A) Background
The relationship between faith and health has been a relatively ignored subject within Danish health care research. However, recent years have shown an increased focus on the field, among other things inspired by growing international research activity. Several sociological studies confirm that approx. 65% of the Danish population believes in a deity. The number of people declaring themselves as atheists is close to 5% [1]. 57 % states that they say a prayer every now and then, and 26% states that they pray every day [2]. Since international research has established connections between faith and risk of disease, longevity, quality of life, and coping with illness, it is evidently interesting to examine similar relationships in Denmark and putting them into a larger European and international perspective.
B) Motivation
The relevancy of research within this field is primarily substantiated by three factors:
B1) Understanding and support. Exploration and dissemination of information about the focus points of the project will, among other things help religious people who are struck by illness to receive qualified support and understanding of their religious ad existential need from both the health care personnel as well as professionals from the religious sector [3, 4, 5, 6]. There is a need for this, as many cancer patients report about insufficient understanding of existential and religious issues when in contact with health care professionals [7:181].
B2) European relevance. Furthermore, Danish research in faith and health could make a considerable contribution to European research within this area. There is only limited knowledge about the scope and application of using religion as a tool in secular societies. Denmark may be characterised as a highly secular society [8] and exploring the significance of faith/religion in Denmark is thus assessed as having the potential to provide results of international relevance. This is also supported by the potential of world-class registry research, which is provided by the Danish Civil Registration System (called CPR) which will be used in two of the projects described (see appendices 6.G1-2).
B3) Integration. Finally, it should be mentioned that immigration to Europe, primarily from Moslem countries, has meant that secular and strong religious traditions cross each other and sometimes collide with each other. No Danish research exists on this, but there is some international research in the field [9, 10, 11]. This framework project will seek to promote understanding of the existential and religious needs of different cancer patients, and may thus contribute to integration in a previously unexplored field.
C) International research in faith and health
The number of articles on faith-related topics from medical and psychological journals have ”exploded” over the last few decades [12,13]. A search containing the term ”Spirituality” on PubMed in consecutive periods of three years led to the following number of articles: 1990-1992: 51; 1993-1995: 90; 1996-1998: 217; 1999-2001: 457; 2002-2004: 1027; 2005-2007: 1441. This is a tangible manifestation of substantial and fast-growing research activity, which has been described in a number of anthologies and reviews [14, 15, 16, 17, 18]. International research within this field has revolved around the concepts of belief and religiousness, and in recent decades around spirituality, and there is an aim for promoting common semantic frames of reference [19, 20, 21].
The research has mainly been carried out within nursing research and evidence-based medicine, especially epidemiology, where we now talk of the concept of “religious epidemiology” [22]. The extensive research deals with the relationship between faith and health – including the key stages of cancer say: Diagnosis [23], treatment [24], rehabilitation [25] and palliation [26]. The studies can be divided into descriptive studies, including the risk of illness (C1.1), best practices (C1.2) and religious changes in case of illness (C1.3), as well as intervention studies (C2).
C1) Descriptive studies
C1.1) The influence of religious matters on the development of illness (risk of illness). Research in this field has primarily included epidemiologic risk studies. The findings indicate that faith and the practising of it are associated with increased health, reduced risk of developing mental and somatic illness, improved quality of life, faster recovery when ill, and increased longevity [27, 28]. Existing studies suggest in particular that a. healthy life style b. increased social support, and c. the importance of hope as being explanatory mechanisms behind the connections between faith and health [22, 29].
C1.2) The influence of religious issues on coping with illness (religious coping). Both quantitative survey studies [18], qualitative studies [30, 31, 32] and theological analyses [33, 34] have sought to examine the possible potentially positive influence that existential and religious issues may have on quality of life and coping with mental and somatic illnesses. Positive religious coping practices have been thought to be associated with increased quality of life, better psychological handling of crises, lower risk of cancer-related depression, and increased longevity [18, 35, 36]. However, religious faith may also be suspected of leading to unfavourable coping, also known as negative religious coping. This might be the case, if a person was to have negative images of God (e.g. God as a punishing judge), which is associated with destructive perceptions of illness (e.g. the illness as punishment) and which seems to have the opposite effect on illness, quality of life, risk of depression, improvement and longevity [37, 38].
C1.3) The influence of illness on religious change. Within the sociological research of religious conversion it is a prevailing and evidence-supported assumption that changes in a person’s belief often occur in connection with a life crisis, e.g. in case of life threatening disease [39, 40]. The Danish belief has been characterised as crisis belief, a type of belief, which is highly activated by illness, but ironically we have almost no evidence-based knowledge on these matters in Denmark.
C2) Intervention studies
So far, research literature has been influenced by an attitude saying that the faith/health field at its current stage should primarily be regarded as basic science. However, this does not mean that intervention studies have been ignored. Thus, the importance of asking about the patient’s spiritual background when making the admittance record has been examined (”taking a spiritual history”) [41, 42]. Here, assessments have been made of the usefulness of a standardised control (”spiritual screening”) of a possible mental crisis arising from the belief that the disease could be God’s punishment [43]. Furthermore, studies on the influence of religious health intervention, such as the patient’s own prayers [44, 45], other people’s prayers [46], multi-religious healing services related to the hospital [47], the importance of participation in faith-related support groups and psycho-analytic support groups with religious support [49, 50], and conversations with chaplaincy health team members [51] have been made.
D) Overall purpose
The participants employ multiple methods in the generation of data and seek in mutual synergy to provide solid evidence based knowledge on the highest international level. The harvest of such knowledge will be of importance to health professionals, patients and their relatives and is concordant with contemporary emphasis on optimal and coherent treatment of patients with their multiple needs, both physical, psychological and existential.
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