Feature Article
The Effects of Holy Name Meditation on
Spiritual Well-being, Depression, and Anxiety
of Patients With Cancer
Jinsun (Sr. Julianna) Yong, PhD, RN ƒ Junyang (Fr. John) Park, STD ƒ
Juhu Kim, PhD ƒ Pyeongman (Fr. Justino) Kim, PhD ƒ Im-Sun Seo, PhD, RN
Hun Lee, BA
This study was conducted to evaluate the effects of the
Holy Name Meditation on cancer patients’ spiritual
well-being, anxiety, depression, and pain. Twenty-eight
patients were enrolled in the control group, and
18 patients were selected for the experimental group.
Only the patients in the experimental group completed 5
weeks of the Holy Name Meditation Program. All
participants were surveyed to assess spiritual well-being
(Spiritual Well-Being Scale), anxiety and depression
(Symptom Checklist 90-R), and pain (numeric pain rating
scale). There were no significant differences between the
two groups" general characteristics, but the baseline
survey revealed that anxiety and depression levels were
higher in the experimental group. Analyzing the results
after controlling the baseline scores of anxiety and
depression showed that spiritual well-being was increased
(F = 4.80, P = .034), whereas anxiety (F = 4.98, P = .031)
and depression (F = 7.28, P = .010) were decreased after
the intervention. No difference in pain was found
between the two groups. The Holy Name Meditation
Jinsun (Sr. Julianna) Yong, PhD, RN, is professor and director, The
WHO Collaborating Centre for Training in Hospice & Palliative Care,
College of Nursing, The Catholic University of Korea, Seoul, South Korea.
Junyang (Fr. John) Park, STD, is professor, College of Theology, The
Catholic University of Korea, Seoul, South Korea.
Juhu Kim, PhD, is professor, Graduate School of Education, Ajou Uni-
versity, Suwon, South Korea.
Pyeongman (Fr. Justino) Kim, PhD, is associate professor, Depart-
ment of Humanities and Social Medicine, College of Medicine, The
Catholic University of Korea, Seoul, South Korea.
Im-Sun Seo, PhD, RN, is assistant professor, Department of Nursing,
Baekseok Culture University, Cheonan, South Korea.
Hun Lee, BA, is coordinator, The WHO Collaborating Centre for Train-
ing in Hospice & Palliative Care, College of Nursing, The Catholic Uni-
versity of Korea, Seoul, South Korea.
Address correspondence to Jinsun (Sr. Julianna) Yong, PhD, RN, College of
Nursing, The Catholic University of Korea, 222 Banpodero Seocho-gu,
Seoul, South Korea 137-701 (jyong@catholic.ac.kr).
The authors have no conflicts of interest to disclose.
This study was financially supported by the Catholic Medical Center Re-
search Foundation in 2012.
Copyright B 2018 by The Hospice and Palliative Nurses Association.
All rights reserved.
DOI: 10.1097/NJH.0000000000000451
368 www.jhpn.com
ƒ
Program was thus effective in enhancing cancer patients"
spiritual well-being and decreasing their anxiety and
depression. Therefore, it is recommended that Holy Name
Meditation be provided in clinical settings to reduce the
psychosocial and spiritual suffering of cancer patients.
KEY WORDS
anxiety, cancer, depression, spiritual intervention,
spiritual well-being
t is projected that there will be a continuous increase
I in worldwide cancer incidence, further intensifying
global cancer burden.1 In Korea, for example, the
prevalence rate was 28 885.8 per 100 000 as of 2014.2
The overall experience of cancer elicits immense suffer-
ing, causing cancer patients to experience cancer-related
pain along with symptoms such as anxiety and depres-
sion.3-5 They also have to deal with spiritual and existen-
tial concerns.6 The number of cancer patients experiencing
this kind of comprehensive, multidimensional suffering is
growing, pointing to a greater need to deliver holistic care
that improves overall quality of life.
It has been demonstrated that the various symptoms ex-
perienced by cancer patients do not only co-occur but also
interact. For patients with cancer, physical pain often ac-
companies psychological and emotional distress such as
anxiety and depression.7,8 These in turn increase fatigue
and exacerbate overall suffering.9 The symptoms of anxi-
ety and depression especially act as factors that diminish
quality of life.10 These symptoms of cancer appear in differ-
ent dimensions of the person, and it is the mutual interac-
tion of such multidimensional symptoms that negatively
impacts quality of life. Spiritual well-being, on the other
hand, has been shown to enhance cancer patients" quality
of life while reducing their anxiety, depression, fatigue, and
desire for hastened death.11,12 Hence, spiritual well-being is
receiving increased attention as a mediating factor for
quality-of-life enhancement.
Indeed, findings reveal that enhancing the spiritual well-
being of cancer patients helps to promote well-being in
other dimensions, thus improving quality of life and reducing
Volume 20 & Number 4 & August 2018

death anxiety.13 In Pearce et al"s14 study on patients with ad-
vanced cancer, 91% of the participants had spiritual needs
and 67% reported a moderate or greater desire for the medical
staff to support their spiritual needs. This is significant, for
the same study found that unmet spiritual needs expose
patients to risks of depression while reducing sense of spir-
itual meaning and peace. As studies introduce interven-
tions that have positive effects on spiritual well-being
and quality of life,15,16 emphasis is being placed on the
need to develop spiritual interventions that address spiritual
concerns and needs.
However, the term spirituality is often used inconsis-
tently in each literature.17 The usage of the terms spiritual
and spirituality in this study is based on the definition
accepted at an international, interdisciplinary consensus
conference, where it was stated that: ‘‘spirituality is a dy-
namic and intrinsic aspect of humanity through which per-
sons seek ultimate meaning, purpose, and transcendence,
and experience relationship to self, family, others, com-
munity, society, nature, and the significant or sacred. Spir-
ituality is expressed through beliefs, values, traditions, and
practices.’’18 This consensus-driven definition is in accord
with the people"s increasing tendency to seek beliefs and
practices that they find meaningful, rather than adhering
to a certain religious tradition. However, despite grow-
ing emphasis at the global level that spiritual needs must
be addressed to enhance quality of life, most patients
are not receiving adequate spiritual care because of lack
of training and knowledge on the part of health care
professionals.19
To address this issue, this study aimed to test the ef-
fects of a spiritual intervention on cancer patients. Called
the ‘‘Holy Name Meditation,’’ the intervention was devel-
oped from Eknath Easwaran"s 20 Eight-Point Passage
Meditation. Although there have been studies that ap-
plied a mantram-based meditation developed from the
Eight-Point Passage to verify its positive effects on the
spiritual and psychosocial well-being of veterans with
posttraumatic stress disorder (PTSD)21,22 and HIV pa-
tients,23,24 no study has yet to apply such an intervention
to cancer patients. The current study makes this attempt.
Holy Name Meditation mainly consists of silently re-
citing the Holy Name or the Holy Word that people have
chosen for themselves. The authors have already applied
the Holy Name Meditation Program to middle manager
nurses in a previous study, which verified that the interven-
tion enhanced their spiritual and psychosocial well-being.25
On the basis of these results, this study sought to evaluate
whether the Holy Name Meditation Program, modified
to suit cancer patients, could show multidimensional effects
not only on health care professionals but also on patients
receiving cancer treatment. In short, the objective of this
study was to apply Holy Name Meditation on cancer pa-
tients and examine its effects on their spiritual well-being
Journal of Hospice & Palliative Nursing
Feature Article
(spiritual dimension), depression and anxiety (psychoso-
cial dimension), and pain (physical dimension).
The conceptual framework for this intervention study
was based on Daniel Sulmasy"s26 biopsychosocial-spiritual
model. This model embraces a holistic view of the human
person, understanding the person as consisting of physical,
psychological, social, and spiritual dimensions. The model
also explains these dimensions as influencing one another
in mutual interaction. Accordingly, this study measured the
Holy Name Mediation"s effects on the biopsychosocial and
spiritual state of cancer patients.
METHODS
Design
The study used a nonequivalent control-group pre-/post-
test design to examine the effects of the Holy Name Medita-
tion on cancer patients" spiritual well-being, depression,
anxiety, and pain. The intervention program was delivered
to the experimental group through a 5-week course com-
prising 50 minutes per week. The results of the interven-
tion were then compared with data collected from the
control group.
Sample
The number of study participants was calculated using
G*Power 3.1.3, which is a software used to compute statis-
tical power for a variety of statistical tests. The calculation
was based on the results of Bormann et al"s21 study that
applied mantram repetition to veterans with PTSD and
another randomized controlled trial study conducted on
HIV patients.23 Considering that this study was the first to
apply an intervention not widely known in Korea to cancer
patients, the study sample was yielded based on a signifi-
cance level of ! = .05, a statistical power of 0.80, and a
medium effect size of f = 0.25. Although a total of 34 partic-
ipants were required on this basis, initial recruitment
targeted 46 people (23 per group) given the estimated at-
trition rate of 30%. The criteria for eligibility were that the
person is a cancer patient between the age of 18 and 70
years, does not take medication for depression or anxiety,
and has freely agreed to participate while understanding
the research objectives. Participating patients who were
included in the final experimental group and selected
for analysis were those who took part in the intervention
for 5 weeks, attending the sessions for more than three
times.
MEASURES
The effects of the Holy Name Meditation were measured
using three tools, whose reliability and validity have al-
ready been verified.
www.jhpn.com 369
 Feature Article
Spiritual Well-being
The Korean version of Paloutzian and Ellison"s27 Spiritual
Well-Being Scale developed by Cheung et al28 was used.
The Cronbach"s ! for Cheung et al"s28 study was 0.89,
whereas the Cronbach"s ! for this study was 0.85.
Depression and Anxiety
Depression and anxiety were measured using Kim et al"s29
standardized Korean version of the Symptom Checklist 90-R
(Cronbach"s ! = 0.77-0.90), a simplified psychometric instru-
ment developed by Derogatis.30 Of the nine psychometric
items, those measuring depression and anxiety were
extracted. In the study by Kim et al,29 the Cronbach"s ! was
0.76 for depression and 0.77 for anxiety. For the current study,
the Cronbach"s ! was 0.88 for depression and 0.91 for anxiety.
Pain
Pain was measured using the numeric pain rating scale val-
idated by Paice and Cohen.31
PROCEDURES
Recruitment and Data Collection
Data were collected from March 2012 to March 2013. Data
collection began after the study had been reviewed and ap-
proved by the Institutional Review Board at The Catholic
University of Korea. Recruitment took place through written
announcements within the university hospital. Partici-
pants were chosen from inpatient and outpatient cancer
patients receiving operational and pharmacological treat-
ment at the hospital. The experimental group consisted
of patients who voluntarily participated in the study, and
the intervention program was individually provided to
them. The intervention was delivered in the order in which
they applied, because cancer patients experienced suffer-
ing and there was uncertainty as to when their conditions
would deteriorate. It was thus assessed that there was not
enough time to wait for all applications before applying the
intervention. The control group consisted of patients re-
ceiving operational and pharmacological treatment after
cancer diagnosis. For convenience, patients in the control
group were selected from those recommended by the
nurses. The selected patients agreed to take part in the sur-
veys that were intended for data comparison with the ex-
perimental group. All participants from both groups
provided written informed consent. The content of the in-
tervention was not exposed to the control group, because
the intervention was applied to the patients in the experi-
mental group on an individual basis, according to each par-
ticipant"s schedule of hospital visits.
A total of 61 participants were selected, with 27 pa-
tients in the experimental group and 34 patients in the
control group. The same pretest survey was conducted
370 www.jhpn.com
on both groups before the program. Participants in the
experimental group completed the posttest survey after
their intervention, whereas those in the control group
filled out the same posttest survey at the end of the 5-week
intervention period. Five of 27 participants in the experi-
mental group were removed after the pretest survey for be-
ing absent more than three times. Four participants were
removed because of incomplete responses to the posttest
survey. As a result, a total of 18 participants remained in the
experimental group. In the control group, 6 of 34 partici-
pants were removed because of incomplete responses to
the posttest survey, leaving 28 participants for analysis. In
short, participants included in the final analysis consisted of
18 patients in the experimental group and 28 patients in the
control group (Figure).
Holy Name Meditation Program
The spiritual intervention program used in this study was
based on Eknath Easwaran"s20 Passage Meditation and
was adopted from the authors" precedent study.25 A re-
search team comprising a nursing scholar, a meditation
expert, a theologian, an educator, and nurses in clinical
leader positions worked to supplement the precedent
study"s program to accommodate cancer patients. The
modified Holy Name Meditation Program consisted of
five modules, whose contents are summarized in Table 1.
Session 1 introduced participants to spiritual care and
guided them to choose their ‘‘Holy Name’’ (or ‘‘Holy
Word’’) from a list of spiritual words, phrases, or pas-
sages. They were then trained to silently repeat the Holy
Name that they found meaningful as often as possible
throughout the day, and not just during their meditation
time. Session 2 involved practice using the Holy Name
repetition to transform negative emotions such as fear
and anger into positive emotions. Session 3 trained par-
ticipants to calm the mind and reduce hurry, thus
preventing stress and waste of energy coming from ev-
eryday life and relationships. This served the purpose
of enabling them to live a harmonious life. During ses-
sion 4, participants practiced one-pointed attention to fo-
cus on the matter at hand while warding off diffusion of
thoughts, in an attempt to attain a peaceful mind. In session
5, participants were trained to integrate all these skills into
their daily life through the Holy Name repetition.
Each session lasted 50 minutes, comprising 30 minutes
of didactic lecture, 10 minutes of question and answer
combined with sharing of experiences, and 10 minutes of
meditation practice. The program was provided through
individual encounters between participants and a re-
searcher on a weekly basis, when the participant visited
the hospital for either outpatient or inpatient cancer treat-
ment. As a weekly assignment, the participants were asked
to keep a daily record of the frequency of their Holy Name
repetition and reflective experiences thereof. The record
Volume 20 & Number 4 & August 2018
 Feature Article

FIGURE. Flow diagram of retention and attrition.

was used when they shared their experience with the
researcher. Participants also received a CD produced as
an audiovisual aid containing the program content, en-
abling them to access the material at home. The control
group only received conventional care, without any other
intervention.
STATISTICAL ANALYSES
marriage status, religion, duration of diagnosis, and type
of diagnosis (Table 2). However, for study variables, the
TABLE 1 Content of the Holy Name
Meditation Program
Week Content
1 Introduction to Spiritual Care

SPSS 12.0 was used for data analysis. The general charac- Choosing and Repeating a Holy Name
teristics of the participants were analyzed on the basis of
- Practice silent repetition.
real numbers, percentage, average, and standard devia-
tion. The general characteristics of the two groups and their 2 Harnessing Emotions
pretest homogeneity were examined using t test and # 2 test.
The analysis of the Holy Name Meditation"s effects on the - Transform any negative emotion into its
positive counterpart.
two groups was conducted using paired t test and one-way
analysis of covariance that had pretest depression and anx- 3 Slowing Down
iety scores as its covariates.
- Calm the mind to reduce hurry that causes
stress and wastes energy.
RESULTS
4 One-Pointed Attention
Homogeneity Test of Variables - Give full concentration to one thing at a time.
Upon reviewing the homogeneity of study variables and
the general characteristics between the experimental 5 Putting It All Together
group and the control group, no differences were iden-
- Integrate all elements with the Holy Name.
tified in the participants" age, sex, level of education,

Journal of Hospice & Palliative Nursing www.jhpn.com 371

 Feature Article

TABLE 2 General Characteristics of the Two Groups

Exp (N = 18) Cont (N = 28)

Characteristics Mean (SD) or n (%) t or # 2 (P)

Age, y 50.4 (15.2) 52.1 (10.7) j0.43 (.671)

Sex

Male 9 (50.0) 14 (50.0) 0.00 (1.000)

Female 9 (50.0) 14 (50.0)

Education

Middle 1 (5.6) 2 (7.1) 0.26 (1.000)

High 8 (44.4) 14 (50.0)

College 8 (44.4) 12 (42.9)

Missing 1 (5.6) 0 (0.0)

Marriage

Single 3 (16.7) 2 (7.1) 1.62 (.620)

Married 15 (83.3) 25 (89.3)

Bereaved 0 (0.0) 1 (3.6)

Religion

Yes 16 (88.9) 20 (74.1) 1.20 (.279)

No 2 (11.1) 7 (25.9)

Duration of diagnosis, y

G1 8 (47.1) 17 (60.7) 2.45 (.344)

e1 and G2 5 (29.4) 3 (10.7)

e2 4 (37.8) 8 (28.6)

Diagnosis

AML 4 (18.2) 0 (0.0) 10.59 (.148)

Ovary/uterine cancer 2 (9.1) 5 (16.7)

Stomach/liver cancer 1 (4.5) 6 (20.0)

Breast cancer 3 (13.6) 2 (6.7)

Colon/rectal cancer 3 (13.6) 6 (20.0)

Lung cancer 2 (9.1) 5 (16.7)

Other 3 (13.6) 4 (13.3)
Abbreviations: AML, acute myeloid leukemia; Cont, control group; Exp, experimental group.

372 www.jhpn.com Volume 20 & Number 4 & August 2018


score for depression in the experimental group was 8.47
points higher (t = 3.44, P = .001) compared to the control
group. The score for anxiety in the experimental group
was also 6.02 points higher (t = 2.83, P = .009) compared
to the control group. It was ascertained that patients in
the experimental group chose to participate in the study
because they were experiencing more psychosocial dif-
ficulties than those in the control group. However, there was
no difference between the two groups’ spiritual well-being
and pain (Table 3).
Effects of the Holy Name Meditation Program
To address the differences in the two groups" pretest
study variables (ie, depression and anxiety), an analysis
of covariance was conducted. The covariates were the
pretest scores for depression and anxiety (Table 4).
The results of this analysis showed that the overall score
for spiritual well-being was higher (F = 4.80, P = .034,
)p2 = 0.10) in the experimental group than the control
group. There was thus a medium to large effect size in
the experimental group. The level of decrease in both
depression (F = 7.28, P = .010, )p2 = 0.14) and anxiety
(F = 4.98, P = .031, )p2 = 0.10) was more significant in
the experimental group compared to the control group
and showed a medium to large effect size in the exper-
imental group. The level of pain was low in both the ex-
perimental group (mean, 2.0) and the control group
(mean, 3.05) before the intervention, and no difference
was identified between the two groups after the inter-
vention.
DISCUSSION
This study verified that the 5-week Holy Name Medita-
tion Program had positive effects on the spiritual well-
being, depression, and anxiety of cancer patients. These
results were similar to those of Oh and Kim"s32 meta-
TABLE 3 Homogeneity Test of Study Variables Between the Two Groups
Exp (N = 18)
Characteristics
Spiritual well-being 77.11 (13.28)
Religious well-being 39.77 (6.91)
Existential well-being 37.33 (7.77)
Depression 21.22 (9.26)
Anxiety 11.05 (8.15)
Pain 2.00 (2.62)
Abbreviations: Cont, control group; Exp, experimental group.
Journal of Hospice & Palliative Nursing
Feature Article
analysis on studies that verified positive effects of various
spiritual interventions on cancer patients" spiritual well-
being, meaning of life, depression, and anxiety. However,
of the 15 studies included in the meta-analysis, only two
addressed both the spiritual and psychosocial effects of
the intervention. Most interventions, including the two,
were strongly religious in nature. Unlike these interven-
tion studies, this study was unique in that it applied a
self-applicable intervention that was transreligious and
had multidimensional effects.
As increasingly more people strive to fulfill the spiri-
tual desires innate to human existence, a greater number
of cancer patients receiving treatment with conventional
medicine are expressing their preference for integrative
medicine.33 As a result, there has also been a rise in the
number of reports in the literature measuring the effects
of spiritual interventions on cancer patients, where the in-
terventions are not necessarily tied to a specific religion.
Examples include meaning-centered psychotherapy,15
Meaning of Life Intervention,34 life-review intervention,35
and Dignity Therapy.36 Although authors use different
terms such as psychotherapeutic or psychospiritual to de-
note these interventions, ‘‘spiritual’’ interventions differ
from the psychosocial in that their goal is to promote spir-
itual well-being and address spiritual distress. It has been
suggested that the wide array of spiritual health interven-
tions may be categorized into (1) therapeutic communica-
tion techniques, (2) therapy, and (3) self-care.37 The Holy
Name Meditation would be a form of meditation under the
category of self-care.
Studies have noted that meditation-based spiritual in-
terventions are beneficial because they can apply to peo-
ple of all religious backgrounds. However, according to
a meta-analysis on mindfulness meditation interventions,
most studies identified psychological well-being as the
primary effect of such mindfulness-based interventions.38
Unlike these interventions, a mantram-based intervention
Cont (N = 28)
Mean (SD) or n (%) t (P)
78.00 (9.10) j0.27 (.789)
36.75 (5.73) 1.61 (.114)
41.25 (5.86) j1.94 (.058)
12.75 (7.36) 3.44 (.001)
5.03 (4.81) 2.83 (.009)
3.05 (2.96) j1.15 (.259)
www.jhpn.com 373
 374
TABLE 4 Comparison of Spiritual Well-being, Depression and Anxiety, and Pain of the Two Groups at Posttest

www.jhpn.com
Exp (N = 18) Cont (N = 28)
Between Groups (Adjusted for
Within Group Within Group Depression and Anxiety)
a
Characteristics Groups Mean (SD) t P Mean (SD) t P F P )p 2
Feature Article

Spiritual well-being

Total score Pretest 77.11 (13.28) j1.64 .118 78.00 (9.10) j0.24 .806

Posttest 80.83 (5.36) 78.41 (8.50) 4.80 .034 0.10

Religious Pretest 39.77 (6.91) 0.14 .889 36.75 (5.73) j0.48 .634
well-being
Posttest 39.61 (3.27) 37.21 (5.17) 3.56 .066 0.07

Existential Pretest 37.33 (7.77) j2.77 .013 41.25 (5.86) 0.04 .966
well-being
Posttest 41.22 (3.82) 41.19 (5.79) 2.16 .149 0.04

Depression Pretest 21.22 (9.26) 4.70 .000 12.75 (7.36) 0.07 .945

Posttest 12.61 (7.14) 12.67 (8.11) 7.28 .010 0.14

Anxiety Pretest 11.05 (8.15) 3.26 .005 5.03 (4.81) j0.13 .895

Posttest 5.22 (5.45) 5.14 (5.21) 4.98 .031 0.10

Pain Pretest 2.00 (2.62) 0.62 .538 3.05 (2.96) 1.17 .252
Posttest 2.06 (2.36) 2.26 (2.39) 0.24 .627 0.00
Abbreviations: Cont, control group; Exp, experimental group.
Within-group difference was examined by paired-sample t test. Between-group difference in posttest values was examined by a one-way analysis of covariance (adjusted for pretest depression and
anxiety).
a
Partial )2 values for the analysis of covariance. Effect sizes: small, 0.01; medium, 0.06; and large, 0.15.

Volume 20 & Number 4 & August 2018


similar to the Holy Name Meditation has been shown to
have both psychological and spiritual effects. But studies
verifying such results were limited to veterans and HIV pa-
tients.21-24 This research is notable for being the first study
to apply a transreligious spiritual intervention to cancer pa-
tients and verify its effects on both their spiritual and psy-
chological well-being.
Stein et al,39 on the other hand, argued that psychoso-
cial interventions should be given priority over spiritual
and/or existential interventions, on the grounds that can-
cer patients who consider themselves spiritual place
greater importance to psychosocial interventions. The
Holy Name Meditation, however, had positive effects
on spiritual well-being, as well as both depression and
anxiety. This shows that spiritual interventions can have
multidimensional effects, encompassing both the psy-
chosocial and spiritual dimensions. Study results showing
that spiritual well-being mediated the reduction of depres-
sion and anxiety support the results of this study.11,12 More-
over, a path analysis by Bormann et al40 suggested that
enhancing the existential, spiritual well-being of veterans
with PTSD may mediate the alleviation of their symptom
severity. A similar study may be conducted on cancer pa-
tients to identify a mechanism for the relationship between
the spiritual and psychosocial effects found in this study.
The potential mediating role of spiritual well-being also
corresponds to Sulmasy"s26 conceptual model that illus-
trates how changes in the patient"s spiritual dimension in-
fluence the biopsychosocial dimension, thus having a
multidimensional impact on the overall quality of life. It
can be stated therefore that spiritual interventions can sub-
sume the psychosocial dimension to which Stein et al39
gave precedence.
The effects of the 5-week Holy Name Meditation Pro-
gram on pain could not be verified. This was due to the fact
that both the experimental and control groups had average
pain scores of 2 to 3, which were not high enough to require
further intervention. However, as the literature review by
Dedeli and Kaptan41 predicted that spiritual practice may
potentially have significant effects on pain management, a
further study is needed to measure positive effects that spir-
itual interventions may have on physical pain.
Holy Name Meditation is a transreligious intervention
with multidimensional effects that can be practiced easily
in the form of self-care. Thanks to this self-applicability,
the Holy Name Meditation features a simple and portable
nature that renders it highly practical and cost-effective for
cancer patients. These strengths present Holy Name Med-
itation as a highly useful clinical intervention.
This study has the following limitations. First, results are
based on a limited sample, because it is composed of can-
cer patients at a single university hospital located in Seoul,
South Korea. In addition, most study participants had a re-
ligious affiliation. Therefore, a follow-up study testing the
Journal of Hospice & Palliative Nursing
Feature Article
Holy Name Meditation"s effects on a more diverse patient
population, including noncancer patients, seems neces-
sary. Second, the pretest results identified significantly
higher scores of depression and anxiety in the experimen-
tal group, meaning that a randomized controlled trial is
needed to reinforce the study results. Last, there is a need
to construct and validate a conceptual model to closely
examine the implied relationship between spiritual well-
being and the biopsychosocial states. This would help ex-
plain the mechanism through which spirituality enhances
the overall quality of life, contributing greatly to the devel-
opment of spiritual interventions.
CONCLUSION
The results of this study present initial evidence that Holy
Name Meditation enhances cancer patients" spiritual well-
being while reducing their depression and anxiety. Be-
cause the Holy Name Meditation is a transreligious spiritual
intervention in the form of self-care that has multidimensional
effects, it can provide an effective means to relieve cancer
patients" total pain and improve their overall quality of life.
With the cancer prevalence rate on the rise, there is an ur-
gent need to address the psychological and spiritual issues
faced by cancer patients in addition to managing their
physical symptoms. As an intervention that can be applied
clinically to enhance the well-being of cancer patients, the
Holy Name Meditation offers a useful way to address this
contemporary challenge.
References
1. Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer
transitions according to the Human Development Index
(2008-2030): a population-based study. Lancet Oncol. 2012;
13:790-801.
2. National Cancer Information Center. Cancer statistics. 2016.
http://www.cancer.go.kr/mbs/cancer/subview.jsp?id=cancer_
040401000000. Accessed August 10, 2017.
3. Van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten
EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in
patients with cancer: systematic review and meta-analysis. J Pain
Symptom Manage. 2016;51(6):1070-1090.e9.
4. Chambers SK, Girgis A, Occhipinti S, et al. Psychological distress
and unmet supportive care needs in cancer patients and carers who
contact cancer helplines. Eur J Cancer Care. 2012;21(2):213-223.
5. Walker J, Hansen CH, Martin P, et al. Prevalence, associations,
and adequacy of treatment of major depression in patients with
cancer: a cross-sectional analysis of routinely collected clinical
data. Lancet Psychiatry. 2014;1:343-350.
6. Ferrell B, Otis-Green S, Economou D. Spirituality in cancer care
at the end of life. Cancer J. 2013;19(5):431-437.
7. De Heer EW, Gerrits MM, Beekman AT, et al. The association
of depression and anxiety with pain: a study from NESDA. PLoS
One. 2014;9(10):e106907.
8. Syrjala KL, Jensen MP, Mendoza E, et al. Psychological and
behavioral approaches to cancer pain management. J Clin
Oncol. 2014;32:1703-1711.
9. Yasin YM, Al-Hamad A. Anxiety and depression as key determinants
of cancer related fatigue among patients receiving chemotherapy.
Eur Sci J. 2015;33:39-52.
www.jhpn.com 375
 Feature Article
10. Jones SM, LaCroix AZ, Li W, et al. Depression and quality of life
before and after breast cancer diagnosis in older women from the
Women"s Health Initiative. J Cancer Surv. 2015;9(4):620-629.
11. Rabow MW, Knish SJ. Spiritual well-being among outpatients
with cancer receiving concurrent oncologic and palliative care.
Support Care Cancer. 2015;23:919-923.
12. Wang YC, Lin CC. Spiritual well-being may reduce the negative
impacts of cancer symptoms on the quality of life and the desire
for hastened death in terminally ill cancer patients. Cancer Nurs.
2016;39:E43-E50.
13. Shukla P, Rishi P. A correlational study of psychosocial & spiritual
well being and death anxiety among advanced stage cancer patients.
Am J App Psychol. 2014;2:59-65.
14. Pearce MJ, Coan AD, Herndon JEII, et al. Unmet spiritual care
needs impact emotional and spiritual well-being in advanced cancer
patients. Support Care Cancer. 2012;20:2269-2276.
15. Breitbart W, Poppito S, Rosenfeld B, et al. Pilot randomized
controlled trial of individual meaning-centered psychotherapy
for patients with advanced cancer. J Clin Oncol. 2012;30:1304-1309.
16. Fish JA, Ettridge K, Sharplin GR, Hancock B, Knott VE. Mindfulness-
based cancer stress management: impact of a mindfulness-based
programme on psychological distress and quality of life. Eur J
Cancer Care. 2014;23(3):413-421.
17. Viftrup DT, Hvidt NC, Buus N. Spiritually and religiously integrated
group psychotherapy: a systematic literature review. Evid Based
Complement Alternat Med. 2013;2013:274625.
18. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual
dimension of whole person care: reaching national and international
consensus. J Palliat Med. 2014;17:642-656.
19. Balboni MJ, Puchalski CM, Peteet JR. The relationship between
medicine, spirituality and religion: three models for integration.
J Relig Health. 2014;53:1586-1598.
20. Easwaran E. Passage Meditation: Bringing the Deep Wisdom of
the Heart into Daily Life. 3rd ed. Tomales, CA: Nilgiri Press; 2008.
21. Bormann JE, Smith TL, Becker S, et al. Efficacy of frequent mantram
repetition on stress, quality of life, and spiritual well-being in
veterans: a pilot study. J Holist Nurs. 2005;23(4):395-414.
22. Bormann JE, Thorp SR, Wetherell JL, Golshan S, Lang AJ. Meditation-
based mantram intervention for veterans with posttraumatic stress
disorder: a randomized trial. Psychol Trauma. 2012;5(3):259-267.
23. Bormann JE, Gifford AL, Shively M, et al. Effects of spiritual
mantram repetition on HIV outcomes: a randomized controlled
trial. J Behav Med. 2006;29:359-376.
24. Kemppainen J, Bormann JE, Shively M, et al. Living with HIV:
responses to a mantram intervention using the critical incident
research method. J Altern Complement Med. 2012;18(1):76-82.
25. Yong J, Kim J, Park J, Seo I, Swinton J. Effects of a spirituality
training program on the spiritual and psychosocial well-being
of hospital middle manager nurses in Korea. J Contin Educ
Nurs. 2011;42:280-288.
376 www.jhpn.com
26. Sulmasy DP. The Birth of the Clinic: An Introduction to
Spirituality in Healthcare. Washington, DC: Georgetown
University Press; 2006.
27. Paloutzian RF, Ellison CW. Loneliness, spiritual well-being and
the quality of life. In: Peplau LA, Perman D, eds. Loneliness: A
Sourcebook of Current Theory, Research and Therapy. New
York, NY: John Wiley & Sons; 1982.
28. Cheung SD, Lee JB, Park HB, et al. A study on reliability and
validity of Korean version of spiritual well being scale. J Korean
Neuropsychiatr Assoc. 2001;40:230-242.
29. Kim KI, Kim JH, Won HT. Korean Manual of Symptom
Checklist-90-Revision. Seoul, Korea: Jungang Publisher; 1984.
30. Derogatis L. SCL-90-R Administration, Scoring & Procedures
Manual-I for the R(evised) Version. Baltimore, MD: Johns
Hopkins University Press; 1977.
31. Paice JA, Cohen FL. Validity of a verbally administered numeric
rating scale to measure cancer pain intensity. Cancer Nurs. 1997;
20(2):88-93.
32. Oh PJ, Kim SH. The effects of spiritual interventions in patients
with cancer: a meta-analysis. Oncol Nurs Forum. 2014;41(5):
E290-E301.
33. M[nstedt K, Vogt T, Rabanus ME, H[bner J. Wishes and beliefs
of cancer patients regarding counseling on integrative medicine.
Breast Cancer. 2014;9(6):416-420.
34. Mok E, Lau K, Lai T, Ching S. The meaning of life intervention
for patients with advanced-stage cancer: development and
pilot study. Oncol Nurs Forum. 2012;39:E480-E488.
35. Wang CW, Chow AY, Chan CL. The effects of life review
interventions on spiritual well-being, psychological distress,
and quality of life in patients with terminal or advanced
cancer: a systematic review and meta-analysis of randomized
controlled trials. Palliat Med. 2017;31(10):883-894.
36. Vuksanovic D, Green HJ, Dyck M, Morrissey SA. Dignity
therapy and life review for palliative care patients: a random-
ized controlled trial. J Pain Symptom Manage. 2017;53(2):162.
e1-170.e1.
37. Puchalski C, Virani R, Baird P, et al. Improving the quality of
spiritual care as a dimension of palliative care: the report of the
consensus conference. J Palliat Med. 2009;12:885-904.
38. Eberth J, Sedlmeier P. The effects of mindfulness meditation: a
meta-analysis. Mindfulness. 2012;3:174-189.
39. Stein EM, Kolidas E, Moadel A. Do spiritual patients want spiritual
interventions?: a qualitative exploration of underserved cancer
patients" perspectives on religion and spirituality. Palliat Sup-
port Care. 2015;13(1):19-25.
40. Bormann JE, Liu L, Thorp SR, Lang AJ. Spiritual wellbeing
mediates PTSD change in veterans with military-related
PTSD. Int J Behav Med. 2012;19(4):496-502.
41. Dedeli O, Kaptan G. Spirituality and religion in pain and pain
management. Health Psychol Res. 2013;1(3):e29.
Volume 20 & Number 4 & August 2018