Addressing Spirituality in Oncology Care for Working-Age Adults: A Scoping Review of Spirituality-Focused Psychosocial Interventions

Addressing Spirituality in Oncology Care for Working-Age Adults: A Scoping Review of Spirituality-Focused Psychosocial Interventions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Addressing Spirituality in Oncology Care for Working-Age Adults: A Scoping Review of Spirituality-Focused Psychosocial Interventions Daiga Katrīna Bitēna, Ieva Salmane-Kuļikovska, Jana Duhovska, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9600015/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Despite growing recognition of spirituality as a clinically relevant dimension of cancer care, no scoping review has examined psychosocial interventions explicitly addressing spirituality among working-age adults with cancer. This review aimed to map the existing evidence on such interventions, characterizing their structural features, theoretical foundations, conceptualization of spirituality, and attention to occupational considerations. Methods A scoping review was conducted following the framework of Arksey and O'Malley [ 1 ], refined by Levac and colleagues [ 2 ]. Seven databases — including MEDLINE via PubMed, Scopus, Science Direct, Cochrane Central, Taylor & Francis, and ProQuest collections — were systematically searched. Records were independently screened and extracted by a five-member team using pre-established criteria. Results Eleven studies, representing 10 unique interventions, met the inclusion criteria. All were conducted within Islamic religious and cultural contexts. Interventions were predominantly group-based, delivered in person in hospital settings, comprising four to ten sessions of 45–90 minutes. Theoretical grounding was limited. Spirituality was inconsistently defined. No study engaged with occupational or return-to-work considerations. Conclusion The evidence base is geographically concentrated, theoretically underdeveloped, and entirely absent of occupational considerations — a dimension central to working-age survivors. These findings reveal a critical gap in survivorship care and suggest the need for culturally diverse, theory-informed research attending to the intersection of spirituality and occupational reintegration in this population. Psychology Scoping review Spirituality Spiritual well-being Psychosocial intervention Oncology Working-age adults Survivorship Figures Figure 1 Introduction The global cancer burden continues to grow: approximately 20 million new cases were diagnosed worldwide in 2022, with projections reaching 35 million by 2050 [ 3 , 4 ]. Improvements in early detection and treatment have produced a growing survivor population, nearly half of whom are younger than 65 years — a group for whom career continuity, occupational identity, and work-related concerns are central to everyday life [ 5 , 6 ]. Integrative oncology (IO) has emerged as a patient-centered framework positioning spirituality as a core dimension of comprehensive cancer care [ 7 , 8 ]. Robust evidence confirms that spiritual well-being is consistently associated with better quality of life, more patient-centered medical decisions, and reduced psychological distress [ 9 ]. However, spirituality is not a uniformly positive phenomenon: spiritual and religious engagement may manifest in both adaptive and maladaptive forms — encompassing sources of meaning and hope alongside spiritual distress, struggle, and loss of faith [ 10 – 12 ]. Despite growing recognition of patients' spiritual needs, the majority of patients with cancer express a desire for spiritual care that remains largely unaddressed by their clinical teams [ 9 ]. Among cancer survivors, working-age adults present a distinctive psychosocial profile, facing the concurrent disruption of occupational identity, economic self-sufficiency, and career continuity [ 13 ]. Return to work (RTW) — widely recognized as a marker of social reintegration and quality of life — has emerged as a central concern in cancer rehabilitation [ 14 , 15 ]. Qualitative research suggests that meaning-making may constitute a psychologically integrative phase of survivors' RTW journey [ 16 ], and preliminary evidence indicates that workplace spirituality may mediate the relationship between job stress and job satisfaction among cancer survivors returning to work [ 17 ]. These findings raise the possibility that spirituality functions not only as a psychosocial resource during illness, but as a potential facilitator of occupational reintegration — a dimension that existing IO frameworks have yet to systematically examine. Existing scoping reviews have examined spiritual interventions in cancer populations broadly – including mindfulness, spiritual counselling, and meaning-making components across diverse settings [ 18 , 19 ] – yet neither centred working-age adults nor occupational outcomes as primary analytical lens. A recently published scoping review by the present authors [ 20 ], focusing specifically on working-age oncology patients, identified spirituality as a significant correlate of quality of life and coping, but was restricted to quantitative observational designs and excluded structured psychosocial interventions. The intersection of spirituality, integrative care, and occupational functioning in this population therefore remains systematically unexamined. This scoping review aimed to systematically map existing psychosocial interventions explicitly addressing spirituality for working-age adults with cancer across the treatment and survivorship continuum. Scoping review methodology was selected for its capacity to examine the extent and nature of evidence without imposing quality-appraisal constraints — an approach suited to the heterogeneous and emergent character of spirituality research in oncology. Methods Study Design This scoping review followed the methodological framework of Arksey and O'Malley [ 1 ], refined by Levac et al. [ 2 ]. Research Questions The primary review question was: what psychosocial interventions explicitly addressing spirituality have been described for working-age adults with cancer, and how are these interventions characterized in terms of content and delivery? Subsidiary questions examined: (1) participants' sociodemographic and clinical characteristics; (2) intervention structure and delivery; (3) theoretical foundations and content components; (4) conceptualization of spirituality and its distinction from religiosity; and (5) the extent to which included studies addressed occupational or return-to-work considerations. Search Strategy Seven databases were searched by two librarians (January 14–31, 2026): MEDLINE via PubMed, Scopus, Science Direct, Cochrane Central, Taylor & Francis, and ProQuest collections (APA PsycArticles; Psychology Collection; Health & Medical Collection). These databases were selected to ensure coverage across biomedical, psychological, and interdisciplinary literature. Search terms combined cancer-related vocabulary (neoplasms, cancer, oncology) with spirituality-related terms (spirituality, spiritual care, spiritual intervention) and intervention-related terms (intervention, therapy, treatment), incorporating MeSH terms, database-specific subject headings, and free-text searches across titles, abstracts, and keywords. Full search strategies are presented in Appendix 1. Searches were limited to peer-reviewed, full-text articles in English. Records were exported to Rayyan; two librarians independently screened titles and abstracts, resolving discrepancies through discussion. A total of 3,716 records were identified. Study Selection Study selection was conducted by a five-member team following PRISMA-ScR guidelines [ 21 ] (Fig. 1 ). Following removal of 1,303 duplicates, 2,413 records advanced to title and abstract screening; 1,859 were excluded as irrelevant. Full-text review of 113 reports was performed by three reviewers, with predatory journal status assessed at this stage. All final inclusion and exclusion decisions were made independently by at least two reviewers, with disagreements resolved through discussion. Of 113 full-text reports assessed, 102 were excluded. Inclusion and exclusion criteria are summarized in Table 1 . Table 1 Inclusion and Exclusion Criteria for Study Selection Criterion Inclusion Exclusion Publication date Published between 2019 and 2026. Published outside 2019–2026. Study design Primary study: qualitative, quantitative, or mixed methods. Not a primary study (e.g., review, editorial, protocol). Population Working-age cancer patients or survivors (mean age or majority of intervention group participants aged 25–54 years); or population explicitly described as working-age adults with age data consistent with this range. Non-cancer patients; no clear age information reported; majority of intervention group participants older than 54 years; mean age of intervention group exceeding 54 years; or participants explicitly described as retired or non–working-age adults. Cancer stage / Disease trajectory Participants not primarily diagnosed with metastatic or terminal cancer, or if the study population described as non-metastatic, early-stage, or mixed-stage without a predominant focus on advanced disease. Where formal staging was not reported, studies were included if the clinical description indicated a curative or post-curative treatment trajectory consistent with potential return to active life. The majority of participants diagnosed with advanced, metastatic or terminal cancer, or if the study setting, aims, or population description indicated a predominant focus on end-stage disease management or symptom palliation. Spirituality Spirituality explicitly identified as a central concern of the study, with the term "spirituality" or "spiritual" clearly stated in the study title, aims, research question, or theoretical framework. Spirituality not explicitly identified as a central concern of the study; or spirituality appears solely as a peripheral or incidental element — for example, as a single subscale within a broader outcome measure, or as one of multiple component in a non-spirituality-focused intervention — without a clear primary orientation toward spirituality in the context of cancer care. Outcomes At least one psychosocial outcome measured to evaluate the impact of an intervention. No relevant psychosocial outcomes reported; or biological, physiological, or immunological outcomes — including, but not limited to, biomarker assessments (e.g., oxytocin levels) without an accompanying psychosocial outcome measure. Intervention Clearly defined, structured spirituality-focused psychosocial intervention (e.g., multi-session program, psychoeducational or informational intervention, spiritual practice). No clearly defined spirituality-focused psychosocial intervention; purely observational or descriptive studies; studies lacking an active intervention component. Other — Duplicate records; unavailable full text; non-English full-text document; publication in a predatory journal. Note. The age range of 25–54 years follows Eurostat's (2024) classification of mid-career workers. This boundary was preferred over the broader 15–64 range because individuals aged 55–64 are disproportionately likely to exit the labour market permanently following a cancer diagnosis (de Boer et al., 2009; Mehnert et al., 2013), while those aged 15–24 remain in transitional educational or early vocational phases qualitatively distinct from established career contexts (Stanton et al., 2015). The 25–54 range thus captures the population for whom return to work is most prognostically relevant and occupational identity most consolidated. Data Extraction and Charting A final set of 11 studies met all inclusion criteria and were included in the review. Data were initially extracted using AI tool Elicit and subsequently verified by two independent reviewers. Charting was organized into five thematic domains corresponding to the review questions, each presented in a dedicated extraction table. Collating, Summarizing, and Reporting the Results Results were synthesized in two steps: first, frequency counts and percentages characterized key study features; second, narrative analysis identified recurring patterns and variations across studies, with thematic categories emerging iteratively from the charted data [ 1 ]. Results Eleven studies published between 2019 and 2024 met inclusion criteria: nine (82%) conducted in Iran, two (18%) in Indonesia. All employed quantitative pre-test/post-test designs with a control group; four (36%) were randomized controlled trials, seven (64%) quasi-experimental. No qualitative or mixed-methods studies met inclusion criteria. Two publications [ 22 , 23 ] drew on the same sample and intervention, differing only in outcomes reported; these are treated as a single study throughout, with all proportions calculated on the basis of 10 unique interventions. A full overview is presented in Table 2 . Table 2 Overview of Included Studies Year Authors Title Journal Study design Country 2019 Nasiri et al. The Effectiveness of Religious-Spiritual Psychotherapy on the Quality of Life of Women with Breast Cancer Journal of Babol University of Medical Sciences Quasi-experimental double-blinded; pre-test, post-test design with two-month follow-up; with a control group Iran 2020 Kashani Lotfabadi et al. The effect of the components of King's spiritual intelligence group training on stigma in patients with cancer Nursing Practice Today Randomized controlled trial; pre-test and post-test design; with an intervention and control group Iran 2020 Nasution et al. Effectiveness of Spiritual Intervention toward Coping and Spiritual Well-being on Patients with Gynecological Cancer Asia-Pacific Journal of Oncology Nursing Quasi-experimental; pre-test and post-test design; with an intervention and control group Indonesia 2021 Nasution et al. The Effectiveness of Spiritual Intervention in Overcoming Anxiety and Depression Problems in Gynecological Cancer Patients Jurnal Keperawatan Indonesia Quasi-experimental; pre-test and post-test design; with an intervention and control group Indonesia 2022 Davari et al. The Effect of Religious–Spiritual Psychotherapy on Illness Perception and Inner Strength among Patients with Breast Cancer in Iran Journal of Religion and Health Randomized controlled trial; pre-test, post-test design with four-month follow-up; with an intervention and control group Iran 2022 Karimi et al. The Effect of a Spiritual Care Program on the Self-Esteem of Patients with Cancer: A Quasi-Experimental Study Iranian Journal of Nursing and Midwifery Research Quasi-experimental; pre-and post-test design; with an intervention and control group Iran 2022 Moin et al. The Comparison of the Effectiveness of Acceptance and Commitment Therapy and Spirituality Therapy in Reducing Anxiety in Women with Breast Cancer Archives of Breast Cancer Quasi-experimental; pre-test and post-test design and a three-month follow-up; with a two intervention groups (ACT and Spirituality Therapy) and control group Iran 2023 Hamidi et al. The effect of spirituality-based education on the meaning of life in cancer patients: a quasi-experimental study Oncology in Clinical Practice Quasi-experimental; pre-test and post-test design; with an intervention and control group Iran 2024 Ghaempanah et al. Good for Coping, Not for Eudaimonia: The Effectiveness of a Spiritual/Religious Intervention in the Healthcare of Breast Cancer Patients Pastoral Psychology Quasi-experimental; pre-test and post-test design; with an intervention and control group Iran 2024 Momennasab et al. The Effect of Spiritual Group Therapy on the Quality of Life and Empowerment of Women with Breast Cancer: A Randomized Clinical Trial in Iran Journal of Religion and Health Randomized controlled trial; pre-test and post-test design; with an intervention and control group Iran 2024 Torabi et al. Effectiveness of Group Spiritual Care on Leukemia Patients’ Hope and Anxiety in Iran: A Randomized Controlled Trial Journal of Religion and Health Randomized controlled trial; pre-test and post-test design and a one-month follow-up and two-month follow-up; with an intervention and control group Iran Sociodemographic and Clinical Characteristics A total of 778 participants were enrolled across included studies (sample sizes: 31–169). Participant age ranged from 18 to 78 years, with intervention group mean ages between 34.90 and 50.53. Seven studies (70%) enrolled exclusively or predominantly female participants, with breast cancer the most frequently represented diagnosis (60%). Cancer stage reporting was inconsistent: studies enrolled participants ranging from Stage I–II only to mixed Stage I–IV populations; two studies did not report stage in standardized terms. The majority (70%) enrolled participants during active treatment; two studies (20%) focused on post-treatment survivorship. Spiritual or religious affiliation was reported in five studies (50%), all identifying participants as Muslim. The concentration of evidence within two countries, combined with the exclusive representation of Muslim participants, suggests that the existing knowledge base reflects a culturally specific understanding of spirituality that cannot be assumed to translate to other oncological contexts. Full characteristics are presented in Table 3 . Table 3 Sociodemographic and Clinical Characteristics of Study Participants Year Authors Sample size Age Gender Cancer type Cancer stage / Disease trajectory* Treatment stage Spiritual or religious affiliation 2019 Nasiri et al. 70 Age range: 18-65 Mean age: Intervention: 44.74 Control: 45.41 Female: 100% Breast I, II, III, IV Active treatment (at least two months after their diagnosis) Muslim 2020 Kashani Lotfabadi et al. 50 Age range: 20–60 Mean age: Intervention: 49.3 Control: 42 Intervention: Female: 65.2% Male: 34.8% Control: Female: 66.7% Male: 33.3% Not specified I,II Active treatment (hospitalized) Not specified 2020; 2021 Nasution et al. 108 Age range: ≥18 Mean age: Intervention: 47.17 Control: 44.35 Female: 100% Gyneco- logical I, II, III, IV Active treatment (inpatients) Muslim 2022 Davari et al. 44 Age range: 31–58 Mean age: 44 Female: 100% Breast Grade 1, Grade 2 Post-treatment survivorship (completed chemotherapy and radiotherapy) Twelver Shi'ism of Islam 2022 Karimi et al. 64 Age range: 18–45 Mean age: Intervention: 34.90 Control: 36.23 Intervention: Female: 96.90% Male: 3.1% Control: Female: 100% Majority breast: Intervention: 65.60% Control: 84.60% Other cancer types not specified. Approved by their physician as not having advanced cancer. Likely active treatment or in post-treatment survivorship (6 months after diagnosis; main treatment being surgery) Muslim 2022 Moin et al. 45 Age range: 40–60 Mean age: Intervention (ACT): 48.22 Intervention (Spiritual Therapy): 47.54 Control: 48.81 Female: 100% Breast I, II Not specified Not specified 2023 Hamidi et al. 169 Age range: 18–65 Mean age: Not specified Intervention: Female: 44% Male: 56% Control: Female: 37.6% Male: 62.4% Intervention: Stomach: 26.2% Colorectal: 35.6% Breast: 15.5% Liver: 4.8% Control: Stomach: 27.1% Colorectal: 54.1% Breast: 11.8% Liver: 7.1% I, II, III, IV Active treatment (outpatient chemotherapy) Not specified 2024 Ghaempanah et al. 60 Age range: 27–78 Mean age: Intervention: 50.53 Control: 48.53 Female: 100% Breast I, II, III (non-metastatic) Post-treatment survivorship (at least six months from the start of treatment and had completed at least one course of chemotherapy); medically stable Not specified 2024 Momennasab et al. 74 Age range: 25–60 Mean age: Intervention: 43.46 Control: 42.97 Female: 100% Breast Not having any signs of metastatic breast cancer. Active treatment (undergoing or had recently undergone chemotherapy or radiotherapy) Not specified 2024 Torabi et al. 94 Age range: Not specified Mean age: Intervention: 41.78 Control: 40.58 Intervention: Female: 43.8% Male: 56.3% Control: Female: 56.3% Male: 43.5% Leukemia I, II, III (non-metastatic) Active treatment (receiving chemotherapy or radiotherapy) Muslim, Shiite *Cancer stage / Disease trajectory reported as eligibility criterion rather than formal clinical staging. Structural and Delivery Characteristics Interventions were predominantly group-based (70%) and delivered in person in hospital or clinical settings (70%), comprising four to ten sessions of 45–90 minutes. The most common format was six sessions (40%) of 60 minutes (40%). Deliverer background was heterogeneous, encompassing psychologists and therapists (40%), researchers or doctoral students (30%), oncology nurses, multidisciplinary teams, and spiritual caregivers. Despite this structural heterogeneity, the convergence around four to ten sessions of 60–90 minutes, delivered weekly in clinical settings, provides preliminary indication of a feasible delivery format for spirituality-focused interventions in oncology care. A detailed overview is presented in Table 4 . Table 4 Structural and Delivery Characteristics of Spirituality-Focused Psychosocial Interventions Intervention Format Number of sessions Session duration Delivery method Deliverer Setting Religious-spiritual psychotherapy (Nasiri et al., 2019) Group 6 sessions held within a week 90 minutes In-person Therapist Clinical setting King's spiritual intelligence group training (Kashani Lotfabadi et al., 2020) Group 10 sessions held twice a week 90 minutes In-person Experienced clinical psychologist trained in spiritual intelligence training, supervised by an oncologist Hospital Spiritual Intervention (Nasution et al., 2020. 2021) Individual 4 sessions held within two weeks 60–90 minutes In-person Oncology nurses with the spiritual guidance certification Hospital Religious-Spiritual Psychotherapy based on the Twelver Shia Sects of Islam (RSP-TSS) (Davari et al., 2022) Individual 10 sessions held once a week within 10 weeks 90 minutes In-person Ph.D. student in psychology and a researcher on Islam Clinical setting Spiritual care program (Karimi et al., 2022) Group 6 sessions held twice a week 60 minutes Mixed: 3 face-to-face sessions, 3 virtual sessions Spiritual caregiver and main researcher Hospital, WhatsApp Spirituality Therapy (Zari Moin et al., 2022) Group 8 sessions held once twice a week 60 minutes In-person Psychotherapist Hospital Spirituality-based education (Hamidi et al., 2023) Group 6 sessions held over three weeks 60 minutes Online Researcher /nurse WhatsApp; audio, video, PowerPoint, PDF materials Spiritual/religious intervention (Ghaempanah et al., 2024) Individual 6–8 sessions held once per week 45 minutes In-person Trained psychologist Likely hospital or clinical setting Spiritual Group Therapy (Momennasab et al., 2024) Group 5 sessions held twice a week for the first two weeks, one session in the third week 60 minutes In-person Researcher's main co-worker under the supervision of an expert on religious matters Hospital Group Spiritual Care Program (Torabi et al., 2024) Group 6 sessions held once a week 45–60 minutes In-person Team including Ph.D. in nursing, MSc in medical-surgical nursing, nursing students, and psychology specialist Hospital Theoretical Foundations and Content Components All interventions were developed specifically for the respective study. Two studies (20%) grounded their interventions in internationally published psychological models: King's [ 24 ] model of spiritual intelligence [ 25 ] and Richards and Bergin's [ 26 ] spiritual psychotherapy framework [ 27 ]. One study (10%) employed a standardized and localized spiritual care model informed by international clinical guidelines and contextualized for Iranian patients with chronic illness [ 28 ]. Three studies (30%) adopted a mixed approach, combining psychological theory with Islamic teachings [ 29 – 31 ]. A fourth study in this category [ 32 ] drew on RSP-TSS – a culturally developed framework integrating psychological theory with Islamic theological principles, validated through a formal Delphi process. The remaining three studies (30%) provided limited or no theoretical grounding: two referenced Islamic teachings exclusively[ 33 ], and one cited prior empirical literature without specifying a theoretical orientation [ 34 ]. Nine recurring content themes were identified across interventions. The most pervasive theme was relationship with God and divine connection (90%), encompassing prayer, Quranic recitation, trust in and reliance on God, communion with God, repentance and seeking forgiveness, encouragement to express feelings directly to God. Coping with illness and acceptance (60%), addressing acceptance of disease, locus of control, patience in chronic illness, and positive reframing of the cancer experience. Interpersonal relationships and communication (60%), covering relationships with family members, effective communication, and supportive communication with caregivers. Forgiveness, patience, and gratitude (60%), including self-forgiveness, forgiving others, patience as a spiritual resource, and — in one study — explicit sessions on appreciation and gratitude [ 27 ]. Self-awareness and identity (60%), encompassing identification of feelings, existential questions such as “who am I?” and “what is the purpose of my life?”, spiritual self-knowledge, expression of illness-related grief, and — in one study — intrapersonal communication and listening to the inner voice [ 27 ]. Meaning-making and purpose in life (50%), addressing the meaning of suffering, life purpose, and existential reflection. Relaxation and mind-body practices (50%), primarily in the form of deep breathing techniques and mental relaxation, often combined with listening to Quranic verses. Spiritual and religious education (60%), introducing participants to program objectives, concepts of spirituality and religion, and — in one case — conducting a formal assessment of spiritual needs [ 28 ]. Death, suffering, and existential questions (30%), encompassed direct engagement with death and fear of death, the meaning and purpose of suffering, and existential-critical reflection on life. The dominance of God-centered and Islamic religious themes suggests these programs function primarily as culturally embedded religious practices rather than theoretically grounded psychosocial interventions – limiting their transferability to diverse populations – and the limited documentation of intervention protocols – with no study making a full therapist manual publicly available or reporting fidelity monitoring – means that the replicability and active ingredients of these interventions cannot be fully assessed from the current evidence base. Conceptualization of Spirituality Spirituality was inconsistently defined across included studies. Five studies (50%) conceptualized it as a source of psychological strength or coping; one as spiritual intelligence [ 25 ]; one as a search for meaning and connection with a sacred source [ 27 ]; two provided no definition. Only two studies (20%) explicitly distinguished spirituality from religiosity. The dual nature of spirituality — encompassing both adaptive manifestations and negative dimensions such as spiritual distress or religious struggle — was substantively addressed in only two studies [ 30 , 31 ]; remaining studies framed spirituality exclusively as a positive resource. A full overview is presented in Table 5 . The limited attention to spirituality as a multidimensional construct — encompassing both adaptive and maladaptive manifestations — constrains the cumulative development of knowledge in this field. Table 5 Conceptualization of Spirituality Across Included Studies Study Definition or description of spirituality Spirituality/Religiosity Conceptualization of spirituality Dual nature of spirituality Nasiri et al., 2019 No explicit definition of spirituality is offered. The authors refer to spirituality as a "new paradigm for responding to the challenges of the future" and a means of "satisfying the transcendent needs of individuals". Spirituality is not explicitly distinguished from religiosity. Spirituality is not consistently conceptualized. Components or factors of spirituality: Not specified The study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention promotes spiritual maturity exclusively as acceptance, gratitude, and trust in God. Kashani-Lotfabadi et al., 2020 Spirituality is defined as intelligence - a set of adaptive psychological capacities created based on non-material and existential transcendental aspects that are considered as the different form of moral-religious identity, and is equipped with it has nothing to do with the belief system or individual religion (King's, 2008). Spirituality is distinguished from religiosity. Spirituality is conceptualized as coping mechanism that can help to cope with negative and maladaptive behaviors in social or personal life and develop a positive orientation toward life. Components or factors of spirituality: critical existential thinking, personal meaning production, transcendental awareness, and conscious state expansion (King's, 2008). The study promotes spirituality as a positive resource. The discussion briefly mentions negative religious interpretations like "punishment from God" as a source of incompatibility. Intervention is designed to enhance spiritual intelligence as adaptive resource. Nasution et al., 2020; 2021 Spirituality is described as one source of individual strength in dealing with difficult situations, uncertainties, and serious events. Spirituality is not explicitly distinguished from religiosity. Spirituality is conceptualized as a coping resource and psychological support mechanism and as part of psychosocial adjustment and existential coping. Components or factors of spirituality: Not specified The study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention addresses spirituality as resource for increasing coping and spiritual well-being. Davari et al., 2022 No explicit definition of spirituality is offered. Spirituality is not explicitly distinguished from religiosity. Spirituality is conceptualized as a coping resource ("key role in coping with cancer and health-related quality of life"). Components or factors of spirituality: Not specified The study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention is designed to enhance positive spirituality through religious-spiritual practices and themes. Karimi et al., 2022 Spirituality is described as being associated with all aspects of one’s health and illness which guides one’s daily behaviors and are a source of support, strength, and healing. Spirituality is not explicitly distinguished from religiosity. Spirituality is conceptualized as coping resource and psychological support mechanism, improving well-being, life satisfaction, and self-esteem. Components or factors of spirituality: individuals’ relationship with God, themselves, others, and with the environment. The study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention is designed to enhance the relationships with God, oneself, others, and the environment. Moin et al., 2022 Spirituality is defined as "searching for meaning and purpose to communicate with a sacred source or ultimate reality". Spirituality is described as related to, but not identical with, religion. It is distinguished from religiosity by its focus on personal beliefs and values rather than specific religious practices. Spirituality is conceptualized as coping resource and means for finding meaning and purpose, reducing anxiety and enhancing hope. Components or factors of spirituality: Not specified The study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention is designed to enhance spirituality as a coping resource. The intervention addresses spirituality by respecting and valuing clients' spiritual issues to enhance hope and reduce anxiety. Hamidi et al., 2023 Spirituality is described as a source to improve the meaning of life in cancer patients. Spirituality is not explicitly distinguished from religiosity. Spirituality is conceptualized as a resource for meaning-making and coping, closely linked to religious beliefs and a relationship with God. Spirituality is framed as a supportive mechanism for psychological adjustment and resilience, particularly in dealing with the challenges of cancer Components or factors of spirituality: Not specified The study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. Spiritual distress is mentioned as obsticle that can be reduced by spiritual interventions. The intervention is designed to enhance positive manifestation of spirituality. Ghaempanah et al., 2024 Spirituality is described as an important way that many deal with hardships (e.g., chronic illness) and everyday life stressors and may act as a shield against these events. Spirituality is not explicitly distinguished from religiosity. Terms “religion” and “spirituality” are used interchangeably. Spirituality is conceptualized as important coping strategy. Components or factors of spirituality: Not specified Spirituality is described as a potential psychological resource. The negative side of spirituality is addressed (e.g., spiritual struggle, spiritual distress, religious struggle, loss of meaning). Both positive and negative dimensions of spirituality are discussed. The intervention addresses or responds to these different spirituality manifestations by enhancing positive religious coping and reducing negative religious coping. Momennasab et al., 2024 Spirituality is described as "an integral part of comprehensive health", as facilitating adjustment to cancer diagnosis and treatment Spirituality is not explicitly distinguished from religiosity. Spirituality is conceptualized as a coping resource and means to enhance quality of life, particularly in emotional functioning. Components or factors of spirituality: Not specified The study conceptualizes spirituality as having both positive and negative manifestations. It describes spirituality as a psychological resource for coping and empowerment, while also acknowledging spiritual distress as a negative aspect. The intervention addresses these dimensions through spiritual group therapy sessions that encourage sharing of both positive and negative experiences. Torabi et al., 2024 Spirituality is defined as resource for improving responses to stress and providing a sense of being supported by a higher power. Spirituality is not explicitly distinguished from religiosity. Spirituality is conceptualized as important as a coping strategy. Components or factors of spirituality: Not specified The study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention is designed to enhance positive manifestation of spirituality. Work-related Considerations No study discussed participants' occupational context, work-related needs, or return-to-work considerations in any form. Employment status was reported in five studies (50%) [ 22 , 23 , 25 , 30 – 32 ], and employment was treated exclusively as a sociodemographic descriptor, and was never discussed in relation to participants' experience of illness, spiritual needs, or the goals of the intervention. That employment status was systematically collected yet never analytically engaged suggests that occupational functioning was not conceptualized as a clinically relevant dimension of participants' cancer experience within any of the identified interventions. A full overview is presented in Table 6 . Table 6 Work-related considerations Study Employment status Work-related considerations Intvention group Control group Nasiri et al., 2019 Not specified Not specified Kashani Lotfabadi et al., 2020 Government employment: 4.3% Freelance job: 13.0% Housewife: 52.2%, Unemployed: 30.4%, Government employment: 3.7% Freelance job: 11.1% Housewife: 48.1% Unemployed: 18.5% Not specified Nasution et al., 2020; 2021 Unemployed: 1.9% Laborer: 72.2% Private sector: 3.7% Entrepreneur 11.1% Government employee: 9.3% Other: 1.9% Unemployed: 0% Laborer: 31.5% Private sector: 42.6% Entrepreneur: 1.9% Government employee: 13.0% Other: 11.1% Not specified Davari et al., 2022 Employed : 22.7% Unemployed: 77.3% Not specified Karimi et al., 2022 Not specified Not specified Moin et al., 2022 Not specified Not specified Hamidi et al., 2023 Not specified Not specified Ghaempanah et al., 2024 Employed: 10% Homemaker: 86.7% Disabled: 3.3% Employed: 0% Homemaker: 96.7% Disabled: 3.3% Not specified Momennasab et al., 2024 Homemaker: 86.7% Employee: 13.3% Homemaker: 83.8% Employee: 16.2% Not specified Torabi et al., 2024 Not specified Not specified Discussion This scoping review sought to map the existing evidence on psychosocial interventions explicitly addressing spirituality for working-age adults with cancer across the treatment and survivorship continuum. Following a systematic search, 11 studies were identified as meeting the inclusion criteria. The principal clinical contribution of this review lies not in identifying a robust toolkit for practice, but in demonstrating that despite growing recognition of spirituality as a clinically relevant dimension of cancer care – evidenced by consistent associations between spiritual well-being and quality of life across diverse survivor populations [ 35 , 36 ] – no replicable, theoretically grounded, or culturally transferable intervention currently exists to guide its systematic integration into oncology services for working-age adults. The identified evidence base is geographically and culturally concentrated within two countries and an exclusively Islamic religious context. This pattern is not unique: Yosep et al. [ 18 ] similarly found that 8 of 10 studies in a broader cancer scoping review originated from Iran and Indonesia. That Miller et al. [ 19 ], applying a broader conceptualization of spirituality, identified studies from eight countries suggests that this concentration reflects eligibility decisions as much as the actual distribution of evidence – underscoring the sensitivity of scoping review conclusions to methodological choices. All interventions were developed for the purposes of the individual study, with no intervention independently replicated, and sample sizes ranging from 31 to 169 participants. This limits any conclusions about replicability or scalability. While some studies incorporated elements of systematic development — including expert validation, Delphi processes, and pilot testing [ 28 , 30 , 32 ] – none progressed through the foundational development and feasibility stages that translational frameworks such as the MRC framework [ 37 ], ORBIT model [ 38 ], and MOST [ 39 ] identify as prerequisites for effective, scalable implementation [ 40 ]. A notable finding concerns the limited role of internationally published psychological theory in intervention design. Only two studies drew on established psychological models [ 25 , 27 ], one employed a standardized clinical framework informed by international guidelines [ 28 ], and four adopted mixed approaches integrating psychological theory with Islamic teachings — among them Davari et al. [ 32 ], whose RSP-TSS framework, though culturally embedded, was developed through a formal Delphi validation process and represents the most methodologically transparent development approach among the included studies. The remaining three studies relied exclusively on Islamic religious texts or general empirical literature without specifying a theoretical orientation. This pattern suggests that intervention design in this field has been driven primarily by religious tradition rather than psychological theory — a concern with direct practical consequences: Izgu et al. [ 36 ] identified the conceptual basis, content, and provider qualifications of spiritual interventions as significant moderators of effectiveness, confirming that theoretical decisions directly shape outcomes. The absence of explicit program theory is thus not a formal shortcoming but a barrier to understanding what works, for whom, and why [ 37 , 40 ]. The degree to which intervention protocols were documented varied considerably. Several studies specified session content, theoretical grounding, and expert validation procedures [ 28 , 30 – 32 ]; however, no study made a full therapist manual publicly available, and none reported fidelity monitoring specific to the spirituality-focused component. As a result, the extent to which reported outcomes can be attributed to the intervention as delivered – rather than to variability in implementation – cannot be determined from the available evidence. Despite this structural heterogeneity, the convergence around four to ten weekly sessions of 60–90 minutes in clinical settings is consistent with session ranges associated with meaningful improvement in adjacent psychosocial intervention research [ 41 , 42 ], and the variation in deliverer background mirrors patterns observed across psychosocial interventions more broadly [ 43 ]. The conceptualization of spirituality across included studies was notably inconsistent. While most studies offered at least a working description of spirituality, two provided no definition whatsoever [ 29 , 32 ], and only two explicitly distinguished spirituality from religiosity [ 25 , 27 ]. More consequentially, the dual nature of spirituality – encompassing both adaptive and maladaptive manifestations – was substantively addressed in only two studies [ 30 , 31 ]; the remaining eight framed spirituality exclusively as a positive resource. This reductionist view is particularly problematic within oncology, where patients frequently encounter existential crises that may manifest as spiritual distress or loss of meaning rather than strengthened faith [ 11 , 44 ]. By failing to account for spiritual struggle, interventions risk overlooking patients for whom spirituality is a source of distress rather than a buffer [ 12 ] - and may inadvertently function as forms of spiritual bypassing [ 45 ], imposing a mandatory positive framework that lacks clinical depth and validity. Rather than representing a limitation of this review, the absence of occupational considerations across all identified studies constitutes a central empirical finding: it demonstrates that spirituality-focused psychosocial interventions for working-age adults with cancer have not, to date, engaged with the occupational dimension of patients' lives — a domain of central relevance to this population. This omission is noteworthy given that, for many working-age survivors, professional engagement may serve not only as an economic necessity but also as a source of identity, purpose, and social belonging — dimensions that have been theoretically linked to spirituality in the broader literature [ 46 ]. In one qualitative study of cancer survivors' return-to-work experience, Barnard et al. [ 16 ] found that meaning-making — understood as the re-assessment of personal values, relational priorities, and life orientation in light of the cancer experience — emerged as a psychologically integrative phase of the adjustment process, though the generalizability of this finding across diverse survivor populations remains to be established — underscoring the need for research that explicitly examines the intersection of spirituality and occupational functioning in this population. Gaps in the Evidence Base and Directions for Future Research Taken together, this review reflects substantive gaps in the field rather than findings that can be meaningfully analyzed. These gaps point to several priorities for future research. First, geographically and culturally diverse studies are needed. The current evidence base – drawn exclusively from two countries and one religious tradition – cannot speak to the spiritual needs and intervention preferences of working-age cancer patients in other cultural contexts. Second, qualitative and mixed-methods approaches would complement the exclusively quantitative designs identified in this review, offering insight into patients' subjective experiences of spirituality-focused care that pre-test/post-test designs cannot capture. Third, future intervention development would benefit from explicit grounding in theory-informed, publicly available protocols. Frameworks that operationalize spirituality in a religiously inclusive manner — such as King's [ 24 , 47 ] model of spiritual intelligence, Büssing's [ 48 ] multidimensional spiritual attitudes framework, Richards and Bergin's [ 26 ] spiritual psychotherapy framework, and Pargament's religious coping theory [ 49 ] – could address the psychological functions of spirituality while remaining applicable across diverse cultural and religious backgrounds. Notably, several of these frameworks have already been drawn upon in interventions identified in this review, suggesting a viable pathway for culturally transferable adaptation. Fourth, greater attention to the dual nature of spirituality – encompassing both its supportive and distressing dimensions – would support more clinically responsive intervention design. Situating such interventions within integrative oncology frameworks, which increasingly recognize mind-body practices as evidence-based components of cancer care [ 7 , 50 ], may support greater theoretical coherence and alignment with existing clinical infrastructure — while also creating space to address the occupational dimensions of survivorship that remain unaddressed for working-age adults. Fifth, whether spirituality-focused interventions could be relevant to occupational functioning — including return to work, maintenance of occupational identity, or navigation of work-related challenges — remains entirely unexamined and represents a potentially fruitful, if as yet speculative, direction for future inquiry. Limitations Several limitations of this scoping review should be acknowledged. First, consistent with scoping review methodology, no formal quality appraisal of included studies was undertaken; consequently, the strength of the evidence base cannot be determined from the findings of this review alone [ 1 ]. Second, the application of inclusion and exclusion criteria inevitably involved boundary decisions that may have affected the final sample. Studies evaluating spirituality-like experiences facilitated by pharmacological substances, or assessed solely through biological outcome measures without accompanying psychosocial outcomes, were excluded. While these decisions ensured conceptual coherence, such studies may capture dimensions of spirituality in oncology that fall outside the scope of this review. Third, the operationalization of the working-age criterion represents a methodological limitation. As few studies recruited participants exclusively within the 25–54 age range, eligibility was determined on the basis of intervention group mean age – a proxy measure that does not guarantee that the majority of participants fell within this range. The upper age boundary of included samples extended to 78 years in some studies, meaning that a proportion of participants likely fell outside the defined working-age range. Consequently, the extent to which findings are representative of working-age adults specifically – rather than a broader adult cancer population – cannot be determined from the available data. Fourth, the search was limited to English-language studies published between 2019 and 2026, which may have resulted in the exclusion of relevant studies published in other languages or outside the defined date range. Conclusion This scoping review mapped the existing evidence on spirituality-focused psychosocial interventions for working-age adults with cancer. The findings reveal an evidence base that is geographically concentrated, theoretically underdeveloped, and conceptually inconsistent in its treatment of spirituality – constraints that limit the ability to identify mechanisms of change or draw comparisons across interventions. All identified studies were conducted within Islamic cultural contexts, no intervention has been independently replicated, and occupational considerations – central to the working-age population this review targeted – were entirely absent from the literature. While spirituality is increasingly recognized as a clinically relevant dimension of cancer care, the current evidence base is insufficient to guide practice in culturally diverse oncology settings. Expanding the geographic, cultural, and methodological scope of future research is essential to developing spirituality-focused interventions that are rigorous, replicable, and relevant to the full diversity of working-age adults living with and beyond cancer. Declarations Ethics approval and consent to participate This scoping review did not involve human participants, personal data, or biological samples; no ethical approval was required. Funding This work was supported by the project "RSU internal and RSU with LSPA external consolidation", project No. 5.2.1.1.i.0/2/24/I/CFLA/005. The project is funded by the European Union (NextGenerationEU) and the National Development Plan of Latvia for 2021–2027. Competing interests The authors declare no competing interests. Five of six authors of this manuscript are co-authors of a cited parallel review [20]; the two studies are independent in design, inclusion criteria, and evidence base. Data availability The data extracted and charted in this scoping review are available within the article and its supplementary appendices (Appendix 1–4). No additional datasets were generated or analysed. References Arksey H, O'Malley L. Scoping studies: towards a methodological framework. 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Journal of Clinical Oncology. 2023;41(28):4562-91. https://doi.org/10.1200/JCO.23.00857 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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approximately 20\u0026nbsp;million new cases were diagnosed worldwide in 2022, with projections reaching 35\u0026nbsp;million by 2050 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Improvements in early detection and treatment have produced a growing survivor population, nearly half of whom are younger than 65 years \u0026mdash; a group for whom career continuity, occupational identity, and work-related concerns are central to everyday life [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIntegrative oncology (IO) has emerged as a patient-centered framework positioning spirituality as a core dimension of comprehensive cancer care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Robust evidence confirms that spiritual well-being is consistently associated with better quality of life, more patient-centered medical decisions, and reduced psychological distress [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, spirituality is not a uniformly positive phenomenon: spiritual and religious engagement may manifest in both adaptive and maladaptive forms \u0026mdash; encompassing sources of meaning and hope alongside spiritual distress, struggle, and loss of faith [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Despite growing recognition of patients' spiritual needs, the majority of patients with cancer express a desire for spiritual care that remains largely unaddressed by their clinical teams [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong cancer survivors, working-age adults present a distinctive psychosocial profile, facing the concurrent disruption of occupational identity, economic self-sufficiency, and career continuity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Return to work (RTW) \u0026mdash; widely recognized as a marker of social reintegration and quality of life \u0026mdash; has emerged as a central concern in cancer rehabilitation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Qualitative research suggests that meaning-making may constitute a psychologically integrative phase of survivors' RTW journey [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and preliminary evidence indicates that workplace spirituality may mediate the relationship between job stress and job satisfaction among cancer survivors returning to work [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These findings raise the possibility that spirituality functions not only as a psychosocial resource during illness, but as a potential facilitator of occupational reintegration \u0026mdash; a dimension that existing IO frameworks have yet to systematically examine.\u003c/p\u003e \u003cp\u003eExisting scoping reviews have examined spiritual interventions in cancer populations broadly \u0026ndash; including mindfulness, spiritual counselling, and meaning-making components across diverse settings [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] \u0026ndash; yet neither centred working-age adults nor occupational outcomes as primary analytical lens. A recently published scoping review by the present authors [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], focusing specifically on working-age oncology patients, identified spirituality as a significant correlate of quality of life and coping, but was restricted to quantitative observational designs and excluded structured psychosocial interventions. The intersection of spirituality, integrative care, and occupational functioning in this population therefore remains systematically unexamined.\u003c/p\u003e \u003cp\u003eThis scoping review aimed to systematically map existing psychosocial interventions explicitly addressing spirituality for working-age adults with cancer across the treatment and survivorship continuum. Scoping review methodology was selected for its capacity to examine the extent and nature of evidence without imposing quality-appraisal constraints \u0026mdash; an approach suited to the heterogeneous and emergent character of spirituality research in oncology.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis scoping review followed the methodological framework of Arksey and O'Malley [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], refined by Levac et al. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch Questions\u003c/h3\u003e\n\u003cp\u003eThe primary review question was: what psychosocial interventions explicitly addressing spirituality have been described for working-age adults with cancer, and how are these interventions characterized in terms of content and delivery? Subsidiary questions examined: (1) participants' sociodemographic and clinical characteristics; (2) intervention structure and delivery; (3) theoretical foundations and content components; (4) conceptualization of spirituality and its distinction from religiosity; and (5) the extent to which included studies addressed occupational or return-to-work considerations.\u003c/p\u003e\n\u003ch3\u003eSearch Strategy\u003c/h3\u003e\n\u003cp\u003eSeven databases were searched by two librarians (January 14\u0026ndash;31, 2026): MEDLINE via PubMed, Scopus, Science Direct, Cochrane Central, Taylor \u0026amp; Francis, and ProQuest collections (APA PsycArticles; Psychology Collection; Health \u0026amp; Medical Collection). These databases were selected to ensure coverage across biomedical, psychological, and interdisciplinary literature.\u003c/p\u003e \u003cp\u003eSearch terms combined cancer-related vocabulary (neoplasms, cancer, oncology) with spirituality-related terms (spirituality, spiritual care, spiritual intervention) and intervention-related terms (intervention, therapy, treatment), incorporating MeSH terms, database-specific subject headings, and free-text searches across titles, abstracts, and keywords. Full search strategies are presented in Appendix 1.\u003c/p\u003e \u003cp\u003eSearches were limited to peer-reviewed, full-text articles in English. Records were exported to Rayyan; two librarians independently screened titles and abstracts, resolving discrepancies through discussion. A total of 3,716 records were identified.\u003c/p\u003e\n\u003ch3\u003eStudy Selection\u003c/h3\u003e\n\u003cp\u003eStudy selection was conducted by a five-member team following PRISMA-ScR guidelines [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Following removal of 1,303 duplicates, 2,413 records advanced to title and abstract screening; 1,859 were excluded as irrelevant. Full-text review of 113 reports was performed by three reviewers, with predatory journal status assessed at this stage. All final inclusion and exclusion decisions were made independently by at least two reviewers, with disagreements resolved through discussion. Of 113 full-text reports assessed, 102 were excluded. Inclusion and exclusion criteria are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInclusion and Exclusion Criteria for Study Selection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriterion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInclusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExclusion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePublication date\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublished between 2019 and 2026.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePublished outside 2019\u0026ndash;2026.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary study: qualitative, quantitative, or mixed methods.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot a primary study (e.g., review, editorial, protocol).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePopulation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorking-age cancer patients or survivors (mean age or majority of intervention group participants aged 25\u0026ndash;54 years); or population explicitly described as working-age adults with age data consistent with this range.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-cancer patients; no clear age information reported; majority of intervention group participants older than 54 years; mean age of intervention group exceeding 54 years; or participants explicitly described as retired or non\u0026ndash;working-age adults.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCancer stage / Disease trajectory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants not primarily diagnosed with metastatic or terminal cancer, or if the study population described as non-metastatic, early-stage, or mixed-stage without a predominant focus on advanced disease. Where formal staging was not reported, studies were included if the clinical description indicated a curative or post-curative treatment trajectory consistent with potential return to active life.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe majority of participants diagnosed with advanced, metastatic or terminal cancer, or if the study setting, aims, or population description indicated a predominant focus on end-stage disease management or symptom palliation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpirituality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpirituality explicitly identified as a central concern of the study, with the term \"spirituality\" or \"spiritual\" clearly stated in the study title, aims, research question, or theoretical framework.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality not explicitly identified as a central concern of the study; or spirituality appears solely as a peripheral or incidental element \u0026mdash; for example, as a single subscale within a broader outcome measure, or as one of multiple component in a non-spirituality-focused intervention \u0026mdash; without a clear primary orientation toward spirituality in the context of cancer care.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt least one psychosocial outcome measured to evaluate the impact of an intervention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo relevant psychosocial outcomes reported; or biological, physiological, or immunological outcomes \u0026mdash; including, but not limited to, biomarker assessments (e.g., oxytocin levels) without an accompanying psychosocial outcome measure.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClearly defined, structured spirituality-focused psychosocial intervention (e.g., multi-session program, psychoeducational or informational intervention, spiritual practice).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo clearly defined spirituality-focused psychosocial intervention; purely observational or descriptive studies; studies lacking an active intervention component.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDuplicate records; unavailable full text; non-English full-text document; publication in a predatory journal.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNote.\u003c/em\u003e The age range of 25\u0026ndash;54 years follows Eurostat's (2024) classification of mid-career workers. This boundary was preferred over the broader 15\u0026ndash;64 range because individuals aged 55\u0026ndash;64 are disproportionately likely to exit the labour market permanently following a cancer diagnosis (de Boer et al., 2009; Mehnert et al., 2013), while those aged 15\u0026ndash;24 remain in transitional educational or early vocational phases qualitatively distinct from established career contexts (Stanton et al., 2015). The 25\u0026ndash;54 range thus captures the population for whom return to work is most prognostically relevant and occupational identity most consolidated.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eData Extraction and Charting\u003c/h3\u003e\n\u003cp\u003eA final set of 11 studies met all inclusion criteria and were included in the review. Data were initially extracted using AI tool Elicit and subsequently verified by two independent reviewers. Charting was organized into five thematic domains corresponding to the review questions, each presented in a dedicated extraction table.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCollating, Summarizing, and Reporting the Results\u003c/h2\u003e \u003cp\u003eResults were synthesized in two steps: first, frequency counts and percentages characterized key study features; second, narrative analysis identified recurring patterns and variations across studies, with thematic categories emerging iteratively from the charted data [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eEleven studies published between 2019 and 2024 met inclusion criteria: nine (82%) conducted in Iran, two (18%) in Indonesia. All employed quantitative pre-test/post-test designs with a control group; four (36%) were randomized controlled trials, seven (64%) quasi-experimental. No qualitative or mixed-methods studies met inclusion criteria. Two publications [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] drew on the same sample and intervention, differing only in outcomes reported; these are treated as a single study throughout, with all proportions calculated on the basis of 10 unique interventions. A full overview is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of Included Studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNasiri et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe Effectiveness of Religious-Spiritual Psychotherapy on the Quality of Life of Women with Breast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal of Babol University of Medical Sciences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental double-blinded; pre-test, post-test design with two-month follow-up; with a control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKashani Lotfabadi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe effect of the components of King's spiritual intelligence group training on stigma in patients with cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNursing Practice Today\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial; pre-test and post-test design; with an intervention and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIran \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNasution et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEffectiveness of Spiritual Intervention toward Coping and Spiritual Well-being on Patients with Gynecological Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAsia-Pacific Journal of Oncology Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental; pre-test and post-test design; with an intervention and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndonesia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNasution et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe Effectiveness of Spiritual Intervention in Overcoming Anxiety and Depression Problems in Gynecological Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJurnal Keperawatan Indonesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental; pre-test and post-test design; with an intervention and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndonesia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDavari et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe Effect of Religious\u0026ndash;Spiritual Psychotherapy on Illness Perception and Inner Strength among Patients with Breast Cancer in Iran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal of Religion and Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial; pre-test, post-test design with four-month follow-up; with an intervention and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKarimi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe Effect of a Spiritual Care Program on the Self-Esteem of Patients with Cancer: A Quasi-Experimental Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIranian Journal of Nursing and Midwifery Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental; pre-and post-test design; with an intervention and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIran \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMoin et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe Comparison of the Effectiveness of Acceptance and Commitment Therapy and Spirituality Therapy in Reducing Anxiety in Women with Breast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eArchives of Breast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental; pre-test and post-test design and a three-month follow-up; with a two intervention groups (ACT and Spirituality Therapy) and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHamidi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe effect of spirituality-based education on the meaning of life in cancer patients: a quasi-experimental study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOncology in Clinical Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental; pre-test and post-test design; with an intervention and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGhaempanah et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood for Coping, Not for Eudaimonia: The Effectiveness of a Spiritual/Religious Intervention in the Healthcare of Breast Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePastoral Psychology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental; pre-test and post-test design; with an intervention and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIran \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMomennasab et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe Effect of Spiritual Group Therapy on the Quality of Life and Empowerment of Women with Breast Cancer: A Randomized Clinical Trial in Iran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal of Religion and Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial; pre-test and post-test design; with an intervention and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorabi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEffectiveness of Group Spiritual Care on Leukemia Patients\u0026rsquo; Hope and Anxiety in Iran: A Randomized Controlled Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal of Religion and Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial; pre-test and post-test design and a one-month follow-up and two-month follow-up; with an intervention and control group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eSociodemographic and Clinical Characteristics\u003c/h3\u003e\n\u003cp\u003eA total of 778 participants were enrolled across included studies (sample sizes: 31\u0026ndash;169). Participant age ranged from 18 to 78 years, with intervention group mean ages between 34.90 and 50.53. Seven studies (70%) enrolled exclusively or predominantly female participants, with breast cancer the most frequently represented diagnosis (60%). Cancer stage reporting was inconsistent: studies enrolled participants ranging from Stage I\u0026ndash;II only to mixed Stage I\u0026ndash;IV populations; two studies did not report stage in standardized terms. The majority (70%) enrolled participants during active treatment; two studies (20%) focused on post-treatment survivorship. Spiritual or religious affiliation was reported in five studies (50%), all identifying participants as Muslim. The concentration of evidence within two countries, combined with the exclusive representation of Muslim participants, suggests that the existing knowledge base reflects a culturally specific understanding of spirituality that cannot be assumed to translate to other oncological contexts. Full characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and Clinical Characteristics of Study Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCancer type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCancer stage / Disease trajectory*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTreatment stage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSpiritual or religious affiliation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNasiri et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: 18-65\u003c/p\u003e \u003cp\u003eMean age:\u003c/p\u003e \u003cp\u003eIntervention: 44.74\u003c/p\u003e \u003cp\u003eControl: 45.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale: 100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eI, II, III, IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eActive treatment (at least two months after their diagnosis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKashani Lotfabadi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: 20\u0026ndash;60\u003c/p\u003e \u003cp\u003eMean age:\u003c/p\u003e \u003cp\u003eIntervention: 49.3\u003c/p\u003e \u003cp\u003eControl: 42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention: Female: 65.2%\u003c/p\u003e \u003cp\u003eMale: 34.8%\u003c/p\u003e \u003cp\u003eControl:\u003c/p\u003e \u003cp\u003eFemale: 66.7%\u003c/p\u003e \u003cp\u003eMale: 33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eI,II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eActive treatment (hospitalized)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020; 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNasution et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: \u0026ge;18\u003c/p\u003e \u003cp\u003eMean age:\u003c/p\u003e \u003cp\u003eIntervention: 47.17 \u003c/p\u003e \u003cp\u003eControl: 44.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale: 100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGyneco-\u003c/p\u003e \u003cp\u003elogical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eI, II, III, IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eActive treatment (inpatients)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDavari et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: 31\u0026ndash;58\u003c/p\u003e \u003cp\u003eMean age: 44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale: 100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGrade 1, Grade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost-treatment survivorship (completed chemotherapy and radiotherapy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTwelver Shi'ism of Islam\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKarimi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: 18\u0026ndash;45\u003c/p\u003e \u003cp\u003eMean age:\u003c/p\u003e \u003cp\u003eIntervention: 34.90\u003c/p\u003e \u003cp\u003eControl: 36.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention:\u003c/p\u003e \u003cp\u003eFemale: 96.90%\u003c/p\u003e \u003cp\u003eMale: 3.1%\u003c/p\u003e \u003cp\u003eControl:\u003c/p\u003e \u003cp\u003eFemale: 100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMajority breast: Intervention: 65.60%\u003c/p\u003e \u003cp\u003eControl: 84.60%\u003c/p\u003e \u003cp\u003eOther cancer types not specified.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eApproved by their physician as not having advanced\u003c/p\u003e \u003cp\u003e cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLikely active treatment or in post-treatment survivorship (6 months after\u003c/p\u003e \u003cp\u003e diagnosis; main treatment being surgery)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMoin et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: 40\u0026ndash;60\u003c/p\u003e \u003cp\u003eMean age:\u003c/p\u003e \u003cp\u003eIntervention (ACT): 48.22\u003c/p\u003e \u003cp\u003eIntervention (Spiritual Therapy): 47.54\u003c/p\u003e \u003cp\u003eControl: 48.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale: 100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eI, II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHamidi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: 18\u0026ndash;65\u003c/p\u003e \u003cp\u003eMean age: Not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention:\u003c/p\u003e \u003cp\u003eFemale: 44%\u003c/p\u003e \u003cp\u003eMale: 56% \u003c/p\u003e \u003cp\u003eControl:\u003c/p\u003e \u003cp\u003eFemale: 37.6%\u003c/p\u003e \u003cp\u003eMale: 62.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntervention:\u003c/p\u003e \u003cp\u003e Stomach: 26.2%\u003c/p\u003e \u003cp\u003e Colorectal: 35.6%\u003c/p\u003e \u003cp\u003eBreast: 15.5%\u003c/p\u003e \u003cp\u003eLiver: 4.8%\u003c/p\u003e \u003cp\u003eControl:\u003c/p\u003e \u003cp\u003eStomach: 27.1%\u003c/p\u003e \u003cp\u003eColorectal: 54.1%\u003c/p\u003e \u003cp\u003eBreast: 11.8%\u003c/p\u003e \u003cp\u003eLiver: 7.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eI, II, III, IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eActive treatment (outpatient chemotherapy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGhaempanah et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: 27\u0026ndash;78\u003c/p\u003e \u003cp\u003eMean age:\u003c/p\u003e \u003cp\u003eIntervention: 50.53\u003c/p\u003e \u003cp\u003eControl: 48.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale: 100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eI, II, III (non-metastatic)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost-treatment survivorship (at least six months from the start of treatment and had completed at least one course of chemotherapy); medically stable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMomennasab et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: 25\u0026ndash;60\u003c/p\u003e \u003cp\u003eMean age:\u003c/p\u003e \u003cp\u003eIntervention: 43.46\u003c/p\u003e \u003cp\u003eControl: 42.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale: 100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNot having any signs of metastatic breast cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eActive treatment (undergoing or had recently undergone chemotherapy or radiotherapy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorabi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge range: Not specified\u003c/p\u003e \u003cp\u003eMean age:\u003c/p\u003e \u003cp\u003eIntervention:\u003c/p\u003e \u003cp\u003e41.78\u003c/p\u003e \u003cp\u003eControl: 40.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention:\u003c/p\u003e \u003cp\u003eFemale: 43.8%\u003c/p\u003e \u003cp\u003eMale: 56.3% Control:\u003c/p\u003e \u003cp\u003eFemale: 56.3%\u003c/p\u003e \u003cp\u003eMale: 43.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLeukemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eI, II, III (non-metastatic)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eActive treatment (receiving chemotherapy or radiotherapy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMuslim, Shiite\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e*Cancer stage / Disease trajectory reported as eligibility criterion rather than formal clinical staging.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStructural and Delivery Characteristics\u003c/h2\u003e \u003cp\u003eInterventions were predominantly group-based (70%) and delivered in person in hospital or clinical settings (70%), comprising four to ten sessions of 45\u0026ndash;90 minutes. The most common format was six sessions (40%) of 60 minutes (40%). Deliverer background was heterogeneous, encompassing psychologists and therapists (40%), researchers or doctoral students (30%), oncology nurses, multidisciplinary teams, and spiritual caregivers. Despite this structural heterogeneity, the convergence around four to ten sessions of 60\u0026ndash;90 minutes, delivered weekly in clinical settings, provides preliminary indication of a feasible delivery format for spirituality-focused interventions in oncology care. A detailed overview is presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStructural and Delivery Characteristics of Spirituality-Focused Psychosocial Interventions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFormat\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of sessions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSession duration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDelivery method\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDeliverer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSetting\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious-spiritual psychotherapy\u003c/p\u003e \u003cp\u003e(Nasiri et al., 2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 sessions held within a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn-person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTherapist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical setting\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKing's spiritual intelligence group training\u003c/p\u003e \u003cp\u003e(Kashani Lotfabadi et al., 2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 sessions held twice a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn-person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eExperienced clinical psychologist trained in spiritual intelligence training, supervised by an oncologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpiritual Intervention\u003c/p\u003e \u003cp\u003e(Nasution et al., 2020. 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndividual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 sessions held within two weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u0026ndash;90 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn-person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOncology nurses with the spiritual guidance certification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious-Spiritual Psychotherapy based on the Twelver Shia Sects of Islam (RSP-TSS)\u003c/p\u003e \u003cp\u003e(Davari et al., 2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndividual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 sessions held once a week within 10 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn-person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePh.D. student in psychology and a researcher on Islam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical setting\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpiritual care program\u003c/p\u003e \u003cp\u003e(Karimi et al., 2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 sessions held twice a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMixed: 3 face-to-face sessions, 3 virtual sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpiritual caregiver and main researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHospital, WhatsApp\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpirituality Therapy\u003c/p\u003e \u003cp\u003e(Zari Moin et al., 2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 sessions held once twice a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn-person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePsychotherapist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpirituality-based education\u003c/p\u003e \u003cp\u003e(Hamidi et al., 2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 sessions held over three weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOnline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eResearcher\u003c/p\u003e \u003cp\u003e/nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eWhatsApp; audio, video, PowerPoint, PDF materials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpiritual/religious intervention\u003c/p\u003e \u003cp\u003e(Ghaempanah et al., 2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndividual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026ndash;8 sessions held once per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn-person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTrained psychologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLikely hospital or clinical setting\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpiritual Group Therapy\u003c/p\u003e \u003cp\u003e(Momennasab et al., 2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 sessions held twice a week for the first two weeks, one session in the third week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn-person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eResearcher's main co-worker under the supervision of an expert on religious matters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup Spiritual Care Program\u003c/p\u003e \u003cp\u003e(Torabi et al., 2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 sessions held once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u0026ndash;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn-person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTeam including Ph.D. in nursing, MSc in medical-surgical nursing, nursing students, and psychology specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheoretical Foundations and Content Components\u003c/h2\u003e \u003cp\u003eAll interventions were developed specifically for the respective study. Two studies (20%) grounded their interventions in internationally published psychological models: King's [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] model of spiritual intelligence [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and Richards and Bergin's [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] spiritual psychotherapy framework [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. One study (10%) employed a standardized and localized spiritual care model informed by international clinical guidelines and contextualized for Iranian patients with chronic illness [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Three studies (30%) adopted a mixed approach, combining psychological theory with Islamic teachings [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. A fourth study in this category [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] drew on RSP-TSS \u0026ndash; a culturally developed framework integrating psychological theory with Islamic theological principles, validated through a formal Delphi process. The remaining three studies (30%) provided limited or no theoretical grounding: two referenced Islamic teachings exclusively[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and one cited prior empirical literature without specifying a theoretical orientation [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNine recurring content themes were identified across interventions. The most pervasive theme was \u003cb\u003erelationship with God and divine connection\u003c/b\u003e (90%), encompassing prayer, Quranic recitation, trust in and reliance on God, communion with God, repentance and seeking forgiveness, encouragement to express feelings directly to God. \u003cb\u003eCoping with illness and acceptance\u003c/b\u003e (60%), addressing acceptance of disease, locus of control, patience in chronic illness, and positive reframing of the cancer experience. \u003cb\u003eInterpersonal relationships and communication\u003c/b\u003e (60%), covering relationships with family members, effective communication, and supportive communication with caregivers. \u003cb\u003eForgiveness, patience, and gratitude\u003c/b\u003e (60%), including self-forgiveness, forgiving others, patience as a spiritual resource, and \u0026mdash; in one study \u0026mdash; explicit sessions on appreciation and gratitude [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. \u003cb\u003eSelf-awareness and identity\u003c/b\u003e (60%), encompassing identification of feelings, existential questions such as \u0026ldquo;who am I?\u0026rdquo; and \u0026ldquo;what is the purpose of my life?\u0026rdquo;, spiritual self-knowledge, expression of illness-related grief, and \u0026mdash; in one study \u0026mdash; intrapersonal communication and listening to the inner voice [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. \u003cb\u003eMeaning-making and purpose in life\u003c/b\u003e (50%), addressing the meaning of suffering, life purpose, and existential reflection. \u003cb\u003eRelaxation and mind-body practices\u003c/b\u003e (50%), primarily in the form of deep breathing techniques and mental relaxation, often combined with listening to Quranic verses. \u003cb\u003eSpiritual and religious education\u003c/b\u003e (60%), introducing participants to program objectives, concepts of spirituality and religion, and \u0026mdash; in one case \u0026mdash; conducting a formal assessment of spiritual needs [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. \u003cb\u003eDeath, suffering, and existential questions\u003c/b\u003e (30%), encompassed direct engagement with death and fear of death, the meaning and purpose of suffering, and existential-critical reflection on life.\u003c/p\u003e \u003cp\u003eThe dominance of God-centered and Islamic religious themes suggests these programs function primarily as culturally embedded religious practices rather than theoretically grounded psychosocial interventions \u0026ndash; limiting their transferability to diverse populations \u0026ndash; and the limited documentation of intervention protocols \u0026ndash; with no study making a full therapist manual publicly available or reporting fidelity monitoring \u0026ndash; means that the replicability and active ingredients of these interventions cannot be fully assessed from the current evidence base.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eConceptualization of Spirituality\u003c/h2\u003e \u003cp\u003eSpirituality was inconsistently defined across included studies. Five studies (50%) conceptualized it as a source of psychological strength or coping; one as spiritual intelligence [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]; one as a search for meaning and connection with a sacred source [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]; two provided no definition. Only two studies (20%) explicitly distinguished spirituality from religiosity. The dual nature of spirituality \u0026mdash; encompassing both adaptive manifestations and negative dimensions such as spiritual distress or religious struggle \u0026mdash; was substantively addressed in only two studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]; remaining studies framed spirituality exclusively as a positive resource. A full overview is presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The limited attention to spirituality as a multidimensional construct \u0026mdash; encompassing both adaptive and maladaptive manifestations \u0026mdash; constrains the cumulative development of knowledge in this field.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConceptualization of Spirituality Across Included Studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDefinition or description of spirituality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality/Religiosity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConceptualization of spirituality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDual nature of spirituality\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNasiri et al., 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo explicit definition of spirituality is offered. The authors refer to spirituality as a \"new paradigm for responding to the challenges of the future\" and a means of \"satisfying the transcendent needs of individuals\".\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is not explicitly distinguished from religiosity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is not consistently conceptualized.\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: Not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed.\u003c/p\u003e \u003cp\u003eThe intervention promotes spiritual maturity exclusively as acceptance, gratitude, and trust in God.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKashani-Lotfabadi et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpirituality is defined as intelligence - a set of adaptive psychological capacities created based on non-material and existential transcendental aspects that are considered as the different form of moral-religious identity, and is equipped with it has nothing to do with the belief system or individual religion (King's, 2008).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is distinguished from religiosity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is conceptualized as coping mechanism that can help to cope with negative and maladaptive behaviors in social or personal life and develop a positive orientation toward life.\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: critical existential thinking, personal meaning production, transcendental awareness, and conscious state expansion (King's, 2008).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study promotes spirituality as a positive resource. The discussion briefly mentions negative religious interpretations like \"punishment from God\" as a source of incompatibility. \u003c/p\u003e \u003cp\u003eIntervention is designed to enhance spiritual intelligence as adaptive resource.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNasution et al., 2020; 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpirituality is described as one source of individual\u003c/p\u003e \u003cp\u003e strength in dealing with difficult situations, uncertainties,\u003c/p\u003e \u003cp\u003e and serious events.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is not explicitly distinguished from religiosity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is conceptualized as a coping resource and psychological support mechanism and as part of psychosocial adjustment and existential coping.\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: Not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention addresses spirituality as resource for increasing coping and spiritual well-being.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDavari et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo explicit definition of spirituality is offered.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is not explicitly distinguished from religiosity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is conceptualized as a coping resource (\"key role in coping with cancer and health-related quality of life\").\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: Not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention is designed to enhance positive spirituality through religious-spiritual practices and themes.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKarimi et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpirituality is described as being associated with all aspects of one\u0026rsquo;s health and illness which guides one\u0026rsquo;s daily behaviors and are a source of support, strength, and healing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is not explicitly distinguished from religiosity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is conceptualized as coping resource and psychological support mechanism, improving well-being, life satisfaction, and self-esteem.\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: individuals\u0026rsquo; relationship with God, themselves, others, and with the environment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention is designed to enhance the relationships with God, oneself, others, and the environment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoin et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpirituality is defined as \"searching for meaning and purpose to communicate with a sacred source or ultimate reality\".\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is described as related to, but not identical with, religion.\u003c/p\u003e \u003cp\u003e It is distinguished from religiosity by its focus on personal beliefs and values rather than specific religious practices.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is conceptualized as coping resource and means for finding meaning and purpose, reducing anxiety and enhancing hope.\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: Not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention is designed to enhance spirituality as a coping resource. The intervention addresses spirituality by respecting and valuing clients' spiritual issues to enhance hope and reduce anxiety.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHamidi et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpirituality is described as a source to improve the meaning of life in cancer patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is not explicitly distinguished from religiosity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is conceptualized as a resource for meaning-making and coping, closely linked to religious beliefs and a relationship with God. Spirituality is framed as a supportive mechanism for psychological adjustment and resilience, particularly in dealing with the challenges of cancer\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: Not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. \u003c/p\u003e \u003cp\u003eSpiritual distress is mentioned as obsticle that can be reduced by spiritual interventions. The intervention is designed to enhance positive manifestation of spirituality.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGhaempanah et al., 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpirituality is described as an important way that many deal with hardships (e.g., chronic illness) and everyday life stressors and may act as a shield against these events.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is not explicitly distinguished from religiosity. Terms \u0026ldquo;religion\u0026rdquo; and \u0026ldquo;spirituality\u0026rdquo; are used interchangeably.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is conceptualized as important coping strategy.\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: Not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSpirituality is described as a potential psychological resource.\u003c/p\u003e \u003cp\u003e The negative side of spirituality is addressed (e.g., spiritual struggle, spiritual distress, religious struggle, loss of meaning).\u003c/p\u003e \u003cp\u003e Both positive and negative dimensions of spirituality are discussed.\u003c/p\u003e \u003cp\u003e The intervention addresses or responds to these different spirituality manifestations by enhancing positive religious coping and reducing negative religious coping.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMomennasab et al., 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpirituality is described as \"an integral part of comprehensive health\", as facilitating adjustment to cancer diagnosis and treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is not explicitly distinguished from religiosity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is conceptualized as a coping resource and means to enhance quality of life, particularly in emotional functioning.\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: Not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study conceptualizes spirituality as having both positive and negative manifestations. It describes spirituality as a psychological resource for coping and empowerment, while also acknowledging spiritual distress as a negative aspect. The intervention addresses these dimensions through spiritual group therapy sessions that encourage sharing of both positive and negative experiences.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTorabi et al., 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpirituality is defined as resource for improving responses to stress and providing a sense of being supported by a higher power.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpirituality is not explicitly distinguished from religiosity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality is conceptualized as important as a coping strategy.\u003c/p\u003e \u003cp\u003eComponents or factors of spirituality: Not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe study promotes spirituality as a positive resource. The dual nature of spirituality is not addressed. The intervention is designed to enhance positive manifestation of spirituality.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eWork-related Considerations\u003c/h2\u003e \u003cp\u003eNo study discussed participants' occupational context, work-related needs, or return-to-work considerations in any form. Employment status was reported in five studies (50%) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], and employment was treated exclusively as a sociodemographic descriptor, and was never discussed in relation to participants' experience of illness, spiritual needs, or the goals of the intervention. That employment status was systematically collected yet never analytically engaged suggests that occupational functioning was not conceptualized as a clinically relevant dimension of participants' cancer experience within any of the identified interventions. A full overview is presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWork-related considerations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eWork-related considerations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eIntvention group\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eControl group\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNasiri et al., 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKashani Lotfabadi et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employment: 4.3%\u003c/p\u003e \u003cp\u003eFreelance job: 13.0%\u003c/p\u003e \u003cp\u003eHousewife: 52.2%,\u003c/p\u003e \u003cp\u003eUnemployed: 30.4%,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eGovernment employment: 3.7%\u003c/p\u003e \u003cp\u003eFreelance job: 11.1%\u003c/p\u003e \u003cp\u003eHousewife: 48.1%\u003c/p\u003e \u003cp\u003eUnemployed: 18.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNasution et al., 2020; 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed: 1.9%\u003c/p\u003e \u003cp\u003eLaborer: 72.2%\u003c/p\u003e \u003cp\u003ePrivate sector: 3.7%\u003c/p\u003e \u003cp\u003eEntrepreneur 11.1%\u003c/p\u003e \u003cp\u003eGovernment employee: 9.3%\u003c/p\u003e \u003cp\u003eOther: 1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eUnemployed: 0%\u003c/p\u003e \u003cp\u003eLaborer: 31.5%\u003c/p\u003e \u003cp\u003ePrivate sector: 42.6%\u003c/p\u003e \u003cp\u003eEntrepreneur: 1.9%\u003c/p\u003e \u003cp\u003eGovernment employee: 13.0%\u003c/p\u003e \u003cp\u003eOther: 11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDavari et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003cp\u003e: 22.7%\u003c/p\u003e \u003cp\u003eUnemployed: 77.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKarimi et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoin et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHamidi et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGhaempanah et al., 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eEmployed: 10%\u003c/p\u003e \u003cp\u003eHomemaker: 86.7%\u003c/p\u003e \u003cp\u003eDisabled: 3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eEmployed: 0%\u003c/p\u003e \u003cp\u003eHomemaker: 96.7%\u003c/p\u003e \u003cp\u003eDisabled: 3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMomennasab et al., 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eHomemaker: 86.7%\u003c/p\u003e \u003cp\u003eEmployee: 13.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eHomemaker: 83.8%\u003c/p\u003e \u003cp\u003eEmployee: 16.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTorabi et al., 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review sought to map the existing evidence on psychosocial interventions explicitly addressing spirituality for working-age adults with cancer across the treatment and survivorship continuum. Following a systematic search, 11 studies were identified as meeting the inclusion criteria. The principal clinical contribution of this review lies not in identifying a robust toolkit for practice, but in demonstrating that despite growing recognition of spirituality as a clinically relevant dimension of cancer care \u0026ndash; evidenced by consistent associations between spiritual well-being and quality of life across diverse survivor populations [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] \u0026ndash; no replicable, theoretically grounded, or culturally transferable intervention currently exists to guide its systematic integration into oncology services for working-age adults.\u003c/p\u003e \u003cp\u003eThe identified evidence base is geographically and culturally concentrated within two countries and an exclusively Islamic religious context. This pattern is not unique: Yosep et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] similarly found that 8 of 10 studies in a broader cancer scoping review originated from Iran and Indonesia. That Miller et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], applying a broader conceptualization of spirituality, identified studies from eight countries suggests that this concentration reflects eligibility decisions as much as the actual distribution of evidence \u0026ndash; underscoring the sensitivity of scoping review conclusions to methodological choices. All interventions were developed for the purposes of the individual study, with no intervention independently replicated, and sample sizes ranging from 31 to 169 participants. This limits any conclusions about replicability or scalability. While some studies incorporated elements of systematic development \u0026mdash; including expert validation, Delphi processes, and pilot testing [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] \u0026ndash; none progressed through the foundational development and feasibility stages that translational frameworks such as the MRC framework [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], ORBIT model [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], and MOST [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] identify as prerequisites for effective, scalable implementation [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA notable finding concerns the limited role of internationally published psychological theory in intervention design. Only two studies drew on established psychological models [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], one employed a standardized clinical framework informed by international guidelines [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and four adopted mixed approaches integrating psychological theory with Islamic teachings \u0026mdash; among them Davari et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], whose RSP-TSS framework, though culturally embedded, was developed through a formal Delphi validation process and represents the most methodologically transparent development approach among the included studies. The remaining three studies relied exclusively on Islamic religious texts or general empirical literature without specifying a theoretical orientation. This pattern suggests that intervention design in this field has been driven primarily by religious tradition rather than psychological theory \u0026mdash; a concern with direct practical consequences: Izgu et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] identified the conceptual basis, content, and provider qualifications of spiritual interventions as significant moderators of effectiveness, confirming that theoretical decisions directly shape outcomes. The absence of explicit program theory is thus not a formal shortcoming but a barrier to understanding what works, for whom, and why [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe degree to which intervention protocols were documented varied considerably. Several studies specified session content, theoretical grounding, and expert validation procedures [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]; however, no study made a full therapist manual publicly available, and none reported fidelity monitoring specific to the spirituality-focused component. As a result, the extent to which reported outcomes can be attributed to the intervention as delivered \u0026ndash; rather than to variability in implementation \u0026ndash; cannot be determined from the available evidence. Despite this structural heterogeneity, the convergence around four to ten weekly sessions of 60\u0026ndash;90 minutes in clinical settings is consistent with session ranges associated with meaningful improvement in adjacent psychosocial intervention research [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], and the variation in deliverer background mirrors patterns observed across psychosocial interventions more broadly [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe conceptualization of spirituality across included studies was notably inconsistent. While most studies offered at least a working description of spirituality, two provided no definition whatsoever [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], and only two explicitly distinguished spirituality from religiosity [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. More consequentially, the dual nature of spirituality \u0026ndash; encompassing both adaptive and maladaptive manifestations \u0026ndash; was substantively addressed in only two studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]; the remaining eight framed spirituality exclusively as a positive resource. This reductionist view is particularly problematic within oncology, where patients frequently encounter existential crises that may manifest as spiritual distress or loss of meaning rather than strengthened faith [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. By failing to account for spiritual struggle, interventions risk overlooking patients for whom spirituality is a source of distress rather than a buffer [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] - and may inadvertently function as forms of spiritual bypassing [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], imposing a mandatory positive framework that lacks clinical depth and validity.\u003c/p\u003e \u003cp\u003eRather than representing a limitation of this review, the absence of occupational considerations across all identified studies constitutes a central empirical finding: it demonstrates that spirituality-focused psychosocial interventions for working-age adults with cancer have not, to date, engaged with the occupational dimension of patients' lives \u0026mdash; a domain of central relevance to this population. This omission is noteworthy given that, for many working-age survivors, professional engagement may serve not only as an economic necessity but also as a source of identity, purpose, and social belonging \u0026mdash; dimensions that have been theoretically linked to spirituality in the broader literature [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. In one qualitative study of cancer survivors' return-to-work experience, Barnard et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] found that meaning-making \u0026mdash; understood as the re-assessment of personal values, relational priorities, and life orientation in light of the cancer experience \u0026mdash; emerged as a psychologically integrative phase of the adjustment process, though the generalizability of this finding across diverse survivor populations remains to be established \u0026mdash; underscoring the need for research that explicitly examines the intersection of spirituality and occupational functioning in this population.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eGaps in the Evidence Base and Directions for Future Research\u003c/h2\u003e \u003cp\u003eTaken together, this review reflects substantive gaps in the field rather than findings that can be meaningfully analyzed. These gaps point to several priorities for future research.\u003c/p\u003e \u003cp\u003eFirst, geographically and culturally diverse studies are needed. The current evidence base \u0026ndash; drawn exclusively from two countries and one religious tradition \u0026ndash; cannot speak to the spiritual needs and intervention preferences of working-age cancer patients in other cultural contexts.\u003c/p\u003e \u003cp\u003eSecond, qualitative and mixed-methods approaches would complement the exclusively quantitative designs identified in this review, offering insight into patients' subjective experiences of spirituality-focused care that pre-test/post-test designs cannot capture.\u003c/p\u003e \u003cp\u003eThird, future intervention development would benefit from explicit grounding in theory-informed, publicly available protocols. Frameworks that operationalize spirituality in a religiously inclusive manner \u0026mdash; such as King's [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] model of spiritual intelligence, B\u0026uuml;ssing's [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] multidimensional spiritual attitudes framework, Richards and Bergin's [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] spiritual psychotherapy framework, and Pargament's religious coping theory [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] \u0026ndash; could address the psychological functions of spirituality while remaining applicable across diverse cultural and religious backgrounds. Notably, several of these frameworks have already been drawn upon in interventions identified in this review, suggesting a viable pathway for culturally transferable adaptation.\u003c/p\u003e \u003cp\u003eFourth, greater attention to the dual nature of spirituality \u0026ndash; encompassing both its supportive and distressing dimensions \u0026ndash; would support more clinically responsive intervention design. Situating such interventions within integrative oncology frameworks, which increasingly recognize mind-body practices as evidence-based components of cancer care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], may support greater theoretical coherence and alignment with existing clinical infrastructure \u0026mdash; while also creating space to address the occupational dimensions of survivorship that remain unaddressed for working-age adults.\u003c/p\u003e \u003cp\u003eFifth, whether spirituality-focused interventions could be relevant to occupational functioning \u0026mdash; including return to work, maintenance of occupational identity, or navigation of work-related challenges \u0026mdash; remains entirely unexamined and represents a potentially fruitful, if as yet speculative, direction for future inquiry.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations of this scoping review should be acknowledged. First, consistent with scoping review methodology, no formal quality appraisal of included studies was undertaken; consequently, the strength of the evidence base cannot be determined from the findings of this review alone [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSecond, the application of inclusion and exclusion criteria inevitably involved boundary decisions that may have affected the final sample. Studies evaluating spirituality-like experiences facilitated by pharmacological substances, or assessed solely through biological outcome measures without accompanying psychosocial outcomes, were excluded. While these decisions ensured conceptual coherence, such studies may capture dimensions of spirituality in oncology that fall outside the scope of this review.\u003c/p\u003e \u003cp\u003eThird, the operationalization of the working-age criterion represents a methodological limitation. As few studies recruited participants exclusively within the 25\u0026ndash;54 age range, eligibility was determined on the basis of intervention group mean age \u0026ndash; a proxy measure that does not guarantee that the majority of participants fell within this range. The upper age boundary of included samples extended to 78 years in some studies, meaning that a proportion of participants likely fell outside the defined working-age range. Consequently, the extent to which findings are representative of working-age adults specifically \u0026ndash; rather than a broader adult cancer population \u0026ndash; cannot be determined from the available data.\u003c/p\u003e \u003cp\u003eFourth, the search was limited to English-language studies published between 2019 and 2026, which may have resulted in the exclusion of relevant studies published in other languages or outside the defined date range.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis scoping review mapped the existing evidence on spirituality-focused psychosocial interventions for working-age adults with cancer. The findings reveal an evidence base that is geographically concentrated, theoretically underdeveloped, and conceptually inconsistent in its treatment of spirituality \u0026ndash; constraints that limit the ability to identify mechanisms of change or draw comparisons across interventions. All identified studies were conducted within Islamic cultural contexts, no intervention has been independently replicated, and occupational considerations \u0026ndash; central to the working-age population this review targeted \u0026ndash; were entirely absent from the literature. While spirituality is increasingly recognized as a clinically relevant dimension of cancer care, the current evidence base is insufficient to guide practice in culturally diverse oncology settings. Expanding the geographic, cultural, and methodological scope of future research is essential to developing spirituality-focused interventions that are rigorous, replicable, and relevant to the full diversity of working-age adults living with and beyond cancer.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e This scoping review did not involve human participants, personal data, or biological samples; no ethical approval was required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This work was supported by the project \u0026quot;RSU internal and RSU with LSPA external consolidation\u0026quot;, project No. 5.2.1.1.i.0/2/24/I/CFLA/005. The project is funded by the European Union (NextGenerationEU) and the National Development Plan of Latvia for 2021\u0026ndash;2027.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors declare no competing interests. Five of six authors of this manuscript are co-authors of a cited parallel review [20]; the two studies are independent in design, inclusion criteria, and evidence base.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e The data extracted and charted in this scoping review are available within the article and its supplementary appendices (Appendix 1\u0026ndash;4). No additional datasets were generated or analysed.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArksey H, O\u0026apos;Malley L. Scoping studies: towards a methodological framework. 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Counseling and psychotherapy culture. 2022;14(56):39-66. https://doi.org/10.32768/abc.202294497-504\u003c/li\u003e\n\u003cli\u003eTorabi M, Yousofvand V, Mohammadi R, Karbin F, Ranjbaran H. Effectiveness of Group Spiritual Care on Leukemia Patients\u0026apos; Hope and Anxiety in Iran: A Randomized Controlled Trial. J Relig Health. 2024;63(2):1413-32. https://doi.org/10.1007/s10943-023-01866-9\u003c/li\u003e\n\u003cli\u003eNasiri F, Keshavarz Z, Davazdahemami MH, Karimkhani Zandi S, Nasirii M. The Effectiveness of Religious-Spiritual Psychotherapy on the Quality of Life of Women with Breast Cancer. Journal of Babol University of Medical Sciences. 2019;21:67-73.\u003c/li\u003e\n\u003cli\u003eGhaempanah Z, Aghababaei N, Rafieinia P, Sabahi P, Makvand Hosseini S, Alzaben F, et al. Good for Coping, Not for Eudaimonia: The Effectiveness of a Spiritual/Religious Intervention in the Healthcare of Breast Cancer Patients. 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BMJ Supportive \u0026amp;amp;amp; Palliative Care. 2025;15(5):572. https://doi.org/10.1136/spcare-2024-005043\u003c/li\u003e\n\u003cli\u003eCasellas-Grau A, Jord\u0026aacute;n de Luna C, Mat\u0026eacute; J, Ochoa C, Sumalla EC, Gil F. Developing a consensus definition of psychosocial complexity in cancer patients using Delphi methods. Palliative and Supportive Care. 2021;19(1):17-27. https://doi.org/10.1017/S1478951520000784\u003c/li\u003e\n\u003cli\u003ePicciotto G, Fox J, Neto F. A phenomenology of spiritual bypass: Causes, consequences, and implications. Journal of Spirituality in Mental Health. 2018;20(4):333-54. https://doi.org/10.1080/19349637.2017.1417756\u003c/li\u003e\n\u003cli\u003ePark CL, Edmondson D, Hale-Smith A. Why religion? Meaning as motivation. APA handbook of psychology, religion, and spirituality (Vol 1): Context, theory, and research. APA handbooks in psychology\u0026reg;. Washington, DC, US: American Psychological Association; 2013. p. 157-71. https://doi.org/10.1037/14045-008\u003c/li\u003e\n\u003cli\u003eKing DB, DeCicco TL. A viable model and self-report measure of spiritual intelligence. International Journal of Transpersonal Studies. 2009;28(1):68-85. https://doi.org/10.24972/ijts.2009.28.1.68\u003c/li\u003e\n\u003cli\u003eB\u0026uuml;ssing A. Spirituality as a Resource to Rely on in Chronic Illness: The SpREUK Questionnaire. Religions. 2010;1(1):9-17. https://doi.org/10.3390/rel1010009\u003c/li\u003e\n\u003cli\u003ePargament KI. The psychology of religion and coping: Theory, research, practice. New York, NY, US: Guilford Press; 1997. xii, 548-xii, p.\u003c/li\u003e\n\u003cli\u003eCarlson LE, Ismaila N, Addington EL, Asher GN, Atreya C, Balneaves LG, et al. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology\u0026ndash;ASCO Guideline. Journal of Clinical Oncology. 2023;41(28):4562-91. https://doi.org/10.1200/JCO.23.00857\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"c3457dfb-4042-4deb-8570-cdb29950f3e3","identifier":"10.13039/501100015042","name":"Rīgas Stradiņa Universitāte","awardNumber":"\"RSU internal and RSU with LSPA external consolidation\", project No. 5.2.1.1.i.0/2/24/I/CFLA/005. ","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Riga Stradiņš University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Scoping review, Spirituality, Spiritual well-being, Psychosocial intervention, Oncology, Working-age adults, Survivorship","lastPublishedDoi":"10.21203/rs.3.rs-9600015/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9600015/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eDespite growing recognition of spirituality as a clinically relevant dimension of cancer care, no scoping review has examined psychosocial interventions explicitly addressing spirituality among working-age adults with cancer. This review aimed to map the existing evidence on such interventions, characterizing their structural features, theoretical foundations, conceptualization of spirituality, and attention to occupational considerations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA scoping review was conducted following the framework of Arksey and O'Malley [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], refined by Levac and colleagues [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Seven databases \u0026mdash; including MEDLINE via PubMed, Scopus, Science Direct, Cochrane Central, Taylor \u0026amp; Francis, and ProQuest collections \u0026mdash; were systematically searched. Records were independently screened and extracted by a five-member team using pre-established criteria.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEleven studies, representing 10 unique interventions, met the inclusion criteria. All were conducted within Islamic religious and cultural contexts. Interventions were predominantly group-based, delivered in person in hospital settings, comprising four to ten sessions of 45\u0026ndash;90 minutes. Theoretical grounding was limited. Spirituality was inconsistently defined. No study engaged with occupational or return-to-work considerations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe evidence base is geographically concentrated, theoretically underdeveloped, and entirely absent of occupational considerations \u0026mdash; a dimension central to working-age survivors. These findings reveal a critical gap in survivorship care and suggest the need for culturally diverse, theory-informed research attending to the intersection of spirituality and occupational reintegration in this population.\u003c/p\u003e","manuscriptTitle":"Addressing Spirituality in Oncology Care for Working-Age Adults: A Scoping Review of Spirituality-Focused Psychosocial Interventions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-05 07:59:15","doi":"10.21203/rs.3.rs-9600015/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff5006a8-c7c3-4426-ae62-dc888d4fc5bc","owner":[],"postedDate":"May 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":67437195,"name":"Psychology"}],"tags":[],"updatedAt":"2026-05-05T07:59:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-05 07:59:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9600015","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9600015","identity":"rs-9600015","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}