{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T00:48:42Z","timestamp":1794358122870,"version":"4.9.0"},"reference-count":42,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,17]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Spiritual well-being (SpWB) is a critical yet often underexplored component of holistic care for patients with advanced cancer. This study aimed to assess the SpWB and quality of life (QOL) levels and examine their correlation among patients receiving palliative care at a tertiary cancer centre in Kerala, India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Institution-based cross-sectional observational study among patients with advanced cancer conducted between August 2023 and December 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The outpatient department of a major tertiary-level, autonomous cancer centre under the Government of Kerala, India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>398 patients with advanced cancer aged 18 and above.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>SpWB and QOL were measured using validated Malayalam versions of the Functional Assessment of Chronic Illness Therapy\u2013Spiritual well-being Expanded Version and European Organisation for Research and Treatment of Cancer, Quality of Life Core 30 questionnaires, respectively. Data collection included patient self-reports or assistance by a medical social worker.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median (IQR) age of participants was 59 (51\u201365) years; most were married (94.5%) and from an upper-lower socioeconomic background (55%). Hinduism was the predominant religion (67.1%). Almost all patients (99%) were aware of their diagnosis, but only 62.3% knew their prognosis. The median (IQR) SpWB score was 67.5 (57\u201376), significantly higher in females (p=0.02). The median (IQR) QOL score was 50 (41.7\u201366.7). SpWB was positively correlated with QOL (r=0.766, p&lt;0.01) and negatively correlated with symptoms like constipation, fatigue, nausea, pain, insomnia and appetite loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SpWB showed a strong positive correlation with QOL among patients with advanced cancer. Enhancing SpWB may play a pivotal role in improving overall QOL in palliative care settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107071","type":"journal-article","created":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T05:00:28Z","timestamp":1764478828000},"page":"e107071","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Correlation between spiritual well-being and quality of life among patients with advanced cancer receiving palliative care in a tertiary cancer centre in Northern Kerala, India: a cross-sectional study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4643-3720","authenticated-orcid":false,"given":"Biji","family":"M S","sequence":"first","affiliation":[{"name":"Pain and Palliative Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, India"},{"name":"Cancer Palliative Medicine, Malabar Cancer Center, Kannur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoba","family":"Nair","sequence":"additional","affiliation":[{"name":"Pain and Palliative Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0732-429X","authenticated-orcid":false,"given":"Praveen Kumar","family":"Shenoy","sequence":"additional","affiliation":[{"name":"Clinical Hematology and Medical Oncology, Malabar Cancer Center, Kodiyeri, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0957-9528","authenticated-orcid":false,"given":"Odette","family":"Spruyt","sequence":"additional","affiliation":[{"name":"Launceston General Hospital, Launceston, Tasmania, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9632-3039","authenticated-orcid":false,"given":"Chitra","family":"Venkateswaran","sequence":"additional","affiliation":[{"name":"Psychiatry and Palliative Care, Believers Church Medical College Hospital, Thiruvalla, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajasree","family":"K C","sequence":"additional","affiliation":[{"name":"Pain and Palliative Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratheesan","family":"K","sequence":"additional","affiliation":[{"name":"Cancer Registry & Epidemology, Malabar Cancer Center, Kodiyeri, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satheesan","family":"B","sequence":"additional","affiliation":[{"name":"Surgical Oncology, Malabar Cancer Center, Kodiyeri, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayakumar","family":"D K","sequence":"additional","affiliation":[{"name":"Breast and Gynaec-Oncology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"2025112921001559000_15.11.e107071.1","doi-asserted-by":"crossref","DOI":"10.1136\/gpsych-2022-100871","article-title":"Cancer-related psychosocial challenges","volume":"35","author":"Wang","year":"2022","journal-title":"Gen Psych"},{"key":"2025112921001559000_15.11.e107071.2","unstructured":"The World Health Organization . Measuring quality of life. 2025. Available: https:\/\/www.who.int\/tools\/whoqol"},{"key":"2025112921001559000_15.11.e107071.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(02)00440-2"},{"key":"2025112921001559000_15.11.e107071.4","doi-asserted-by":"publisher","DOI":"10.1111\/1467-6494.00077"},{"key":"2025112921001559000_15.11.e107071.5","doi-asserted-by":"crossref","first-page":"E471","DOI":"10.1097\/NCC.0000000000000925","article-title":"Existential Distress in Cancer Patients","volume":"45","author":"Chen","year":"2022","journal-title":"Cancer Nurs"},{"key":"2025112921001559000_15.11.e107071.6","first-page":"25","article-title":"Spiritual Care in Palliative Care: A Systematic Review of the Recent European Literature","volume":"7","author":"Gijsberts","year":"2019","journal-title":"Med Sci"},{"key":"2025112921001559000_15.11.e107071.7","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1176\/appi.ajp.2007.06122088","article-title":"Religion, Spirituality, and Medicine: Psychiatrists\u2019 and Other Physicians\u2019 Differing Observations, Interpretations, and Clinical Approaches","volume":"164","author":"Curlin","year":"2007","journal-title":"AJP"},{"key":"2025112921001559000_15.11.e107071.8","doi-asserted-by":"crossref","first-page":"944","DOI":"10.3109\/0142159X.2011.588976","article-title":"An assessment of US physicians\u2019 training in religion, spirituality, and medicine","volume":"33","author":"Rasinski","year":"2021","journal-title":"Med Teach"},{"key":"2025112921001559000_15.11.e107071.9","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21187"},{"key":"2025112921001559000_15.11.e107071.10","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/annonc\/mds088","article-title":"Spirituality in the cancer trajectory","volume":"23 Suppl 3","author":"Puchalski","year":"2012","journal-title":"Ann Oncol"},{"key":"2025112921001559000_15.11.e107071.11","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1626"},{"key":"2025112921001559000_15.11.e107071.12","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1097\/PPO.0b013e3182a5baa5","article-title":"Spirituality in Cancer Care at the End of Life","volume":"19","author":"Ferrell","year":"2013","journal-title":"The Cancer Journal"},{"key":"2025112921001559000_15.11.e107071.13","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26221"},{"key":"2025112921001559000_15.11.e107071.14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.24.8005"},{"key":"2025112921001559000_15.11.e107071.15","doi-asserted-by":"publisher","DOI":"10.4103\/0019-509X.75828"},{"key":"2025112921001559000_15.11.e107071.16","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/0277-9536(91)90460-T","article-title":"What\u2019s important for quality of life to Indians\u2014In relation to cancer","volume":"33","author":"Chaturvedi","year":"1991","journal-title":"Social Science & Medicine"},{"key":"2025112921001559000_15.11.e107071.17","doi-asserted-by":"crossref","unstructured":"Nazam F , Husain A . Hope, meaning in life and religious\/spiritual struggle predicts the quality of life in cancer patients with early and advanced malignancy: a structural equation modeling approach. Health Psychol Behav Med 2024;12. doi:10.1080\/21642850.2024.2351936","DOI":"10.1080\/21642850.2024.2351936"},{"key":"2025112921001559000_15.11.e107071.18","doi-asserted-by":"crossref","first-page":"358","DOI":"10.25259\/IJPC_79_2024","article-title":"Linguistic Validation of the Functional Assessment of Chronic Illness Therapy-Spiritual-Well-being-Expanded Version 4 Tool into Malayalam Language and its Feasibility in Advanced Cancer Patients Receiving Palliative Care","volume":"30","author":"Biji","year":"2024","journal-title":"IJPC"},{"key":"2025112921001559000_15.11.e107071.19","unstructured":"FACIT-sp-ex. 2025. Available: https:\/\/www.facit.org\/measures\/facit-sp-ex"},{"key":"2025112921001559000_15.11.e107071.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2007.05.029"},{"key":"2025112921001559000_15.11.e107071.21","unstructured":"Quality of life of cancer patients | eortc \u2013 quality of life. 2025. Available: https:\/\/qol.eortc.org\/questionnaire\/eortc-qlq-c30\/"},{"key":"2025112921001559000_15.11.e107071.22","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/85.5.365"},{"key":"2025112921001559000_15.11.e107071.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(01)00448-8"},{"key":"2025112921001559000_15.11.e107071.24","doi-asserted-by":"crossref","first-page":"99","DOI":"10.4103\/0973-1075.116716","article-title":"Spiritual concerns in Hindu cancer patients undergoing palliative care: A qualitative study","volume":"19","author":"Simha","year":"2013","journal-title":"Indian J Palliat Care"},{"key":"2025112921001559000_15.11.e107071.25","doi-asserted-by":"crossref","unstructured":"Smilee L , Kirubakaran H , Jacob D . The Influence of Spiritual Well-being on the Quality of Life of Cancer patients in Palliative care, Chennai. SEEJPH 2024;870\u20135. doi:10.70135\/seejph.vi.2154","DOI":"10.70135\/seejph.vi.2154"},{"key":"2025112921001559000_15.11.e107071.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2010.09.017"},{"key":"2025112921001559000_15.11.e107071.27","unstructured":"The gender gap in religion around the world: women are generally more\u2026 - Pew Research Center, Conrad Hackett, Caryle Murphy, David Mcclendon, Anne Shi - Google Books. 2025. Available: https:\/\/books.google.co.in\/books\/about\/The_Gender_Gap_in_Religion_Around_the_Wo.html?id=n00UDAEACAAJ&redir_esc=y"},{"key":"2025112921001559000_15.11.e107071.28","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2979\/FSR.2005.21.1.35","article-title":"A Million Shaktis Rising: Pongala, a Women\u2019s Festival in Kerala, India","volume":"21","author":"Jenett","year":"2005","journal-title":"Journal of Feminist Studies in Religion"},{"key":"2025112921001559000_15.11.e107071.29","doi-asserted-by":"crossref","DOI":"10.1186\/s12912-023-01306-9","article-title":"Current status and influencing factors of spiritual needs of patients with advanced cancer: a cross-sectional study","volume":"22","author":"Shi","year":"2023","journal-title":"BMC Nurs"},{"key":"2025112921001559000_15.11.e107071.30","doi-asserted-by":"crossref","unstructured":"Kislev E . Happy singlehood: the rising acceptance and celebration of solo living. 2019.","DOI":"10.1525\/9780520971004"},{"key":"2025112921001559000_15.11.e107071.31","doi-asserted-by":"publisher","DOI":"10.1136\/ewjm.173.5.352"},{"key":"2025112921001559000_15.11.e107071.32","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1322"},{"key":"2025112921001559000_15.11.e107071.33","doi-asserted-by":"crossref","first-page":"S406","DOI":"10.1016\/j.annonc.2020.08.499","article-title":"390P Spiritual well-being in brain tumour patients: An insight","volume":"31","author":"Singh","year":"2020","journal-title":"Ann Oncol"},{"key":"2025112921001559000_15.11.e107071.34","doi-asserted-by":"crossref","unstructured":"Jetan M , Daifallah A , Rabayaa MK , et al . The Impact of Spiritual Well-Being on the Quality of Life of Cancer Patients: A Cross-Sectional Study. Integr Cancer Ther 2023;22. doi:10.1177\/15347354231210841","DOI":"10.1177\/15347354231210841"},{"key":"2025112921001559000_15.11.e107071.35","unstructured":"Pashupatinath temple. 2025. Available: https:\/\/pashupatinathtemple.org\/"},{"key":"2025112921001559000_15.11.e107071.36","doi-asserted-by":"crossref","DOI":"10.3389\/fsoc.2023.1145131","article-title":"Transformation of the concepts and practice of total pain and total care: 30 years of Danish hospices","volume":"8","author":"Timm","year":"2023","journal-title":"Front Sociol"},{"key":"2025112921001559000_15.11.e107071.37","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1093\/geront\/42.suppl_3.24","article-title":"A biopsychosocial-spiritual model for the care of patients at the end of life","volume":"42 Spec No 3","author":"Sulmasy","year":"2002","journal-title":"Gerontologist"},{"key":"2025112921001559000_15.11.e107071.38","doi-asserted-by":"crossref","unstructured":"Koenig HG . Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry 2012;1:33. doi:10.5402\/2012\/278730","DOI":"10.5402\/2012\/278730"},{"key":"2025112921001559000_15.11.e107071.39","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1080\/07347332.2021.1990184","article-title":"Relationship between spirituality and depression among patients with malignant cancer at a selected tertiary care Institute - A study from North India","volume":"40","author":"Haokip","year":"2022","journal-title":"J Psychosoc Oncol"},{"key":"2025112921001559000_15.11.e107071.40","first-page":"1812","article-title":"Spirituality and its association with psychological distress in cancer patients attending a tertiary care hospital in Bangalore, India","volume":"3","author":"VD","year":"2025","journal-title":"Int J Community Med Public Heal"},{"key":"2025112921001559000_15.11.e107071.41","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)13310-7"},{"key":"2025112921001559000_15.11.e107071.42","doi-asserted-by":"publisher","DOI":"10.1207\/S15324796ABM2401_06"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107071","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T05:00:33Z","timestamp":1764478833000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":42,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,29]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2025-107071"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107071","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107071.supp4","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107071.supp1","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107071.supp2","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107071.supp3","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}