Narrative-Based Insights into Spiritual Health and Holistic Care for Advanced Cancer Patients: A Comparative Study Between Macao and Global Perspectives

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Spiritual health has garnered growing attention as a crucial element of palliative care, particularly in enhancing patients' quality of life (QoL) and psychological resilience. Nevertheless, studies regarding the spiritual well-being of advanced cancer patients in Macau remain scarce. This study seeks to investigate the spiritual health and narrative experiences of advanced cancer patients in Macao, while comparing the results with worldwide perspectives to emphasize cultural particularities and implications for holistic care. Method This study employed a qualitative narrative research approach to perform semi-structured interviews with five patients suffering from advanced cancer in a palliative care centre in Macau from March to May, 2025. Utilizing the FICA model (Beliefs, Importance, Community, and Assistance) as a framework. Themes were derived by story analysis, and the credibility of the findings was validated through collaborative developing between the researcher and the participants. Result Five primary themes were identified in the study: ( 1 ) psychological adjustment and emotional transformation; ( 2 ) investigation of life meaning and values; ( 3 ) family support and social interaction; ( 4 ) spiritual practice and self-healing; and ( 5 ) life reflection and experience transmission. Culture-specific findings encompassed the significance of familial support, the amalgamation of traditional culture and spiritual practices (e.g., Buddhism beliefs), and the impact of nurse-patient narrative exchanges in addressing spiritual needs. Conclusion Spiritual health is a critical component of the comprehensive treatment of patients with advanced cancer. Narrative research effectively elucidates patients' spiritual demands and coping mechanisms. This study advocates for the use of spiritual therapies grounded in culture and narrative understanding into palliative care procedures. Spiritual health narrative research palliative care advanced cancer cultural perspectives holistic care Macao FICA model Introduction Physical suffering is not the only obstacle that cancer patients encounter; they also involve psychological duress and spiritual requirements. Spiritual wellness is crucial for enhancing the quality of life and psychological resilience in people with terminal cancer ( 1 , 2 , 6 , 28 , 29 ). Nonetheless, despite extensive global research on spiritual health, there remains a deficiency in studies that focus on the specific cultural and spiritual requirements of cancer patients in Macau ( 1 , 2 , 8 ). Macau is a region shaped by a fusion of Chinese and Western cultures, where familial ties, traditional beliefs, and spiritual practices significantly impact patients' coping strategies. Current data indicates that spiritual intervention positively impacts the alleviation of emotional distress and enhances the quality of life for cancer patients ( 1 , 2 , 6 , 7 ). Nonetheless, a deficiency exists in the utilization of narrative research to investigate the cultural attributes of patients' spiritual experiences. This research endeavours to address this deficiency by conducting a comprehensive examination of the spiritual health requirements and coping strategies of advanced cancer patients in Macao and comparing them to global studies. Method Research Design This research uses a narrative methodology within qualitative research. The theoretical framework is grounded in hermeneutic theory and Maslow's Hierarchy of Needs Theory (particularly Theory Z), emphasising spiritual well-being ( 7 , 12 ). It posits that individuals create unique facts, which are comprehended through dialogue and interaction between the nurse and the patient. This process facilitates the interpretation of meanings and the understanding of the patient's spiritual well-being by actively listening to the participant's narratives and empathising with them ( 6 , 7 ). Participants and location To enrich the study's material, several cancer types were picked, and the participant count was determined by data saturation and the lack of novel themes. Five participants were ultimately incorporated into the study, utilising a purposive sampling strategy to choose advanced cancer patients from the Cancer Palliative Centre of a hospital in Macao as subjects. Criteria for inclusion: 1. Pathologically verified advanced carcinoma, TNM clinical stage III-IV. 2.Age must be 18 years or older. 3. Knowing of the illness. 4. No cognitive or psychological impairments. 5. Can communicate verbally without difficulty. 6. Obtained informed consent for participation in the study. Criteria for patient exclusion: 1. Existence of more severe mental disorders (including major depression evaluated by PHQ-9) .2. Cognitive dysfunction. Collecting data: Semi-structured interviews were developed utilising the FICA model (Beliefs, Importance, Community, and Facilitation) based on a review of literature and books, addressing patients' spiritual health experiences and their coping mechanisms ( 2 , 15 , 16 ). The researcher, serving as the research instrument, had thorough training in qualitative research methods and engaged in the nursing care of the respondents during their hospitalisation, thereby fostering a strong nurse-patient interaction. Initially, participants were requested to articulate their emotions from the moment of diagnosis confirmation and treatment initiation until their admission to the palliative care centre, subsequently developing and sharing narratives concerning the spiritual health dimensions of 'heaven, people, things, and self.' The researcher attentively listened, observed, and documented the narratives, encompassing the time, location, individuals involved, events, the patient's emotions, perceptions, and interpretations, as well as the patient's feelings following the narrative life experience. The interviews were audio-recorded, transcribed, and lasted from 45 minutes to 1 hour, accompanied by field notes. The research process adhered to ethical standards, evaluated patients' physical condition and PHQ-9 mood assessment, secured written informed consent from participants, received approval from the hospital ethics committee (approval number: KWH2025-013), and prioritised the comfort and safety of participants during interviews. Analysing data: A categorical content analysis was employed for data coding and topic extraction. The researcher and participants collaboratively analysed the data and solicited palliative care professionals for peer review to validate the reliability and authenticity of the findings ( 4 , 14 , 21 ). The stages of the category-content analysis were as follows: ( 1 )Alternative texts were selected based on the concept of 'spiritual health,' and all sections pertinent to the study objectives were compiled into a new text to constitute the primary data for analysis. ( 2 ) The researcher perused the alternative texts multiple times to delineate the new groups. ( 3 ) Classifying the material: Upon reviewing the alternative text, the sentences or words within it are organised into appropriate groups. ( 4 ) Categorisation: The researcher formed the findings by interpreting and comprehending the meaning connotations and concepts from the categorisation after it was finished. ( 5 ) Analysing the experience: Providing feedback on the study's interpretation to participants, encouraging dialogue and input to foster mutual understanding and consensus. This collaborative effort aims to co-create the meaning of the participants' narratives, validating the accuracy of the researcher's written interpretation, ensuring it authentically reflects the participants' expressions, experiences, and psychological sentiments, as well as comprehending their insights and feedback throughout the research process. It also allows us to comprehend the interviewees' experiences and feedback during the research process ( 4 , 14 , 21 , 24 , 32 ). Findings Fundamental Themes: 1. Psychological Adaptation and Affective Transformations: Participants experienced a wavelength of psychological processes following a cancer diagnosis, beginning with adverse emotions such as denial, helplessness, depression, and uncertainty, and progressing towards gradual acceptance of their condition ( 11 , 26 ). They navigated their emotions while embracing the battle against cancer, encouraging themselves to maintain optimism, trust in their survival, and align with the natural course of their journey. "At first, I thought I had lost. I received this condition, but you have to remember that there are a lot of people who can help you. You can take medication and go to the place where you reside to get therapy and be thankful. (P1) "When I first got the diagnosis, I felt so helpless and hopeless. I couldn't eat anything, and the worst part was that I couldn't move my legs. They didn't seem like my own. But after thinking about it, I realised that there was no reason for my life to end so soon, so I fought hard at that time and asked for my survival. I have been working with the medical treatment, and I started to feel better little by little. I started with congee and water, then moved on to rice flour, rice soup, and solid rice. I didn't think about how close I was to death; I just focused about how to stay alive. (P2) "When I first got the diagnosis, I wanted to know why I had this sickness. I'm really sad and shocked, and I can't confront the truth or believe in science or be hopeful that things will get better. I feel better, and I don't know if the disease will come back, so I just have to go with the flow of nature. (P4) 2. Examination of the significance of life and its values: The family constitutes the fundamental source of meaning in patients' lives, and this study revealed that familial heritage occupies an indispensable central role in their sense of purpose ( 22 ). The formation of family serves as a testament to the development of personal identity roles and the reality of existence. Some patients derive their self-worth and fulfilment from the execution of their professional and social roles, taking pride in their past achievements, which mitigates the feelings of loss and failure associated with an initial cancer diagnosis. "I used to work at a childcare centre, and I really cared about the kids. I trained and encouraged them, and most of them got into good schools. A traffic cop once who was a kid I used to take care of. He had grown up to be a parent and sent his son to school. He still remembers who I was. A youngster came back to see me after he grew up and told me that the news of his marriage. He gave me money for buying food, and I was happy that it wasn't about money. Not because of the money, but because of the good relationship after all these years. (P1) "My work has made me the happiest because I've made so many woollen clothes for export over the past 30 years. I've been able to make my own money and support my family." The money I've made from my own hard work makes me the happiest. (P3) My family was impoverished, and I didn't have anyone to help me, so I did poorly in school. After junior high school, I worked as a porter for my adoptive father. Then, over time, I tried out several jobs and started a family of my own. My kids have been helping me and my family since I got sick. (P5) 3. Familial support and social networks: Family members offer essential emotional and practical assistance. Participants also derived trust and reassurance from the doctor-patient contact. "My grandson has been coming to see me every day since I went to the hospital. My retired coworkers and my in-laws also come to see me a lot, and I look forward to their visits every day." (P1) "Parents, wife, kids, and grandkids are all very significant individuals in life. My kids are nice to me, come to see me every day, and bring me food. My son is married, and my granddaughter is born. There is no reason why my life is so short. (P2) "My husband, daughter, and daughter-in-law are all with me for follow-up appointments. I also have a 90-year-old mother who is living in countryside. She knows I'm sick but tells me to stay positive about my health." My grandson calls me every day to check on me and tell me how happy he is to see me. (P4) 4. Spiritual methodologies and self-recovery: Spiritual practices (such as prayer, meditation, and exposure to nature) serve to relieve psychological stress ( 25 ). Individuals who partake in religious rituals have enhanced inner tranquilly. Patients concentrate their recovery on the quotidian aspects of life, mitigating the uncertainties of illness by creating a consistent daily routine. After I got my diagnosis, I went to Avalokiteśvara of the South Sea with a friend from the Buddhist Association. The place was incredibly clean and lovely. It was really important for me to let go of myself when I went to Avalokiteśvara of the South Sea. All of a sudden, my mind was opened up. I can say that I can let go of myself. (P1) ‘Mum is a believer in Buddhism, so I will recite the Buddha's name. I believe in the Buddha, but I will respect people who come to preach. Every day I will read the Buddha's name, which is a source of inner peace and comfort.’ (P2) "When I have time, I'll look over the recipes and make everything that sounds good to me." I can't eat by myself, but my family can. I also went to Beijing with my family last year while I was getting chemotherapy, and I explored the city. (p3) "I like walking the most." I went to Guia Hill Municipal Park in the morning and the Macau Reservoir Park in the afternoon. I faced nature and chat about other topics with a few other people to relax. (p4) " "During hospitalization, sometimes volunteers take me out to sunbathe, afternoon my wife and my son to buy me snacks." (P5) 5. Reflection on Life and Conveyance of Experience: Participants reflected on their lives, expressed thanks, and intended to instil values in their families through narratives. "I haven't said much since I found out I had cancer, but you are willing to listen to me." This conversation makes me think about how we need to be thankful. We've been assisted a lot in our life, and talking to you is a sign of friendship. (P1) "The world is changing so quickly that we can't do so much. Life is already good, so we should be satisfied." (P3) "I didn't have much of a point of view before, but now that I'm sick, I've felt the anguish and know I must follow my heart and be nice. I pray that God may bless other individuals with good health and freedom from this kind of disease. (P4) "Always look at problems in a positive way; don't overthink them." There are benefits to being hopeful. "I'm really happy with my life; I've made a lot of progress." (P5) Findings that are specific to a particular culture 1.The significance of familial support: Family connections are essential for patients' emotional stability and interpersonal significance. This study revealed that participants' familial core beliefs significantly influenced patients' production of meaning in life. The support of family, the fulfilment of social roles, and the anticipation of future generations confer a feeling of life meaning upon patients, enhancing their life satisfaction ( 6 , 13 , 27 ). Familial support serves as a crucial source of emotional stability for patients, with interactions with family members being the most significant interpersonal engagement following sickness. Literature indicates that patients with advanced cancer in Chinese culture prioritise family in their spiritual health requirements, with familial relationships being the most significant interpersonal connections. Robust familial connections provide patients with hope, comfort, serenity, and tranquilly, so augmenting their confidence and motivation to actively confront the illness ( 7 , 8 , 13 , 16 ). 2.The amalgamation of traditional culture and spiritual activities: Buddhist beliefs and conventional spiritual practices significantly influenced patients' coping mechanisms. This study revealed that our culture is defined by perseverance, diligence, and optimism, with patients embodying the wisdom of traditional Chinese culture when confronted with challenges and crises ( 10 , 27 ). They utilised their inner strength to adapt, confront the realities of their illness, and accept the principles of life through their understanding of the disease experience ( 9 , 10 ). The study's results indicated that patients exhibited varied spiritual health responses and sought connection and support in the interaction among 'heaven, humanity, objects, and self.' In addition to personal beliefs, some participants utilised familial support, spiritual practices (such as pilgrimages to Buddhist shrines and recitation of Buddhist prayers), and engagement with nature (including walking and travelling) to effectively divert their attention from cancer and alleviate psychological stress ( 19 , 23 ). This indicates that religious beliefs and environment can improve patients' mental health and redirect their concern over cancer. 3. The Function of Narrative Interactions: Communicating life experiences with healthcare providers facilitated emotional expression and fostered trust among patients. The narrative perspective indicates that nurse-patient communication transcends mere information exchange and management regarding a disease; it is also a dynamic process of sharing and meaning-making among all involved parties ( 32 , 34 ). During the study, the researcher posited that 'benevolence' arises from reciprocal care and comprehension between two individuals, exemplified by concepts such as 'benevolence, righteousness, and morality' and 'benevolence, compassion, and benevolence,' among others. The medical and nursing professions attend to individuals' physical, mental, and spiritual well-being; thus, 'benevolence' constitutes a fundamental aspect of humanistic nursing literacy. The in-depth interviews with participants were predicated on the trust they placed in the researcher, who adopted a pluralistic perspective in lieu of a dichotomous one, honouring the diverse cultural backgrounds, beliefs, and values of the participants while embracing their viewpoints. The researcher substitutes a binary perspective with a pluralistic approach, honours the cultural backgrounds, beliefs, and values of others, acknowledges patients and values their perspectives, empowers them to articulate their thoughts through patient narratives, and refrains from imposing personal opinions or professional authority on patients. This facilitates healthcare providers' access to patients' inner worlds, fosters 'visual integration' between nurses and patients, enhances communication between patients and nurses, and cultivates a harmonious patient-nurse relationship, thereby promoting the spiritual well-being of patients. Discussion Comparison with international studies: This chapter examines the ways in which patients from various cultural backgrounds comprehend, articulate, and undergo their illness experiences. Spiritual well-being extends beyond individual psychology, being fundamentally influenced by societal values, religious beliefs, family structures, and the healthcare system. Five participants from Macau derived their sense of worth, role identity, and coping support from collective perspectives, including family and societal influences. Their life story is narrated from social group. Asian patients tend to value harmony in family relations over individualistic autonomy and that communication in cancer care in Asia is characterized by a reluctance to tell the truth, implicit communication, and family-centred decision-making styles ( 18 ). The narrative, presented from a personal perspective, illustrates a family's response to illness and its significance for the patient. The family constitutes the fundamental unit. A diagnosis primarily represents negative implications for the family rather than for the individual. Significant medical decisions frequently occur during family meetings. Patients highlight the importance of continuing treatment for their family's benefit, reflecting resilience, acceptance, and a commitment to progress. Culturally sensitive, effective strategies for communication with patients with cancer and their families are of utmost importance in Asia ( 3 , 18 ). European and American cultures emphasize the importance of individual uniqueness. Cancer patients highlight the importance of personal emotions and the autonomy in decision-making. Narratives focus on the individual. Spiritual well-being arises from an individual's relationship and communication with God. Rituals such as meditation, prayer, yoga, and mindfulness highlight the importance of inner spiritual connection, thereby enhancing patients' spiritual well-being ( 20 ). Patients in Latin America place significant importance on religion and spirituality. Family also serves as a fundamental support system for many Latin Americans, akin to its role in Chinese culture. It is emphasized that the significance of spiritual beliefs and religious faith in the experiences of Latin American patients with advanced cancer and their influence on symptomatology ( 5 ). The findings corroborate the universal comprehension of the impact of spiritual health on markedly enhancing the quality of life for cancer patients. Nonetheless, the current cultural contexts of many locations are subtly impacting patients' spiritual health coping mechanisms. The spiritual health requirements of patients can be addressed through the help of various individuals from other viewpoints, including foreign cultures that engage with religious beliefs, positive thinking, meditation, yoga, and other personal spiritual practices ( 17 , 30 , 31 , 33 ). Macao, formerly a Portuguese colony, possesses a distinctive culture marked by the amalgamation of Chinese and Western influences, varied religious practices, a robust familial ethos, and a focus on inheritance. From the standpoint of spiritual health, interpersonal ties, particularly with family members, underscore the significance of family as a support system, indicating that spiritual practices should be shaped by cultural and geographical contexts in the provision of spiritual health care to patients ( 8 , 9 , 16 ). In conclusion, comparative analysis with global contexts demonstrates cultural diversity alongside the universal human quest for meaning in the face of suffering. Human spiritual needs during life-threatening situations are universal, encompassing the search for meaning, connection, hope, and peace. The primary objective of palliative care is to assist patients in discovering their inner resilience and tranquillity in the face of significant vulnerability. Future palliative care and holistic care should enhance cultural sensitivity to effectively engage with patients' spiritual dimensions and support them throughout this challenging yet significant journey. Practical Implications: Integrating narrative spiritual care into clinical practice can enhance healthcare workers' understanding of their patients' needs. Priority must be accorded to counselling programs that incorporate family involvement and culturally pertinent spiritual interventions. Constraints of the research: The sample size is somewhat small and confined to Macau, potentially impacting the generalizability of the findings. The research ought to be expanded to encompass additional regions and younger cancer sufferers. Future Research Directions: Investigate the utilization of digital narrative technologies in spiritual care. To conduct cross-cultural analyses to examine the spiritual requirements of patients across various locations. Conclusion Spiritual well-being is an important component of whole-person care for patients with advanced cancer. Narrative research provides an effective way to reveal patients' spiritual needs and coping strategies. This study highlights that spiritual interventions based on cultural insights should be incorporated into palliative care programs to enhance patients' quality of life. Recommendations for Practice: Promote spiritual health assessment tools (e.g., the FICA model) in clinical settings. Strengthen the training of healthcare professionals in narrative skills and cultural sensitivity. Integrate spiritual care into whole-person treatment programs through interdisciplinary collaboration. Declarations Consent for publication: Not applicable Funding support NO Author Contribution Waichi Lo wrote the main manuscript. Zhimin Luo supervised. All authors reviewed the manuscript. Acknowledgements We would like to thank the participants and the staff of the Macao Palliative Care Centre for their support of this study. Availability of data and materials Information can be acquired from the author of the corresponding upon a reasonable request. Conflict of Interest The author declares that no conflict of interest exists. Ethical Approval and Participant Consent The study received approval from the Ethics Committee of Kiang Wu Hospital in Macau, and all participants provided their written informed consent. We certify that the study was performed in accordance with the 1964 declaration of HELSINKI and later amendments. References Acorn M. The integration of personal narratives into hospital-based palliative care can relieve patient psychosocial and existential suffering. Evid Based Nurs. 2019. https://doi.org/10.1136/ebnurs-2019-103207 . Cheng JF, Lin YC, Huang PH, Wei CH, Sun JL. Spiritual Care Model for Terminal Cancer Patients. J Nurs. 2021;61(6):93–7. https://doi.org/10.6224/JN.61.6.93 . Cheng Q, Chen Y, Duan Y, et al. Exploring the spiritual needs of patients with advanced cancer in China: a qualitative study. Sci Rep. 2024;14:4009. https://doi.org/10.1038/s41598-024-54362-9 . Creswell JW. 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Supplementary Files 29AugversionDemographicDataofParticipants.docx Englishversionoftheinterviewoutline.docx Cite Share Download PDF Status: Published Journal Publication published 11 Dec, 2025 Read the published version in BMC Palliative Care → Version 1 posted Editorial decision: Revision requested 21 Oct, 2025 Reviews received at journal 20 Oct, 2025 Reviews received at journal 18 Oct, 2025 Reviewers agreed at journal 05 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviewers invited by journal 09 Sep, 2025 Editor assigned by journal 04 Sep, 2025 Editor invited by journal 02 Sep, 2025 Submission checks completed at journal 29 Aug, 2025 First submitted to journal 29 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Spiritual wellness is crucial for enhancing the quality of life and psychological resilience in people with terminal cancer (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Nonetheless, despite extensive global research on spiritual health, there remains a deficiency in studies that focus on the specific cultural and spiritual requirements of cancer patients in Macau (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMacau is a region shaped by a fusion of Chinese and Western cultures, where familial ties, traditional beliefs, and spiritual practices significantly impact patients' coping strategies. Current data indicates that spiritual intervention positively impacts the alleviation of emotional distress and enhances the quality of life for cancer patients (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Nonetheless, a deficiency exists in the utilization of narrative research to investigate the cultural attributes of patients' spiritual experiences. This research endeavours to address this deficiency by conducting a comprehensive examination of the spiritual health requirements and coping strategies of advanced cancer patients in Macao and comparing them to global studies.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eResearch Design\u003c/p\u003e\u003cp\u003eThis research uses a narrative methodology within qualitative research. The theoretical framework is grounded in hermeneutic theory and Maslow's Hierarchy of Needs Theory (particularly Theory Z), emphasising spiritual well-being (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). It posits that individuals create unique facts, which are comprehended through dialogue and interaction between the nurse and the patient. This process facilitates the interpretation of meanings and the understanding of the patient's spiritual well-being by actively listening to the participant's narratives and empathising with them (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eParticipants and location\u003c/p\u003e\u003cp\u003eTo enrich the study's material, several cancer types were picked, and the participant count was determined by data saturation and the lack of novel themes. Five participants were ultimately incorporated into the study, utilising a purposive sampling strategy to choose advanced cancer patients from the Cancer Palliative Centre of a hospital in Macao as subjects. Criteria for inclusion: 1. Pathologically verified advanced carcinoma, TNM clinical stage III-IV. 2.Age must be 18 years or older. 3. Knowing of the illness. 4. No cognitive or psychological impairments. 5. Can communicate verbally without difficulty. 6. Obtained informed consent for participation in the study. Criteria for patient exclusion: 1. Existence of more severe mental disorders (including major depression evaluated by PHQ-9) .2. Cognitive dysfunction.\u003c/p\u003e\u003cp\u003eCollecting data:\u003c/p\u003e\u003cp\u003eSemi-structured interviews were developed utilising the FICA model (Beliefs, Importance, Community, and Facilitation) based on a review of literature and books, addressing patients' spiritual health experiences and their coping mechanisms (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The researcher, serving as the research instrument, had thorough training in qualitative research methods and engaged in the nursing care of the respondents during their hospitalisation, thereby fostering a strong nurse-patient interaction. Initially, participants were requested to articulate their emotions from the moment of diagnosis confirmation and treatment initiation until their admission to the palliative care centre, subsequently developing and sharing narratives concerning the spiritual health dimensions of 'heaven, people, things, and self.' The researcher attentively listened, observed, and documented the narratives, encompassing the time, location, individuals involved, events, the patient's emotions, perceptions, and interpretations, as well as the patient's feelings following the narrative life experience. The interviews were audio-recorded, transcribed, and lasted from 45 minutes to 1 hour, accompanied by field notes. The research process adhered to ethical standards, evaluated patients' physical condition and PHQ-9 mood assessment, secured written informed consent from participants, received approval from the hospital ethics committee (approval number: KWH2025-013), and prioritised the comfort and safety of participants during interviews.\u003c/p\u003e\u003cp\u003eAnalysing data:\u003c/p\u003e\u003cp\u003eA categorical content analysis was employed for data coding and topic extraction. The researcher and participants collaboratively analysed the data and solicited palliative care professionals for peer review to validate the reliability and authenticity of the findings (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe stages of the category-content analysis were as follows:\u003c/p\u003e\u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)Alternative texts were selected based on the concept of 'spiritual health,' and all sections pertinent to the study objectives were compiled into a new text to constitute the primary data for analysis.\u003c/p\u003e\u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) The researcher perused the alternative texts multiple times to delineate the new groups.\u003c/p\u003e\u003cp\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Classifying the material: Upon reviewing the alternative text, the sentences or words within it are organised into appropriate groups.\u003c/p\u003e\u003cp\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Categorisation: The researcher formed the findings by interpreting and comprehending the meaning connotations and concepts from the categorisation after it was finished.\u003c/p\u003e\u003cp\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Analysing the experience: Providing feedback on the study's interpretation to participants, encouraging dialogue and input to foster mutual understanding and consensus. This collaborative effort aims to co-create the meaning of the participants' narratives, validating the accuracy of the researcher's written interpretation, ensuring it authentically reflects the participants' expressions, experiences, and psychological sentiments, as well as comprehending their insights and feedback throughout the research process. It also allows us to comprehend the interviewees' experiences and feedback during the research process (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eFundamental Themes:\u003c/p\u003e\u003ch3\u003e1. Psychological Adaptation and Affective Transformations:\u003c/h3\u003e\u003cp\u003eParticipants experienced a wavelength of psychological processes following a cancer diagnosis, beginning with adverse emotions such as denial, helplessness, depression, and uncertainty, and progressing towards gradual acceptance of their condition (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). They navigated their emotions while embracing the battle against cancer, encouraging themselves to maintain optimism, trust in their survival, and align with the natural course of their journey.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"At first, I thought I had lost. I received this condition, but you have to remember that there are a lot of people who can help you. You can take medication and go to the place where you reside to get therapy and be thankful. (P1)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"When I first got the diagnosis, I felt so helpless and hopeless. I couldn't eat anything, and the worst part was that I couldn't move my legs. They didn't seem like my own. But after thinking about it, I realised that there was no reason for my life to end so soon, so I fought hard at that time and asked for my survival. I have been working with the medical treatment, and I started to feel better little by little. I started with congee and water, then moved on to rice flour, rice soup, and solid rice. I didn't think about how close I was to death; I just focused about how to stay alive. (P2)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"When I first got the diagnosis, I wanted to know why I had this sickness. I'm really sad and shocked, and I can't confront the truth or believe in science or be hopeful that things will get better. I feel better, and I don't know if the disease will come back, so I just have to go with the flow of nature. (P4)\u003c/em\u003e\u003c/p\u003e\u003ch3\u003e2. Examination of the significance of life and its values:\u003c/h3\u003e\u003cp\u003eThe family constitutes the fundamental source of meaning in patients' lives, and this study revealed that familial heritage occupies an indispensable central role in their sense of purpose (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The formation of family serves as a testament to the development of personal identity roles and the reality of existence. Some patients derive their self-worth and fulfilment from the execution of their professional and social roles, taking pride in their past achievements, which mitigates the feelings of loss and failure associated with an initial cancer diagnosis.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I used to work at a childcare centre, and I really cared about the kids. I trained and encouraged them, and most of them got into good schools. A traffic cop once who was a kid I used to take care of. He had grown up to be a parent and sent his son to school. He still remembers who I was. A youngster came back to see me after he grew up and told me that the news of his marriage. He gave me money for buying food, and I was happy that it wasn't about money. Not because of the money, but because of the good relationship after all these years. (P1)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"My work has made me the happiest because I've made so many woollen clothes for export over the past 30 years. I've been able to make my own money and support my family.\" The money I've made from my own hard work makes me the happiest. (P3)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eMy family was impoverished, and I didn't have anyone to help me, so I did poorly in school. After junior high school, I worked as a porter for my adoptive father. Then, over time, I tried out several jobs and started a family of my own. My kids have been helping me and my family since I got sick. (P5)\u003c/em\u003e\u003c/p\u003e\u003ch3\u003e3. Familial support and social networks:\u003c/h3\u003e\u003cp\u003eFamily members offer essential emotional and practical assistance. Participants also derived trust and reassurance from the doctor-patient contact.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"My grandson has been coming to see me every day since I went to the hospital. My retired coworkers and my in-laws also come to see me a lot, and I look forward to their visits every day.\" (P1)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Parents, wife, kids, and grandkids are all very significant individuals in life. My kids are nice to me, come to see me every day, and bring me food. My son is married, and my granddaughter is born. There is no reason why my life is so short. (P2)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"My husband, daughter, and daughter-in-law are all with me for follow-up appointments. I also have a 90-year-old mother who is living in countryside. She knows I'm sick but tells me to stay positive about my health.\" My grandson calls me every day to check on me and tell me how happy he is to see me. (P4)\u003c/em\u003e\u003c/p\u003e\u003ch3\u003e4. Spiritual methodologies and self-recovery:\u003c/h3\u003e\u003cp\u003eSpiritual practices (such as prayer, meditation, and exposure to nature) serve to relieve psychological stress (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Individuals who partake in religious rituals have enhanced inner tranquilly. Patients concentrate their recovery on the quotidian aspects of life, mitigating the uncertainties of illness by creating a consistent daily routine.\u003c/p\u003e\u003cp\u003e\u003cem\u003eAfter I got my diagnosis, I went to Avalokiteśvara of the South Sea with a friend from the Buddhist Association. The place was incredibly clean and lovely. It was really important for me to let go of myself when I went to Avalokiteśvara of the South Sea. All of a sudden, my mind was opened up. I can say that I can let go of myself. (P1)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e‘Mum is a believer in Buddhism, so I will recite the Buddha's name. I believe in the Buddha, but I will respect people who come to preach. Every day I will read the Buddha's name, which is a source of inner peace and comfort.’ (P2)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"When I have time, I'll look over the recipes and make everything that sounds good to me.\" I can't eat by myself, but my family can. I also went to Beijing with my family last year while I was getting chemotherapy, and I explored the city. (p3)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I like walking the most.\" I went to Guia Hill Municipal Park in the morning and the Macau Reservoir Park in the afternoon. I faced nature and chat about other topics with a few other people to relax. (p4) \"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"During hospitalization, sometimes volunteers take me out to sunbathe, afternoon my wife and my son to buy me snacks.\" (P5)\u003c/em\u003e\u003c/p\u003e\u003ch3\u003e5. Reflection on Life and Conveyance of Experience:\u003c/h3\u003e\u003cp\u003e Participants reflected on their lives, expressed thanks, and intended to instil values in their families through narratives.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I haven't said much since I found out I had cancer, but you are willing to listen to me.\" This conversation makes me think about how we need to be thankful. We've been assisted a lot in our life, and talking to you is a sign of friendship. (P1)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"The world is changing so quickly that we can't do so much. Life is already good, so we should be satisfied.\" (P3)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I didn't have much of a point of view before, but now that I'm sick, I've felt the anguish and know I must follow my heart and be nice. I pray that God may bless other individuals with good health and freedom from this kind of disease. (P4)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Always look at problems in a positive way; don't overthink them.\" There are benefits to being hopeful. \"I'm really happy with my life; I've made a lot of progress.\" (P5)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFindings that are specific to a particular culture\u003c/p\u003e\u003ch3\u003e1.The significance of familial support: Family connections are essential for patients' emotional stability and interpersonal significance.\u003c/h3\u003e\u003cp\u003eThis study revealed that participants' familial core beliefs significantly influenced patients' production of meaning in life. The support of family, the fulfilment of social roles, and the anticipation of future generations confer a feeling of life meaning upon patients, enhancing their life satisfaction (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Familial support serves as a crucial source of emotional stability for patients, with interactions with family members being the most significant interpersonal engagement following sickness. Literature indicates that patients with advanced cancer in Chinese culture prioritise family in their spiritual health requirements, with familial relationships being the most significant interpersonal connections. Robust familial connections provide patients with hope, comfort, serenity, and tranquilly, so augmenting their confidence and motivation to actively confront the illness (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e2.The amalgamation of traditional culture and spiritual activities: Buddhist beliefs and conventional spiritual practices significantly influenced patients' coping mechanisms.\u003c/p\u003e\u003cp\u003eThis study revealed that our culture is defined by perseverance, diligence, and optimism, with patients embodying the wisdom of traditional Chinese culture when confronted with challenges and crises (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). They utilised their inner strength to adapt, confront the realities of their illness, and accept the principles of life through their understanding of the disease experience (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The study's results indicated that patients exhibited varied spiritual health responses and sought connection and support in the interaction among 'heaven, humanity, objects, and self.' In addition to personal beliefs, some participants utilised familial support, spiritual practices (such as pilgrimages to Buddhist shrines and recitation of Buddhist prayers), and engagement with nature (including walking and travelling) to effectively divert their attention from cancer and alleviate psychological stress (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This indicates that religious beliefs and environment can improve patients' mental health and redirect their concern over cancer.\u003c/p\u003e\u003cp\u003e3. The Function of Narrative Interactions: Communicating life experiences with healthcare providers facilitated emotional expression and fostered trust among patients.\u003c/p\u003e\u003cp\u003eThe narrative perspective indicates that nurse-patient communication transcends mere information exchange and management regarding a disease; it is also a dynamic process of sharing and meaning-making among all involved parties (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). During the study, the researcher posited that 'benevolence' arises from reciprocal care and comprehension between two individuals, exemplified by concepts such as 'benevolence, righteousness, and morality' and 'benevolence, compassion, and benevolence,' among others. The medical and nursing professions attend to individuals' physical, mental, and spiritual well-being; thus, 'benevolence' constitutes a fundamental aspect of humanistic nursing literacy. The in-depth interviews with participants were predicated on the trust they placed in the researcher, who adopted a pluralistic perspective in lieu of a dichotomous one, honouring the diverse cultural backgrounds, beliefs, and values of the participants while embracing their viewpoints. The researcher substitutes a binary perspective with a pluralistic approach, honours the cultural backgrounds, beliefs, and values of others, acknowledges patients and values their perspectives, empowers them to articulate their thoughts through patient narratives, and refrains from imposing personal opinions or professional authority on patients. This facilitates healthcare providers' access to patients' inner worlds, fosters 'visual integration' between nurses and patients, enhances communication between patients and nurses, and cultivates a harmonious patient-nurse relationship, thereby promoting the spiritual well-being of patients.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eComparison with international studies:\u003c/p\u003e\u003cp\u003eThis chapter examines the ways in which patients from various cultural backgrounds comprehend, articulate, and undergo their illness experiences. Spiritual well-being extends beyond individual psychology, being fundamentally influenced by societal values, religious beliefs, family structures, and the healthcare system.\u003c/p\u003e\u003cp\u003e Five participants from Macau derived their sense of worth, role identity, and coping support from collective perspectives, including family and societal influences. Their life story is narrated from social group. Asian patients tend to value harmony in family relations over individualistic autonomy and that communication in cancer care in Asia is characterized by a reluctance to tell the truth, implicit communication, and family-centred decision-making styles (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The narrative, presented from a personal perspective, illustrates a family's response to illness and its significance for the patient. The family constitutes the fundamental unit. A diagnosis primarily represents negative implications for the family rather than for the individual. Significant medical decisions frequently occur during family meetings. Patients highlight the importance of continuing treatment for their family's benefit, reflecting resilience, acceptance, and a commitment to progress. Culturally sensitive, effective strategies for communication with patients with cancer and their families are of utmost importance in Asia (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEuropean and American cultures emphasize the importance of individual uniqueness. Cancer patients highlight the importance of personal emotions and the autonomy in decision-making. Narratives focus on the individual. Spiritual well-being arises from an individual's relationship and communication with God. Rituals such as meditation, prayer, yoga, and mindfulness highlight the importance of inner spiritual connection, thereby enhancing patients' spiritual well-being (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePatients in Latin America place significant importance on religion and spirituality. Family also serves as a fundamental support system for many Latin Americans, akin to its role in Chinese culture. It is emphasized that the significance of spiritual beliefs and religious faith in the experiences of Latin American patients with advanced cancer and their influence on symptomatology (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe findings corroborate the universal comprehension of the impact of spiritual health on markedly enhancing the quality of life for cancer patients. Nonetheless, the current cultural contexts of many locations are subtly impacting patients' spiritual health coping mechanisms. The spiritual health requirements of patients can be addressed through the help of various individuals from other viewpoints, including foreign cultures that engage with religious beliefs, positive thinking, meditation, yoga, and other personal spiritual practices (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Macao, formerly a Portuguese colony, possesses a distinctive culture marked by the amalgamation of Chinese and Western influences, varied religious practices, a robust familial ethos, and a focus on inheritance. From the standpoint of spiritual health, interpersonal ties, particularly with family members, underscore the significance of family as a support system, indicating that spiritual practices should be shaped by cultural and geographical contexts in the provision of spiritual health care to patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn conclusion, comparative analysis with global contexts demonstrates cultural diversity alongside the universal human quest for meaning in the face of suffering. Human spiritual needs during life-threatening situations are universal, encompassing the search for meaning, connection, hope, and peace. The primary objective of palliative care is to assist patients in discovering their inner resilience and tranquillity in the face of significant vulnerability. Future palliative care and holistic care should enhance cultural sensitivity to effectively engage with patients' spiritual dimensions and support them throughout this challenging yet significant journey.\u003c/p\u003e\u003cp\u003ePractical Implications:\u003c/p\u003e\u003cp\u003eIntegrating narrative spiritual care into clinical practice can enhance healthcare workers' understanding of their patients' needs. Priority must be accorded to counselling programs that incorporate family involvement and culturally pertinent spiritual interventions.\u003c/p\u003e\u003cp\u003eConstraints of the research:\u003c/p\u003e\u003cp\u003eThe sample size is somewhat small and confined to Macau, potentially impacting the generalizability of the findings. The research ought to be expanded to encompass additional regions and younger cancer sufferers.\u003c/p\u003e\u003cp\u003eFuture Research Directions:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eInvestigate the utilization of digital narrative technologies in spiritual care.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTo conduct cross-cultural analyses to examine the spiritual requirements of patients across various locations.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSpiritual well-being is an important component of whole-person care for patients with advanced cancer. Narrative research provides an effective way to reveal patients' spiritual needs and coping strategies. This study highlights that spiritual interventions based on cultural insights should be incorporated into palliative care programs to enhance patients' quality of life.\u003c/p\u003e\u003cp\u003eRecommendations for Practice:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePromote spiritual health assessment tools (e.g., the FICA model) in clinical settings.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eStrengthen the training of healthcare professionals in narrative skills and cultural sensitivity.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIntegrate spiritual care into whole-person treatment programs through interdisciplinary collaboration.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConsent for publication:\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding support\u003c/h2\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eNO\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eWaichi Lo wrote the main manuscript. Zhimin Luo supervised. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003e We would like to thank the participants and the staff of the Macao Palliative Care Centre for their support of this study.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\u003cp\u003eInformation can be acquired from the author of the corresponding upon a reasonable request.\u003c/p\u003e\u003ch2\u003eConflict of Interest\u003c/p\u003e\u003cp\u003eThe author declares that no conflict of interest exists.\u003c/p\u003e\u003ch2\u003eEthical Approval and Participant Consent\u003c/h2\u003e\u003cp\u003e The study received approval from the Ethics Committee of Kiang Wu Hospital in Macau, and all participants provided their written informed consent. 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Curr Oncol. 2024;31(10):5873\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/curroncol31100437\u003c/span\u003e\u003cspan address=\"10.3390/curroncol31100437\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu J, Tian P, Li L. (2022) Research Progress of Narrative Nursing Clinical Application. \u003cem\u003eNursing Science,11,197\u0026ndash;202.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12677/NS.2022.112035\u003c/span\u003e\u003cspan address=\"10.12677/NS.2022.112035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang L, Wu XQ, Huang YL, Chen JZ, Yang T, Fu J. Best evidence summary for palliative management of psychological distress in patients with advanced cancer. Nurs J. 2023;38(7):75\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.3870/j.issn.1001-4152.2023.07.075\u003c/span\u003e\u003cspan address=\"10.3870/j.issn.1001-4152.2023.07.075\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang J, Zhang S. (2024). Application of Narrative Nursing in Informing.\u003c/span\u003e \u003cspan\u003eCancer Patients of Their Condition. Cancer Adv, \u003cem\u003e1\u003c/em\u003e(1).\u003c/span\u003e \u003cspan\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.26855/ca.2024.12.003\u003c/span\u003e\u003cspan address=\"10.26855/ca.2024.12.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Spiritual health, narrative research, palliative care, advanced cancer, cultural perspectives, holistic care, Macao, FICA model","lastPublishedDoi":"10.21203/rs.3.rs-7385385/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7385385/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIndividuals with advanced cancer frequently have substantial physical, psychological, and spiritual obstacles. Spiritual health has garnered growing attention as a crucial element of palliative care, particularly in enhancing patients' quality of life (QoL) and psychological resilience. Nevertheless, studies regarding the spiritual well-being of advanced cancer patients in Macau remain scarce. This study seeks to investigate the spiritual health and narrative experiences of advanced cancer patients in Macao, while comparing the results with worldwide perspectives to emphasize cultural particularities and implications for holistic care.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003e This study employed a qualitative narrative research approach to perform semi-structured interviews with five patients suffering from advanced cancer in a palliative care centre in Macau from March to May, 2025. Utilizing the FICA model (Beliefs, Importance, Community, and Assistance) as a framework. Themes were derived by story analysis, and the credibility of the findings was validated through collaborative developing between the researcher and the participants.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003eFive primary themes were identified in the study: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) psychological adjustment and emotional transformation; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) investigation of life meaning and values; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) family support and social interaction; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) spiritual practice and self-healing; and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) life reflection and experience transmission. Culture-specific findings encompassed the significance of familial support, the amalgamation of traditional culture and spiritual practices (e.g., Buddhism beliefs), and the impact of nurse-patient narrative exchanges in addressing spiritual needs.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSpiritual health is a critical component of the comprehensive treatment of patients with advanced cancer. Narrative research effectively elucidates patients' spiritual demands and coping mechanisms. This study advocates for the use of spiritual therapies grounded in culture and narrative understanding into palliative care procedures.\u003c/p\u003e","manuscriptTitle":"Narrative-Based Insights into Spiritual Health and Holistic Care for Advanced Cancer Patients: A Comparative Study Between Macao and Global Perspectives","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-16 14:19:09","doi":"10.21203/rs.3.rs-7385385/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-21T14:58:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-20T08:25:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-18T08:51:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14456553319528514455292636327389324631","date":"2025-10-05T13:53:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267430456351325519533078357479843928615","date":"2025-10-04T05:41:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-09T08:04:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-04T05:56:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-02T14:05:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-29T15:29:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2025-08-29T15:26:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"db3fdb6a-87f7-4638-9a97-0559cf097f80","owner":[],"postedDate":"September 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:11:01+00:00","versionOfRecord":{"articleIdentity":"rs-7385385","link":"https://doi.org/10.1186/s12904-025-01946-5","journal":{"identity":"bmc-palliative-care","isVorOnly":false,"title":"BMC Palliative Care"},"publishedOn":"2025-12-11 15:58:30","publishedOnDateReadable":"December 11th, 2025"},"versionCreatedAt":"2025-09-16 14:19:09","video":"","vorDoi":"10.1186/s12904-025-01946-5","vorDoiUrl":"https://doi.org/10.1186/s12904-025-01946-5","workflowStages":[]},"version":"v1","identity":"rs-7385385","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7385385","identity":"rs-7385385","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}