Table 6.

Phase 3 results

Concept	Quantitative Mean, S.D. (min-max) or Estimate/p	Qualitative	Mixed
Spirituality/Spiritual well-being	2.56, .64 (.92–4 out of 0–4)	Participants described spirituality as connection to self, to something greater (nature, Higher Power, community), and a sense of meaning or purpose. Lived experiences of spirituality were unique, yet often were reported to offer benefits when facing cancer and mortality	Spirituality levels were moderate in this sample. Meanings of spirituality and the ways it appeared in everyday life varied widely
Pain-related catastrophizing	15.24, 9.25 (0–39 out of 0–52)	Pain-related catastrophizing was described by several participants, with a focus on “spirals” of mental stress and fear, anger and frustration with pain, and feelings of hopelessness	Pain-related catastrophizing levels were moderate in this sample. Lived experiences with pain-related catastrophizing varied across participants (anger, helplessness, fears about the future)
Pain	Worst pain 5.29, 1.99 (1–9 out of 0–10) Average pain 3.70, 1.62 (1–8 out of 0–10) Pain-related distress 2.36, .90 (14-out of 0–4) Pain interference 3.79, 2.56 (0–8.86 out of 0–10)	Pain was described as originating from various causes (cancer, cancer treatment, other co-occurring conditions, and unknown origins). Participants described pain as a pervasive and challenging aspect of their lives, and attempted various strategies to manage it (medications, topical treatments, lifestyle modifications, etc.)	All participants in the study reported some level of pain, yet there was a range of experiences with pain across individuals. Average levels were mild and worst levels were moderate. A range of causes, descriptions, and attempts to manage pain were explored
Relationship between spiritual well-being and pain-related catastrophizing	Estimate: −1.818 p=0.040*	For some participants, spirituality offered a respite from pain-related catastrophizing, providing an opportunity to zoom out, connect with meaning and a wider perspective on life. Faith, trust, and emotional comfort brought about by spirituality could help facilitate transcendence of spirals of pain-related worry and anger	Findings support the idea that aspects of spirituality are helpful for some patients when facing pain-related catastrophizing. Various possible mechanisms underlying this relationship were identified and explored
Relationship between spiritual well-being and pain experience	Average pain Estimate: −0.162 (p = 0.040*) Pain-related distress Estimate: -0.117 (p = 0.040*) Pain interference Estimate: −0.290 (p = 0.040*)	For some participants, spirituality served as a support when facing pain, inspiring motivation to continue with self-care activities amidst suffering, helping provide meaning around pain, and offering comfort/emotional regulation which had the capacity to alter the way pain was experienced. Other participants reported that spirituality did not help them when facing pain	Findings support the hypothesis that aspects of spirituality are helpful for some patients when facing pain, yet limitations of spirituality’s usefulness in the face of pain were also revealed