Oh, P.J., & Kim, S.H. (2014). The effects of spiritual interventions in patients with cancer: A meta-analysis. Oncology Nursing Forum, 41, E290–E301. 

STUDY PURPOSE: To evaluate the effects of spiritual interventions in patients with cancer

TYPE OF STUDY: Meta-analysis and systematic review

• FINAL NUMBER STUDIES INCLUDED = 15
• TOTAL PATIENTS INCLUDED IN REVIEW = 827
• SAMPLE RANGE ACROSS STUDIES: 24–120 patients

PHASE OF CARE: Multiple phases of care 

APPLICATIONS: Palliative care

Primary outcomes were spiritual well-being and meaning of life. Anxiety and depression were secondary outcomes. Nine studies examined effects on depression, and six examined effects on anxiety. Seven studies were randomized, controlled trials. There was a moderate effect on spiritual well-being. A large effect size was seen for anxiety (d = - 0.87, p = 0.02), and a moderate effect size for depression was found (d = - 0.62, p = 0.001). The largest effect sizes were seen in studies that were not randomized, controlled trials. Interventions were categorized as religious or existential. Religious interventions had an impact on depression, and existential interventions had an effect on anxiety. There was substantial heterogeneity. This article reports numerous subgroup analysis results based on type of intervention, the intervention provider, and other variables. In the majority of cases, interventions were provided by nurses.

The findings of this meta-analysis suggest that religious and existential spiritual interventions have a positive and at least moderate effect on anxiety and depression as well as spiritual well-being and meaning of life.

The review included nonpeer-reviewed doctoral dissertation results, and an analysis showed a probable publication bias, suggesting that studies with negative findings may not have been retrievable. There was substantial heterogeneity and a varied risk of bias across studies. The highest effect sizes were seen in nonrandomized, controlled studies, which also had the highest risk of bias and heterogeneity. Most studies were of patients at the end of life, so findings may not be applicable to patients at other stages of care.

The findings of this meta-analysis suggest that spiritual interventions, particularly at the end of life, can be beneficial in reducing anxiety and depression and increasing a sense of spiritual well-being and meaning of life. Nurses traditionally recognize the importance of the spiritual dimensions of care, and these findings support that view. The findings must be viewed with caution given the limitations of these results. However, spiritual interventions are low-risk and, as shown here, can be delivered by nurses who already have relevant proficiencies such as engagement, caring, support, and communication.