title: Twenty-five years later--what do we know about religion/spirituality and psychological well-being among breast cancer survivors? A systematic review.
abstract: BACKGROUND
  A diagnosis of cancer is a life-changing event for most people. The trauma and uncertainties of a breast cancer diagnosis can affect survivors' psychological well-being. Religion and/or spirituality can provide a means of support for many women as they live with the realities of a diagnosis of cancer. The purpose of this focused review is to critically analyze and synthesize relationships among psychological well-being, religion, and spirituality among women with breast cancer.
  
  
  METHODS
  MEDLINE, CINAHL, Web of Science, Cambridge Scientific Abstracts, Cochrane CENTRAL, and PsycINFO databases were searched: January 1985-March 2010. The search terms religi*(religious/religion), spiritu*(spiritual/spirituality), breast cancer, psychological adjustment, psychological outcomes, psychological distress, psychological well-being, and outcomes were searched for separately and in combination.
  
  
  RESULTS
  Eighteen quantitative studies were analyzed in order to examine associations among religion, spirituality, and psychological well-being for women diagnosed with breast cancer. These three variables were operationally defined as follows: (a) religious practice, religious coping, and perception of God; (b) spiritual distress, spiritual reframing, spiritual well-being, and spiritual integration; and (c) combined measure of both the religion and spirituality constructs.
  
  
  CONCLUSIONS
  Results of this review suggest that within this population, limited relationships exist among religion, spirituality, and psychological well-being. Given the various definitions used for the three variables, the strength and clarity of relationships are not clear. In addition, the time of assessment along the course of the disease varies greatly and in some instances is not reported. Diagnosis and/or prognosis, factors that could influence psychological well-being, are frequently not factored into results. There does, however, appear to be sufficient evidence to include a brief, clinically focused assessment of women diagnosed with breast cancer regarding the importance of a given belief system as they face the diagnosis and treatment of their disease.
  
  
  CONCLUSIONS
  The implications for cancer survivors are as follows: (a) Psychological well-being of women diagnosed with breast cancer may depend to some extent on their belief system. (b) Coping through "turning to God" for women without a significant prior relationship with God, or minimal spiritual behaviors, may experience diminished well-being. (c) Longitudinal studies suggest that struggling with, or questioning, one's belief system in early survivorship may also be associated with lower levels of well-being. This diminished well-being often resolves over time.
authors.affiliation: School of Nursing, University of Louisville, Louisville, KY, USA. jaschr07@louisville.edu
authors.forename: Judith A
authors.initials: JA
authors.lastname: Schreiber
authors.forename: Dorothy Y
authors.initials: DY
authors.lastname: Brockopp
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D001943:Breast Neoplasms / Q000523:psychology*; D003469:Culture; D005260:Female; D006801:Humans; D011788:Quality of Life; D012067:Religion; D012737:Sex Factors; D029181:Spirituality; D013315:Stress, Psychological / Q000453:epidemiology; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome