14 Apr

Spirituality and Care of Prostate Cancer Patients: A Pilot Study

African-American men are more likely to be diagnosed with prostate cancer than white men and also more likely to be adversely affected. Although mortality rates are declining among black and white men, rates in black men remain more than twice as high as rates in white men. Epidemiological studies have suggested that several factors may play a role in prostate cancer, but only age, race, and a family history are well-established risk factors. Like most forms of cancer, prostate cancer is emotionally laden and little attention has been paid to how black men cope with the disease. Canadian Pharmacy prednisone

The role of spirituality and health is not new to the field of health and medicine. But there has been a resurgence of clinical and behavioral studies that have begun to clarify how spirituality and religion can contribute to the coping processes used in the experience of illness. While many physicians still feel that it may be inappropriate to discuss spiritual issues with patients for a variety of personal, philosophic, scientific, or ethical reasons, a 1996 Gallup poll revealed that 61% of Americans see faith as the most important aspect of their lives. Similarly, 63% of respondents indicated that doctors should talk to their patients about spiritual faith. Canadian Pharmacy viagra

Treatment of disease has always been associated with contact between doctor and patient and this relationship, ideally built on trust, is more long-term when the illness is chronic or life-threatening rather than a minor health problem. As part of this relationship, patients may desire to confide concerns about treatment, as well as inform physicians about aspects of their lives that may have a bearing on their health. For many patients, spiritual and religious beliefs may be key elements they would like to bring to the doctor-patient relationship. King and Bushwick found that patients wanted physicians to consider their spiritual needs in the course of treatment. impotence drugs

Research shows that spirituality can play an important role in the management of sickness and disease. The quality of the studies, though still limited in this area, has been improving over the last decade. Religious coping has been widely used by patients with all types of chronic diseases, including cancer. To this end, the notion that religion and spirituality are unimportant in the lives of patients can likely be dispelled. However, many questions remain unanswered. generic sildenafil citrate

The current study begins an examination of men’s health experience and the role that religious beliefs play in coping with disease. More specifically, we examine, through quantitative and qualitative methods, the role of spirituality in coping with illness among African-American men diagnosed with prostate cancer.

METHODS

Sample

A total of 38 men (14 African-American and 24 white) completed a self-administered survey, while 29 of these men (12 African-American and 17 white) also participated in focus groups. The data being reported in this paper focuses on the 14 African-American men who participated in the quantitative self-administered survey. generic tadalafil 5 mg

Recruitment

The study was promoted through three channels: (1) letters and telephone calls to cancer support groups; (2) flyers, newspaper advertisements, and word of mouth; and (3) participation in a morning radio talk show. From these sources, interested men were instructed to call the study office for information. To be included in the study, the men had to have reported a physician’s diagnosis of prostate cancer and be between the ages of 50 and 75. After an initial screening to determine eligibility, all of those contacted agreed to participate. Signed informed consent was obtained prior to data collection. Each participant received an honorarium for his time and cooperation. It is uncertain if those who participated were different from those who did not on characteristics other than severity of illness and sociodemographics. Data were collected during May and June 2001. All but two of the surveys were completed at the beginning of focus groups held to qualitatively explore issues relevant to prostate cancer patients within the context of religion and coping. buy sildenafil citrate

Table 1. Attribution of Causation for Prostate Cancer
Cause of Cancer

Agree

Disagree

No
(N=14)

%(N)

%(N)

Opinion
%(N)
No cause yet

71.4 (10)

7.1 (1)

21.4(3)
discovered
Worrying or stress

57.1 (8)

14.3 (2)

28.6 (4)
Eating fatty foods

42.9 (6)

28.6 (4)

28.6 (4)
Genetics*

38.5 (5)

15.4 (2)

46.2 (6)
Smoking

35.7 (5)

28.6 (4)

35.7 (5)
Lack of regular

35.7 (5)

28.6 (4)

35.7 (5)
exercise
God teaching

7.1 (1)

64.3 (9)

21.4 (3)
a lesson
Devil or Satan

7.1 (1)

64.3 (9)

28.6 (4)
*ltem missing from one respondent

Measurement

The total self-administered survey instrument used in the study consisted of 29 items to gather demographic data on the participants, as well as to provide a measure of validation for the qualitative analysis of the focus group sessions. In addition to demographic information, items included measures of religious affiliation and attendance, spiritual beliefs, social support, symptoms, perceptions of causes of prostate cancer, knowledge of prostate cancer treatments, and quality of life and physical well-being. We utilized a subset of the items for this current research. Viagra Professional online

Demographic data included age (years), education (years), marital status, work status (working, retired, unemployed), denominational affiliation (Protestant, Catholic, other), and frequency of church attendance (from less than once a month to weekly). The prostate-specific items included family history of prostate cancer (yes/no); familiarity with the PSA and digital rectal exam as screening procedures (yes/no); and familiarity with surgery, radiation, and hormone therapy as treatment options (yes/no). Respondents were also asked if they agreed, disagreed, or had no opinion on a list of causal factors for prostate cancer that included fatty foods, smoking, lack of exercise, genetics, stress, God or Satan, and no known cause. Canadian Levitra

Five items related to spirituality and medicine. Four items were in a yes/no format and probed the doctor-patient exchange as it related to religion and spirituality. The fifth item asked “How much does your recovery from prostate cancer depend on your spirituality or relationship with God or a higher power?” (l=does not depend at all, 10=depends very much). Buy Cialis Soft Tabs

The research team developed the survey instru¬ment based upon review of relevant literature and input from experts on the team, as well as consult¬ants. Four prostate cancer advocates pre-tested the instrument for content, sensitivity, literacy, length, and completeness. Levitra Professional

RESULTS

Demographic Survey Items

The mean age was 62 (SD=9.05); average education was 13 years (SD=1.5); and average number of years since diagnosis was 5.1 (SD=2.6). In addi tion, most of the men were currently married (91%) and 50% were currently employed. Ten (71.4%) of the men indicated their denominational affiliation was Protestant, 93% (N=13) were currently members of a church, and over 70% (N=10) responded that they attended church at least once a week. buy tamsulosin 400 online

Table 2. Religiosity and the Medical Setting

N=14 Yes (%)               No (%)
Have you told your doctor anything about your sense of
religion or spirituality? 64.3 (9)                35.7 (5)
Has your doctor ever asked you about spirituality or
religion as part of helping you handle your disease? 50.0 (7)                50.0 (7)
Have your doctor and clergy been in contact with each
other since your diagnosis? 35.7 (5)                64.3 (9)
Would you want your doctor and clergy to be in contact? 57.1 (8)                35.7 (5)*

* One person indicated other

Prostate Cancer-Related Items

When asked about their current treatment, the majority of the men (81%) were not currently in treatment. Less than half of the men (43%) had a family history of prostate cancer and 29% did not know their history. At the time of their diagnosis, half (50%) of the men had been familiar with the PSA and 86% had been familiar with the digital rectal exam. Regarding treatment options for prostate cancer, 57% were familiar with surgery and radiation as an option while 36% were aware of chemotherapy. Dutasteride 500 online

Table 1 lists the responses of agreement or disagreement regarding causal attribution for prostate cancer. The top three attributions were “no known cause” (71%), “worrying or stress” (57%), and “fatty foods” (43%). The least attributed causes were “God teaching a lesson” (7.1%), and “Devil or Satan” (7.1%).

Spirituality, Doctor-Patient Relationship and Prostate Cancer Recovery Items

When asked, “How much does your recovery from prostate cancer depend on your spirituality or relationship with God or a higher power?” the mean response was 8.86 (SD = 2.5). The modal response was 10.0 (64% of all respondents). Table 2 shows a set of responses to questions regarding the doctor-patient relationship and spirituality. The numbers indicate that a majority of the patients (about 64%) have relayed their spiritual and religious beliefs to their physicians. The men reported that half of the physicians had asked about their spirituality/religious beliefs in coping with the disease. While about 35% indicated their doctor and clergy had been in contact with one another, almost 58% of the men reported they would want the two to be in contact. Viagra Jelly online

DISCUSSION

From the results, we see the importance of religion and spirituality in the lives of these African-American men with prostate cancer. Most of the men have membership in a church and attend church on a frequent basis. Almost two-thirds of the men have spoken with their physicians about their spiritual life and half have had their physician ask about their spiritual beliefs. While a moderate percentage report contact between the doctor and their clergy, more than half would like for such contact to take place. This is consistent with the study’s qualitative results, which found a strong theme of the beneficial effect of religion and spiri¬tuality in coping with cancer. It is also consistent with the research by King and Bushwick (1994) we noted earlier that found that the majority of patients wanted to have spiritual needs met as part of the doctor-patient encounter. Buy Revatio online

This is a pilot study with limited generalizable findings. However, the research does begin to raise the question, “Should we integrate religion/spirituality into medical care?” This preliminary work suggests that the answer may be “yes.” Further investigation with the participation of physicians and physician organizations is warranted to more substantively answer this question. If these findings hold in other research it would suggest that for African-American patients, and perhaps others, encouraging or opening dialogue around issues of spiritual life in the doctor-patient encounter would be beneficial to the treatment process for prostate cancer. Generic Propecia

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