Spirituality is very important for cancer patients during the illness based on the literature evidences; however, literature on the spirituality of cancer patients are mainly focused on Western population, but few literature were found in Asians. Specially, there is no spiritual study on cancer patients found in Vietnamese hospitals. The investigator would like to understand the spiritual distress on cancer patients in Vietnam.
Purpose
The purpose of this study is to survey the spiritual distress on cancer patients of Northern Quang Nam general hospital in Vietnam. Especially, the investigator would like to understand the spiritual distress on the cancer patients in terms of the relationship with themselves, others, religion, and facing death by quantitative study. The theoretical/conceptual framework is conducting a qualitative study by interviewing 20 patients with incurable cancer, and developed a 30 items-spiritual distress scale (SDS) with four domains: relations with self, relations with others, relations with God, and attitude toward death, in the period of 2002–2003. Following the establishing the reliability and validity of SDS, a shorter- version 11 items-SDS was built by confirmatory factor analysis. Spiritual distress of cancer patients include four concepts as the relationship with the patients themselves, others, God and facing death. The concept for the relationship with the patients themselves included three sub-concepts as suffering, sorrow, and loneliness. The concept for the relationship with others included three sub-concepts as being unable to trust, obey, and forgive to others. The concept for the relationship with God included two sub-concepts as being no protection from my ancestors and unable to attend the religious activities. The concept for the relationship with others included three sub-concepts as being afraid to discuss death, worry about dying situation, and worry about dying ceremony. There are five hypotheses based on theoretical/conceptual framework: 1. The higher levels of cancer patients perceived suffering, sorrow, loneliness, the higher spiritual distress scores in the relationship with the patients themselves; 2. The higher levels of cancer patients perceived being unable to trust, obey, and forgive to others, the higher spiritual distress scores in the relationship with others; 3. The higher levels of cancer patients perceived being unable to be protected from ancestors and attend the religious activities, the higher spiritual distress scores in the relationship with God; 4. The higher levels of cancer patients perceived to be afraid to discuss the death, worry about dying situations, and ceremony, the higher spiritual distress scores in facing death; 5. The higher spiritual distress scores in the relationship with the patients themselves, with others, with God, and facing death, the higher spiritual distress scores of the cancer patients.
Methods
This is a quantitative study with cross sectional design to assess the spiritual distress on the cancer patients in Northern Quang Nam general hospital of Vietnam. The data of cancer patients will be collected in the Northern Quang Nam general hospital of Vietnam. This is a second class of hospital with 500 beds with one Department of Oncology/Hematology where there is an average number of patients per year about 200 cancer patients. There are 1 head nurse and 4 nurses with the average 5 patients cared by one nurse in one caner unit of 30 beds. Currently the cancer patient care in the hospital is mainly focused on the implementation of technical interventions such as medicines, vital signs, counselling, and health education. For the palliative care of cancer patient is mainly focused on the pain relief for the sickness, and less concerned with the mental and spiritual care of the cancer patients.
The major characteristics of cancer patients in the hospital are in the middle age of men with the different kinds of cancer diagnoses including the liver, lung, colon, and stomach cancers and the most common problems for cancer patients requested for nursing care are pain and anxiety. This study used purposively sampling with the inclusion criteria including the patient is at least 18 years or older, diagnosed with any kind of cancer, with cancer for at least 1 year or more, with or without chemotherapies, conscious clear, could communicate, and willing to participate into this study. The exclusion criteria included the patient with dementia or deafness, under serious complications for the chemotherapies, in the terminal stage, conscious unclear and could not communicate, and refused to participate in the study. The sample size of this study is 110 cancer patients in Northern Quang Nam general hospital of Vietnam. Because the shorter-version spiritual distress scale (SDS) included 11 items, each item required 10 study samples so that 110 cancer patients should be recruited into this study. However, due to 20% attrition rate of survey, it is more appropriate for the investigator to design 132 samples.
The scale in this study was used Spiritual Distress Scale (SDS) (Ku, Kuo, & Yao, 2010) which was developed by 85 cancer patients who has completed the SDS during their hospitalization in the oncology unit of a medical centre in southern Taiwan. The SDS included four domains of sub-scales as the relationship with themselves (14 items), others (5 items), God (7 items), and facing death (4 items). The content validity of SDS was established by four health care professionals working in the cancer and hospice units in southern Taiwan and the content validity index was 0.95 with four domains ranged from 0.90 to o.95. The reliability of SDS was established by the internal consistency in terms of the Cronbach’s alpha of the SDS among 85 cancer patients reached 0.95 with four domains ranged from 0.90 to 0.95. The construct validity of SDS was developed by the factor analysis, which found that the SDS consisted of 30 items with four domains comprising 64.831% explanation of total variance and all factor loadings among the 30 items of SDS were over 0.30. This study was approved by the adviser and two committees of Fooyin University and the Research Council of Northern Quang Nam General Hospital before the official data collection. The data analysis will start immediately after completing the 11-items Shorten SDS for 132 Vietnam cancer patients.
The data analysis by the descriptive statistics included the demographics such as age, sex, marital status, education, religion, employment status, occupation, income, main caregiver, years since cancer diagnosis, number of hospitalizations, length of hospitalizations, methods of treatment. Additionally, spiritual distress on the relationship with the patient themselves, others, God, and facing the death will demonstrate by percentage. Furthermore, the Chi-Square statistical data analysis will be conducted to compare the different spiritual distress on the four domains in terms of their percentage levels with each other and the total SDS, as well as the demographics of cancer patients. Finally, the advanced statistics will be applied into the further data analysis. ANOVA Scheffe multiple tests will be used for further analyzing the relationship between demographics and SDS for 132 cancer Vietnam patients.
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