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1.5 CE Test Hours

Assessing and Managing Spiritual Distress in Cancer Survivorship

Contrada, Emily

AJN, American Journal of Nursing: January 2020 - Volume 120 - Issue 1 - p 48
doi: 10.1097/01.NAJ.0000652036.59404.30


  • Read the article. Take the test for this CE activity online at
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  • Registration deadline is December 3, 2021.


LPD will award 1.5 contact hours for this continuing nursing education (CNE) activity. LPD is accredited as a provider of CNE by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.5 contact hours. LPD is also an approved provider of CNE by the District of Columbia, Georgia, Florida, West Virginia, South Carolina, and New Mexico #50-1223. Your certificate is valid in all states.


The registration fee for this test is $17.95.

Assessing and Managing Spiritual Distress in Cancer Survivorship


To illustrate, through the use of a composite clinical case study, how nurses can incorporate into practice evidence-based recommendations for assessing and managing spiritual distress in cancer survivors.


After completing this continuing education activity, you should be able to

  • outline findings from the literature about the importance of assessing cancer survivors for distress.
  • discuss the various spiritual assessment tools that can help evaluate cancer survivors' distress.
  • plan the appropriate assessment and intervention for cancer survivors who have spiritual distress.
  1. The National Comprehensive Cancer Network (NCCN) defines “distress in cancer” as interference with the ability to cope effectively with life after cancer diagnosis because of unpleasant experiences that are psychological, physical, spiritual, or
    1. social.
    2. sexual.
    3. behavioral.
  2. Of the 15.5 million cancer survivors in the United States, more than 67% have
    1. had a cancer recurrence.
    2. required psychological counseling.
    3. passed the 5-year survival point.
  3. DeRouen and colleagues specified that distress among cancer survivors may stem from the residual impact of the cancer diagnosis on survivors' sense of
    1. self-worth.
    2. self-efficacy.
    3. self-confidence.
  4. According to the National Cancer Institute, even when cancer survivors have high levels of pain or fatigue, spiritual well-being is significantly associated with their
    1. economic stability.
    2. self-determination.
    3. enjoyment of life.
  5. Ashing-Giwa reported that spiritual well-being corresponds with which of the following aspects of health-related quality of life among cancer survivors?
    1. work productivity
    2. good health habits
    3. nutritional awareness
  6. The NCCN recommends screening all survivors for distress before clinical visits using the 39-item Problem List and the
    1. Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale.
    2. Spiritual Distress Assessment Tool.
    3. Distress Thermometer.
  7. Which of the following organizations recommends asking survivors to complete a spiritual assessment tool, using paper and pencil?
    1. National Cancer Institute
    2. NCCN
    3. National Consensus Project for Quality Palliative Care (NCP)
  8. Which of the following organizations recommends developing partnerships with community clergy to deliver education and counseling for end-of-life care?
    1. National Cancer Institute
    2. NCCN
    3. NCP
  9. Although more than half of cancer survivors surveyed by Astrow and colleagues felt it was appropriate for their clinician to ask about religious beliefs or spiritual needs, what percentage of patients said that staff had asked about either?
    1. less than 10%
    2. just about 15%
    3. approximately 20%
  10. Which of the following spiritual assessment tools incorporates meaning, transcendence, values, and identity into its domains?
    1. Spiritual Needs Scale
    2. Spiritual Distress Assessment Tool
    3. Spiritual Needs Assessment for Patients
  11. Which of the following spiritual assessment tools has been validated in cancer patients, chronic disease patients, and healthy individuals?
    1. Spiritual Needs Questionnaire
    2. Spiritual Needs Inventory
    3. Spiritual Needs Scale
  12. The NCCN's recommendations for managing distress are focused on which components of distress?
    1. existential
    2. psychosocial
    3. physiological
  13. According to the NCCN, nurses should do which of the following when survivors are grappling with questions about their life's purpose or with feelings of hopelessness or uncertainty?
    1. Reassure them that other cancer survivors share these feelings and they are normal.
    2. Remind them that they have survived a life-threatening illness and they are OK now.
    3. Refer them to a mental health professional, social worker, or spiritual counselor.
  14. According to Marion and colleagues, before engaging in spiritual conversations with patients, clinicians should
    1. learn about the various religions so they can offer informed dialogue.
    2. examine their own feelings about spirituality, acknowledging any biases they have.
    3. be prepared to help patients focus more on the realm of spirituality and not religion.
  15. Sterba and colleagues reported that, among certain survivors, conversations about goals for care and medical decisions following a spiritual assessment may foster
    1. hope.
    2. relief.
    3. altruism.
  16. Psychospiritual integrative therapy is an intervention that combines cognitive behavioral therapy, mindfulness, and
    1. naturopathy.
    2. reflexology.
    3. meditation.
  17. The authors noted that survivors receiving treatment away from home may prefer to seek spiritual guidance from
    1. family members.
    2. a member of their community.
    3. reading about spiritual practices.
  18. Clinicians can play an active role in assessing survivors' spiritual needs and empowering them to
    1. identify spiritually informed goals for care.
    2. consider an offering of self, such as volunteering.
    3. seek a different belief system that addresses their current needs.
  19. A cancer survivor who scores a 6 on the Distress Thermometer requires
    1. no specific action.
    2. supportive services.
    3. a mental health evaluation.
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