Table 4.

Representative Theme Quotes on the Appropriateness of Prayer in the Cancer Care Context According to Advanced Cancer Patients, Oncology Physicians, and Nurses, n = 388

Theme	Respondent	Representative Quote
Conditions for patient-practitioner prayer	Cancer patient	If the MD is comfortable praying then it is fine but it must be genuine. Prayer is always good because it is a powerful force. Context is very important. It is helpful if both are of the same beliefs but even this is not absolutely necessary. There needs to be a comfort level between people for it to be appropriate.
	Oncology nurse	As for offering prayer, my bias is not to offer but to let the patient take the lead, so as not to make the mistake of imposing prayer on someone who doesn’t want it, or who sees the oncologist as not responsible for that role. However, there are parts of the country and patient populations where oncologists may be expected to offer prayer more often, and if so, after considering these cultural issues and discussing with peers, it may be appropriate for the oncologist to offer prayer more frequently.
	Oncology physician	I think it would only be appropriate for the nurse to offer prayer if she/he knew the patient very well in the context of their religious/spiritual preferences and shared that similarity.
Potential benefits of patient-practitioner prayer	Cancer patient	If they are willing, it would make the patient feel more helped and at peace.
	Oncology physician	Praying with a patient if requested by the patient may be appropriate as a way of supporting the patient and providing comfort.
	Oncology nurse	For many individuals, spirituality is very important. For these patients offering spiritual support can make a great difference in how they respond to their treatment and diagnosis.
Critical attitudes toward patient-practitioner prayer	Oncology nurse	I am a practitioner of medicine not spirituality. I can refer patients to spiritual advisors but would never personally pray with a patient, I personally do not feel that it is appropriate. And as an atheist, I do not feel that I offer any type of prayer with any credible level of sincerity.
	Cancer patient	Religion is private. Treat [my] disease, not my soul.
	Oncology physician	Patient-initiated prayer would require faking, whereas a nurse offering prayer seems to be crossing professional boundaries. I would not take them out to dinner either.
Positive attitudes toward patient-practitioner prayer	Cancer patient	It is appropriate because God is so important and powerful. God is a healer. It is important for the physician to know where I as the patient stand. I go home with God and they should know how I feel on the inside. If offered prayer, the patient can easily decline if they are not interested in receiving prayer. But another patient may be very interested in receiving that prayer.
	Oncology physician	If praying provides the patient with comfort and the physician feels comfortable praying with the patient, it is a beneficial thing to do in keeping with a physician’s mission.
	Oncology nurse	As nurses our job is to provide comfort. If prayer is a way to do this then we should help the patient with prayer, even if we do not share the same beliefs.
Potential negative consequences of patient-practitioner prayer	Oncology nurse	It may be appropriate. However, it needs to be clear that the oncologist visits are not primarily spiritual. If an oncologist privately chooses to pray for patients, that is completely appropriate. However, it seems that discussing it with a patient may cause awkwardness and deflect the focus from more important parts of the oncologist’s job.
	Cancer patient	If they offered [prayer] I would think that I’m very sick.
	Oncology physician	I am personally not comfortable praying with patients. Offering prayer is lovely and from the heart, but I have an uncomfortable feeling that it is imposing beliefs that the patient might not share. Asking permission would be more appropriate, or praying only when the patient requests.
Prayer alternatives	Cancer patient	It is fine for the physician to pray on his own without disclosing to the patient directly.
	Oncology nurse	Even if the oncologist is not spiritual and/or religious, they can bow their head in respectful silence while the patient prays. If they are religious, they can join aloud or silently. If the provider is religious, it would be natural to offer a prayer for their patients in general or a specific patient, either privately or as part of a formal service, e.g., “prayers of the people” in the Anglican or Catholic tradition.
	Oncology physician	Religion is a personal matter. I am happy to support my patients in their views, but do not feel comfortable in participating in their practices with them.