{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T07:22:28Z","timestamp":1769844148335,"version":"3.49.0"},"reference-count":77,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2018,9,20]],"date-time":"2018-09-20T00:00:00Z","timestamp":1537401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Religions"],"abstract":"<jats:p>Cancer affects individuals in all human dimensions. Cancer patients are more susceptible to spiritual distress. Several studies have addressed spiritual distress using quantitative designs; however, a qualitative approach to the experience of spiritual distress could provide a deeper understanding of the phenomenon. This study aims to synthesis the experience of spiritual distress as lived by cancer patients in qualitative primary studies. This is a literature review based on electronic databases search. A total of 4075 citations was identified and 23 studies were included. The most frequent qualitative research method was phenomenology (n = 15), and interviews were the main data collection method (n = 20). Two major themes have been identified related to the experience of spiritual distress: suffering and coping. Spiritual distress is an intimate, deep and suffering experience in life, which requires coping strategies and involves spiritual values and beliefs. Healthcare providers should be aware of this experience and recognize spiritual distress in cancer patients, as it is critical in providing holistic nursing care.<\/jats:p>","DOI":"10.3390\/rel9100285","type":"journal-article","created":{"date-parts":[[2018,9,21]],"date-time":"2018-09-21T03:46:35Z","timestamp":1537501595000},"page":"285","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Spiritual Distress in Cancer Patients: A Synthesis of Qualitative Studies"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5804-7934","authenticated-orcid":false,"given":"Helga","family":"Martins","sequence":"first","affiliation":[{"name":"Institute of Health Sciences, Universidade Cat\u00f3lica Portuguesa, 1649-023 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9804-2297","authenticated-orcid":false,"given":"S\u00edlvia","family":"Caldeira","sequence":"additional","affiliation":[{"name":"Researcher at the Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Cat\u00f3lica Portuguesa, Palma de Cima, 1649-023 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2018,9,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1188\/03.ONF.593-598","article-title":"Spirituality and Life-Threatening Illness: A Phenomenologic Study","volume":"30","author":"Albaugh","year":"2003","journal-title":"Oncology Nursing Forum"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.5430\/elr.v3n1p39","article-title":"Interviewing as a Data Collection Method: A Critical Review","volume":"3","author":"Alshenqeeti","year":"2014","journal-title":"English Linguistics Research"},{"key":"ref_3","unstructured":"American Cancer Society (2018). Cancer Facts & Figures 2018, American Cancer Society."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1007\/s00520-012-1690-6","article-title":"\u201cTo Cherish Each Day as it Comes\u201d: A Qualitative Study of Spirituality Among Persons Receiving Palliative Care","volume":"21","author":"Asgeirsdottir","year":"2013","journal-title":"Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.jpainsymman.2013.09.020","article-title":"Nurse and Physician Barriers to Spiritual Care Provision at the End of Life","volume":"48","author":"Balboni","year":"2014","journal-title":"Journal of Pain and Symptom Management"},{"key":"ref_6","first-page":"41","article-title":"Beyond Quality of Life: The Meaning of Death and Suffering in Palliative Care","volume":"11","author":"Balducci","year":"2010","journal-title":"Asian Pacific Journal of Cancer Prevention: APJCP"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.soncn.2008.08.002","article-title":"Suffering as a Multicultural Cancer Experience","volume":"24","author":"Barreto","year":"2008","journal-title":"Seminars in Oncology Nursing"},{"key":"ref_8","first-page":"268","article-title":"Addressing Existential Suffering","volume":"58","author":"Bates","year":"2016","journal-title":"British Columbia Medical Journal"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/2045-4015-3-21","article-title":"Coping Strategies for Existencial and Spiritual Suffering in Israeli Patients with Advanced Cancer","volume":"3","author":"Bentur","year":"2014","journal-title":"Israel Journal of Health Policy Research"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1017\/S1478951514001217","article-title":"Assessment of Spiritual Suffering in the Cancer Context: A Systematic Literature Review","volume":"13","author":"Best","year":"2015","journal-title":"Palliative and Supportive Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1191\/0269216305pm1038oa","article-title":"Existential Issues Do Not Necessarily Result in Existential Suffering: Lessons from Cancer Patients in Israel","volume":"19","author":"Blinderman","year":"2005","journal-title":"Palliative Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/j.2047-3095.2013.01234.x","article-title":"Spiritual Distress-Proposing a New Definition and Defining Characteristics","volume":"24","author":"Caldeira","year":"2013","journal-title":"International Journal of Nursing Knowledge"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1590\/0104-1169.3073.2382","article-title":"Between Spiritual Wellbeing and Spiritual Distress: Possible Related factors in Elderly Patients with Cancer","volume":"22","author":"Caldeira","year":"2014","journal-title":"Revista Latino-Americana de Enfermagem (RLAE)"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1097\/NCC.0000000000000310","article-title":"Nursing Diagnosis of \u201cSpiritual Distress\u201d in Women with Breast Cancer Prevalence and Major Defining Characteristics","volume":"39","author":"Caldeira","year":"2016","journal-title":"Cancer Nursing"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/2047-3095.12105","article-title":"Clinical Validation of the Nursing Diagnosis Spiritual Distress in Cancer Patients Undergoing Chemotherapy","volume":"28","author":"Caldeira","year":"2017","journal-title":"International Journal of Nursing Knowledge"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1038\/sj.bjc.6601887","article-title":"High Levels of Untreated Distress and Fatigue in Cancer Patients","volume":"90","author":"Carlson","year":"2004","journal-title":"British Journal of Cancer"},{"key":"ref_17","unstructured":"CASP (2018, January 16). Critical Appraisal Skills Programme. Available online: http:\/\/www.casp-uk.net\/#!checklists\/cb36."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/01.JNR.0000347604.89509.bf","article-title":"The Essence of Spirituality of Terminally Ill Patients","volume":"10","author":"Chao","year":"2002","journal-title":"Journal of Nursing Research (Taiwan Nurses Association)"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1590\/S0103-21002010000200018","article-title":"Valida\u00e7\u00e3o do Diagn\u00f3stico de Enfermagem Ang\u00fastia Espiritual: An\u00e1lise por Especialistas","volume":"23","author":"Chaves","year":"2010","journal-title":"Acta Paulista de Enfermagem"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1111\/j.1365-2702.2006.01854.x","article-title":"The Lived Experiences of Spiritual Suffering and the Healing Process among Taiwanese Patients with Terminal Cancer","volume":"17","author":"Chio","year":"2008","journal-title":"Journal of Clinical Nursing"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/08854726.2011.559832","article-title":"Case Study of a Chaplain\u2019s Spiritual Care for a Patient with Advanced Metastatic Breast Cancer","volume":"17","author":"Cooper","year":"2011","journal-title":"Journal of Health Care Chaplaincy"},{"key":"ref_22","first-page":"1","article-title":"Resolution of Spiritual Disequilibrium by Women Newly Diagnosed with Breast Cancer","volume":"31","author":"Coward","year":"2004","journal-title":"Oncology Nursing Forum"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s10865-009-9211-x","article-title":"A Longitudinal Investigation of Coping Strategies and Quality of Life Among Younger Women with Breast Cancer","volume":"32","author":"Danhauer","year":"2009","journal-title":"Journal of Behavioral Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1177\/1049909113485804","article-title":"Insomnia in Patients with Advanced Cancer","volume":"31","author":"Davis","year":"2013","journal-title":"American Journal of Hospice & Palliative Medicine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1177\/1049909112458030","article-title":"Spirituality, Religiosity, and Spiritual Pain among Caregivers of Patients with Advanced Cancer","volume":"30","author":"Parsons","year":"2013","journal-title":"American Journal of Hospice and Palliative Medicine"},{"key":"ref_26","first-page":"E52","article-title":"Sampling Methods in Clinical Research: An Educational Review","volume":"5","author":"Elfil","year":"2017","journal-title":"Emergency"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1089\/jpm.2012.0246","article-title":"The Spiritual Struggle of Anger toward God: A Study with Family Members of Hospice Patients","volume":"16","author":"Exline","year":"2013","journal-title":"Journal of Palliative Medicine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/JNR.0000000000000088","article-title":"The Meaning of Disease and Spiritual Responses to Stressors in Adults with Acute Leukemia Undergoing Hematopoietic Stem Cell Transplantation","volume":"23","author":"Farsi","year":"2015","journal-title":"Journal of Nursing Research"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2132","DOI":"10.1016\/j.socscimed.2005.04.026","article-title":"The Role of Constructed Meaning in Adaptation to the Onset of Life-Threatening Illness","volume":"61","author":"Fife","year":"2005","journal-title":"Social Science & Medicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1007\/s10943-016-0252-5","article-title":"Prevalence and Nature of Spiritual Distress Among Palliative Care Patients in India","volume":"56","author":"Gielen","year":"2017","journal-title":"Journal of Religion and Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1590\/S0034-71672011000100008","article-title":"Rela\u00e7\u00e3o Entre Espiritualidade e C\u00e2ncer: Perspectiva do Paciente","volume":"64","author":"Guerrero","year":"2011","journal-title":"Revista Brasileira de Enfermagem"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"290","DOI":"10.5205\/reuol.11108-10319-1-LE.0502201118","article-title":"Spiritual Distress in Cancer Patients: Nursing Interventions","volume":"5","author":"Guilherme","year":"2011","journal-title":"Journal of Nursing UFPE\/Revista de Enfermagem UFPE"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1176\/appi.psy.43.4.259","article-title":"Stress Response Syndromes and Cancer: Conceptual and Assessment Issues","volume":"43","author":"Gurevich","year":"2002","journal-title":"Psychosomatics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.ejon.2014.03.015","article-title":"You Never Know When Your Last Day Will Come and Your Trip Will Be Over\u2014Existential Expressions from a Melanoma Diagnosis","volume":"18","author":"Hajdarevic","year":"2014","journal-title":"European Journal of Oncology Nursing"},{"key":"ref_35","first-page":"1534","article-title":"Struggling with Paradoxes: The Process of Spiritual Development in Women with Cancer","volume":"28","author":"Halstead","year":"2001","journal-title":"Oncology Nursing Forum"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Herdman, Heather T., and Kamitsuru, Shigemi (2018). NANDA: NANDA International Nursing Diagnoses: Definitions and Classification 2018\u20132010, Wiley-Blackwell. [11th ed.]. First published 1994.","DOI":"10.1055\/b-006-161179"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1177\/1049909110385917","article-title":"The Frequency and Correlates of Spiritual Distress Among Patients with Advanced Cancer Admitted to an Acute Palliative Care Unit","volume":"28","author":"Hui","year":"2011","journal-title":"The American journal of Hospice & Palliative Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s00520-003-0460-x","article-title":"Distress of Inpatients with Terminal Cancer in Japanese Palliative Care Units: From the Viewpoint of Spirituality","volume":"11","author":"Kawa","year":"2003","journal-title":"Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer"},{"key":"ref_39","first-page":"4095","article-title":"Spiritual\/Religious Coping Strategies and Their Relationship with Illness Adjustment among Iranian Breast Cancer Patients","volume":"17","author":"Khodaveirdyzadeh","year":"2016","journal-title":"Asian Pacific Journal of Cancer Prevention"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"134","DOI":"10.12968\/ijpn.2010.16.3.47325","article-title":"Establishing the Validity of a Spiritual Distress Scale for Cancer Patients Hospitalized in Southern Taiwan","volume":"16","author":"Ku","year":"2010","journal-title":"International Journal of Palliative Nursing"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1046\/j.1471-6712.2002.00093.x","article-title":"Significant Others\u2019 Experience of Suffering When Living with Women with Breast Cancer","volume":"16","author":"Lindholm","year":"2002","journal-title":"Scandinavian Journal of Caring Sciences"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"131","DOI":"10.12968\/ijpn.2004.10.3.12466","article-title":"Spiritual Distress in a Terminally Ill Patient with Breast Cancer","volume":"10","author":"Loh","year":"2004","journal-title":"International Journal of Palliative Nursing"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Martins, Helga, Romeiro, Joana, and Caldeira, S\u00edlvia (2017). Spirituality in Nursing: An Overview of Research Methods. Religions, 8.","DOI":"10.3390\/rel8100226"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00520-002-0360-5","article-title":"Creating a Language for \u201cSpiritual Pain\u201d Through Research: A Beginning","volume":"10","author":"McGrath","year":"2002","journal-title":"Support Care Cancer"},{"key":"ref_45","first-page":"1","article-title":"Validation of the Spiritual Distress Assessment Tool in Older Hospitalized Patients","volume":"12","author":"Monod","year":"2012","journal-title":"BioMed Central Geriatrics"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ijnurstu.2012.08.016","article-title":"Psychological Responses of Terminally Ill Patients Who Are Experiencing Suffering: A Qualitative Study","volume":"50","year":"2013","journal-title":"International Journal of Nursing Studies"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1590\/S0103-21002010000300021","article-title":"Spiritual Care: An Essential Component of the Nurse Practice in Pediatric Oncology","volume":"23","author":"Nascimento","year":"2010","journal-title":"Acta Paulista de Enfermagem"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/NCC.0000000000000169","article-title":"Moving Beyond Suffering: The Experiences of Thai Persons with Advanced Cancer","volume":"38","author":"Nilmanat","year":"2015","journal-title":"Cancer Nursing"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"5","DOI":"10.12968\/bjcn.2014.19.5.255","article-title":"Supporting Patients in Coping with Cancer","volume":"19","author":"Nyatanga","year":"2014","journal-title":"British Journal of Community Nursing"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1108\/09526861311319573","article-title":"The Distress Thermometer: A Rapid and Effective Tool for the Oncology Social Worker","volume":"26","author":"Gill","year":"2013","journal-title":"International Journal of Health Care Quality Assurance"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.jpainsymman.2018.03.009","article-title":"Spiritual Distress within Inpatient Settings\u2014A Scoping Review of Patient and Family Experiences","volume":"56","author":"Sinuff","year":"2018","journal-title":"Journal of Pain and Symptom Management"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"510","DOI":"10.12968\/ijpn.2005.11.10.19978","article-title":"The Experience of Suffering as Lived by Women with Breast Cancer","volume":"11","author":"Perreault","year":"2005","journal-title":"International Journal of Palliative Nursing"},{"key":"ref_53","unstructured":"Polit, Denise F., and Beck, Cheryl Tatano (2014). Essentials of Nursing Research: Appraising Evidence for Nursing Practice, Wolters Kluwer Health\/Lippincott Williams & Wilkins. [8th ed.]. First published 2001."},{"key":"ref_54","first-page":"19","article-title":"Iranian Cancer Patients\u2019 Perception of Spirituality: A Qualitative Content Analysis Study","volume":"11","author":"Rahnama","year":"2012","journal-title":"Bio Med Central Nursing"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"370","DOI":"10.12968\/bjon.2014.23.7.370","article-title":"What are the Barriers to Spiritual Care in a Hospital Setting?","volume":"23","author":"Rushton","year":"2014","journal-title":"British Journal of Nursing"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1177\/1049909113512201","article-title":"Spiritual Experiences of Transcendence in Patients with Advanced Cancer","volume":"32","author":"Renz","year":"2015","journal-title":"American Journal of Hospice & Palliative Medicine"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1017\/S1478951507070071","article-title":"Crying: A Force to Balance Emotions Among Cancer Patients in Palliative Home Care","volume":"5","author":"Friedrichsen","year":"2007","journal-title":"Palliative and Supportive Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1590\/S1413-35552007000100013","article-title":"Estudos de Revis\u00e3o Sistem\u00e1tica: Um Guia Para S\u00edntese Criteriosa da Evid\u00eancia Cient\u00edfica","volume":"11","author":"Sampaio","year":"2007","journal-title":"Brazilian Journal of Physical Therapy"},{"key":"ref_59","first-page":"244","article-title":"Meeting the Information Needs of Cancer Patients","volume":"15","author":"Sawyer","year":"2000","journal-title":"Professor Nurse"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1188\/09.ONF.E31-E38","article-title":"Spiritual Needs of Taiwan\u2019s Older Patients with Terminal Cancer","volume":"36","author":"Shih","year":"2009","journal-title":"Oncology Nursing Forum"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1136\/eb-2014-101747","article-title":"Selecting the Sample","volume":"17","author":"Shorten","year":"2014","journal-title":"Evidence-Based Nursing"},{"key":"ref_62","first-page":"7","article-title":"Cancer statistics, 2018","volume":"68","author":"Siegel","year":"2018","journal-title":"CA: A Cancer Journal for Clinicians"},{"key":"ref_63","first-page":"2591","article-title":"Ang\u00fastia Espiritual: A Busca Por Novas Evid\u00eancias","volume":"7","author":"Chaves","year":"2015","journal-title":"Revista de Pesquisa: Cuidado \u00e9 Fundamental Online"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1188\/15.CJON.99-104","article-title":"Challenges in Assessing Spiritual Distress in Survivors of Cancer","volume":"19","author":"Skalla","year":"2015","journal-title":"Clinical Journal of Oncology Nursing"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"226","DOI":"10.4212\/cjhp.v68i3.1456","article-title":"Qualitative Research: Data Collection, Analysis, and Management","volume":"68","author":"Sutton","year":"2015","journal-title":"The Canadian Journal of Hospital Pharmacy"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2923","DOI":"10.1111\/jocn.12358","article-title":"Hospice Nurses\u2019 Perspectives of Spirituality","volume":"22","author":"Tiew","year":"2013","journal-title":"Journal of Clinical Nursing"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"47","DOI":"10.7748\/ns.2017.e10312","article-title":"Assessing the Spiritual Needs of Patients","volume":"31","author":"Timmins","year":"2017","journal-title":"Nursing Standard"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1158\/1055-9965.EPI-15-0578","article-title":"Global. Cancer Incidence and Mortality Rates and Trends\u2014An Update","volume":"25","author":"Torre","year":"2016","journal-title":"Cancer Epidemiology, Biomarkers & Prevention"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/00004650-200511000-00010","article-title":"Spiritual Distress in Adult Cancer Patients: Toward Conceptual Clarity","volume":"19","author":"Villagomeza","year":"2005","journal-title":"Holistic Nursing Practice"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1002\/pon.4287","article-title":"What Do people Fear About Cancer? A Systematic Review and Meta-Synthesis of Cancer Fears in the General Population","volume":"26","author":"Vrinten","year":"2017","journal-title":"Psycho-Oncology"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1097\/MPH.0b013e318230dd98","article-title":"Impact of Culture on the Expression of Pain and Suffering","volume":"33","author":"Wein","year":"2011","journal-title":"Journal of Pediatric Hematology\/Oncology"},{"key":"ref_72","unstructured":"WHO (2014). World Cancer Report, World Health Organization, International Agency for Research on Cancer."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1089\/109662104322737223","article-title":"Dying Young, Dying Poor: A Sociological Examination of Existential Suffering Among Low-Socioeconomic Status Patients","volume":"7","author":"Williams","year":"2004","journal-title":"Journal of Palliative Medicine"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1188\/12.ONF.E41-E48","article-title":"Self-Transcendence in Stem Cell Transplantation Recipients: A Phenomenologic Inquiry","volume":"39","author":"Williams","year":"2012","journal-title":"Oncology Nursing Forum"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1200\/JCO.2006.08.6801","article-title":"Suffering with Advanced Cancer","volume":"25","author":"Wilson","year":"2007","journal-title":"Journal of Clinical Oncology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1080\/10508619.2016.1183251","article-title":"Religious and Spiritual Struggles, Past and Present: Relations to the Big Five and Well-Being","volume":"27","author":"Wilt","year":"2016","journal-title":"The International International Journal for the Psychology of Religion"},{"key":"ref_77","first-page":"27","article-title":"Coping: A concept analysis in the cancer context","volume":"2","author":"Yang","year":"2018","journal-title":"TMR Integrative Nursing"}],"container-title":["Religions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-1444\/9\/10\/285\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:21:43Z","timestamp":1760196103000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-1444\/9\/10\/285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,20]]},"references-count":77,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,10]]}},"alternative-id":["rel9100285"],"URL":"https:\/\/doi.org\/10.3390\/rel9100285","relation":{},"ISSN":["2077-1444"],"issn-type":[{"value":"2077-1444","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,20]]}}}