Carvalho, C.C., Lopes Chaves, E.C., Iunes, D.H., Simão, T.P., Marciano Grasselli, C.S., & Braga, C.G. (2014). Effectiveness of prayer in reducing anxiety in cancer patients. Revista Da Escola De Enfermagem Da USP, 48, 684–690. 

To evaluate the effect of prayer on the anxiety of patients with cancer receiving chemotherapy

Participants were interviewed about sociodemographic and clinical characteristics. They were then given the Duke University Religion Index (DUREL) to measure three dimensions of religiosity. Then, they applied the State-Trait Anxiety Inventory (STAI-S and STAI-T). Preintervention data collection included a repeat STAI-S and a saliva and vital sign measurement taken by the same examiner. The prayer intervention was then conducted by the researcher. The intervention consisted of a specific Christian prayer delivered in an audio recording over 11 minutes. Thirty minutes after prayer, the STAI-S and salivary sample and vital signs were repeated. The control group received the same protocol with no prayer intervention.

• N = 20  
• AGE = > 18
• MALES: 75%, FEMALES: 25%
• KEY DISEASE CHARACTERISTICS: Cancer diagnosis
• OTHER KEY SAMPLE CHARACTERISTICS: Receiving continuous IV chemotherapy; willing to receive prayer; and clinically stable

• SITE: Single site    
• SETTING TYPE: Inpatient    
• LOCATION: Minas Gerais, Brazil

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care and palliative care 

Quasi-experimental, pre- and postintervention study with a control group

• State-Trait Anxiety Inventory (STAI): Two-part STAI-T and STAI-S
• Duke University Religion Index (DUREL)
• BioEstat 5.0 program used to chart and analyze results
• The Wilcoxon signed-rank test compared state anxiety levels, salivary cortisol, blood pressure, and heart and respiratory rate pre- and postintervention.

The sample revealed a high level of religiosity. Anxiety state was influenced by nonorganizational religious activity (p = 0.01), and a correlation with age group (p = 0.01) existed. The anxiety profile measure before the intervention displayed moderate levels of anxiety. A comparison of pre- and postintervention means demonstrated modified values for state anxiety, blood pressure, and respiration rate. The STAI-S showed reduced anxiety after prayer at each moment. Values related to anxiety levels and vital signs were reduced after each intervention and for all three repetitions of pre- and postintervention observation (anxiety levels [p < 0.00], respiratory rate [p = 0.04], blood pressure [p = 0.00]).

The authors concluded that prayer is effective in reducing the anxiety of patients receiving chemotherapy. Evaluating anxiety by measuring vital signs is recommended as a simple technique. The nursing application of a standardized prayer protocol in the clinical environment addresses patients' spiritual dimensions and could reduce anxiety.

• Small sample (< 30)
• Risk of bias (no control group)
• Risk of bias (no random assignment)
• Findings not generalizable
• Questionable protocol fidelity
• Other limitations/explanation: The researcher was the creator, administrator, and evaluator of the intervention.

The spiritual care of patients with cancer is an important dimension of care. Continued research on the effectiveness of prayer for patients who value prayer can be meaningful in reducing anxiety.