A systematic review and meta-analysis of effects of psychosocial interventions on spiritual well-being in adults with cancer

Laurie E. McLouth, C. Graham Ford, James E. Pustejovsky, Crystal L. Park, Allen C. Sherman, Kelly Trevino, John M. Salsman

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Objective: Spiritual well-being (SpWb) is an important dimension of health-related quality of life for many cancer patients. Accordingly, an increasing number of psychosocial intervention studies have included SpWb as a study endpoint, and may improve SpWb even if not designed explicitly to do so. This meta-analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on SpWb in adults with cancer and tested potential moderators of intervention effects. Methods: Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which SpWb was an outcome. Doctoral-level rater pairs extracted data using Covidence following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Standard meta-analytic techniques were applied, including meta-regression with robust variance estimation and risk-of-bias sensitivity analysis. Results: Forty-one RCTs were identified, encompassing 88 treatment effects among 3883 survivors. Interventions were associated with significant improvements in SpWb (g = 0.22, 95% CI [0.14, 0.29], p < 0.0001). Studies assessing the FACIT-Sp demonstrated larger effect sizes than did those using other measures of SpWb (g = 0.25, 95% CI [0.17, 0.34], vs. g = 0.10, 95% CI [−0.02, 0.23], p = 0.03]. No other intervention, clinical, or demographic characteristics significantly moderated effect size. Conclusions: Psychosocial interventions are associated with small-to-medium-sized effects on SpWb among cancer survivors. Future research should focus on conceptually coherent interventions explicitly targeting SpWb and evaluate interventions in samples that are diverse with respect to race and ethnicity, sex and cancer type.

Original languageEnglish
Pages (from-to)147-158
Number of pages12
Issue number2
StatePublished - Feb 2021

Bibliographical note

Funding Information:
We thank Mark Berendson, for his contribution designing search strategies for the larger meta‐analysis comprising this study R03CA184560 (PI: Salsman), and Craig Esposito, for his assistance in abstract reviews. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number R03CA184560 (PI: Salsman). Dr. McLouth was supported by R25CA122061 (PI: Avis) and the University of Kentucky Markey Cancer Center (P30 CA177558).

Publisher Copyright:
© 2020 John Wiley & Sons Ltd.


  • cancer
  • interventions
  • meta-analysis
  • psycho-oncology
  • randomized controlled trials
  • spiritual well-being

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Oncology
  • Psychiatry and Mental health


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