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Clinical guidance for responding to suffering in adults with cancer


1. National Breast Cancer Centre and National Cancer Control Initiative. Clinical practice guidelines for the psychosocial care of adults with cancer. National Breast Cancer Centre, Camperdown, NSW, 2003.

2. Cancer Australia. Conceptualisation, assessment and interventions to alleviate suffering in the cancer context: a systematic literature review. Cancer Australia Surry Hills, NSW, 2013.

3. Naden D and Saeteren B. Cancer patients' perception of being or not being confirmed. Nursing Ethics. 2006;13:222-35.

4. Daneault S, Lussier V, Mongeau S, et al. Primum non nocere: could the health care system contribute to suffering? In-depth study from the perspective of terminally ill cancer patients. Canadian Family Physician. 2006;52(12):1574-5.

5. Ehman JW, Ott BB, Short TH, et al. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Archives of Internal Medicine. 1999;159(15):1803.

6. Grant E, Murray Scott A, Kendall M, et al. Spiritual issues and needs: perspectives from patients with advanced cancer and nonmalignant disease. A qualitative study. Palliative & Supportive Care. 2004;2:371-8.

7. Ohlen J. Violation of dignity in care-related situations. Research & Theory for Nursing Practice. 2004;18:371-85.

8. McGrath P and Clarke H. Creating the space for spiritual talk: insights from survivors of haematological malignancies. Australian Health Review. 2003;26:116-32.

9. Murray SA, Kendall M, Grant E, et al. Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management. 2007;34(4):393-402.

10. Adelbratt S and Strang P. Death anxiety in brain tumour patients and their spouses. Palliative Medicine. 2000;14(6):499-507.

11. Lethborg C, Carrie L, Sanchia A and David K. Meaning in adjustment to cancer: A model of care. Palliative & Supportive Care. 2008;6(1):61.

12. Ohlen J, Bengtsson J, Skott C and Segesten K. Being in a lived retreat--embodied meaning of alleviated suffering. Cancer Nursing. 2002;25:318-25.

13. McCord G, Gilchrist VJ, Grossman SD, et al. Discussing spirituality with patients: a rational and ethical approach. The Annals of Family Medicine. 2004;2(4):356-361.

14. Herth K. Enhancing hope in people with a first recurrence of cancer. Journal of Advanced Nursing. 2000:1431-41.

15. Ando M, Morita T, Akechi T, et al. Efficacy of short-term life-review interviews on the spiritual well-being of terminally ill cancer patients. Journal of Pain & Symptom Management. 2010;39(6):993-1002.

16. Breitbart W, Poppito S, Rosenfeld B, et al. Pilot Randomized Controlled Trial of Individual Meaning-Centered Psychotherapy for Patients With Advanced Cancer. Journal of Clinical Oncology. 2012;30(12):1304-1309.

17. Breitbart W, Rosenfeld B, Gibson C, et al. Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psycho-Oncology. 2010;19(1):21-8.

18. Henry M, Cohen SR, Lee V, et al. The Meaning-Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: a randomized controlled pilot study. Psycho-Oncology. 2010;19:1340-7.

19. Rustoen T, Wiklund I, Hanestad BR and Moum T. Nursing intervention to increase hope and quality of life in newly diagnosed cancer patients. Cancer Nursing. 1998;21:235-45.

20. Duggleby Wendy D, Degner L, Williams A, et al. Living with hope: initial evaluation of a psychosocial hope intervention for older palliative home care patients. Journal of Pain & Symptom Management. 2007;33:247-57.

21. Badger TA, Segrin C, Figueredo AJ, et al. Psychosocial interventions to improve quality of life in prostate cancer survivors and their intimate or family partners. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation. 2011;20:833-844.

22. Ferguson Robert J, McDonald Brenna C, Rocque Michael A, et al. Development of CBT for chemotherapy-related cognitive change: Results of a waitlist control trial. Psycho-Oncology. 2012;21:176-186.

23. Northouse L, Kershaw T, Mood D and Schafenacker A. Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers. Psycho-Oncology. 2005;14(6):478-491.

24. Delbar V and Benor Dan E. Impact of nursing intervention on cancer patients' ability to cope. Journal of Psychosocial Oncology. 2001;19:57-75.

25. Koinberg I, Langius-Eklof A, Holmberg L and Fridlund B. The usefulness of a multidisciplinary educational programme after breast cancer surgery: a prospective and comparative study. European Journal of Oncology Nursing. 2006;10:273-82.

26. Hansen Mary J, Enright Robert D, Baskin Thomas W and Klatt J. A palliative care intervention in forgiveness therapy for elderly terminally Ill cancer patients. Journal of Palliative Care. 2009;25:51-60.

27. Witek-Janusek L, Albuquerque K, Chroniak KR, et al. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, Behavior, and Immunity. 2008;22(6):969-981.

28. Henderson VP, Clemow L, Massion AO, et al. The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: A randomized trial. Breast Cancer Research and Treatment. 2012;131:99-109.

29. Garland SN, Carlson LE, Cook S, et al. A non-randomized comparison of mindfulness-based stress reduction and healing arts programs for facilitating post-traumatic growth and spirituality in cancer outpatients. Supportive Care in Cancer. 2007;15:949-961.

30. Moadel AB, Shah C, Wylie-Rosett J, et al. Randomized Controlled Trial of Yoga Among a Multiethnic Sample of Breast Cancer Patients: Effects on Quality of Life. Journal of Clinical Oncology. 2007;25(28):4387-4395.

31. Chandwani KD, Thornton B, Perkins GH, et al. Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. Journal Of The Society For Integrative Oncology. 2010;8:43-55.

32. Antoni MH, Lehman JM, Kilbourn KM, et al. Cognitive-Behavioral Stress Management Intervention Decreases the Prevalence of Depression and Enhances Benefit Finding Among Women Under Treatment for Early-Stage Breast Cancer. Health Psychology. 2001;20(1):20-32.

33. Penedo F, Molton I, Dahn J, et al. A randomized clinical trial of group-based cognitive-behavioral stress management in localized prostate cancer: Development of stress management skills improves quality of life and benefit finding. Annals of Behavioral Medicine. 2006;31(3):261-270.

34. Antoni MH, Lechner SC, Kazi A, et al. How Stress Management Improves Quality of Life After Treatment for Breast Cancer. Journal of Consulting & Clinical Psychology. 2006;74(6):1143-1152.

35. Danhauer SC, Mihalko SL, Russell GB, et al. Restorative yoga for women with breast cancer: Findings from a randomized pilot study. Psycho-Oncology. 2009;18:360-368.

36. Fallah R, Golzari M, Dastani M and Akbari ME. Integrating spirituality into a group psychotherapy program for women surviving from breast cancer. Iranian Journal of Cancer Prevention. 2011;4:142-148.

37. Rummans TA, Clark MM, Sloan JA, et al. Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: A randomized controlled trial. Journal of Clinical Oncology. 2006;24:635-642.

38. Hsiao FH, Jow GM, Kuo WH, et al. The effects of psychotherapy on psychological well-being and diurnal cortisol patterns in breast cancer survivors. Psychotherapy and Psychosomatics. 2012;81:173-182.

39. Rousseau P. Spirituality and the Dying Patient. Journal of Clinical Oncology. 2000;18(9):2000-2002.

40. Zaider T and Kissane D. The assessment and management of family distress during palliative care. Current opinion in supportive and palliative care. 2009;3(1):67-71.

41. Arman M, Rehnsfeldt A, Lindholm L and Hamrin E. The face of suffering among women with breast cancer-being in a field of forces. Cancer Nursing. 2002;25:96-103.

42. Storey P. Spiritual care at the end of life. Texas Medicine. 2001;97:56-9.

43. Penson RT, Yusuf RZ, Chabner BA, et al. Losing God. Oncologist. 2001;6(3):286-97.

44. Turner J, Kelly B and Girgis A. Supporting oncology healthcare professionals: a review. Psycho-Oncologie. 2011;5(2):77-82.

45. Leung D and Esplen M. Alleviating existential distress of cancer patients: Can relational ethics guide clinicians? European Journal of Cancer Care. 2010;19(1):30-38.

46. Rydahl-Hansen S. Hospitalized patients experienced suffering in life with incurable cancer. Scandinavian Journal of Caring Sciences. 2005;19(3):213-222.

47. Strang S, Strang P and Ternestedt BM. Existential support in brain tumour patients and their spouses. Supportive Care in Cancer. 2001;9:625-33.

48. Cassell EJ. Diagnosing suffering: A perspective. Annals of Internal Medicine. 1999;131(7):531-534.

49. Bayes R, Limonero JT, Barreto P and Comas MD. A way to screen for suffering in palliative care. Journal of Palliative Care. 1997;13(2):22-6.

50. Baines BK and Norlander L. The relationship of pain and suffering in a hospice population. American Journal of Hospice and Palliative Medicine. 2000;17(5):319-326.

51. Barton-Burke M, Barreto RC, Jr. and Archibald LIS. Suffering as a multicultural cancer experience. Seminars in Oncology Nursing. 2008;24(4):229-36.

52. Arman M and Rehnsfeldt A. The hidden suffering among breast cancer patients: A qualitative metasynthesis. Qualitative Health Research. 2003;13(4):510-527.

53. Dettmore D and Gabriele LC. Don't just do something, stand there: responding to unrelieved patient suffering. Journal of Psychosocial Nursing & Mental Health Services. 2011;49(4):34-8.

54. Puchalski CM, Lunsford B, Harris MH and Miller RT. Interdisciplinary spiritual care for seriously ill and dying patients: A collaborative model. Cancer Journal. 2006;12:398-416.

55. Okon TR. "Nobody understands": On a cardinal phenomenon of palliative care. Journal of Medicine and Philosophy. 2006;31:13-46.

56. Yang W, Staps T and Hijmans E. Existential crisis and the awareness of dying: The role of meaning and spirituality. Omega: Journal of Death and Dying. 2010;61:53-69.

57. Lo B, Ruston D, Kates LW, et al. Discussing religious and spiritual issues at the end of life. JAMA: the journal of the American Medical Association. 2002;287(6):749-754.

58. Kissane DW, Clarke DM and Street AF. Demoralization syndrome--a relevant psychiatric diagnosis for palliative care. Journal of Palliative Care. 2001;17(1):12-21.

59. Abbey JG, Rosenfeld B, Pessin H and Breitbart W. Hopelessness at the end of life: The utility of the hopelessness scale with terminally ill cancer patients. British Journal of Health Psychology. 2006;11:173-183.

60. Frank JD. Psychotherapy: The Restoration of Morale. The American Journal of Psychiatry. 1974;131(3):271-274.

61. Clarke DM and Kissane DW. Demoralization: Its phenomenology and importance. Australian and New Zealand Journal of Psychiatry. 2002;36(6):733-742.

62. Body R and Foex BA. Optimising well-being: Is it the pain or the hurt that matters? Emergency Medicine Journal. 2012;29:91-94.

63. Skott C. Symptoms beyond diagnosis--a case study. European Journal of Cancer Care. 2008;17:549-56.

64. Ott C. Spirituality and the nurse. Nebraska Nurse. 1997;30:34-5.

65. Rodgers BL and Cowles KV. A conceptual foundation for human suffering in nursing care and research. Journal of Advanced Nursing. 1997;25(5):1048-1053.

66. Mitchell G, Murray J, Wilson P, et al. “Diagnosing” and “Managing” spiritual distress in palliative care: Creating an intellectual framework for spirituality useable in clinical practice. Australasian Medical Journal. 2010;3(6):364-369.

67. Romanoff BD and Thompson BE. Meaning Construction in Palliative Care: The Use of Narrative, Ritual, and the Expressive Arts. American Journal of Hospice and Palliative Medicine. 2006;23(4):309-316.

68. Chapman C and Gavrin J. Suffering and its relationship to pain. Journal of Palliative Care. 1993;9:5-13.

69. Zaza C and Baine N. Cancer Pain and Psychosocial Factors: A Critical Review of the Literature. Journal of Pain and Symptom Management. 2002;24(5):526-542.

70. Mak YYW and Elwyn G. Voices of the terminally ill: Uncovering the meaning of desire for euthanasia. Palliative Medicine. 2005;19:343-350.

71. Mako C, Galek K and Poppito SR. Spiritual pain among patients with advanced cancer in palliative care. Journal of Palliative Medicine. 2006;9(5):1106-13.

72. Strasser F, Walker P and Bruera E. Palliative pain management: when both pain and suffering hurt. Journal of Palliative Care. 2005;21:69-79.

73. Ferrell BR. To know suffering. Oncology Nursing Forum. 1993;20:1471-7.

74. Cohen MZ, Williams L, Knight P, et al. Symptom masquerade: understanding the meaning of symptoms. Supportive Care in Cancer. 2004;12:184-90.

75. Chochinov Harvey M, Kristjanson Linda J, Breitbart W, et al. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncology. 2011;12:753-62.

76. Abraham A, Kutner JS and Beaty B. Suffering at the end of life in the setting of low physical symptom distress. Journal of Palliative Medicine. 2006;9(3):658-665.

77. Sasser CG and Puchalski CM. The Humanistic Clinician: Traversing the Science and Art of Health Care. Journal of Pain and Symptom Management. 2010;39(5):936-940.

78. Milstein JM. Introducing spirituality in medical care: Transition from hopelessness to wholeness. JAMA. 2008;299(20):2440-2441.

79. Chan TH, Ho RT and Chan CL. Developing an outcome measurement for meaning-making intervention with Chinese cancer patients. Psycho-Oncology. 2007;16:843-850.

80. Fitzpatrick R, Davey C, Buxton M and Jones D. Evaluating patient-based outcome measures for use in clinical trials. Health Technology Assessment. 1998;2(14):1-76.

81. Anandarajah G, Gowri A and Ellen H. Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. American family physician. 2001;63(1):81.

82. Edwards A, Pang N, Shiu V and Chan C. Review: The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research. Palliative Medicine. 2010;24(8):753-770.

83. Kahn DL and Steeves RH. The significance of suffering in cancer care. Seminars in Oncology Nursing. 1995;11:9-16.

84. Ferris FD, von Gunten CF and Emanuel LL. Competency in end-of-life care: last hours of life. J Palliat Med. 2003;6(4):605-13.

85. Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ: British Medical Journal. 2007;335(7612):184.

86. National Breast Cancer Centre. Eliciting and responding to emotional cues - Evidence from the literature and recommended steps. National Breast Cancer Centre Camperdown, NSW, 2007.

87. Borneman T, Ferrell B and Puchalski CM. Evaluation of the FICA Tool for Spiritual Assessment. Journal of Pain and Symptom Management. 2010;40(2):163-173.

88. Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. Journal of Palliative Medicine. 2009;12(10):885-904.

89. Chochinov HM and Chochinov HM. Dignity and the Eye of the Beholder. Journal of Clinical Oncology. 2004;22(7):1336-1340.

90. Turner J, Clavarino A, Yates P, et al. Oncology nurses' perceptions of their supportive care for parents with advanced cancer: challenges and educational needs. Psycho-Oncology. 2007;16(2):149-157.

91. Back AL, Bauer-Wu SM, Rushton CH and Halifax J. Compassionate silence in the patient–clinician encounter: a contemplative approach. Journal of Palliative Medicine. 2009;12(12):1113-1117.

92. National Breast and Ovarian Cancer Centre. Breaking bad news: Evidence from the literature and recommended steps. National Breast and Ovarian Cancer Centre Surry Hills, NSW, 2007.

93. Kissane D, Bultz B, Butow P and Finlay I. Handbook of communication in oncology and palliative care. Oxford University Press, 2010.

94. Queensland Health and Islamic Council of Queensland. Health Care Providers’ Handbook on Muslim Patients Second Edition Division of the Chief Health Officer, Queensland Health, Brisbane, QLD, 2010.

95. Queensland Health. Health Care Providers’ Handbook on Hindu Patients. Division of the Chief Health Officer, Queensland Health, Brisbane, QLD, 2011.

96. Queensland Health and University of Queensland. Providing care to patients from culturally and linguistically diverse backgrounds: guidelines to practice. Queensland Health, Brisbane, QLD, 1998.

97. Thompson S, Shahid S, Greville H and Bessarab D. “A whispered sort of stuff"- A community report on research around Aboriginal people’s beliefs about cancer and experiences of cancer care in Western Australia. Cancer Council Western Australia, Perth, WA, 2011.

98. Heiney SP, McWayne J, Hurley TG, et al. Efficacy of Therapeutic Group by Telephone for Women with Breast Cancer. Cancer Nursing. 2003;26:439-447.

99. BĂƒĽchi S, Buddeberg C, Klaghofer R, et al. Preliminary validation of PRISM (Pictorial Representation of Illness and Self Measure)--a brief method to assess suffering. Psychotherapy and Psychosomatics. 2002;71(6):333-41.

100. BĂƒĽchi S, Sensky T, Sharpe L and Timberlake N. Graphic Representation of Illness: A Novel Method of Measuring Patients' Perceptions of the Impact of Illness. Psychotherapy and Psychosomatics. 1998;67(4-5):222-225.

101. Lehmann V, Oerlemans S, van de Poll-Franse LV, et al. Suffering in long-term cancer survivors: An evaluation of the PRISM-R2 in a population-based cohort. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation. 2011;20(10):1645-1654.

102. Wouters EJM, Reimus JLM, van Nunen AMA, et al. Suffering Quantified? Feasibility and Psychometric Characteristics of 2 Revised Versions of the Pictorial Representation of Illness and Self Measure (PRISM). Behavioral Medicine. 2008;34(2):65-78.

103. Adunsky A, Aminoff Bechor Z, Arad M and Bercovitch M. Mini-Suffering State Examination: Suffering and survival of end-of-life cancer patients in a hospice setting. American Journal of Hospice & Palliative Medicine. 2008;24:493-498.

104. Rosenfeld B, Pessin H, Lewis C, et al. Assessing hopelessness in terminally ill cancer patients: Development of the Hopelessness Assessment in Illness Questionnaire. Psychological Assessment. 2011;23:325-336.

105. Kissane DW, Wein S, Love A, et al. The Demoralization Scale: a report of its development and preliminary validation. Journal of Palliative Care. 2004;20:269-76.

106. Mullane M, Dooley B, Tiernan E and Bates U. Validation of the Demoralization Scale in an Irish advanced cancer sample. Palliative & Supportive Care. 2009;7:323-30.

107. Beck AT, Weissman A, Lester D and Trexler L. The Measurement of Pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology. 1974;42(6):861-865.

108. Fortner B, Okon T, Schwartzberg L, et al. The Cancer Care Monitor: psychometric content evaluation and pilot testing of a computer administered system for symptom screening and quality of life in adult cancer patients. Journal of Pain and Symptom Management. 2003;26(6):1077-1092.

109. Jacobsen J, Vanderwerker L, Maciejewski P, et al. Depression and demoralization as distinct syndromes: Preliminary data from a cohort of advanced cancer patients. Indian Journal of Palliative Care. 2006;12(1):8-15.

110. Wilson KG, Graham ID, Viola RA, et al. Structured interview assessment of symptoms and concerns in palliative care. Canadian journal of psychiatry. Revue canadienne de psychiatrie. 2004;49(6):350-358.

111. Cockram CA, Doros G and de Figueiredo JM. Diagnosis and measurement of subjective incompetence: The clinical hallmark of demoralization. Psychotherapy and Psychosomatics. 2009;78:342-345.

112. Herth K. Abbreviated instrument to measure hope: development and psychometric evaluation. Journal of Advanced Nursing. 1992;17(10):1251-1259.

113. Herth K. Development and Refinement of an Instrument to Measure Hope. Scholarly Inquiry for Nursing Practice. 1991;5(1):39-51.

114. Phillips-Salimi CR, Haase JE, Kintner EK, et al. Psychometric properties of the Herth Hope Index in adolescents and young adults With cancer. Journal of Nursing Measurement. 2007;15(1):3-23.

115. Chi GC-H-L. The role of hope in patients with cancer. Oncology Nursing Forum. 2007;34(2):415-424.

116. Snyder CR. The will and the ways: Development and validation of an individual-differences measure of hope. Journal of personality and social psychology. 1991;60(4):570-585.

117. Nekolaichuk CL, Jevne RF and Maguire TO. Structuring the meaning of hope in health and illness. Social Science & Medicine. 1999;48(5):591-605.

118. Nekolaichuk CL and Bruera E. Assessing hope at the end of life: validation of an experience of hope scale in advanced cancer patients. Palliative & Supportive Care. 2004;2:243-53.

119. Miller JF and Powers MJ. Development of an Instrument To Measure Hope. Nursing Research. 1988;37(1):6-10.

120. Nowotny ML. Assessment of hope in patients with cancer: development of an instrument. Oncology Nursing Forum. 1989;16(1):57.

121. Peterman AH, Fitchett G, Brady MJ, et al. Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Annals of Behavioral Medicine. 2002;24:49-58.

122. Edmondson D, Park Crystal L, Blank Thomas O, et al. Deconstructing spiritual well-being: Existential well-being and HRQOL in cancer survivors. Psycho-Oncology. 2008;17:161-169.

123. Canada AL, Murphy PE, Fitchett G, et al. A 3-factor model for the FACIT-Sp. Psycho-Oncology. 2008;17:908-916.

124. Murphy PE, Canada AL, Fitchett G, et al. An examination of the 3-factor model and structural invariance across racial/ethnic groups for the FACIT-Sp: A report from the American Cancer Society's Study of Cancer Survivors-ll (SCS-II). Psycho-Oncology. 2010;19:264-272.

125. Steinhauser KE, Voils CI, Clipp EC, et al. "Are you at peace?": One item to probe spiritual concerns at the end of life. Archives of Internal Medicine. 2006;166:101-105.

126. Hungelmann J, Kenkel-Rossi E, Klassen L and Stollenwerk R. Focus on Spiritual Well-Being: Harmonious interconnectedness of mind-body-spirit—Use of the JAREL Spiritual Well-Being Scale: Assessment of spiritual well-being is essential to the health of individuals. Geriatric Nursing. 1996;17(6):262-266.

127. Johnson ME, Piderman KM, Sloan JA, et al. Measuring spiritual quality of life in patients with cancer. The Journal of Supportive Oncology. 2007;5:437-42.

128. Locke DE, Decker PA, Sloan JA, et al. Validation of single-item linear analog scale assessment of quality of life in neuro-oncology patients. Journal of Pain and Symptom Management. 2007;34:628-638.

129. Mack JW, Nilsson M, Balboni T, et al. Peace, equanimity, and acceptance in the cancer experience (PEACE): Validation of a scale to assess acceptance and struggle with terminal illness. Cancer. 2008;112:2509-2517.

130. Reed PG. Self-transcendence and mental health in oldest-old adults. Nursing Research. 1991;40(1):5-11.

131. Thomas JC, Burton M, Quinn Griffin MT and Fitzpatrick JJ. Self-Transcendence, Spiritual Well-Being, and Spiritual Practices of Women With Breast Cancer. Journal of Holistic Nursing. 2010;28(2):115-122.

132. Selman L, Siegert RJ, Higginson IJ, et al. The "spirit 8" successfully captured spiritual well-being in African palliative care: Factor and Rasch analysis. Journal of Clinical Epidemiology. 2012;65:434-443.

133. Highfield MF. Spiritual health of oncology patients. Nurse and patient perspectives. Cancer Nursing. 1992;15(1):1-8.

134. Reed PG. Spirituality and well-being in terminally ill hospitalized adults. Research in Nursing & Health. 1987;10(5):335-344.

135. Leung K-K, Chiu T-Y and Chen C-Y. The Influence of Awareness of Terminal Condition on Spiritual Well-Being in Terminal Cancer Patients. Journal of Pain and Symptom Management. 2006;31:449-456.

136. Ellison CW. Spiritual well-being: Conceptualization and measurement. Journal of Psychology and Theology. 1983;11(4):330-340.

137. Sherman DW, Ye XY, McSherry C, et al. Spiritual well-being as a dimension of quality of life for patients with advanced cancer and AIDS and their family caregivers: results of a longitudinal study. American Journal of Hospice & Palliative Medicine. 2005;22:349-62.

138. Reker G. Manual for the Life Attitude Profile - Revised. Student Psychologists Press, Ontario, 1992.

139. White CA. Meaning and its measurement in psychosocial oncology. Psycho-Oncology. 2004;13(7):468-481.

140. Reker GT and Fry PS. Factor structure and invariance of personal meaning measures in cohorts of younger and older adults. Personality and Individual Differences. 2003;35(5):977-993.

141. Reker GT. The Life Attitude Profile (LAP): A multidimensional instrument for assessing attitudes toward life. Canadian journal of behavioural science. 1981;13(3):264-273.

142. Vickberg Johnson SM, Bovbjerg DH, DuHamel KN, et al. Intrusive thoughts and psychological distress among breast cancer survivors: Global meaning as a possible protective factor. Behavioral Medicine. 2000;25(4):152-160.

143. Vickberg Johnson SM, Duhamel Katherine N, Smith Meredith Y, et al. Global meaning and psychological adjustment among survivors of bone marrow transplant. Psycho-Oncology. 2001;10:29-39.

144. Erci B. Meaning in life for patients with cancer: validation of the Life Attitude Profile-Revised Scale. Journal of Advanced Nursing. 2008;62(6):704.

145. Anagnostopoulos F, Slater J, Fitzsimmons D and Kolokotroni P. Exploring global meaning in Greek breast cancer patients: validation of the Life Attitude Profile—Revised (LAP-R). Psycho-Oncology. 2011;20(4):419-427.

146. Mehnert A and Koch U. Psychometric evaluation of the German version of the Life Attitude Profile–Revised (LAP-R) in prostate cancer patients. Palliative & Supportive Care. 2008;6(02):119-124.

147. Fife BL. The measurement of meaning in illness. Social Science & Medicine. 1995;40:1021-1028.

148. Evers AWM, Kraaimaat FW, van Lankveld W, et al. Beyond unfavorable thinking: The Illness Cognition Questionnaire for chronic diseases. Journal of Consulting and Clinical Psychology. 2001;69(6):1026.

149. Kroz M, Bussing A, von L, et al. Reliability and validity of a new scale on internal coherence (ICS) of cancer patients. Health and Quality of Life Outcomes. 2009;7

150. Salmon P, Manzi F and Valori RM. Measuring the meaning of life for patients with incurable cancer: the life evaluation questionnaire (LEQ). European Journal of Cancer. 1996;32A:755-60.

151. Tomich PL and Helgeson VS. Five years later: A cross-sectional comparison of breast cancer survivors with healthy women. Psycho-Oncology. 2002;11:154-169.

152. Jim HS, Purnell JQ, Richardson SA, et al. Measuring meaning in life following cancer. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation. 2006;15:1355-1371.

153. Starck PL. Patients' perceptions of the meaning of suffering. International Forum for Logotherapy. 1983;6(2):110-116.

154. Chen ML. Validation of the structure of the perceived meanings of cancer pain inventory. Journal of Advanced Nursing. 1999;30:344-51.

155. Wong PTP. Implicit theories of meaningful life and the development of the personal meaning profile. Lawrence Erlbaum, Mahwah, NJ, 1998.

156. Jaarsma TA, Pool G, Ranchor AV and Sanderman R. The concept and measurement of meaning in life in Dutch cancer patients. Psycho-Oncology. 2007;16:241-248.

157. Bower JE, Meyerowitz BE, Desmond KA, et al. Perceptions of Positive Meaning and Vulnerability Following Breast Cancer: Predictors and Outcomes Among Long-Term Breast Cancer Survivors. Annals of Behavioral Medicine. 2005;29:236-245.

158. Crumbaugh JC. An experimental study in existentialism: The psychometric approach to Frankl's concept ofnoogenic neurosis. Journal of Clinical Psychology. 1964;20(2):200-207.

159. Passik SD, Inman A, Kirsh K, et al. Initial validation of a scale to measure purposelessness, understimulation, and boredom in cancer patients: toward a redefinition of depression in advanced disease. Palliative & Supportive Care. 2003;1:41-50.

160. Fegg MJ, Kramer M, L'Hoste S and Borasio GD. The Schedule for Meaning in Life Evaluation (SMiLE): Validation of a New Instrument for Meaning-in-Life Research. Journal of Pain and Symptom Management. 2008;35(4):356-364.

161. Antonovsky A. The structure and properties of the sense of coherence scale. Social Science & Medicine. 1993;36(6):725-733.

162. Reker GT. Manual of the Sources of Meaning Profile-Revised (SOMP-R). Department of Psychology, Trent University, Trent, 1996.

163. Prager E. Exploring personal meaning in an age-differentiated Australian sample: Another look at the Sources Of Meaning Profile (SOMP). Journal of Aging Studies. 1996;10(2):117-136.

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