{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T20:35:15Z","timestamp":1784838915334,"version":"3.55.0"},"reference-count":91,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Scandinavian Caring Sciences"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Following the diagnosis of breast cancer, women experience a sudden disruption and disintegration in the concept of life, crisis, uncertainty and a sense of loss and experience unbearable suffering called spiritual distress. Clarifying the term spiritual distress and its characteristics can be useful in promoting evidence\u2010based practice and supporting the better diagnosis and treatment of spiritual problems in breast cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The present study aimed to analyse the concept of spiritual distress in women with breast cancer. It was done using the Walker and Avant model (2019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a conceptual and library analysis study. To clarify the concept of spiritual distress, we searched the Internet using the keywords spiritual distress, spiritual pain, spiritual conflict, spiritual problems, spiritual resentment, spiritual imbalance, breast cancer, concept analysis; also, Walker and Avant in the reliable databases of Springer, Science Direct, Pubmed, Proquest, Wiley and Scopus was performed. After a comprehensive review of the literature from all over the world in different languages from 2000 to 2020, about 17 related articles in the English language were included in the study using the Walker and Avant model (2019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on the analysis, the most important features of spiritual distress included feelings of alienation (identity crisis), disturbance in the mental image of one's body, despair, dysfunction of roles, worry, fear and anxiety, refusal to interact with others, complaining to God, the feeling of being abandoned and questioning the existence of supreme power and values. The antecedents of this concept included stressors related to the disease, the patient's negative evaluation of his condition, insufficient mechanisms of personal adjustment and a lack of appropriate social support systems. The consequences of this concept included a false sense of hope about the outcome of cancer, dissatisfaction with the quality of life, severe disturbance in self\u2010confidence, increased physical complaints, loss of important relationships, sudden acute illnesses, self\u2010harm, severe social isolation and suicide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Based on the findings, spiritual distress is an important aspect of clinical practice and nursing care. Clarification and comprehensive understanding of spiritual distress may increase the ability of clinical nurses to effectively prevent and manage spiritual distress in women with breast cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/scs.70046","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T03:15:30Z","timestamp":1751339730000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Spiritual Distress in Women With Breast Cancer: A Concept Analysis"],"prefix":"10.1111","volume":"39","author":[{"given":"Naeem","family":"Abdi","sequence":"first","affiliation":[{"name":"School of Nursing and Midwifery Shiraz University of Medical Sciences  Shiraz Iran"},{"name":"Social Determinants of Health Research Center Yasuj University of Medical Sciences  Yasuj Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2995-0264","authenticated-orcid":false,"given":"Zinat","family":"Mohebbi","sequence":"additional","affiliation":[{"name":"Community Based Psychiatric Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Ghanbarzadeh","sequence":"additional","affiliation":[{"name":"Medical College Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Keshtkaran","sequence":"additional","affiliation":[{"name":"Department of Nursing, School of Nursing and Midwifery Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parisa","family":"Zaj","sequence":"additional","affiliation":[{"name":"Medical School Yasuj University of Medical Sciences  Yasuj Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"WHO \u201cBreast Cancer \u201d(2020) https:\/\/www.who.int\/cancer\/prevention\/diagnosis\u2010screening\/breast\u2010cancer\/en."},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","unstructured":"Z.ZaidiandH.Adlane Dib \u201cThe Worldwide Female Breast Cancer Incidence and Survival \u201dAACR Annual Meeting 2019 (2019) https:\/\/doi.org\/10.1158\/1538\u20107445.AM2019\u20104191.","DOI":"10.1158\/1538-7445.AM2019-4191"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1929"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/0284186X.2012.681699"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2354.2008.00952.x"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1590\/0104-1169.3073.2382"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951508000606"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2004.05.002"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.57167\/Rev-SBPH.12.462"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/NCC.0b013e31823528fb"},{"issue":"2","key":"e_1_2_13_13_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.24875\/RIC.17002200","article-title":"Self\u2010Image and Sexuality Issues Among Young Women With Breast Cancer: Practical Recommendations","volume":"69","author":"Hungr C.","year":"2017","journal-title":"Revista de Investigaci\u00f3n Cl\u00ednica"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951504040490"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/NCC.0000000000000310"},{"key":"e_1_2_13_16_1","doi-asserted-by":"crossref","unstructured":"K. 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