Table 1.

Spirituality in childhood cancer care: studies and main findings

Authors	Journal	Category	Main findings
Batista et al4	Revista Bioética	Importance of spirituality to patients, their families, and their caregivers	The study showed that the higher level of spirituality, the greater quality of life regarding peace. This conclusion leads to the reflection that it is important to focus not only on the disease, but also on the subjective aspects that provide inner peace.
Foster et al10	Seminars in Oncology Nursing	Strengthening of spirituality in the health care context	Spiritual care includes the creation of environments in which children and their families can continue to grow, especially throughout the illness experience. Attending to a person’s spirit respects the inherent inseparable relationship of mind–body–spirit and honors and responds to the core being of each person, recognizing his or her uniqueness.
Kamper et al11	Journal for Specialists in Pediatric Nursing	Importance of spirituality to patients, their families, and their caregivers	Children’s care will be enhanced when given the opportunity to express their spiritual and relational concerns. Children’s responses were primarily relational in nature, particularly to their parents. Seventy-eight percent of the interviewees reported they did something to “feel close to God.” Children prayed for a “sense of normalcy” (59%) and relational concerns (31%).
Faria et al1	Estudos de Psicologia (Natal)	Importance of spirituality to patients, their families, and their caregivers	The study confirms, through a qualitative approach, that the possibility of giving a meaning to the disease (eg, God’s will), diminishes feelings of guilt of the caregiver. Beliefs and spirituality give meaning to life, mitigating conflicts created by suffering and unexpected situations.
Angelo et al2	O Mundo da Saúde	Importance of spirituality to patients, their families, and their caregivers	Results of the study evidenced that suffering from cancer diagnosis of a child stimulates in the family a new way of looking at life, and that spirituality can have different meanings to the family while dealing with the disease.
Fornazari et al5	Psicologia: Teoria e Pesquisa	Importance of spirituality to patients, their families, and their caregivers	All participants referred to having a belief before receiving the diagnosis. However, this belief was deepened, and they hold to it more frequently after diagnosis.
Pedrão et al8	Einstein	Strengthening of spirituality in the health care context	The assessment of spiritual welfare of nurses showed that the majority of the nurses presented positive scores. It was considered important to offer the patient spiritual assistance. However, the majority of the interviewed nurses reported not having received a professional training on spiritual assistance in their graduation courses.
Alves et al22	O Mundo da Saúde	Strengthening of spirituality in the health care context	Spirituality/religiosity of patients is not fully comprehended. This can be due to lack of training or sensibility of health care professional. The study shows that it is important to overcome the biomedic model and the fragmented view of the patient, so as he/she can be treated as a whole.
Mueller et al15	Pediatric Nursing	Strengthening of spirituality in the health care context	Children are born with “spiritual competence,” an inner quality or power for faith development. Increased demands on time and rapidly changing complex medical cases allow less time and energy directed toward spiritual issues for the nurse, while at the same time increasing the possibility of spiritual needs of the child and family.
Nascimento et al20	Acta Paulista de Enfermagem	Strengthening of spirituality in the health care context	Religion and spirituality are sources of comfort and hope and have helped children and adolescents to better accept their chronic condition.
Angelo et al23	Escola Anna Nery Revista de Enfermagem	Importance of spirituality to patients, their families, and their caregivers	The mother needs to find support in faith, in “something” that transcends her strength and people’s support. It is important for the mother to have a place where she could feel comforted in the moments of fragility and practice her spirituality.
Hinds et al12	Journal of Clinical Oncology	Importance of spirituality to patients, their families, and their caregivers	Among parents whose child died in a pediatric intensive care unit, 73% identified faith-based sources of comfort at the end of their child’s life. Four religious themes were identified: prayer, faith, access to clergy, and belief that the parent–child relationship endures beyond death. Faith is important to some parents at this point in their child’s care. Clinicians can support parents’ faith-related practices by asking about parents’ beliefs, religious symbols, or practices and asking how clinicians can best show their respect.
Schneider and Mannell13	Issues in Comprehensive Pediatric Nursing	Importance of spirituality to patients, their families, and their caregivers	Data show that spirituality and faith, no matter how they are defined, appear to be important factors in the childhood cancer journey. Most parents in this study described their spirituality as being an effective coping mechanism. Not all parents defined spirituality from a purely religious perspective, though. During these difficult times, parents questioned their beliefs but did not turn away from their faith.
Moreira-Almeida et al19	Revista Brasileira de Psiquiatria	Importance of spirituality to patients, their families, and their caregivers	There is enough evidence that religious involvement is frequently associated with a better mental health state.
Ross16	Journal of Clinical Nursing	Importance of spirituality to patients, their families, and their caregivers	Clients and their families should benefit from care which is more holistic and addresses their deepest concerns and needs.
Paro et al18	Arquivos de Ciências da Saúde	Strengthening of spirituality in the health care context	The study identified that the caregiver is a complex being with feelings, needs, difficulties, and perceptions regarding his/her surroundings, but with a limited ability to cope with and change stressing situations, such as death in childhood.
Kane et al14	Journal of Pediatric Oncology Nursing	Strengthening of spirituality in the health care context	The concept of stress-buffering may also be relevant in spiritual support. Many agree that the keys to emotional coping with serious illness and disability are frequently found within the matrix of spirituality. Improved understanding of the social and spiritual support process will allow us to implement interventions designed to minimize the suffering and improve the quality of life of children living with and dying from serious illnesses and their families.
Lemos et al21	Revista Latino-Americana de Enfermagem	Strengthening of spirituality in the health care context	The study involved patients subjected to intrathecal chemotherapy and showed that patients find in spirituality, whether through beliefs or prayers, a coping strategy to face the challenges presented by the disease.
Taylor17	Cancer Nursing	Strengthening of spirituality in the health care context	The study identified spiritual needs associated with an “ultimate other;” the need for positivity, hope, and gratitude; the need to give and to receive love; the need to review beliefs, the need to have meaning; and needs related to religiosity and preparation for death.
WHO7	Social Science and Medicine	Strengthening of spirituality in the health care context	The WHOQOL includes a spiritual dimension (the person’s perception of “meaning in life” or the overarching personal beliefs that structure and qualify experience). We have argued elsewhere that the broad physical, psychological, social, and spiritual domains of quality of life are universal values across cultures, and there is some evidence that this is so. Based on the focus group data, several revisions were made to the proposed structure of the instrument. For example, religion and spirituality were consistently suggested as important dimensions of quality of life.

Abbreviations: WHO, World Health Organization; WHOQOL, World Health Organization Quality of Life.