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Comparison of Attitudes of Guilt and Forgiveness in Cancer Patients Without Evidence of Disease and Advanced Cancer Patients in a Palliative Care Setting

van Laarhoven, Hanneke W. M. MD, PhD, MA; Schilderman, Johannes PhD; Verhagen, Constans A. H. H. V. M. MD, PhD; Prins, Judith B. PhD

doi: 10.1097/NCC.0b013e318243fb30

Background: Attitudes toward guilt and forgiveness may be important factors determining distress in cancer patients. Direct comparative studies in patients with different life expectancies exploring attitudes toward guilt and forgiveness are lacking. Also, sociodemographic and religious characteristics determining the attitudes toward guilt and forgiveness are unknown.

Objective: The objective of this study was to compare attitudes toward guilt and forgiveness in cancer patients without evidence of disease and advanced cancer patients.

Methods: A descriptive research design was used. Ninety-seven patients without evidence of disease and 55 advanced cancer patients filled out the Dutch Guilt Measurement Instrument and the Forgiveness of Others Scale.

Results: Both groups had an attitude of nonreligious guilt and forgiveness, but not of religious guilt. No significant differences in attitudes toward guilt and forgiveness were observed between the 2 groups. In contrast to sociodemographic characteristics, religious characteristics were relevant predictors for guilt and forgiveness. Significant differences in relations between images of God and attitudes toward guilt were observed between the 2 patient groups.

Conclusions: An attitude of nonreligious guilt and forgiveness was found in cancer patients, irrespective of the stage of disease. Religious characteristics were significantly associated with attitudes of guilt and forgiveness. This correlation differed in the early and the advanced setting of disease.

Implications for Practice: The observed relations between religious characteristics and attitudes of guilt and forgiveness suggest that a careful examination of the role of religious beliefs and values is relevant in the clinical care of patients with cancer, both in the setting of early and advanced disease.

Author Affiliations: Department of Medical Oncology (Drs van Laarhoven and Verhagen), Department of Empirical Theology, Faculty of Theology (Drs van Laarhoven and Schilderman), Expert Centre of Palliative Care (Dr Verhagen), and Department of Medical Psychology (Dr Prins), Radboud University Nijmegen Medical Centre, the Netherlands; and Department of Medical Oncology (Dr van Laarhoven), Academic Medical Centre, University of Amsterdam the Netherlands.

This study was funded in part by the Dutch Comprehensive Cancer Centre East.

The authors have no conflicts of interest to disclose.Correspondence: Hanneke W. M. van Laarhoven, MD, PhD, MA, Department of Medical Oncology, Academic Medical Centre, Meibergdreef 9, F4-224, 1105 AZ Amsterdam, the Netherlands (

Accepted for publication November 27, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.