Cancer is the second leading cause of death worldwide; about 1 in 6 deaths is due to cancer. 1World Health Organization Cancer. World Health Organization, 2018Available from: http://wwwwhoint/news-room/fact-sheets/detail/cancerDate accessed: August 12, 2018Google Scholar Diagnosis and medical treatment for cancer usually cause great physical and emotional distress and add stress to cancer patients' lives. 2Puchalski CM, King SD, Ferrell BR. Spiritual considerations. Hematol Oncol Clin North Am 505–17.Google Scholar Spirituality and religious beliefs have been found, especially important for patients who suffer from severe illness and/or are facing life-threatening health problems. 3Conway J. Integrating spiritual care as part of comprehensive cancer treatment. Oncol Nurse Advis 24–7.Google Scholar Spirituality is an aspect of one's life regarding seeking meaning, purpose, and connection to a higher power, and it allows the individual to effectively function toward his/her life goal. 4Lee YH, Salman A. The mediating effect of spiritual well-being on depressive symptoms and health-related quality of life among elders. Arch Psychiatr Nurs 418–24.Google Scholar It is believed that spirituality is one essential factor providing a context for cancer patients to derive hope and meaning to cope with their illness from the diagnosis through treatment, survival, recurrence, and dying, and it could serve as a protector buffers the deteriorating impacts of life stress and illness. 2Puchalski CM, King SD, Ferrell BR. Spiritual considerations. Hematol Oncol Clin North Am 505–17.Google Scholar, 5Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol 49–55.Google Scholar Individuals who are living with a life-threatening illness such as cancer may be most vulnerable to spiritual distress and are more aware and sensitive to their spiritual selves and spiritual needs. 3Conway J. Integrating spiritual care as part of comprehensive cancer treatment. Oncol Nurse Advis 24–7.Google Scholar, 5Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol 49–55.Google Scholar, 6Cheng Q, Xu X, Liu X, Mao T, Chen Y. Spiritual needs and their associated factors among cancer patients in China: A cross-sectional study. Support Care Cancer 3405–12.Google Scholar Addressing spiritual needs could help patients cope with the challenges associated with illness. 7Hodge DR, Sun F, Wolosin RJ. Hospitalized Asian patients and their spiritual needs: Developing a model of spiritual care. J Aging Health 380–400.Google Scholar As spirituality is a critical component of holistic and person-centered care, spiritual interventions should be considered and incorporated into the plan of care for each cancer patient. 2Puchalski CM, King SD, Ferrell BR. Spiritual considerations. Hematol Oncol Clin North Am 505–17.Google Scholar, 5Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol 49–55.Google Scholar During the past decade, there has been a considerable increase in the number of studies in spiritual and religious coping in adjustment to severe illness such as cancer. 8National Institutes of Health Spirituality in Cancer Care (PDQ®): Health Professional Version.Available from: https://wwwcancergov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-hp-pdqDate: 2017Date accessed: August 16, 2018Google Scholar Spirituality is one essential indicator of quality of life, 4Lee YH, Salman A. The mediating effect of spiritual well-being on depressive symptoms and health-related quality of life among elders. Arch Psychiatr Nurs 418–24.Google Scholar, 9Amoah CF. The central importance of spirituality in palliative care. Int J Palliat Nurs 353–8.Google Scholar and spiritual well-being is found to be positively associated with spirituality and health outcomes in patients diagnosed with cancer. 5Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol 49–55.Google Scholar, 10Bai M, Lazenby M. A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer. J Palliat Med 286–98.Google Scholar Cancer patients who had high levels of spiritual well-being reported better quality of life, a lower level of depression, less anxiety about death, and a lower level of distress. 5Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol 49–55.Google Scholar, 8National Institutes of Health Spirituality in Cancer Care (PDQ®): Health Professional Version.Available from: https://wwwcancergov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-hp-pdqDate: 2017Date accessed: August 16, 2018Google Scholar Cancer patients reported that spirituality is a source of strength that helps them cope with their cancer experiences, define wellness during treatment and survivorship, find meaning in their lives, find a sense of health, and make sense of their cancer experiences during illness. 5Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol 49–55.Google Scholar Consistent associations between spirituality, spiritual well-being, and health outcomes found in published studies highlight the importance of providing spiritual care to enhance cancer patients' spiritual well-being and address their spiritual needs. Experiencing spiritual distress is not uncommon among cancer patients. 8National Institutes of Health Spirituality in Cancer Care (PDQ®): Health Professional Version.Available from: https://wwwcancergov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-hp-pdqDate: 2017Date accessed: August 16, 2018Google Scholar Unfulfilled spiritual needs could be a contributor causing distress. 2Puchalski CM, King SD, Ferrell BR. Spiritual considerations. Hematol Oncol Clin North Am 505–17.Google Scholar Spiritual distress and suffering may influence a person's experiences and symptoms associated with illness and contribute to poorer health and psychosocial outcomes. 2Puchalski CM, King SD, Ferrell BR. Spiritual considerations. Hematol Oncol Clin North Am 505–17.Google Scholar, 8National Institutes of Health Spirituality in Cancer Care (PDQ®): Health Professional Version.Available from: https://wwwcancergov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-hp-pdqDate: 2017Date accessed: August 16, 2018Google Scholar Cancer patients' spiritual needs should be assessed and addressed when planning and providing care to them, and the assessment for spiritual wellness and distress is vital in addressing cancer patients' needs, 10Bai M, Lazenby M. A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer. J Palliat Med 286–98.Google Scholar, 11Hui D, de la Cruz M, Thorney S, Parsons HA, Delgado-Guay M, Bruera E, et al. The frequency and correlates of spiritual distress among patients with advanced cancer admitted to an acute palliative care unit. Am J Hosp Palliat Care 264–70.Google Scholar Health-care providers have responsibilities to provide holistic care to patients with cancer and to acknowledge and encourage exploration of their spiritual issues and needs. 3Conway J. Integrating spiritual care as part of comprehensive cancer treatment. Oncol Nurse Advis 24–7.Google Scholar Nurses and other health-care professionals should be educated and trained to be competent in assessing and addressing cancer patients' spiritual needs. The impacts of culture should be taken into account to provide holistic and culturally competent spiritual care to provide each cancer patient with appropriate spiritual care and to address each cancer patient's spiritual needs. 12Cockell N, McSherry W. Spiritual care in nursing: An overview of published international research. J Nurs Manag 958–69.Google Scholar, 13Lee YH, Salman A. Evaluation of using the Chinese version of the spirituality index of well-being (SIWB) scale in Taiwanese elders. Appl Nurs Res 206–11.Google Scholar The connections between spirituality, culture, and religion are dynamical and reciprocal. 14Surbone A, Baider L. The spiritual dimension of cancer care. Crit Rev Oncol Hematol 228–35.Google Scholar Culture could influence a person's spiritual belief, spiritual well-being, and spiritual practices since spirituality is experienced through daily lived experience. 13Lee YH, Salman A. Evaluation of using the Chinese version of the spirituality index of well-being (SIWB) scale in Taiwanese elders. Appl Nurs Res 206–11.Google Scholar Reciprocally, spiritual and religious beliefs may contribute to an individual's interpretation and management of physical and psychological distress as well as play an imperative role in shaping one's cultural understandings of life, death, and living a meaningful life. 7Hodge DR, Sun F, Wolosin RJ. Hospitalized Asian patients and their spiritual needs: Developing a model of spiritual care. J Aging Health 380–400.Google Scholar, 14Surbone A, Baider L. The spiritual dimension of cancer care. Crit Rev Oncol Hematol 228–35.Google Scholar, 15Martin EM, Barkley TW Jr. Improving cultural competence in end-of-life pain management. Home Healthc Now 96–104.Google Scholar For example, cancer patients' perceptions and interpretations of pain could be influenced by a combination of various social, cultural, and spiritual factors. 15Martin EM, Barkley TW Jr. Improving cultural competence in end-of-life pain management. Home Healthc Now 96–104.Google Scholar Patients from some cultures may believe that pain is a part of God's plan or is a sign of progress toward recovery, while other patients from different cultural groups may review pain as the result of an imbalance between yin and yang. 15Martin EM, Barkley TW Jr. Improving cultural competence in end-of-life pain management. Home Healthc Now 96–104.Google Scholar A spiritual intervention may be as effective as a medical intervention in pain management for cancer patients. 2Puchalski CM, King SD, Ferrell BR. Spiritual considerations. Hematol Oncol Clin North Am 505–17.Google Scholar Assessing cancer patients' spiritual, cultural, and social beliefs is important, and it could help health-care providers to more accurately assess cancer patients' perceptions of physical and psychological distress and adequately provide interventions and medications to cancer patients. While individuals with the same cultural background or within the same religious group most likely share a set of common beliefs, it should be acknowledged that there is variance in beliefs and spiritual needs among different individuals and situations. The mixture of spirituality, religion, culture, and the beliefs of individuals, families, communities, and other social structures powerfully influence patients' decision-making, care delivery, and views about death and illness. 14Surbone A, Baider L. The spiritual dimension of cancer care. Crit Rev Oncol Hematol 228–35.Google Scholar, 16Fang ML, Sixsmith J, Sinclair S, Horst G. A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: Findings from a scoping review. BMC Geriatr 107.Google Scholar It is crucial that health-care providers acknowledge and adapt culturally appropriate and patient-centered care to fulfill the diverse spiritual needs of patients. As spiritual care for cancer patients needs to be interdisciplinary and culturally appropriate, using valid and reliable instruments and tools that are culturally appropriate for assessing spiritual needs and evaluating outcomes of spiritual care becomes extremely important. 13Lee YH, Salman A. Evaluation of using the Chinese version of the spirituality index of well-being (SIWB) scale in Taiwanese elders. Appl Nurs Res 206–11.Google Scholar A culturally appropriate and responsive spiritual assessment is the initial step to address the spiritual needs of patients. 13Lee YH, Salman A. Evaluation of using the Chinese version of the spirituality index of well-being (SIWB) scale in Taiwanese elders. Appl Nurs Res 206–11.Google Scholar Uses of culturally appropriate tools could aid in integrating culturally specific spiritual beliefs and practices into the plan of spiritual care and allow health-care providers to respond better to cancer patients' spiritual needs. Although many assessment tools are available and applicable to perform a religious and spiritual assessment, it is unclear whether these tools originally developed for Western populations are equally reliable and valid for the use in Asian populations. Appropriate tools and instruments for assessing patients' spiritual needs, spiritual distress, and spiritual well-being in Asian populations which are influenced by their unique and diverse spiritual, religious, and cultural beliefs may be absent or scarce. The lack of valid and reliable tools that are culturally appropriate and sensitive could be a barrier that limits nurses and health professionals' capabilities to deliver appropriate spiritual care to address Asian cancer patients' spiritual needs and to evaluate the outcomes of spiritual care. Further efforts to develop appropriate assessment tools for the Asian populations require researchers' attentions. Although responding to diverse spiritual needs may be challenging, this process can be rewarding for health-care providers, patients, and patients' family members since it provides chances for reciprocal spiritual and religious growth during the exchange of new understandings and meanings. 3Conway J. Integrating spiritual care as part of comprehensive cancer treatment. Oncol Nurse Advis 24–7.Google Scholar Even if the integral role of providing spiritual care as part of a holistic approach to cancer patients and the necessity for spiritual assessment is generally recognized, cancer patients reported their spiritual needs were not recognized, addressed, or supported. 5Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol 49–55.Google Scholar, 8National Institutes of Health Spirituality in Cancer Care (PDQ®): Health Professional Version.Available from: https://wwwcancergov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-hp-pdqDate: 2017Date accessed: August 16, 2018Google Scholar, 17Richardson P. Spirituality, religion and palliative care. Ann Palliat Med 150–9.Google Scholar Multiple complex barriers have been reported in literature such as spiritual and religious differences between patients and providers, a lack of understanding of spirituality, a lack of education and preparedness, and a lack of time and experience to adequately address patients' spiritual needs and deliver spiritual care. 2Puchalski CM, King SD, Ferrell BR. Spiritual considerations. Hematol Oncol Clin North Am 505–17.Google Scholar, 18Zakaria Kiaei M, Salehi A, Moosazadeh Nasrabadi A, Whitehead D, Azmal M, Kalhor R, et al. Spirituality and spiritual care in Iran: Nurses' perceptions and barriers. Int Nurs Rev 584–92.Google Scholar, 19Saguil A, Phelps K. The spiritual assessment. Am Fam Physician 546–50.Google Scholar The barriers to providing spiritual care must be overcome so that appropriate and comprehensive care can be delivered to address cancer patients' needs. Given the fact that the significance of providing spiritual care to cancer patients has become increasingly more evident, nurses and other health-care professionals have responsibilities to assess cancer patients' spiritual needs as well as to plan and deliver culturally appropriate spiritual care to them. More studies investigating spiritual well-being, spiritual needs, and culturally appropriate spiritual care for cancer patients with Asian cultural backgrounds are urgently needed to overcome barriers preventing the delivery of proper and competent spiritual care to all cancer patients. It is necessary to ensure nurses become familiarized with the aspects of spirituality, understand cultural influences on cancer patients' spirituality and spiritual well-being, and overcome the barriers to providing spiritual care to properly deliver appropriate and comprehensive care to each cancer patient. A growing number of studies have investigated the linkages between spirituality and health outcomes in cancer patients and emphasized the importance of spiritual care and spiritual well-being in cancer patients worldwide; however, the majority of these studies were carried out in Western countries. Research that explored and provided evidence regarding spirituality and spiritual care among cancer patients in Asian countries is scarce. The lack of information causes a knowledge gap that limits health-care providers' capabilities to deliver appropriate spiritual care to oncology patients with Asian cultural backgrounds. Studies to investigate barriers and facilitators to the delivery of culturally appropriate and sensitive spiritual care among cancer patients with diverse cultural and social backgrounds in Asian countries require further attentions and efforts. The aim of this special issue is to provide a platform for health professionals, researchers, educators, politicians, nongovernment agencies, and interested others to share knowledge and experiences on developing and providing spiritual care for cancer patients in Asian countries. It is our intent to create a dialog to gain a deeper understanding about developing and providing spiritual care in Asia and for the future collaboration and support of each other to improve spiritual care in this region. The papers in this issue contribute to enhancing our knowledge and capabilities in assessing and addressing spiritual needs as well as developing and delivering culturally appropriate and patient-centered spiritual care to all cancer patients. It is a great privilege to write the editorial for this special issue, and I appreciate all the authors who contributed their excellent work to this special issue. Nil. There are no conflicts of interest.
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