Document Type : Original Article


1 Department of Midwifery, Faculty of Nursing and Midwifery, Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran

2 Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia Branch, Urmia, Iran

3 Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Islamic Azad University, Urmia Branch, Urmia, Iran


BACKGROUND: Death anxiety is one of the most common problems among women with cancer,
which can affect the useful treatment process. With regard to the superior role of spiritual well‑being
over other aspects of health, the present study is aimed to compare the relationship between spiritual
well‑being and death anxiety among women with breast and cervical cancers and women with gastric
and colorectal cancers.
METHODOLOGY: This was a descriptive–correlational study. Research statistical population included
Iranian women with cancer at major hospitals in Isfahan, Iran. 160 research samples were selected
through convenience sampling method based on inclusion criteria using a demographic questionnaire,
spiritual well‑being scale (Paloutzian et al.) and death anxiety scale (Templer). Research data were
analyzed through SPSS 22 using independent t‑test, Pearson’s correlation, and analysis of variance
at significance level 0.05.
RESULTS: The study findings indicated a significant inverse relationship between death anxiety
and spiritual well‑being (at 0.05) in both groups. As a result, people with higher spiritual well‑being
would experience less anxiety about death. In addition, the relationship between death anxiety and
spiritual well‑being in women with gastric and colorectal cancers was stronger than those with breast
and cervical cancers.
CONCLUSION: Spiritual well‑being is of effective factors of death anxiety among women suffering
from cancer. Spirituality and meeting spiritual needs are considered as nursing care priorities for
these women. Furthermore, paying attention to the spirituality by nurses may shield against individual


  1. Babazadeh M, Pourali L, Attaran N, Nikfarjam Z, Masoudi T,
    Salehi M. Demographic survey of 600 patients with gynecologic
    cancers in Mashhad, Iran in 1985‑2012. Iran J Obstetr Gynecol
    Infertil 2016;19:1‑8.
    2. Soltan Dallal MM, Yazdi MH, Mohammad Hassan ZH,
    Holakuyee M, Abedi Mohtasab TP, Aminharaty F, et al. The
    evaluation of probiotic effect of L. acidophilus on the immune
    responses in BALB/c mice against transplanted tumor derived
    from breast tissue. Adv Med Biomed Res 2010;18:37‑48.
    3. Manganiello A, Hoga LA, Reberte LM, Miranda CM, Rocha CA.
    Sexuality and quality of life of breast cancer patients post
    mastectomy. Eur J Oncol Nurs 2011;15:167‑72.
    4. Vaziri S, Lotfi Kashani F, Akbari ME, Hosseini L, Sarafraz S.
    Perceptions of the spouse’s role and opposite sex relationship
    in breast cancer women with mastectomy and healthy women.
    Cibtech J Zool 2014;3:118‑24. Available from: http://www.‑Zoology/PUBLICATIONS/2014/Vol_3_No_2/
    CJZ‑03‑02‑Contents.htm. [Last accessed on 2020 Jul 10].
    5. Khadijeh O, Alireza A, Elaheh J. Epidemiology of human
    papilloma virus (HPV) type 16 and 18 in the patients with cervical
    cancer in Tehran. J Microbial World 2016;8:281‑9. Available from: [Last accessed on
    2020 Jul 10].
    6. Javadzade SH, Reisi M, Mostafavi F, Hasanzade A, Shahnazi H,
    Sharifirad G. Factors associated with the fecal occult blood testing
    for colorectal cancer screening based on health belief model
    structures in moderate risk individuals, Isfahan, 2011. J Educ
    Health Promot 2012;1:18. [Last accessed on 2020 Jul 10].
    7. Ramesht MH, Pourfarzi F, Entezari M, Karamati H. An
    Epidemiologic study of spatial and temporal patterns of gastric
    cancer in Ardabil years 2006‑2012. J Health 2015;6:345‑54. Available
    [Last accessed on 2020 Jul 10].
    8. Rahimi Pordanjani S, Baeradeh N, Lotfi MH, Pourmohammadi B.
    Epidemiology of colorectal cancer: Incidence, mortality, survival
    rates and risk factors. Razi J Med Sci 2016;23:41‑50. Available from:‑1‑4116‑en.html. [Last accessed on
    2020 Jul 10].
    9. Momeni M, Ghanbari A, Jokar F, Rahimi A, Leyli EK. Predictors
    of quality of life in patients with colorectal cancer in Iran. Indian
    J Cancer 2014;51:550‑6.
    10. Salajegheh S, Raghibi M. The effect of combined therapy of
    spiritual‑cognitive group therapy on death anxiety in patients
    with cancer. SSU J 2014;22:1130‑9. Available from: http://jssu.‑1‑2322‑en.html. [Last accessed on 2020 Jul 10].
    11. Lehto RH, Stein KF. Death anxiety: An analysis of an evolving
    concept. Res Theory Nurs Pract 2009;23:23‑41.
    12. Bahrami N, Moradi M, Soleimani MA, Kalantari Z, Hosseini F.
    Death anxiety and its relationship with quality of life in women
    with cancer. Iran J Nurs 2013;26:51‑61. Available from: http://‑1‑1562‑en.html. [Last accessed on 2020 Jul
    13. Hosseini R, Alijanpour Agamaleki M, Mehrabi T, Ziraki Dana A,
    Dadkhah A. The relationship between existential dimension of
    spiritual well‑being and quality of life in women with infertility.
    J Health Care 2014;16:53‑60. Available from: http://hcjournal.‑1‑271‑en.html. [Last accessed on 2020 Jul 10].
    14. Khezri L, Bahreyni M, Ravanipour M, Mirzaee K. The Relationship
    between spiritual wellbeing and depression or death anxiety in
    cancer patients in Bushehr 2015. Nurs Vulnerables 2015;2:15‑28.
    15. Fathi M, Sanagoo A, Joibari L, Yazarloo M, Sharifi Nia H. Death
    anxiety in hemodialysis patients admitted to Panj‑Azar teaching
    hospital, 2013. Nurs Res Censer Golestan Univer Med Sci Gorgan
    Iran 2016;12:48‑55.
    16. Aghajani M, Valiee S, Tol A. Death anxiety amongst nurses
    in critical care and general wards. Iran J Nurs 2010;23:59‑68.
    Available from:
    aspx?ID=214099. [Last accessed on 2020 Jul 10].
    17. Tomás‑Sábado J, Gómez‑Benito J. Psychometric properties of
    the Spanish form of Templer’s Death Anxiety Scale. Psychol Rep
    18. Farahaninia M, Abbasi M, Haghani H. Nursing students’ spiritual
    well‑being and their perspectives towards spirituality and
    spiritual care perspectives. Iran J Nurs 2006;18:7‑14.
  2. 19. Baljani E, Khashabi J, Amanpour E, Azimi N. Relationship
    between spiritual well‑being, religion, and hope among patients
    with cancer. J Hayat 2011;17:27‑37. Available from: http://hayat.‑1‑52‑en.html. [Last accessed on 2020 Jul 10].
    20. Abhari MB, Fisher JW, Kheiltash A, Nojomi M. Validation of the
    persian version of spiritual well‑being questionnaires. Iranian
    journal of medical sciences. 2018;43(3):276. PMCID: PMC5993904.
    Available from:
    PMC5993904/pdf/IJMS‑43‑276.pdf. [Last accessed on 2020 Jul
    21. Aghabarari M, Ahmadi F, Aghaalinejad H, Mohammadi E,
    Hajizadeh E. Effect of designed exercise program on stress,
    anxiety and depression in women with breast cancer receiving
    chemotherapy. J Shahrekord Univer Med Sci 2008;9:26‑35.
    Available from: [Last
    accessed on 2020 Jul 10].
    22. Gurm BK, Stephen J, MacKenzie G, Doll R, Barroetavena MC,
    Cadell S. Understanding Canadian Punjabi‑speaking South Asian
    women’s experience of breast cancer: A qualitative study. Int J
    Nurs Stud 2008;45:266‑76.
    23. Missel M, Birkelund R. Living with incurable oesophageal cancer.
    A phenomenological hermeneutical interpretation of patient
    stories. Eur J Oncol Nurs 2011;15:296‑301.
    24. Moghimian M, Salmani F. The study of correlation between
    spiritual well‑being and hope in cancer patients referring
    to Seyyedo Shohada Training‑Therapy Center of Isfahan
    University of Medical Sciences, 2010, Isfahan, Iran. Qom Univ
    Med Sci J 2012;6:40‑5. Available from:
    article‑1‑120‑en.html. [Last accessed on 2020 Jul 10].
    25. Kim SH. The effects of spiritual interventions in patients with
    cancer: A meta‑analysis. Oncol Nurs Forum 2014;41:E290.
    26. RezaieShahsavarloo Z, Taghadosi M, Mousavi M, Lotfi MS,
    Harati KH. The relationship between spiritual well‑being &
    religious attitudes with life satisfaction in elderly cancer patients.
    Iran J Psychiatr Nurs 2016;4:47‑55.
    27. Askarizadeh G, Babaei MR, Karamoozian M. Relationship
    between spirituality and sensation seeking with tanatophobia in
    hemodialysis patients. J Res Health 2018;8:322‑8.
    28. Cooper RS. Case study of a chaplain’s spiritual care for a patient
    with advanced metastatic breast cancer. J Health Care Chaplain