Islamic perspectives of spiritual needs in patients with breast cancer: A qualitative study

Abstract

Background

Breast cancer patients often face difficulties in doing prayers due to cancer diagnosis and treatment. Spiritual needs, especially in the context of Islamic beliefs, need to be explored as a foundation for developing innovative Islamic spiritual nursing interventions that help patients accepting their illness. This study aimed to explore the perspective of Islamic spiritual needs in breast cancer patients.

Methods

A qualitative study with descriptive phenomenology approach was conducted at Islamic Hospital at Semarang, Central Java, Indonesia at September 2025. Twenty seven breast cancer patients purposively selected. Data were collected until data saturation through in depth interview lasting 25-30 minutes each. Data analysis was completed using the Colaizzi’s method.

Results

Seven main themes were successfully identified, including: (1) The meaning of illness as part of Allah's plan and test, (2) Increased religiosity due to illness, (3) Obstacles to carrying out worship when sick, (4) Gratitude in sick conditions, (5) The process of accepting illness, (6) The role of family and social support in meeting spiritual needs; (7) The need for Islamic media during treatment.

Discussion

The findings suggest that spiritual meaning and religious practices play a very important role in increasing the coping of breast cancer patients. Islamic spiritual nursing interventions need to fulfil the patients need such as facilitating religious practices at the hospital and the provision of spiritual media to support the spiritual well-being.

Conclusion

This study offers a patient-centered understanding of how spiritual meaning and religious practices shape coping among Muslim women with breast cancer. The study’s unique contribution lies in translating patients’ lived experiences into practical insights for Islamic spiritual nursing, emphasizing the need for care that is culturally and spiritually responsive within clinical settings.

Introduction

Breast cancer affects not only physical, but also psychological, social, and spiritual aspects of patients' lives.^1,2 Cancer diagnoses often trigger an existential crisis that diminishes patients' confidence and religious beliefs.³ Spirituality is recognized as an important dimension of holistic health. The World Health Organization (WHO) has added a spiritual aspect to the definition of health and emphasizes the importance of paying attention to patients’ beliefs during treatment. For many patients with cancer, religious beliefs and spiritual practices are the main source of strength, hope, and meaning in the face of life-threatening illnesses.⁴ Several studies have suggested that fulfilling spiritual needs can improve coping ability, speed recovery, and enhance overall well-being among patients with cancer,^3,5 whereas neglecting spiritual needs can lead to spiritual distress, and feelings of emptiness and hopelessness^3,6,7

In Muslim patients, spirituality often manifests in the form of a belief that illness is a destiny and a test from Allah. From an Islamic perspective, suffering can be interpreted as part of Allah's plan that contains wisdom; therefore, sincerely accepting illness is considered a form of patience and worship. Muslim patients often use religious coping methods, such as du'a, salat, reciting the Qur'an, and dhikr, to gain inner peace and strength to face cancer.^5,8 Recent systematic studies have confirmed that Islamic religious practices, particularly recitation (reading or listening to the Qur'an), effectively reduce stress and anxiety in patients with cancer undergoing chemotherapy.⁹ Moreover, in a study in Iraq, listening to the Qur'an before chemotherapy significantly lowered anxiety among patients with cancer, with effectiveness equivalent to that of music therapy.¹⁰ Therefore, interventions incorporating Islamic spiritual elements have substantial potential to improve the well-being of patients with cancer.

Holistic nursing requires nurses to be sensitive to patients’ spiritual dimensions and actively meet their spiritual needs.^3,5 However, in practice, the fulfilment of patients' spiritual needs is often neglected because of various constraints, including limited time, lack of nurse training in spiritual care, or the idea that spiritual issues are outside the medical realm.⁵ In Indonesia, a Muslim-majority country, a strong religious cultural context exists in which patients typically expect health workers to understand and appreciate their spiritual needs, such as the need to remain able to worship during illness or to receive spiritual support according to their religion.⁶ Studies conducted in Iran and other Muslim countries have reported that patients strongly expect health care workers to help meet their religious needs, such as prayer or prayer facilities, during treatment^5,11

Despite evidence of the benefits of spiritual care, gaps remain in its implementation. One identified challenge is the lack of resources to support the fulfillment of patients' spiritual needs during long and stressful treatment procedures, such as chemotherapy.¹² Patients with breast cancer undergoing chemotherapy often experience high anxiety before and during drug infusion sessions.¹⁰ Under these conditions, spiritual practices, such as listening to Qur'an readings, religious music, or prayer, are a non-pharmacological strategy that can calm patients' minds. Listening to chanting of the Qur'an before chemotherapy has been found to effectively lower patients' anxiety, and the addition of this intervention in nursing care plans was recommended as complementary therapy.¹⁰ Similarly, a recent systematic review by Raziani et al. (2025) has indicated that religious therapy, particularly recitation of the Qur'an, consistently has positive effects including reducing stress and anxiety, and increasing calmness among patients with cancer during chemotherapy.⁹ These findings underscore the need for innovation in providing spiritual content to patients during treatment.⁹

The existing evidence clearly indicates that¹ meeting the spiritual needs of Muslim patients with breast cancer is an important part of holistic care²; a knowledge gap exists regarding the details of the specific Islamic spiritual needs of patients with breast cancer, but such data are needed to provide a basis for designing interventions; and³ technology has promise as an innovative means to deliver engaging spiritual interventions. Therefore, this study was aimed at exploring Islamic spiritual needs among patients with breast cancer. The results of this exploration will be used to design a video-based Islamic spiritual nursing intervention aimed at improving patients’ spiritual and emotional quality of life. This research is expected to contribute to the development of more holistic, patient-centered, and culturally sensitive oncology nursing services.

Materials and Methods

Study design

This study used a descriptive phenomenological approach to explore and understand the spiritual experiences of patients with breast cancer. Descriptive phenomenology was chosen because it allows researchers to understand participants’ personal meanings, lived experiences, and perspectives in depth.¹³ Given the focus on spirituality and coping, this design was considered appropriate to capture rich and nuanced narratives that might not be fully understood through quantitative methods.

Sampling and participants

Participants were selected through purposive sampling, a method that allows researchers to intentionally recruit individuals with direct experience with the phenomenon under study.¹⁴ Women diagnosed with breast cancer who identified as Muslim and were willing to share their experiences of spiritual coping were invited to participate.

Patients with stage IV (metastatic) breast cancer were not included in this study. This decision was made carefully, given that women in the terminal stage often face different realities, including advanced disease progression, palliative treatment, and end-of-life concerns. These circumstances can shape spiritual needs and coping in deeper and sometimes more urgent ways. Therefore, including these patients might have introduced different experiences from those of women undergoing active treatment with curative intent. Sampling continued until data saturation was reached, meaning that no new themes or significant insights emerged from additional interviews.¹⁵ This approach ensured that the findings enabled comprehensive understanding of participants’ experiences.

Data collection

After each interview, the transcript was reviewed, and preliminary codes were developed. Saturation was assessed gradually throughout this process. Apparent saturation was determined to have been reached when interviews began to repeat similar ideas, and no substantially new themes were emerging. To ensure that the determination of saturation was not premature, we conducted additional interviews beyond that point. After apparent saturation was observed, three further interviews were performed to confirm that no new themes or significant variations arose. Because these additional interviews continued to reinforce existing patterns without generating new insights, we concluded that data saturation had been achieved.¹⁵ This step-by-step and reflective approach helped strengthen the depth, credibility, and completeness of the findings. A total of 27 participants were recruited by the end of saturation. The confidentiality of the participants' identities was ensured. Audio from all interviews was recorded with the consent of the participants. After the interview, informal member checking was conducted, in which the interviewer summarized how the participants' answers had been understood and asked the participants to provide confirmation.

Data analysis

Data analysis was conducted by two members of the research team with backgrounds in nursing and training in qualitative methods. The interviewer was involved in the analysis. Coding and theme development were discussed collaboratively to reduce individual bias.

Data from the interview recordings were transcribed verbatim in Indonesian. Data analysis was performed manually with Colaizzi's phenomenological method, which is consistent with descriptive phenomenology and provides a systematic process for identifying the participants' essence. The stages of analysis included¹ data familiarization, in which the researchers read the transcript repeatedly to understand the content and look for important meanings²; coding, in which the researchers marked the segments of text that were relevant to the research question and labeled the codes. The codes were compiled both deductively (on the basis of initial frameworks such as the domain of spirituality: the meaning of life, relationship with Allah, and practice of worship) and inductively (on the basis of unexpected issues arising from the data)³; theme search, in which similar or related codes were grouped into sub-themes, then generalized into main themes⁴; theme review, in which the identified themes and sub-themes were re-examined by comparison against the original transcript, to ensure fit and clear distinctions among themes⁵; naming and definition of themes, in which each theme was given a concise name explaining the essence of its meaning; and⁶ reporting, in which the findings were structured narratively with participant citations to reinforce each theme.

Researcher triangulation was performed in the analysis process. Two members of the research team independently analyzed the data and then discussed the results. Differences in interpretation were resolved through consensus. Manual data analysis was considered adequate, given the sample size and focus of the study. However, systematic measures were implemented to maintain a clear audit trail (e.g., initial code documentation, grouping of sub-themes, and reflective notes of researchers).

To ensure credibility, a formal member check was performed after the analysis was completed. A summary of the results (identified themes) was presented to five randomly selected participants to confirm whether the themes matched their experience. Most participants expressed agreement and acknowledged their experiences in these themes. Transferability was facilitated by providing a detailed description of the participants’ context and study setting, to enable readers to assess relevance to other contexts. Dependability and confirmability were facilitated by conducting trail audits: recording all stages of research and analytical decisions, and conducting peer debriefing with spiritual nursing experts. The researchers also conducted self-reflection to identify personal biases. Interviews were conducted by the first author, a doctoral candidate with formal training and prior experience in qualitative research. The interviewer had no prior personal relationship with participants but was familiar with the clinical context. Reflexive notes were recorded after each interview to reflect on assumptions and potential influences on data interpretation.

Trustworthiness

An audit trail documenting methodological decisions and theme development was maintained. Peer debriefing with senior qualitative researchers helped challenge interpretations. Reflexivity was addressed through field notes and ongoing self-reflection to ensure that the findings remained grounded in the participants’ accounts.

Results

This study recruited 27 patients with breast cancer hospitalized at Islamic Hospital at Semarang, Central Java, Indonesia. Detailed demographic and characteristics are presented in Table 1.

Table 1.

Patient demographics and characteristics (n = 27).

Characteristics	Number
Age
Adult	19
Older	8
Marital status
Married	20
Widowed	7
Education
Elementary school	13
Secondary school	11
University	3
Length of illness
<1 year	15
>1 year	12
Cancer grade
I or II	21
III	6

This study identified seven main themes describing the Islamic spiritual needs of patients with breast cancer¹: the meaning of illness as part of Allah's plan and test²; changes and improvement in spirituality during illness³; challenges in worship during illness⁴; gratitude for the gift of illness⁵; the process toward acceptance of the disease (sincerity)⁶; family and social support as spiritual support; and⁷ the need for Islamic media for spiritual tranquility during treatment. The keywords, sub-themes, and themes are described in Scheme 1.

Scheme 1.

Keywords, sub-themes, and themes derived from the data.

Theme 1. The meaning of illness as part of Allah's plan and trials

The first theme describes how participants interpreted their cancer from an Islamic spiritual perspective. Most participants attributed illness to God's will and plan, and saw it as a test of faith. Divine destiny emerged as a powerful sub-theme: many participants were resigned to accepting cancer as a destiny from God to be lived. “This pain is from Allah; inevitably it must be accepted,” said P2. P6 and P19 also agreed with the same statement. The attitude of accepting pain as destiny makes patients try to be sincere. P5 declared, “Sickness is God's destiny.” P9, P12, P14, P15, P17, and P21 also revealed that they viewed their cancer as having been outlined by God. Some participants affirmed the belief that illness is not a gift from a witch or similar, but purely God's decree: “This disease is a divine destiny, not a voodoo,” said P11 (as also stated by P12).

Theme 2. Spirituality changes and enhancement during illness

The second theme related to changes in the spiritual lives of participants after diagnosis with breast cancer. Most participants reported an increase in religiosity. They became more diligent in worship and closer to God than they had been before becoming ill. The pain that they experienced seemed to be a turning point that strengthened their spirituality. “Since I was sick, I have been diligent in dhikr and sunnah prayers,” said P2. P16, P19, and P22 agreed and indicated that they felt the same way. Many patients claimed to increase the frequency and quality of their worship as a response to illness. For example, P4 and P20 said, “I am more diligent in tahajud after being sick.” P3 and P21 said, “I read the Qur'an more regularly,” thus indicating an increase in participation in religious activities. Similarly, P18, P26, and P27 said, “I add sunnah prayers, almsgiving, dhikr,” in an effort to get closer to God.

Theme 3. Challenges in worship during illness

This third theme included the obstacles that patients felt in fulfilling ritual obligations (particularly prayer) during cancer treatment, as well as their need for solutions. The first sub-theme was the lack of knowledge regarding rukhsah (relief or adaptation of worship for the sick). Many patients were confused about how to pray or perform ablution/tayamum when their physical conditions did not permit these practices. “If I had chemo, I didn't pray because I was confused about how,” said P2. P22 and P27 also reported having the same experience. A lack of understanding od praying for sick people, the way of tayamum, or praying while lying down was permissible made patients choose to cease prayer for a while. “I don't know how to pray while lying down in bed,” admitted P13, P17, P18, who admitted that they did not pray in time while the chemotherapy treatment is begun. P13 said, “If you have chemo, don't pray for fear of making mistakes,” indicating a fear of worship in an inappropriate way.

Theme 4. Gratitude for the gift of illness

The fourth theme revealed that, despite having cancer, patients found reasons to be grateful and practiced gratitude as part of their spiritual coping skills. Most participants stated that they tried to gain wisdom and be grateful in their illness. Things to be grateful for included appreciation for life's opportunities, sustenance, and family support. “I am grateful that I am still given a chance to live,” said P2, who felt lucky that his cancer could still be treated. P5 said, “I am grateful for whatever Allah gives,” including this painful test. P11 added, “I remain grateful to be given sustenance and family,” thus highlighting the financial support and the existence of accompanying family as a gift.

Theme 5. The process toward acceptance of illness (sincerity)

The participants' stories from diagnosis to finally reaching the stage of acceptance suggested that they went through stages resembling the model stages of grief (denial, anger, depression, and acceptance) when facing the reality of cancer.

Stage 1. Denial

On the basis of the interview results, the participants who accepted pain as fate described the following: “Initially shocked and rejected” (P2 and P4); “At first crying” (P3 and P25); “A shock” (P4); “At first it was difficult to accept” (P6); and “Initially refused” (P22).

Stage 2. Anger

On the basis of the interview results, the participants who accepted pain as fate described the following: “Initially disappointed” (P6 and P8); “I was angry at the beginning” (P7, P9, P21, and P27); and “At first I cried, angry” (P17).

Stage 3. Depression

On the basis of the interview results, the participants who accepted pain as destiny described the following: “When I first knew I was sick, I was sad” (P11 and P18) and “I was initially desperate” (P26).

Stage 4. Acceptance

On the basis of the interview results, the participants who accepted their pain as destiny described the following: “but now I accept it” (P2, P3, P6, P8, P22, P25, P26, and P27); “Now I surrender” (P4, P7, and P26); “takes time to receive” (P5, P9, and P20); “But now it's more exciting” (P11); “Have received pain since the surgery, surrender to Allah” (P16, P21, and P26); “Then I give up” (P18); and “I have been able to receive chemotherapy since the beginning” (P19).

Theme 6. Family and social support as spiritual support

All participants emphasized that the presence of family, relatives, and friends with moral and spiritual support was very helpful as they underwent the trials of cancer. Family support was the most dominant theme. “The family always accompanies and encourages,” said P2. P4, P5, P8, P11, P12, P13, and P17 also stated the same. Patients felt grateful to have a nuclear family (husband and children) and extended family that continued to provide support. P3 stated, “Children and husbands are always there,” and P6 and P18 made similar statements. The presence of family members provided patients with a sense of calm and not being alone. Social support from neighbors, friends, and the recitation community was also felt. P10 said, “Brothers and family sometimes accompany.” P25, P16, and P19 noted, “Neighbors are also encouraging.” Some patients who were active in the taklim assembly or religious community received visits and prayers from their colleagues. This social warmth strengthened patients’ spirit of life, and feelings that they remained needed and loved by many people.

Theme 7. Need for Islamic media for spiritual calm during treatment

Participants expressed their ideas and hopes that having Islamic video or audio available and accessible during treatment would be very beneficial for their spiritual and psychological condition. Many patients spontaneously expressed a need for Islamic based intervention. “Islamic videos must be very helpful,” said P3, P4, P6, P8, P9, P21, and P26, indicating that videos on religious topics (e.g., lectures or prayers) to be watched during chemotherapy would provide peace of mind. P2, P5, P13, P19, P7, P11, P20, P25, and P27 said, “If there is a video of the Qur'an and prayer, it can make you calm.” Patients believed that the tense atmosphere of the chemotherapy room could be balanced by listening to the recitation of the Qur'an or prayer, to calm the heart.

Discussion

The meaning of illness as part of Allah's plan and trials

Overall, this theme indicated patients' spiritual need to understand illness within a religious framework. By interpreting cancer as fate, a test, or a rebuke from God, patients felt calmer and were able to find meaning in the midst of suffering. This finding is in line with the concept of positive religious coping widely discussed in the literature, in which the patients able to find spiritual meaning in illness tend to experience enhanced mental well-being.⁴ Among participants, the belief that disease comes from Allah also encouraged an attitude of surrender and tawaqal as a form of faith. The need to acquire this theological understanding is very strong. Some patients may need spiritual guidance (from a hospital spiritual advisor) to reinforce the positive meaning.⁷ Patients in this study tended to interpret breast cancer as God's destiny and a type of spiritual test or ordeal. This theological understanding was in line with the concept of religious appraisal in religious coping theory, in which sufferers view stressful events as part of God's plan. A classic study among Malaysian Muslims has also reported that Muslim women with breast cancer emphasize acceptance of destiny as the key to coping (as an attempt to find meaning). More recent studies in similar contexts have not been extensive, but some have suggested that the spiritual needs of patients with cancer often include finding meaning in illness and suffering.³ These meanings are often transcendent, for example, believing in pain as God's way of communicating (rebuke) or a means of purification of sins. This type of belief is classified as positive religious coping and has been associated with diminished distress and enhanced quality of life in patients with cancer.⁴

Spirituality changes and enhancement during illness

This theme underscored patients' spiritual need for deepening faith and religious practice as a coping mechanism. Nurses noted that patients actually felt grateful because their illness “forced” them to improve their worship. This finding was in line with the concept of spiritual awakening, in which health crises can trigger spiritual growth. Some literature calls this phenomenon, in which patients experience spiritual maturity after going through life-threatening experiences such as cancer, post-traumatic growth in the spiritual domain. Further support has come from research indicating that patients with cancer who use religion/spirituality in coping tend to report improved spiritual well-being and hope.⁴ The participants considered meeting the need to worship more intensely to be highly important. They required facilities and support to worship (e.g., a comfortable prayer room in the hospital and prayer time reminders), as well as moral encouragement to continue practicing rituals despite their declining physical condition. The finding that patients become more religious after diagnosis is in line with the common phenomenon in which crises trigger more intense spiritual searching. Patients increase prayer and dhikr, and subsequently feel closer to Allah. A study in Malaysia has linked greater spirituality to better quality of life and lower stress in patients with breast cancer.¹² These findings support that increasing spiritual activity can be a component of psychosocial rehabilitation. Intervention programs that direct patients to spiritual activities have the potential to strengthen their coping skills. Indeed, several clinical trials have tested religious spiritual interventions.¹⁶ One study examining an Islamic-based caring program (including prayer training and dhikr meditation) in patients with breast cancer during chemotherapy has indicated significantly improved spiritual well-being with respect to that in the control group.^9,17 In a follow-up study, similar interventions were also found to improve psychological well-being and decrease patient stress.¹⁷ Many studies have emphasized the importance of culturally sensitive care. Iran nationally emphasizes the fulfillment of patients’ religious needs, for example by providing prayer rooms in wards.³ In Indonesia, this practice is also common, but the aspect of spiritual education must be strengthened.

Barriers to worship and the role of spiritual education

Patients described difficulty in worship because of factors including infusions and weakness, thus resulting in their abandoning prayer. This finding indicated the gaps that spiritual care services must fill. A study has confirmed that integration of spiritual care (including worship assistance) can lower stress and enhance quality of life in patients with chronic conditions.¹⁸ Simple interventions such as teaching patients the tayamum, or providing tayamum kits or “praying in pain” leaflets, would be very useful. Unfortunately, nurses sometimes feel insecure in such teaching because of a lack of religious knowledge.^5,8 Therefore, increasing nurses’ capacity in spiritual competencies is necessary.

Our findings indicated a need for education: patients must be taught the correct worship procedures according to their illness conditions (rukhsah shar'i), so that they can continue to worship without feeling sinful. The spiritual needs identified in this theme were¹ the need for information and education about the rukhsah of worship²; the need for support from nurses to facilitate ritual implementation; and³ tolerance of a conducive treatment environment. Health workers' lack of understanding of the importance of worship for patients was evidenced by patients' complaints that nurses did not teach or remind them about worship. This area must be improved in spiritual nursing practice. Empirically, the constraint of worship among sick patients is not new. Studies have shown that oncology nurses are aware that Muslim patients have a spiritual need to be able to perform religious rituals even when they are sick, and they try to help, for example by encouraging patients to keep dhikr or recite the Qur'an, although they cannot pray while standing.⁵

Gratitude as a positive coping mechanism

The practice of gratitude is already known in positive psychology as an intervention to improve well-being. Similarly, studies comparing gratitude interventions vs behavioral therapies have indicated that both effectively lower anxiety in patients with breast cancer.¹⁹ Therefore, incorporating an element of gratitude into the spiritual intervention would be beneficial. For example, a Virtual Reality (VR) module could include a gratitude reflection segment in which patients are invited to remember good things (e.g., family or God's gifts) while being shown a visual of beautiful memories or a spiritual affirmation text. This approach can strengthen resilience. In addition, training patients to say Alhamdulillah in all circumstances can be used as part of daily spiritual therapy. Descriptive studies have shown that the strongest spiritual need among gynecological patients with cancer in Indonesia is performing prayer five times.²⁰ However, in addition to prayer, dhikr hamdalah, and istighfar are often referred to as self-coping, in agreement with our findings.

This theme highlights patients’ spiritual needs to actualize gratitude. Experiencing gratitude provides psychological strength for patients. Psychologically, gratitude is known to be associated with positive emotions and improved quality of life in people with chronic diseases.²¹ Patients who are able to be grateful tend to have higher expectations and resilience. In phenomenological studies, patients with cancer have described gratitude as giving them a new perspective on life, reducing their focus on suffering, and improving their well-being. In our study, participants required support to maintain an attitude of gratitude. This support could be in the form of spiritual reminders, such as religious advice (tausiyah) that helps patients see the grace behind a disaster. Many patients claim to be helped by Islamic inspirational stories that encourage gratitude. Therefore, the content of the spiritual intervention should include material on this “gratitude in spiritual test from Allah” to reinforce coping skills.

The process of spiritual acceptance and support

Patients’ emotional process from shock to sincerity highlights the importance of ongoing spiritual-psychological assistance. In the initial phase, patients need intensive emotional support. Invisible support from the spiritual community (such as visits by ustaz/ustazah) can provide a new perspective that can help patients adapt more quickly. Consequently, helping patients surrender themselves to God accelerates acceptance. Islamic spiritual interventions such as collective prayer and reading the exemplary story of the Prophet Ayyub (a biblical figure who was patient in pain) can inspire patients to be sincere. In addition, Islamic mindfulness techniques (murāqabah, realizing the presence of Allah) can be taught, given that research has indicated that spiritual mindfulness lowers anxiety in patients with cancer.

The theme of this acceptance process indicates a spiritual need in the form of emotional-spiritual assistance during the illness journey. Patients require spiritual guidance that can help them move from the shock/anger phase to sincerity. The role of a spiritual counselor is important, for example, by providing soothing religious counsel, responding to patients’ theological anxieties, and praying for patients. The support of empathetic families and health workers also contributes to accelerating acceptance. According to the literature, positive religious coping (such as praying) correlates with decreased distress and increased acceptance in patients with cancer.⁴ Research in Turkey has also indicated that Islamic spiritual support in treatment has positive effects in decreasing anxiety and depression in patients undergoing radiotherapy; consequently, patients can better accept their condition.¹¹ Spiritual facilities are therefore necessary to meet these needs.

Family and spiritual support together

The family is the pillar of coping. The finding that families pray and accompany patients is in harmony with Indonesia's communal culture. Family involvement in spiritual care effectively improves outcomes.^22,23 A meta-analysis has indicated that most successful spiritual interventions involve families or groups (group therapy).¹⁷ One dyadic spiritual coping approach targets the patient as an individual.²⁴ In Islamic culture, family often provides reminders for worship. Nurses can facilitate education of families about the importance of awakening patients' spirituality. One study in Saudi Arabia on the perception of spirituality has suggested that spiritual education must target not only patients but also families, to achieve a synchronous vision of spiritual fulfillment.¹⁸

This theme indicated that patients' spiritual needs are inseparable from social support. In Islam, a harmonious family environment and mutual prayers are considered a great sustenance. Prayers and encouragement from loved ones strengthen patients’ faith and hope. A study in Malaysia has correlated the spirituality of patients with cancer with lower levels of stress, and indicated that the effect is partly moderated by the education and support received.¹² Consequently, social support helps actualize the benefits of spirituality. Another study has confirmed that spiritual coping is a sibling bonding between patients and caregivers; families who engage in spiritual activities (e.g., praying) together can improve the spiritual well-being of both parties.²⁴ Therefore, involvement of the family is necessary in spiritual care interventions.^22,23,25

The need for Islamic media

One notable finding was that the patients themselves proposed the use of Islamic video media during chemotherapy. This finding confirmed patients' awareness of the benefits of therapeutic listening to the Qur'an/prayer. This theme clearly revealed the need for structured media interventions, potentially in audio-video format. Patients identified content types including Qur'an reading, dhikr, prayer, preaching, and worship guides, in line with findings describing nurses' experiences, in which they often encourage patients to read or listen to the Qur'an, because it brings peace of mind.⁵ In studies in Lebanon, nurses expressed awareness of the calming effects of the Qur'an and often advised Muslim patients to perform dhikr or listen to recitations when anxious. Scientifically, listening to the holy verses of the Qur'an has been shown to reduce anxiety, pain, and stress in patients with cancer.²⁶ Even Qur'anic murottal therapy has been reported to reduce physical adverse effects such as nausea and vomiting after chemotherapy. Scientific evidence supports the patients' suggestions: for example, Qur'an audio has been demonstrated to effectively decrease pre-chemotherapy anxiety.¹⁰ One review has described that Holy Qur'an recitation is an effective intervention to reduce anxiety in cancer, particularly during chemotherapy.⁹ Similarly, research has confirmed that Qur'an murottal reduces pain, anxiety, and even nausea.²⁶

This qualitative research explored the Islamic spiritual needs of patients with breast cancer and identified a rich spectrum of themes including religious interpretations of disease and expectations for technology-based interventions containing spiritual content. These findings provide an empirical foundation for designing spiritual nursing interventions that are culturally appropriate and beliefs to Muslim patients. In general, our results confirmed findings in the literature indicating that spirituality and religion play central roles in coping among patients with cancer and must be integrated into holistic treatment.⁴

Conclusion

This study indicated that Muslim patients with breast cancer have a variety of typical Islamic spiritual needs, including the need to interpret the disease according to the divine perspective (as a destiny and test from Allah), the need to improve and maintain the practice of worship during illness, the need for convenience and guidance in performing rituals (rukhsah), the need to express gratitude and find wisdom behind suffering, the need for assistance to achieve sincerity in accepting illness, the need for spiritual support from the family/environment, and the need for facilities to provide media or Islamic content to calm patients’ hearts while they undergo medical therapy.

Ethical approval

Ethical approval for this study was obtained from the appropriate institutional review board before the start of data collection (ethics No. 227/KEPK-RSISA/IX/2025). In addition, careful attention was paid to ensure that all participants fully understood the purpose and process of the study. Before each interview, participants were provided with clear verbal and written explanations of the study's aims, procedures, potential risks and benefits, and confidentiality measures, as well as the participants' right to withdraw at any time without consequences in their care. Written informed consent was obtained from all participants before the interview. Consent specifically included permission for audio recording the conversations. Signed consent forms were securely stored by the research team to ensure proper documentation. Participants were also reminded at the beginning of each interview that they could decline to answer any question or stop the interview at any time. These steps were taken to ensure that participation was voluntary, informed, and respectful of the dignity and autonomy of each woman who shared her experience.

Authors contributions

Desi Ariyana Rahayu: Conceptualization, Methodology, Data collection, Data analysis, Writing—original draft, Funding acquisition. NR: Conceptualization, Methodology, Data collection, Data analysis, Writing—review and editing. TS: Conceptualization, Methodology, Data analysis. AB: Conceptualization, Methodology, Data analysis. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript

Source of funding

We gratefully acknowledge financial support from the University MuhammadiyahSemarang for the research funding based on contract number 042/UNIMUS.L/PG/PDP/PJ.INT/2025.

Conflicts of interest

The authors have no conflict of interest to declare.