title: Cancer as part of the journey: the role of spirituality in the decision to decline conventional prostate cancer treatment and to use complementary and alternative medicine.
abstract: BACKGROUND
  The role of spirituality in patients' use of complementary and alternative medicine (CAM) approaches to cancer management has hardly been explored.
  
  
  OBJECTIVE
  To explore the role of spirituality in cancer management by men with prostate cancer who have declined conventional treatment and are using CAM.
  
  
  METHODS
  This qualitative analysis is part of a longitudinal study to assess decision making by men with prostate cancer who decline conventional treatment and use CAM. In-depth interviews were conducted at study entry (n = 29). Themes were presented to participants in focus groups to further explore and validate the interview results. For a subset of participants (n = 10), spirituality emerged as an important theme; therefore, we conducted a secondary analysis of the interview data of these men to explore the role of spirituality in cancer management and decision making.
  
  
  RESULTS
  Spirituality appeared to influence all aspects of the cancer experience. Most participants intensified their use of spiritual practice after a diagnosis of prostate cancer. These practices included spiritual ceremonies, indigenous healing, prayer, meditation, and use of spiritual imagery. Themes related to the role of spirituality in cancer management include beliefs about Western medicine, the role of spiritual beliefs in treatment decision making, the use of spiritual imager y and metaphor in healing, and the impact of cancer on spirituality. The discussion of these themes draws on quotes and case examples, illustrating how spirituality influenced study participants' response to diagnosis, treatment decision making, and cancer care. Two case examples provide a more in-depth understanding of how some participants incorporated spiritual imagery and metaphor into treatment decision making and cancer care. Ways in which cancer influenced spirituality are also discussed. Having prostate cancer appeared to influence their spirituality by strengthening their links with a spiritual community, increasing feelings of gratitude toward life, and improving personal relationships.
  
  
  CONCLUSIONS
  These findings indicate that spiritual beliefs and practices may play an important role in the formation of treatment choices for some patients. Health care providers need to be aware of and address patient concerns about how conventional treatment may conflict with their spiritual beliefs and practices. Further research and medical education is needed on spirituality and prostate cancer.
authors: Margaret
authors: M
authors: White
authors: Marja
authors: M
authors: Verhoef