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Journal of Psychosocial
Oncology
Publication details, including instructions for
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Spirituality and Coping Among

Survivors of Prostate Cancer
a
Janice V. Bowie PhD, MPH , Kim Dobson Sydnor PhD
b c
, Michal Granot PhD & Kenneth I. Pargament PhD
d

a
Department of Health Policy and Management,
Bloomberg School of Public Health , The Johns
Hopkins University , 624 North Broadway, Baltimore,
MD, 21205-1996, USA
b
Public Health Program , Morgan State University ,
Baltimore, USA
c
Department of Nursing , University of Haifa ,
Haifa, Israel
d
Department of Psychology , Bowling Green State
University , Bowling Green, OH, USA
Published online: 25 Sep 2008.

To cite this article: Janice V. Bowie PhD, MPH , Kim Dobson Sydnor PhD , Michal
Granot PhD & Kenneth I. Pargament PhD (2005) Spirituality and Coping Among
Survivors of Prostate Cancer, Journal of Psychosocial Oncology, 22:2, 41-56, DOI:
10.1300/J077v22n02_03

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Spirituality and Coping Among Survivors

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of Prostate Cancer
Janice V. Bowie, PhD, MPH
Kim Dobson Sydnor, PhD
Michal Granot, PhD
Kenneth I. Pargament, PhD

ABSTRACT. This pilot study explored the influence of religion and

spirituality on coping among survivors of prostate cancer. Thirty-eight
men (14 African Americans and 24 Caucasians) completed a self-ad-
ministered survey; 29 of the men participated in five focus group ses-
sions. Four major themes emerged from these sessions: (1) the beneficial
effect of faith or religious belief on coping with the disease, (2) the mul-
tiple functions of church social and spiritual support and educational fo-
rum, (3) the durability of faith in God, and (4) the distinction between
religion and spirituality (institutional versus personal). Consistent with
the group sessions, the survey data indicated that a majority of partici-
pants reported a high degree of religiosity, measured by denominational
affiliation and attendance at places of worship. The data also showed
that having prostate cancer influenced greater religious attendance, with
the change attributed to a desire to gain spiritual support. Racial compar-

Dr. Bowie is an Assistant Professor, Department of Health Policy and Management,

Bloomberg School of Public Health, The Johns Hopkins University, 624 North Broad-
way, Baltimore, MD 21205-1996 (E-mail: [email protected]). Dr. Sydnor is an Assis-
tant Professor, Public Health Program, Morgan State University, Baltimore. Dr.
Granot is an Associate Professor, Department of Nursing, University of Haifa, Haifa,
Israel. Dr. Pargament is a Professor, Department of Psychology, Bowling Green State
University, Bowling Green, OH.
The pilot research was supported by a grant from the Prostate Cancer Research Pro-
gram, U.S. Department of Defense.
Journal of Psychosocial Oncology, Vol. 22(2) 2004
http://www.haworthpress.com/web/JPO
 2004 by The Haworth Press, Inc. All rights reserved.
Digital Object Identifier: 10.1300/J077v22n02_03 41
 42 JOURNAL OF PSYCHOSOCIAL ONCOLOGY

isons showed that the African American men had higher levels of religi-
osity than the Caucasian men did, as measured by church attendance,
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quality of spiritual life, and importance of God in the recovery process.

[Article copies available for a fee from The Haworth Document Delivery Ser-
vice: 1-800-HAWORTH. E-mail address: <[email protected]>
Website: <http://www.HaworthPress.com>  2005 by The Haworth Press, Inc.
All rights reserved.]

KEYWORDS. Prostate cancer, spirituality, coping, ethnicity, qualita-

tive research

Among the more rapidly growing bodies of literature is empirical re-

search on the relationship between spirituality and health. Because reli-
gion and spirituality are significant personal and cultural resources
within many racial and ethnic traditions (Levin, Taylor, & Chatters,
1994), they offer a context for promoting health and individual well-be-
ing. Research suggests that individuals who use religion and spiritual
resources experience more beneficial health outcomes than do those
who do not (Comstock & Partridge, 1972; Koenig et al., 1995; Levin &
Schiller, 1987; Levin & Vanderpool, 1992).
An emerging subdomain of spirituality and health research is in the
area of cancer and coping. As with the broader body of work, in this
subdomain there is also evidence that people who report having spiri-
tual support in times of trouble experience important beneficial health
outcomes. Particular outcomes include reduced mortality after cardiac
surgery (Oxman, Freeman, & Manheimer, 1995), reduced levels of pain
(Yates et al., 1981), and lower blood pressure (Larson et al., 1989). The
research also indicates that people with higher levels of religiosity tend
to use more positive coping strategies (Burgener, 1994; Kurtz, Wyatt, &
Kurtz, 1995; Saudia et al., 1991).
Although there is growing evidence that religiosity has a beneficial
effect on coping, less is known about the processes and mechanisms
that may form the foundation of the connection between religion and
health. Researchers in the field of cancer have, sporadically, considered
religion and spirituality as factors influencing adaptation to and man-
agement of cancer (Jenkins & Pargament, 1995; Kaczorowski, 1989).
The existing research suffers for two reasons. One, the tendency has
been to limit the working definitions of religion and spirituality to ste-
reotypical constructs, such as fatalism and church attendance. Two, al-
though physicians are giving greater attention to the role of religion in
health (Dossey, 1993), many of them still suggest that religion serves
only as a passive defense mechanism and thus negate its potential func-
tion as an active agent in the coping process. Consequently, the value of
 Bowie et al. 43

religion as a source of motivation and strength could be overlooked

(Jenkins & Pargament, 1995).
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The health outcome of interest for our pilot study was prostate can-
cer. Although the volume of literature on cancer and quality of life has
grown considerably since the 1980s, males and minorities have been in-
cluded less often than women have in such research (Curbow, 1997).
By engaging in research on prostate cancer, we begin to add to the lim-
ited number of existing studies that include men. Our study sample also
contained both African American and White men. This racial heteroge-
neity allowed us to begin the determination of differences in religious
coping between the two ethnic groups. Our current research used quali-
tative and quantitative data to elicit beliefs about religion and spiritual-
ity among the participants. The conceptual schematic that guided the
development of our research is illustrated in Figure 1.

REVIEW OF THE LITERATURE

The influence of culture on health in the past several years has led to
the recognition that religious and spiritual beliefs and practices, which
are often interwoven with one’s cultural heritage, may play a crucial
role in a person’s perception of illness. According to more than 70 years
of Gallup surveys on religion in the United States, religion has been and
is essential in the lives of many Americans (Religion in America, 1996).
Consistent with this finding is that a majority of Americans also believe
that prayer (Wallis, 1996) and religious faith (McNichol, 1996) can aid

FIGURE 1. Conceptual schematic used to guide the pilot study showing the
potential relationships among religious orientation, prostate cancer as the dis-
ease experience, religious coping, and adjustment to the disease.

Disease Quality of Life and

General Religious/
Experience Well-Being
Spiritual Orientation

Religious/Spiritual Coping
 44 JOURNAL OF PSYCHOSOCIAL ONCOLOGY

in recovery from illness. Most evidence to date suggests that there is an

association between increased religiosity or spirituality and health, but
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more studies are needed to determine the nature of the association–

whether the association is direct or whether there are intermediate fac-
tors that explain the observed effects (Koenig, McCullough, & Larson,
2001; Larson, Swyers, & McCullough, 1997). Patients facing a serious
or life-threatening illness express how relevant religion and spirituality
are in coping with health problems despite the debate by professionals
about its risks or benefits to health. Indeed, what seems to be without
debate is that people’s conceptualizations or expressions regarding the
causes and curing of illness are linked to the psychosocial domain and
encompass a cultural base in which religious and spiritual interventions
may be extremely important.
The extensive literature on the processes of coping provides strong
evidence of its importance of these processes with respect to how pa-
tients respond to a medical diagnosis (Pargament & Hahn, 1986), make
treatment decisions (Gotay, 1985), manage a serious illness (Spilka,
Ladd, & David, 1993), and experience quality of life (Reed, 1987). Re-
ligion and spirituality are often defined as the process or search for sig-
nificance or meaning, such as trying to find one’s purpose in life.
Similarly, the process of coping can be thought of as a search for signifi-
cance or meaning in “times of stress.” In times of great stress, people
search for compelling ways to manage and thus draw on resources that
have been shaped by their culture, values, and experiences. In The Psy-
chology of Religion and Coping, Pargament (1997) linked the associa-
tion between religion and coping. For many people, it is their religious
versus another orientation system that gets tapped in difficult times.
Similarly, some individuals use their religious beliefs positively or neg-
atively to cope with a threat, such as a serious health problem. When ill-
ness interrupts one’s strivings or the process of attainment of specified
goals or tasks, its impact can lead to a search for ways to protect the sig-
nificance of one’s life. During an illness also is when people will turn to
their God or a higher power to transform their lives or to restore order in
a way that allows them to be sustained in the face of change. Cancer can
pose threats to one’s functional status and, possibly, to mortality and
may stimulate the use of religious resources for coping, adjustment, and
survival (Cella & Tross, 1986; Jenkins & Pargament, 1995).
Prostate cancer continues to create tremendous pain and suffering in
the lives of many men. The burden of the disease is felt most severely
among African American men, who experience the disease at a greater
rate than White men do (ACS, 2000). For many African American and
 Bowie et al. 45

other disadvantaged men, lack of knowledge about the disease, mis-

education about therapeutic options, and a sense of fear and stigma as-
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sociated with sexual dysfunction may lead them to be unreceptive to

screening and timely treatment. The ability to cope with the effects of a
diagnosis of prostate cancer requires a variety of resources that can be
accessed to foster optimal functioning for men with prostate cancer.

METHODS

Participants

Thirty-eight men (24 Whites and 14 African Americans) participated

in the study and completed a self-administered survey. Twenty-nine of
them (17 Whites and 12 African Americans) participated in focus group
sessions; the other 9 men, who were slated for the sessions, were unable
to attend but completed the self-administered survey. The men’s total
and group means and standard deviations for age, years of education,
and years since diagnosis are presented in Table 1. The mean age for the
38 men was 66 years (range, 49 to 79 years). All the men reported at
least 12 years of education, with 20 years being the highest number of
years of education. All the participants had been diagnosed with pros-
tate cancer, and most of them (79%) had completed treatment as well.
The shortest time since diagnosis was 1 year, and the longest time was
19 years.
Thirty-three participants (88%) were married at the time of the study,
2 were widowed, 1 was divorced, and 1 was separated. Twenty-two
(58%) were Protestant, 6 (16%) were non-Christian, 1 was nondenomi-
national, and 9 (24%) reported no denomination. All 10 men reporting
no denomination said they were a member of a church or place of wor-
ship.

Recruitment Procedure

Participants for the study were recruited through three channels: (1)
letters and telephone calls to cancer support groups, (2) flyers, newspa-
per advertisements, and word of mouth, and (3) participation in a morn-
ing radio talk show. From these sources, interested men were instructed
to call the study office for information. To be included in the study, the
men had to have reported a physician’s diagnosis of prostate cancer and
be between the ages of 50 and 75 years. Fourteen potential participants
 46 JOURNAL OF PSYCHOSOCIAL ONCOLOGY

TABLE 1. Participants’ Mean Age, Years of Education, and Years Since Can-
cer Diagnosis, by Focus Group and the Survey Instrument ( N = 38)
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Source Participants Demographic Characteristics

Mean (SD)
Ethnicity Number Age Education Years Since
Diagnosis
Focus group
1 White 7 69.29 (6.4) 16.00 (1.9) 4.50 (4.3)
2 White 7 65.43 (9.7) 13.00 (1.7) 5.57 (6.2)
3 African American 4 59.00 (9.9) 12.75 (1.5) 5.00 (1.4)
4 African American 7 65.43 (8.3) 12.86 (1.6) 5.71 (3.2)
5 Mixed 4a 72.00 (5.1) 14.00 (2.3) 4.25 (4.0)

Survey only Mixed 9b 66.56 (8.6) 15.63 (2.1) 5.22 (3.0)

All participants 38 66.42 (8.4) 14.19 (2.2) 5.14 (3.8)
aThree Whites, one African American.
bSeven Whites, two African Americans.

were known to be members of an existing support group. After an initial

screening to determine eligibility, all but two of the men who responded
to the recruitment efforts participated in the study. Of the two non-
participants, one had a language barrier, and the other, who agreed to
participate, died of a non-cancer-related event before his scheduled fo-
cus group. Each participant received an honorarium for his time and co-
operation. It is uncertain if those who participated were different from
those who did not on characteristics other than severity of illness and
sociodemographic characteristics.

Data Collection

Focus groups. Five focus group sessions were held over a period of
two months. Two sessions consisted only of Whites, two consisted only
of African Americans, and one session consisted of both African Amer-
icans and Whites (see Table 1). A trained race-matched male facilitator
led each racially homogeneous focus group; the mixed-race group was
led by a Latino American male facilitator. Before the start of each ses-
sion, participants completed the informed consent process and filled out
a quantitative survey instrument. Each facilitator used a prepared inter-
view guide to lead the discussion. In addition, the focus group partici-
pants viewed two videos containing scripted vignettes with male actors
 Bowie et al. 47

discussing issues relevant to prostate cancer. One vignette, titled “Why

Me?” described the potential feelings of isolation that may accompany a
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recent diagnosis of prostate cancer. The second vignette, “What About

My Sexuality?” was designed to generate discussion about sexual dys-
function often associated with the severity of the disease and its treat-
ment. Given the emotionally laden nature of the two videos, both scripts
presented a hypothetical scenario that participants could respond to
without self-disclosure. Each vignette featured an African American or
a White actor, depending on the composition of the focus group. The fo-
cus group sessions were audiotaped as well as recorded in writing by an
observer.
The research team developed interview items used to guide the focus
group sessions and constructed the instrument based on a review of rel-
evant literature and input from experts on the team as well as from con-
sultants. The instrument was pretested by four advocates for patients
with prostate cancer for the appropriateness of its content. The domains
included spirituality and religious belief, spirituality as a coping mecha-
nism, and quality-of-life issues. The probes used to generate discussion
or, in some situations, to provide clarity included such questions as the
following: “Do you see your doctor(s) as instruments of God?” “Has
your sense of spirituality played any role in helping you understand
your own prostate cancer?” “Do you wonder sometimes whether God
has abandoned you in the midst of your disease?” “How has your dis-
ease affected the things that matter to your life?”
The data used for the qualitative analysis were generated from the
transcriptions of the audiotapes and the observer’s notes. One person
who did not participate in any of the study’s activities transcribed all the
audiotapes. The research assistant and an outside person hired to help
with note taking took individual notes during the sessions, then re-
viewed the transcriptions of the audiotapes and their hand-written notes
for agreement.
After the five focus-group transcripts were completed and reviewed,
the sentences were dissected into fragments on the basis of their content
and were entered into a Microsoft Excel database. A category was cre-
ated for each distinct theme that emerged from the sentence fragments.
The themes were then summarized to characterize the salient issues re-
lated to spirituality and coping. The observers’ notes allowed us to de-
velop an overall characterization of both individual participants and the
group as a whole. Each session was analyzed separately, then evaluated
for areas of commonality and differences across the five groups.
 48 JOURNAL OF PSYCHOSOCIAL ONCOLOGY

Survey instrument. The self-administered survey instrument con-

sisted of 29 items designed to gather demographic data as well as to pro-
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vide a measure of validation for the qualitative analysis of the focus

group sessions. In addition to demographic information, items included
measures of religious affiliation and attendance, spiritual beliefs, social
support, symptoms, perceptions regarding causes of prostate cancer,
knowledge about treatments, and quality of life and physical well-be-
ing. Included in the survey were two scaled items, both with ratings
from 1 to 10: “What is the quality of your spiritual life like now or since
your diagnosis of prostate cancer?” (1, Very poor; 10, Very good) and
“How much does your recovery from prostate cancer depend on your
spirituality or relationship with God or a higher power?” (1, Does not
depend at all; 10, Depends very much). Categorical items included cur-
rent church membership (yes/no), change in church attendance since the
diagnosis (0, Less frequent attendance; 1, No change in attendance; 2,
More frequent attendance), and reason for more frequent attendance (0,
Did not apply; 1, Gain spiritual support; 2, Other).
The data from the quantitative survey instrument were entered into
the database, recoded, and then transferred into Version 10 of the SPSS
software package for analysis. Because the initial analyses showed min-
imal demographic differences between the “survey only” group and the
focus groups, all surveys were analyzed together, and a set of descrip-
tive statistics (means and frequencies) was generated. The data also
were stratified by race to compare findings.

RESULTS

Focus Groups

Emerging themes regarding religion and spirituality. The focus

groups revealed four salient themes related to religion and spirituality.
The first theme was the beneficial value of faith or religious belief. The
dialogue surrounding the role of faith and religion in coping with pros-
tate cancer indicated that the effect of faith and religion was positive.
This theme was consistent throughout the discussions, even though
men’s levels of faith and belief varied. For example, a man who ex-
pressed strong faith said, “Just before I was going into the hospital for
surgery, I couldn’t stop praying ’cause I didn’t know how things were
going to turn out. God brought me through it.” Another man, who pro-
fessed uncertainty in his faith, said:
 Bowie et al. 49

If you’re sick you’re supposed to touch the Torah and ask God to
heal you. If there’s a God maybe somewhere up there, maybe he
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can hear my prayers and maybe I can be cured of this thing. I felt
better when I touched the scripture.

The second theme apparent throughout the discussions was the mul-
tiple usefulness of attending worship services. Members described a
place of worship as a place of social support and a place to advocate as
well as a place for spiritual renewal. The following statements were ex-
amples of this theme:

As soon as I was diagnosed, I immediately went down and asked

everyone to pray for me. Everybody in my church knows I have
prostate cancer.

***

Being in a house of worship gives me strength to handle whatever

comes along.

***

I conduct [prostate cancer] workshops for churches around the

state and other states.

The third theme was the durability of faith in God. Participants ex-
pressed the view that despite their prostate cancer, they believed that
God was in control of their lives in a positive way. For example, “God
has not abandoned us,” “The Lord has his reasons, even if I don’t know
what they are,” and “I see God as maybe possibly revealed to me to be
the pioneer in this cancer thing so I can benefit man.”
Another sentiment related to this theme was the lack of blame placed
on God for the illness:
Previously, [I] blamed God for the first diagnosis, but now [I’m]
closer to God and church. . . . [I] read more religious work.
***
You must reap what you sow, and I’ve done a few wrong things–
maybe I’m reaping. I’m talking to him all day, like a friend.
***
 50 JOURNAL OF PSYCHOSOCIAL ONCOLOGY

God didn’t do this to me.

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***
I never blamed God.
The fourth theme that came through was the distinction between reli-
gion as formal church worship and religion or spirituality as a belief in
God or higher power. The men’s comments included the following:
Religion can help focus spirituality.
***
I was going to church regularly, but now I try to get more out of the
services.
***
I broke from my church [before the diagnosis, but] . . . I have in-
creased my faith, [I] pray privately.
***
To me, religion is a money-making business. . . . I go directly to God.
***
My wife has been turned off by religion. . . . [But] she has a spiri-
tual side.
Other observations. Although not related directly to the participants’
own perceptions of religion and spirituality, the role of wives in their
husbands’ coping process came through strongly. The men noted that
their wives were important to their spiritual life and their adjustment to
prostate cancer and were caretakers of their health. For example:
You got to have a woman there, you got to have somebody to love
you, and . . . my wife has been very supportive. Marriage is not all
about sex.
***
 Bowie et al. 51

My wife’s religion is stronger than mine; I would not be as strong

without her.
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***
My wife coaxed me, and still does, to get exams and she keeps it on
her calendar.
***
Wives are brought into diagnosis now [much more positive ar-
rangement].
***
My wife [is the best thing in my life].
***

I feel ashamed sometimes when I can’t get an erection, but she’s

very understanding.

Although religion and spirituality came through strongly in each

group, an overview of the extracted communications showed that the
four themes ran more extensively through the focus group discussions
of the African American participants. Spiritual and religious references
dominated their discussions to a greater extent than was the case among
the White men.

Survey Instrument

The results of the self-administered survey instrument are summa-

rized in Tables 2 and 3. Table 2 shows that most of the men reported cur-
rent membership in a place of worship. However, the percentage was
higher among the African Americans than it was among the Whites.
The majority of men reported that no change had occurred in their pat-
tern of attendance at their place of worship since their diagnosis.
Among the men who did report a change in their attendance, the per-
centage of change for both increased and decreased attendance was
higher among the White men. Approximately one-fourth of the partici-
pants reported more frequent attendance and attributed the increase to
 52 JOURNAL OF PSYCHOSOCIAL ONCOLOGY

the desire to gain additional spiritual support. The proportions of men

who gave this response were similar in both racial groups.
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On the average, the men rated the quality of their spiritual life as high
since the diagnosis (Table 3). The mean was 8.59 on a scale of 1 to 10.
When the group was stratified by race, the mean score for the African
Americans was slightly higher than the mean for the White men (a dif-
ference of .99). Although the means regarding the second item, impor-
tance of God to recovery from prostate cancer, were slightly lower than
the means for the first item, the patterns of distribution were similar.
Again, the mean for the African Americans was higher than for the

TABLE 2. Summary of Participants’ Responses to Survey Questions About

Church Membership and Attendance, by Race

Measure Total African American White

(N = 38) (n = 14) (n = 24)
Number (%) Number (%) Number (%)
Belong to a church?
Yes 31 (81.6) 13 (92.9) 18 (75.0)
No 7 (18.4) 1 (7.1) 6 (25.0)

Change in church attendance?a

Attend less frequently 4 (11.4) 1 (7.1) 3 (14.3)
No change 22 (62.9) 10 (71.4) 12 (57.1)
Attend more frequently 9 (25.7) 3 (21.4) 6 (28.6)

Reason for more frequent attendance?a

Does not apply (same/less) 26 (74.3) 11 (78.6) 15 (71.4)
Gain spiritual support 7 (20.0) 3 (21.4) 4 (19.0)
Other 2 (5.7) 0 2 (9.5)
aThree White participants did not respond to the question

TABLE 3. Summary of Participants’ Responses to Survey Questions About

Quality of Spiritual Life and Importance of God to Recovery

Participants Quality of Spiritual Life Importance of God

Mean (SD) to Recovery
Mean (SD)
Total (N = 38) 8.59 (2.2)a 7.58 (3.4)
African American (n = 14) 9.21 (1.3) 8.86 (2.5)
White (n = 24) 8.22 (2.6)b 6.83 (3.6)
an = 37.
bn = 23.
 Bowie et al. 53

Whites, but also larger than was the case for the first item (a difference
of 2.02).
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DISCUSSION

The theme that emerged from the focus group analysis was that for
the men in the present study, religion and spirituality were important as-
pects of coping with prostate cancer. Further, the dialogue among the
men coalesced around the perspective that religion and spirituality had a
positive influence with regard to their strategy for coping with the dis-
ease. Resonating through the sessions was the idea that the men drew
strength from their faith in dealing with the disease and drew strength
from their participation in and attendance at their place of worship. The
men expressed the value of their attendance in terms of social support,
spiritual uplift, and the opportunity to share their stories and educate
others. This finding indicates that formal religious participation may
serve various functions in the lives of individuals and that these func-
tions can be viewed as discrete phenomena.
The men in the study also appeared to make a distinction between
formal religion (attendance at a place of worship) and belief in God or a
higher power, with the former not being necessary for the latter. The fo-
cus group discussions also highlighted the valuable role that women
play in the lives of men with prostate cancer by providing both emo-
tional and instrumental support.
Data from the quantitative survey validate, in some measure, the ob-
servations derived from the focus group analysis concerning the level of
spirituality and spirituality as a form of religious coping. Most of the
men were members of a place of worship, indicating a high degree of re-
ligiosity, as measured by affiliation. The influence their diagnosis had
on their attendance was generally positive, prompting more frequent at-
tendance. Participants in the focus groups attributed the positive change
in their attendance to a desire to gain spiritual support. This result ap-
pears to be consistent with the findings that the quality of the men’s
spiritual life was relatively high according to the scale provided.
Racial comparisons showed that the African-American men had
higher levels of religiosity, as measured by church membership, quality
of spiritual life, and importance of God in the recovery process. These
findings are consistent with a larger body of literature on spirituality and
religiosity in the lives of African Americans (e.g., Chatters & Taylor,
 54 JOURNAL OF PSYCHOSOCIAL ONCOLOGY

1998; Chatters, Levin, & Taylor, 1992; Neighbors et al., 1983) and re-
flect the fact that African American participants expressed a more elab-
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orate incorporation of religiosity in their lives than did the White

participants. This finding is similar to an intrinsic religious orientation
in which individuals integrate religious belief and practice.
Further study in this area is clearly warranted. Next steps could in-
clude developing a quantitative instrument that would further capture
and assess the themes noted from the focus groups. Research that would
capture the commonalities and differences of religion as a coping strat-
egy for African Americans versus Whites also appears to be needed.
Exploring how religion may function differently for men coping with
prostate cancer, women coping with breast cancer, and patients coping
with non-gender-specific cancers also might prove to be valuable. Our
preliminary research also suggests that additional studies on the role
and burden of female partners of men with prostate cancer might make
an important contribution to the literature. Finally, the study shows that
it may be valuable for health professionals to consider the potential im-
portance of the linkage of spirituality and health when making decisions
about cancer treatment, providing care to cancer patients, and evaluat-
ing the usefulness of spirituality in coping with the disease.

STRENGTHS AND LIMITATIONS OF THE STUDY

One primary strength of the present study was the engagement of

men in discussions about their use of religious coping strategies and do-
ing so in a way that incorporated a mixed methods approach to the col-
lection of data. Given the emotionally laden nature of prostate cancer,
the focus groups and the inclusion of the videotaped vignettes created
hypothetical situations that generated discussion about issues of inti-
macy and isolation that may have been difficult for participants to talk
about in an interview or to express through a survey. An additional
strength was the inclusion of both African American and White men,
which allowed comparisons between the two racial groups.
One limitation of the study was the lack of variation in the men’s ages
and the stage of their prostate cancer. Although we acknowledge this
lack of variation as a limitation, it also presents an opportunity to build
on the study findings by including more participants and by recruiting
patients at various stages of diagnosis and treatment. Also, hindsight
suggests that the study should have included additional questions that
might have provided a greater understanding of diagnostic procedures
 Bowie et al. 55

and treatment options the participants used in relation to the initiation,

amount, and type of spiritual resources they implemented for coping.
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Another limitation worth noting is that rather than being accrued through
some randomization procedure that would have increased the general-
izability of the findings, the participants self-selected themselves into
the study. To assess the cross-cultural implications of prostate cancer, a
larger sample of African Americans and Whites would be warranted.
The small sample size and the nonrandom nature of the quantitative data
restrict the ability to generalize the findings of the present study to the
broader population.

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Received: September 24, 2002

Accepted: January 23, 2003