A Spiritual Health Intervention (PATH) for Improving Spiritual, Religious and Emotional Distress in Cancer Patients

Feasibility will be examined by conducting frequency and descriptive statistics for enrollment rates. The benchmark for feasibility is ≥ 50% of screened eligible patients enroll in the study. To test this, will perform a one-sample proportion test to examine if the proportion of participants meeting the benchmark for feasibility is significantly higher than 0.50. Feasibility process outcomes will be analyzed to determine whether the intervention is feasible for future dissemination and implementation efforts and recruitment of a full-scale randomized controlled trial.

Intervention completion metrics will include all 6 intervention sessions as well as both follow-up timepoints (days 42 and 84). Patients will be required to attend at least 70% of all sessions (5 of 6). Feasibility will be examined by conducting frequency and descriptive statistics for intervention completion. The benchmark for feasibility is ≥ 70% of enrolled patients completing the intervention. To test this, will perform a one-sample proportion test to examine if the proportion of participants meeting the benchmark for feasibility is significantly higher than 0.70. Feasibility process outcomes will be analyzed to determine whether the intervention is feasible for future dissemination and implementation efforts and recruitment of a full-scale randomized controlled trial.

Acceptability will be assessed by the Theoretical Framework of Acceptability (TFA) questionnaire and three additional quality improvement questions. To analyze intervention acceptability, scores on the TFA questionnaire will be calculated using the total mean score of seven TFA items. In this study, will use a cutoff of >= 70% of patients agreeing (or rating as confident, liking, acceptable or 4 out of 5 or higher on the TFA) as being acceptable for use.

Satisfaction will be assessed by using three items assessing overall satisfaction. Satisfaction thresholds will require an average or mean of 7 out of 10 on each of the three items.

Spiritual, religious, and existential (SRE) distress will be measured using the Religious and Spiritual Struggles Scale-5 (RSS-5), a valid and reliable 5-item Likert-type self-report measure of spiritual struggle. Each item is rated on a 5-point scale ranging from 1 ("not at all") to 5 ("a great deal"). Item scores are summed or averaged to create an overall SRE distress score. Total mean score ranges from 1 to 5, with higher scores indicating greater levels of SRE distress. Change in SRE distress will be assessed at baseline and at 1- and 6-week follow-up.

Self-transcendence will be measured using the Self-Transcendence Scale (STS), a validated 15-item Likert-type self-report measure assessing individuals' sense of connection to something greater in 4 realms (intrapersonal, interpersonal, temporal and transpersonal). Each item is rated on a 4-point scale ranging from 1 ("not at all") to 4 ("very much"), and item scores are summed or averaged to generate an overall self-transcendence score. Total mean score ranges from 1 to 4, with higher scores indicating greater levels of self-transcendence. Change in self-transcendence will be assessed at baseline and at 1- and 6-week follow-up.

Psychological distress will be measured using the Patient Health Questionnaire-8 (PHQ-8), a well-validated 8-item Likert-type self-report measure of depressive symptoms commonly used in cancer populations. Each item is rated on a 4-point scale ranging from 0 ("not at all") to 3 ("nearly every day"), and all items are summed to produce a total score. Total scores can range from 0 to 24, with higher scores indicating greater levels of psychological distress. Change in distress will be assessed at baseline and at 1- and 6-week follow-up.

Anxiety will be measured using the Generalized Anxiety Disorder-7 (GAD-7), a validated 7-item Likert-type self-report measure of anxiety severity. Each item is rated on a 4-point scale ranging from 0 ("not at all") to 3 ("nearly every day"), and item scores are summed to create a total anxiety score. Total scores can range from 0 to 21, with higher scores indicating greater levels of anxiety. Change in anxiety will be assessed at baseline and at 1- and 6-week follow-up.