Symposium VI

Patients' Interpretation of Illness is associated with their Spiritual Needs and Specific Forms of Spirituality

Janus Surzykiewicz & Arndt Buessing

Background: Based on the assumptions of the self-regulation model, the individual being an active problem solver consciously activates efforts to modulate thoughts, emotions and behaviors when facing illness or health threads. An important aspect for dealing with illness in terms of coping and illness interpretation are individual representations of disease. Relying on Diefenbach and Leventhal (1996) there are two main types of representations: cognitive and emotional. Based on numerous previous studies concerning the influence of spirituality and religiosity on illness interpretation and coping), the dimension of spirituality as a third important dimension of illness representation is introduced and discussed. Assuming that spirituality beliefs are important factors for individual coping strategies as well as behavioral reactions in the context of illness it is hypothesized that different qualities of spirituality (i.e. search for transcendence, need for inner peace, ethical sensitivity, harmony) result in different interpretations of illness (i.e. illness as a value, as a chance, as a punishment etc.), and thus different coping styles (i.e. helping others, self-transcendence, religious meaning, escaping from illness).

Method: Cross-sectional survey among 275 Polish patients (mean age 56±16; 74% women; 26% men) with both fatal and non-fatal chronic diseases: cancer (35%), diabetes mellitus (16%), chronic pain diseases (10%), and other chronic conditions. Standardized questionnaires were the Interpretation of Illness Scale; Spiritual needs Questionnaire (SpNQ), Self-description Questionnaire of Spirituality (SQS), Spirituality/Religiosity and Coping (SpREUK-15), Life Satisfaction (BMLSS), and Escape from Illness Scale.

Results: Most patients regarded their illness as something negative, i.e., 61% interruption of life, 50% enemy, 20% weakness, 8% punishment, 13% relieving break, 22% call for help; yet, a large fraction also as something positive, i.e., 42% challenge, 18% value. Compared to patients with cancer, patients with non-fatal chronic diseases regarded their illness less often as an enemy (F=7.3; p < .01), while all other interpretations did not differ significantly between these disease groups.

Value was strongly associated with religious trust (r=.50), and moderately (r>.30) with patients´ ability to reflect their life, with religious needs and needs for giving / generativity, with SQS´s religious attitudes and ethical sensitivity, and other measures of spirituality. However, challenge was only weakly associated with search for a spiritual source (r=.21) and reflection (r=.20). In contrast, a negative disease perception such as enemy was strongly associated escape from illness (r=.59), and moderately with existential needs (r=.30); also other negative disease perceptions such as interruption of life (r=.55) or punishment (r=.36) were moderately or strongly associated with escape. Call for help was positively correlated with escape from illness (r=.48), and negatively with life satisfaction (r= -.38). However, weakness or relieving break is not significantly associated with measures of spirituality. Regression analysis based on these correlations show significant impact of spirituality on interpretation styles of illness as well as coping strategies.

Conclusion: Data show that the type of spirituality is an important predictor for the patients´ interpretation of illness and coping. Spiritual attitudes result in a positive interpretation of illness as being something of value, indicating potentially the chance for a spiritual transformation. Negative interpretations were mainly related to the intention to escape from illness, reduced life satisfaction, and existential needs.

Faith as a Ressource in German Patients with Multiple Sclerosis

Anne-Gritli Wirth

To analyse how agnostic / atheist patients with multiple sclerosis (MS) cope with their illness compared to spiritual / religious patients we performed a prospective, multi-centre, anonymous study using standardised questionnaires. 213 patients (75% women; mean age 43¬±11 years, EDSS Score 3.7±1.8) were recruited from three hospitals that specialize in the treatment of MS.

Among them, 54% rated themselves as neither religious nor spiritual (R-S-), 16% as not religious but spiritual (R-S+), 19% as religious but not spiritual (R+S-), and 20% as both, religious and spiritual (R+S+). 29% stated that their “faith is a strong hold in difficult times” (52% rejected it, and 19% were undecided). Having this faith as a resource was not significantly influenced by gender, family status, educational level, course of disease, and it was also not related to patients´ health status, life satisfaction, negative mood states, or Positive attitudes. Instead, this resource was associated with MS patients´ ability to reflect on what is essential in life, with the conviction that illness may have meaning and could be regarded as a chance for development, and to appreciate and value life. Of interest was the fact that the experience of Gratitude / Awe was lowest in R-S- patients, and the highest in R+S+ patients. When asked for their individual source of hope, orientation and inspiration in life, 53% of patents had none, 10% stated faith / religion, 22% family / partner / children, 18% other (mainly philosophical sources).

Thus, religious individuals may find hope and hold in their faith, and related engagement in individual forms of religiosity (i.e., private prayers, meditation, rituals) and/or organized forms of religiosity (i.e. church attendance), while R-S- cannot rely on this source. One may suggest that they may have either no specific interest or are less willing to reflect these issues. How these individuals could be supported requires further exploration.

Spiritual Needs in Elderly Living in Residential/Nursing Homes

Jülyet Öven Uslucan

The aim of this study was to analyze psychosocial and spiritual needs among seniors living in residential / nursing homes in the South of Germany on one hand, and the underlying connections with their life satisfaction, moods, and meaning in life on the other hand.

112 seniors (76% women and 24% men with a mean age of 83 ± 7 years) were recruited in 9 different residential / nursing homes for elderly and assisted accommodation homes in Bavaria (predominantly with a Catholic denomination). To measure psychosocial and spiritual needs, we used the Spiritual Needs Questionnaire (SpNQ) which differentiates 4 main factors, i.e., Religious Needs, Existential Needs, need for Inner Peace, and need for Giving / Generativity.

We found that Religious Needs scored highest, while all other needs were of similar, yet lower relevance. There were no significant differences between men and women; also age and educational level had no significant influence. While there were no particular differences in the magnitude of unfulfilled needs with respect to self-care ability, there were significant differences in terms of elderly living in residential homes or residential nursing homes. In fact, those living in residential nursing homes had lower Religious Needs, but higher Existential Needs and Inner Peace needs. These results clearly differ from a similar study among elderly conducted in Schleswig-Holstein (Erichsen and Büssing, 2013), located in the North of Germany (predominantly with a Protestant denomination). It could be observed that Religious needs, in which praying for oneself was placed at the first place, was the most powerful issue. The more meaning in life (SMiLE questionnaire) the residents would ascribe and the more religious Trust (SpREUK questionnaire) they posses, the more relevant their Religious needs become. Of importance was the fact that residents´ grief was moderately associated with Inner Peace needs and Existential Needs, weakly also despair.

In conclusion, the data show that also elderly living in retirement homes may have specific unmet spiritual needs. It must be guaranteed they have access to chaplains / ministers, the opportunity to participate in formal religious practices (i.e. service attendance), and the privacy to practice their of religious rituals (i.e. praying) - or whatever is needed. Through these rituals they may obtain a certain level of hope, tranquillity and trust in their ability to fearlessly face an unknown future with a certain level of bravery, and aspiration believing to start a “new life after death”.

Spiritual Needs of Mothers with sick new born or preterm Children

Undine Wassermann

Spirituality is part of the basic needs of all humans, yet often ignored in hospitals because it is regarded as beyond professional duties of medical doctors, nurses or psychologists. Meanwhile there is an increasing body of evidence that even in secular societies, patients with chronic diseases may have specific spiritual needs. However, less is known about the spiritual needs of mothers of preterm or sick new born children. Aim of this study was thus to identify the needs of such mothers. So far, 62 mothers from the paediatric intensive care unit of the Communal Hospital Herdecke meeting the inclusion / exclusion criteria responded to a set of standardized questionnaires, i.e., spiritual needs questionnaire (SpNQ), spiritual well-being (FACIT-Sp), mood states (ASTS), stress perception (PSS), self-efficacy expectation (SWE), life satisfaction (BMLSS), etc. We will present first data on mothers´ spiritual needs and spiritual well-being during their struggle with their new borns´ health affections. By supporting their needs in hospital we hope to be able increasing mothers´ well-being and binding to their children.