to read and write in English. Symptom distress was measured using the Symptom Distress Scale. Psychospiritual well-being was measured by combining scores from the psychological subscale of the breast-cancer specific version of the Functional Assessment of Cancer Therapy Scale and the Functional Assessment of Chronic Illness Therapy (Spiritual) Measurement System 12 for a composite score.

Main Research Variables: Symptom distress, psychospiritual well-being.

Findings: Symptom distress and psychospiritual well-being were inversely related. No relationship was found between age and symptom distress; however, age was inversely related to psychospiritual well-being. Age and symptom distress accounted for 23.1% of the variance in psychospiritual well-being.

Conclusions: Participants experienced a small amount of symptom distress, which was inversely related to psychospiritual well-being. Although their symptom distress was similar to other studies, patients in this study reported lower psychospiritual well-being than participants in other studies.

Implications for Nursing: Psychospiritual well-being is an important concept for nurses seeking a holistic approach to practice because it connects the mind and spirit with the body.

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    Acton, G.J., & Miller, E.W. (2003). Spirituality in caregivers of family members with dementia. Journal of Holistic Nursing, 21, 117-130.

    Ballard, A., Green, T., McCaa, A., & Logsdon, M.C. (1997). A comparison of the level of hope in patients with newly diagnosed and recurrent cancer. Oncology Nursing Forum, 24, 899-904.

    Bash, A. (2004). Spirituality: The emperor's new clothes? Journal of Clinical Nursing, 13, 11-16.

    Benzein, E., Norberg, A., & Saveman, B.I. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine, 15, 117-126.

    Berger, A. (2003). Treating fatigue in cancer patients. Oncologist, 8(Suppl. 1), 10-14.

    Brady, M.J., Cella, D.F., Mo, F., Bonomi, A.E., Tulsky, D.S., Lloyd, S.R., et al. (1997). Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. Journal of Clinical Oncology, 15, 974-986.

    Brady, M.J., Peterman, A.H., Fitchett, G., Mo, M., & Cella, D. (1999). A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology, 8, 417-428.

    Budin, W.C. (1998). Psychosocial adjustment to breast cancer in unmarried women. Research in Nursing and Health, 21, 155-166.

    Cella, D.F., Tulsky, D.S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., et al. (1993). The Functional Assessment of Cancer Therapy Scale: Development and validation of the general measure. Journal of Clinical Oncology, 11, 570-579.

    Chang, B., Noonan, A.E., & Tennstedt, S.L. (1998). The role of religion/spirituality in coping with caregiving for disabled elders. Gerontologist, 38, 463-470.

    Cimprich, B. (1999). Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nursing, 22, 185-194.

    Cimprich, B., & Ronis, D.L. (2003). An environmental intervention to restore attention in women with newly diagnosed breast cancer. Cancer Nursing, 26, 284-292.

    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: L. Erlbaum.

    Cohen, M.Z., Kahn, D.L., & Steeves, R.H. (1998). Beyond body image: The experience of breast cancer. Oncology Nursing Forum, 25, 835-841.

    Degner, L.F., & Sloan, J.A. (1995). Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer. Journal of Pain and Symptom Management, 10, 423-431.

    Ellison, C.W., & Smith, J. (1991). Toward an integrative measure of health and well-being. Journal of Psychology and Theology, 19, 35-48.

    Fehring, R.J., Miller, J.F., & Shaw, C. (1997). Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer. Oncology Nursing Forum, 24, 663-671.

    Ferrans, C.E., & Powers, M.J. (1992). Psychometric assessment of the Quality of Life Index. Research in Nursing and Health, 15, 29-38.

    Ferrell, B.R., Grant, M., Funk, B., Otis-Green, S., & Garcia, N. (1998). Quality of life in breast cancer: Part II: Psychological and spiritual well-being. Cancer Nursing, 21, 1-9.

    Fitchett, G., Peterman, A.H., & Cella, D. (1996). Spiritual beliefs and quality of life in cancer and HIV patients. Nashville, TN: Society for Scientific Study of Religion.

    Flemming, K. (1997). The meaning of hope to palliative care cancer patients. International Journal of Palliative Nursing, 3, 14-18.

    Giardino, E.R., & Wolf, Z.R. (1993). Symptoms: Evidence and experience. Holistic Nursing Practice, 7(2), 1-12.

    Glanz, K., & Lerman, C. (1992). Psychosocial impact of breast cancer: A critical review. Annals of Behavioral Medicine, 14, 204-212.

    Graydon, J. (1994). Women with breast cancer: Their quality of life following a course of radiation therapy. Journal of Advanced Nursing, 19, 617-622.

    Hill, P.C., & Pargament, K.I. (2003). Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research. American Psychologist, 58, 64-74.

    Hughes, K.K. (1993). Psychosocial and functional status of breast cancer patients. The influence of diagnosis and treatment choice. Cancer Nursing, 16, 222-229.

    Koenig, H.G. (2002). An 83-year-old woman with chronic illness and strong religious beliefs. JAMA, 288, 487-493.

    Kurtz, M.E., Kurtz, J.C., Given, C.W., & Given, B. (1995). Relationship of caregiver reactions and depression to cancer patients' symptoms, functional states and depression—A longitudinal view. Social Science and Medicine, 40, 837-846.

    Landis, B.J. (1996). Uncertainty, spiritual well-being, and psychosocial adjustment to chronic illness. Issues in Mental Health Nursing, 17, 217-231.

    Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.

    Levin, J.S., Chatters, L.M., & Taylor, R.J. (1995). Religious effects on health status and life satisfaction among black Americans. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 50(3), S154-S163.

    Lin, H.R., & Bauer-Wu, S.M. (2003). Psychospiritual well-being in patients with advanced cancer: An integrative review of the literature. Journal of Advanced Nursing, 44, 69-80.

    Longman, A.J., Braden, C.J., & Mishel, M.H. (1999). Side-effects burden, psychological adjustment, and life quality in women with breast cancer: Pattern of association over time. Oncology Nursing Forum, 26, 909-915.

    Lukkarinen, H., & Hentinen, M. (1998). Assessment of quality of life with the Nottingham Health Profile among women with coronary artery disease. Heart and Lung: The Journal of Critical Care, 27, 189-199.

    Manning, J. (2000). The effects of spiritual coping on quality of life and life satisfaction in women with breast cancer. Dissertation Abstracts International, 61, 5237.

    McCorkle, R. (1987). The measurement of symptom distress. Seminars in Oncology Nursing, 3, 248-256.

    McCorkle, R., Cooley, M.E., & Shea, J.A. (n.d.). A user's manual for the Symptom Distress Scale. Philadelphia: University of Pennsylvania.

    McCorkle, R., & Young, K. (1978). Development of a symptom distress scale. Cancer Nursing, 1, 373-378.

    McSherry, W. (1998). Nurses' perceptions of spirituality and spiritual care. Nursing Standard, 13(4), 36-40.

    Miller, D.L., Manne, S.L., Taylor, K., Keates, J., & Dougherty, J. (1996). Psychological distress and well-being in advanced cancer: The effects of optimism and coping. Journal of Clinical Psychology in Medical Settings, 3, 115-130.

    Miller, J.F. (1985). Assessment of loneliness and spiritual well-being in chronically ill and healthy adults. Journal of Professional Nursing, 1, 79-85.

    Molassiotis, A., Van Den Akker, O.B.A., Milligan, D.W., Goldman, J.M., & Boughton, B.J. (1996). Psychological adaptation and symptom distress in bone marrow transplant recipients. Psycho-Oncology, 5, 9-22.

    Munkres, A., Oberst, M.T., & Hughes, S.H. (1992). Appraisal of illness, symptom distress, self-care burden, and mood states in patients receiving chemotherapy for initial and recurrent cancer. Oncology Nursing Forum, 19, 1201-1209.

    Munro, B.H. (2002). Statistical methods for health care research (4th ed.). Philadelphia: Lippincott Williams and Wilkins.

    Narayanasamy, A. (2004). Spiritual coping mechanisms in chronic illness: A qualitative study. Journal of Clinical Nursing, 13, 116-117.

    Northouse, L.L., Caffey, M., Deichelbohrer, L., Schmidt, L., Guziatek-Trojniak, L., West, S., et al. (1999). The quality of life of African American women with breast cancer. Research in Nursing and Health, 22, 449-460.

    Northouse, L.L., Dorris, G., & Charron-Moore, C. (1995). Factors affecting couples' adjustment to recurrent breast cancer. Social Science and Medicine, 41, 69-76.

    Polit, D.F., & Beck, C.T. (2003). Nursing research: Principles and methods. Philadelphia: Lippincott Williams and Wilkins.

    Portenoy, R.K., Thaler, H.T., Kornblith, A.B., Lepore, J.M., Friedlander-Klar, H., Coyle, N., et al. (1994). Symptom prevalence, characteristics and distress in a cancer population. Quality of Life Research, 3, 183-189.

    Riley, B.B., Perna, R., Tate, D.G., Forchheimer, M., Anderson, C., & Luera, G. (1998). Types of spiritual well-being among patients with chronic illness: Their relation to various forms of quality of life. Archives of Physical Medicine and Rehabilitation, 79, 258-264.

    Sarna, L. (1998). Effectiveness of structured nursing assessment of symptom distress in advanced lung cancer. Oncology Nursing Forum, 25, 1041-1048.

    Sherman, D. (1996). Nurses' willingness to care for AIDS patients and spirituality, social support, and death anxiety. Image—Journal of Nursing Scholarship, 28, 205-213.

    Swenson, C.H., Fuller, S., & Clements, R. (1993). Stage of religious faith and reactions to terminal cancer. Journal of Psychology and Theology, 21, 238-245.

    Taylor, E.J. (1993). Factors associated with meaning in life among people with recurrent cancer. Oncology Nursing Forum, 20, 1399-1407.

    Taylor, E.J. (2003). Nurses caring for the spirit: Patients with cancer and family caregiver expectations. Oncology Nursing Forum, 30, 585-590.

    Taylor, E.J., Baird, S.B., Malone, D., & McCorkle, R. (1993). Factors associated with anger in cancer patients and their caregivers. Cancer Practice, 1, 101-109.

    U.S. Census Bureau. (2000). Educational attainment in the United States (update). Retrieved August 12, 2002, from

    Utley, R. (1999). The evolving meaning of cancer for long-term survivors of breast cancer. Oncology Nursing Forum, 26, 1519-1523.

    Walton, J. (1999). Spirituality of patients recovering from an acute myocardial infarction: A grounded theory study. Journal of Holistic Nursing, 17, 34-53.

    Wyatt, G., & Friedman, L.L. (1996). Long-term female cancer survivors: Quality of life issues and clinical implications. Cancer Nursing, 19, 1-7.

    Zorn, C.R., & Johnson, M.T. (1997). Religious well-being in noninstitutionalized elderly women. Health Care for Women International, 18, 209-219.