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Sources of spiritual well-being in advanced cancer
  1. Christopher Lo1,2,3,
  2. Camilla Zimmermann1,
  3. Lucia Gagliese1,2,4,
  4. Madeline Li1 and
  5. Gary Rodin1,2,3
  1. 1Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
  2. 2Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada
  3. 3Department of Psychiatry, University of Toronto, Toronto, Canada
  4. 4School of Kinesiology and Health Science, York University, Toronto, Canada
  1. Correspondence to Dr Gary Rodin, Department of Psychosocial Oncology and Palliative Care, 16-724, Princess Margaret Hospital, 610 University Avenue, Toronto, ON M5G 2M9, Canada; gary.rodin{at}


Objective To test a conceptual model of sources of spiritual well-being in patients facing life-limiting disease.

Design Cross-sectional survey.

Setting Princess Margaret Hospital, Toronto, Canada.

Participants 747 patients with stage IV gastrointestinal, breast, genitourinary or gynaecological cancer, or stage IIIA, IIIB or IV lung cancer, recruited from 2002 to 2008.

Main outcome measure Spiritual well-being as assessed by the FACIT-Sp-12.

Results Using structural equation modelling, spiritual well-being was specified as being predicted by religiosity, self-esteem, social relatedness and the physical burden of disease. The model had a good fit, Comparative Fit Index=0.96, Non-normed Fit Index=0.94, Root Mean Square Error of Approximation=0.057. Standardised path coefficients relating each factor to spiritual well-being were as follows: religiosity 0.50, social relatedness 0.28, self-esteem 0.26 and physical burden −0.11.

Conclusions The authors confirmed our theoretical model in which spiritual well-being is positively associated with religiosity, self-esteem and social relatedness, and is negatively associated with physical suffering. Our findings support a multidimensional approach to spiritual well-being that addresses not only religious issues, but also pain and symptom control, and the potentially damaging effects of advanced disease on self-worth and close relationships. The spiritually informed clinical encounter may be one in which sufficient time and opportunity for reflection are afforded to consider illness trajectories and treatment decisions in the context of religious beliefs and personal values, self-worth, support systems and concerns about dependency.

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  • Funding Canadian Institutes of Health Research (CIHR #MOP-62861 and #MOP-74684; G Rodin) and York University (L Gagliese). The funders had no role in the conception, analysis, writing and submission of this article.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. There was an error in the first sentence of the ‘What is already known on this topic’ box.