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159Seminars in Oncology Nursing, Vol 21, No 3 (August), 2005: pp 159-163

BJECTIVES:

o review literature documenting

he frequency of use and efficacy

f spiritual complementary thera-

ies. Implications for clinical

ractice and research that reflect

his literature are offered.

ATA SOURCES:

ata based research on comple-

entary therapy usage and clini-

al articles about selected mind/

ody therapies.

ONCLUSION:

piritual complementary thera-

ies are among the most fre-

uently used. Prayer, spiritual

ealing, and meditation are the

ost frequently used spiritual

herapies. Equivocal evidence

upports their efficacy.

MPLICATIONS FOR NURSING

RACTICE:

lthough spiritual practices may

ot be considered a “therapy,”

linicians should assess and sup-

ort these practices. Clinicians

hould only pray with patients

hen observing ethical guidelines.

From the School of Nursing, Lomainda University, Loma Linda, CA.Elizabeth Johnston Taylor, PhD, RN: As-

ociate Professor, School of Nursing, Lomainda University, Loma Linda, CA.Address correspondence to Elizabeth

ohnston Taylor, PhD, RN, 2133 Lorainoad, San Marino, CA 91108; e-mail:jtaylor@sn.llu.edu

2005 Elsevier Inc. All rights reserved.

be

749-2081/05/2103-$30.00/0oi:10.1016/j.soncn.2005.04.003

SPIRITUAL

COMPLEMENTARY

THERAPIES IN

CANCER CARE

ELIZABETH JOHNSTON TAYLOR

RAYER, distance healing, faith or spiritual healing,meditation, yoga, tai chi, and qi gong are classifiedas mind/body complementary therapies (CTs).These CTs reflect a religious tradition or involvespiritual beliefs or practices. Because some of these

Ts (ie, spiritual healing, prayer, and meditation) are frequentlysed by persons living with cancer, this article will briefly explorehe prevalence and efficacy of these spiritual CTs. Implications forancer nursing research and practice are offered. First, however, aescription of these three spiritual CTs is in order.

DESCRIPTIONS OF PREVALENT SPIRITUAL CTS

iven the prevalence of spiritual healing, prayer, and medita-tion, it is helpful to consider what these terms mean. The

ictionary of Alternative Medicine1 equates spiritual and faithealing, and defines them as “entrusting the healing process to a

higher’ (God in the Judeo-Christian construct) or other power(s)hrough prayer” (p. 139). Such a broad definition allows for spir-tual healing to include participation in a religious ritual of healing,eeking out a person known for invoking supernatural healingowers, or personal prayer.Prayer has been defined by theologians in a variety of ways.2 It

an be described as human communication or conversation withhe divine, awakening to God’s presence, or human encounterith—or consciousness of—an ultimate Other. Although forany, meditation becomes prayer, most definitions of meditation

istance it from theistic religion and describe it as “the ‘intentionalelf-regulation of attention,’ a systematic mental focus on partic-lar aspects of inner or outer experience” (p. 132).3 There are twoasic forms of meditation: exclusive/restrictive meditation (which

ncourages strict focus on an internal or external object, restrict-

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160 ELIZABETH JOHNSTON TAYLOR

ng distraction), and inclusive/mindfulness medi-ation (which encourages full awareness of theresent moment and experience).4

PREVALENCE AND RELATED FACTORS

indings from the 2002 National Health Inter-view Survey of over 31,000 adults indicated

hat while 62% of these Americans reported hav-ng used a complementary or alternative therapyuring the past year, 45.2% indicated that theyad used prayer for health reasons.5 While mostrayed for their own health (43%), 24% appreci-ted the prayers of others for them, 10% were in arayer group, and 2% participated in a healingitual. Whereas prayer was the most frequentlysed CT, meditation (7.6%), yoga (5.1%), tai chi1.3%), and qi gong (0.3%) were also used.

Several investigative teams have interviewedersons living with cancer about their use ofTs.6-13 Spiritual CTs are typically the most fre-uently used CTs, being one of the top three mostsed CTs in all of the studies presented in Table 1.esearch suggests that “spiritual healing,”prayer,” and “meditation” are the most fre-uently used spiritual CTs. Use of spiritual CTs,owever, may be under-reported. Not only doome questionnaires about CTs not inquire aboutrayer or other spiritual CTs, but some people doot recognize prayer and religious practices asTs. For example, during their interviews withomen with breast cancer, Balneaves et al6 ob-

erved that prayer along with some other CTsere thought of as part of a lifestyle, not a “ther-py.”Because prayer is the most prevalent spiritual

T (and likely the most prevalent CT in general),t is instructive to consider findings from surveysxploring individuals’ use of prayer. Surveys ofmericans conducted over the past half centuryave consistently shown that about 90% believe inrayer.14 Surveys conducted during the 1990sound that 82% of Americans say they have prayedor personal health.15,16 Seventy-nine percent of51 respondents in one national poll even saidhat God answers prayers for healing incurableisease.15 Data from other studies indicate thateople typically pray more as a response to livingith cancer.17-19 This evidence, in concert, sug-ests that most persons believe in prayer and prayo some degree—whether or not it is labeled a CT.

While studying what complementary or alterna- j

ive therapies persons with cancer use, many re-earchers have also identified factors that are as-ociated with CT use. While factors such as higherevels of education, younger age, and being femaleppear quite consistently linked with use ofTs,5-7,10-11,13 there is little evidence to suggest arofile for those who use spiritual CTs. Two stud-es indicate that black women with breast cancerse “spiritual healing” more than those of otherthnic groups; Latino women use it more thanhites and Asians.10-11 Gotay et al7 found Romanatholic Hawaiian cancer patients used CTs more

han did those of other religions or no religion (P.044). Wyatt et al9 noted no correlation between

pirituality and CT use among older cancer pa-ients. Findings from studies that find elders,lacks, and women are more likely to pray, sug-est a possible link for some of these seeminglyisconnected findings.20

EFFICACY

lthough spiritual healing, prayer, medita-tion, and other spiritual CTs are used fre-

uently by persons living with cancer, how wello they work? In a systematic review of ran-omized trials designed to determine the effi-acy of “distant healing” (defined as includingrayer, mental healing, therapeutic touch, orpiritual healing), Astin et al21 found 13 of 23tudies yielded statistically significant treat-ent outcomes. However, only five of these

tudies investigated prayer as an intervention;wo of these showed a positive outcome. While its inconclusive as to whether prayer contributeso physiologic healing, there is growing empiri-al evidence indicating personal prayer is asso-iated with positive emotional outcomes.22 Re-ardless of what scientific evidence shows, it ismportant to recognize that persons who do usepiritual healing believe it is very important inemaining free from cancer.13

A review of empirical studies researching thefficacy of meditation showed it decreases anx-ety, depression, pain, stress, and use of healthare resources. Meditation may also improveood, self-esteem, and reduce clinical symp-

oms.4,23 Other studies exploring the efficacy ofeditation do so by combining it with yoga or

ther mind/body CTs in a psychoeducationalntervention. For example, meditation, in con-

unction with yoga can improve quality of life,

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SPIRITUAL COMPLEMENTARY THERAPIES 161

leep quality, coping, and decrease negativeood and symptom distress for cancer pa-

ients.3

IMPLICATIONS

onsidering the high use of spiritual CTs (es-pecially prayer) among persons with cancer,

ncology nurses cannot ignore the implications ofhis fact. Some implications for clinical practice

TABSpiritual “Therapies” Used by Persons Wit

Researcher/s Methods

Balneaves et al6 64 central Canadian womecancer; completed quesincluding Belief and TreaPractices Survey

Gotay et al7 122 Hawaiian residents; sestructured interviews

VandeCreek et al8 112 Midwestern outpatientcancer; CAM surveys coduring interviews

Wyatt et al9 699 older cancer patientstreatment in Michigan; qincluded 17-item ComplTherapy Utilization instruyes/no answer options

Lee et al10 379 San Francisco womenbeen diagnosed with breto 5 years prior to studyinterview

Alferi et al11 231 early stage breast canliving in Miami, FL; interv

Lengacher et al12 105 mostly Caucasian wombreast cancer recruitedMidwest and Southeastequestionnaire identified

Henderson & Donatelle13 588 women living in the Poarea who had been diagbreast cancer an averagyears prior; telephone inbeginning with question12 months, have you us[15 categories of CAMsas answer options]

nd nursing research will be reviewed here. L

or Practice

What spiritual CTs are used by patients, andow they use them, are salient facts for clini-ians to assess. Assessment questions could in-lude, for example, “What spiritual or religioushings help you live with cancer?” and “Howould I as your nurse help you with these spir-tual ‘therapies’?” Such questioning could un-arth potential spiritual, emotional, or physicalroblems that the clinician should address.

1.ncer: Findings From the Past 5 Years 6-13

Findings

h breastairest

64% used meditation/relaxation therapies54% used spiritual/faith healing (37%

had sought out a spiritual/faith healer)Field notes from non-CAM users revealed

many used prayer and otherapproaches but considered them to belifestyle or religious practice, not CAM.

50% used prayer (by oneself, fromothers, faith healing, or healing mass)

20% used mind/body control (ie, guidedimagery, meditation, mental/spiritualself-improvement, positive thinking,reading self-help books, relaxation,support groups, visiting a psychic, orvisualization)

h breastted

76% used prayer29% used spiritual healing19% mental imagery

vingonnairestaryt with

6.4% used spiritual healing1.9% used relaxation/imagery/yoga

hadancer 3hone

24% overall used spiritual healing (byethnic group: 36% for blacks, 7% forChinese, 26% for Latinos, and 23% forwhites)

atients 29% used meditation and imagery21% used spiritual healing

iththeS;Ms

49% used regularly prayer and spiritualhealing

6% used regularly yoga and meditation6% used regularly guided imagery

d, ORd with3.5wse past___?”offered

28% used relaxation/meditation26% used spiritual healing

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162 ELIZABETH JOHNSTON TAYLOR

ould reveal the distress of wondering why Gods not answering a prayer, an exacerbation ofepression, or anticipate a potential negativehysiologic outcome from participating in a re-

igious ritual.Patients pray. Their family caregivers pray. And

he majority of nurses pray, even praying for theiratients.22 To suppress or deny this fundamentaluman need, this “primary speech,”24 hinderspiritual health for both nurses and their patients.hile some nurses pray with their patients (even

overtly, fearing negative consequences), otherselieve that it is inappropriate to do so. Observingeveral ethical guidelines can help nurses to prayith their patients in ways that are sensitive andffective—healing:First, strive to understand the client’s spiritualneeds, resources, and preferences;Pray with permission; respect the client’s ex-pressed wishes;Do not prescribe or push religious beliefs;Strive to understand your own spiritual beliefsand needs before addressing others’; andWhen it is appropriate to pray with individuals,do so in a manner that is authentic and conso-nant with your spiritual beliefs.25

A thorough discussion of how to pray with dis-ressed patients is beyond the limitations of thisrticle and can be accessed elsewhere.22,26 Nursesho follow the above guidelines, however, shoulde assured that healing can occur when they prayith authenticity with a client who appreciates

heir respect and compassion.

or Research

After reviewing the research pertinent to spiri-ual CTs, several recommendations for future re-earch can be offered. Most of this research inves-igates the perspectives of women with breast

ancer, most of whom were white and probably b

REFEREN

ancer. Fam Community Health 2003;26:64-73.

t2H

tw

aJ

hristian. Because there is some evidence thathe religious and prayer experiences of men andomen are different, future research should ex-lore these diverse perspectives of men, non-hites, non-Christians, and those with other can-er experiences.Future research exploring the use of spiritualTs should clarify and consider more specificescriptions for CTs. Several research reportsite “spiritual healing” as a frequent CT. Yethere is variability among researchers and par-icipants as to what this term means. Althoughost researchers who study CT use include

piritual CTs, many study participants do notiew prayer and some other spiritual CTs asuch. For them, praying, attending services, oreditating, is a way of life, a religious practice

hat they distinguish from any “therapy.” In-eed, prayer may not be something someoneuses”; it may be something one lives or expe-iences. Therefore, a research study that asksubjects about how often they “use spiritualherapies” alongside other complementary/al-ernative therapies may not fully document re-lity.

CONCLUSION

piritual healing, meditation, and especiallyprayer are some spiritual CTs that are fre-

uently used by persons living with cancer. Rec-gnizing their role in patient’s spiritual, emo-ional, and possibly physical healing is requisiteo truly health-promoting cancer care. Viewinghese approaches toward healing not as thera-ies, interventions, or magical strategies to use,ut rather as gracious gifts or opportunities thatan be integrated in health-seeking living, may

e the first step in this process of caring.

CES

1. Segen JC: Dictionary of Alternative Medicine. Stamford,T; Appleton & Lange; 1998.2. Wierzbicka A: What is prayer? In search of a definition.

n: Brown LB (ed): The Human Side of Prayer. Birmingham,L; Religious Education Press; 1994.3. Astin JA, Shapiro SL, Eisenberg DM, et al: Mind-bodyedicine: State of the science, implications for practice. J Amoard Fam Pract 2003;16:131-47.4. Tacon AM: Meditation as a complementary therapy in

5. Barnes PM, Powell-Griner E, McFann K, et al: Complemen-ary and alternative medicine use among adults: United States,002. Advance data from vital and health statistics; no 343.yattsville, MD; National Center for Health Statistics; 2004.

6. Balneaves LG, Kristjanson LJ, Tataryn D: Beyond conven-ion: Describing complementary therapy use by women livingith breast cancer. Patient Educ Counsel 1999;38:143-153.

7. Gotay CC, Hara W, Issell BF, et al: Use of complementarynd alternative medicine in Hawaii cancer patients. Haw Med

1999;58:94-98.

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SPIRITUAL COMPLEMENTARY THERAPIES 163

8. VandeCreek L, Rogers E, Lester J: Use of alternativeherapies among breast cancer outpatients compared with theeneral population. Altern Ther Health Med 1999;5:71-76.9. Wyatt GK, Friedman LL, Given CW, et al: Complemen-

ary therapy use among older cancer patients. Cancer Pract999;7:136-144.10. Lee MM, Lin SS, Wrensch MR, et al: Alternative thera-

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11. Alferi SM, Antoni MH, Ironson G, et al: Factors predicinghe use of complementary therapies in a multiethnic sample ofarly-stage breast cancer patients. J Am Med Womens Assoc001;56:120-126.12. Lengacher CA, Bennett MP, Kip KE, et al: Design and

esting of the use of a complementary and alternative therapiesurvey in women with breast cancer. Oncol Nurs Forum003;30:811-821.13. Henderson JW, Donatelle RJ: Complementary and alter-

ative medicine use by women after completion of allopathicreatment for breast cancer. Altern Ther Health Med 2004;0:52-57.14. Poloma MM, Gallup GH. Jr: Varieties of prayer: A survey

eport. Philadelphia, PA; Trinity Press; 1991.15. Woodward KL: Is God listening? Newsweek; March 31,

997;57-65. p

16. Gallup GH. Jr: Religion in America. Princeton, NJ;rinceton Religion Research Center; 1996.17. Richards DG: The phenomenology and psychological

orrelates of verbal prayer. J Psychol Theol 1999;19:354-363.18. Meriviglia MG: Prayer in people with cancer. Cancer

urs 2002;25:326-331.19. Taylor EJ, Outlaw FH: Use of prayer among persons with

ancer. Holist Nurs Pract 2002;16:46-60.20. Levin JS, Taylor RJ: Age differences in patterns and

orrelates of the frequency of prayer. Gerontologist 1997;7:75-88.21. Astin JA, Harkness E, Ernst E: The efficacy of “distant

ealing”: A systematic review of randomized trials. Ann Interned 2000;132:903-910.22. Taylor EJ: Prayer’s clinical issues and implications. Ho-

ist Nurs Pract 2003;17;179-188.23. Bonadonna R: Meditation’s impact on chronic illness.olist Nurs Pract 2003;17:309-319.24. Ulanov A, Ulanov B: Primary speech: A psychology of

rayer. Atlanta, GA; John Knox; 1982.25. Winslow GR, Winslow BW: Examining the ethics of

raying with patients. Holist Nurs Pract 2003;17:170-177.26. Taylor EJ: Spiritual care: Nursing theory, research, and

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