Spiritual Beliefs and Preferences among Patients with Multiple Myeloma

Abstract

Introduction

Multiple myeloma is the second most common hematologic malignancy in the United States, with over 36,000 new cases annually. Despite its prevalence, little is known about the role of spirituality and religion throughout the myeloma disease course. We surveyed patients with multiple myeloma to assess their spiritual beliefs and preferences for incorporating spirituality into care.

Methods

We developed a comprehensive electronic survey incorporating validated instruments, including the Centrality of Religiosity Scale (CRS), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12), and the European Organization for the Research and Treatment of Cancer Myeloma Module Quality of Life Questionnaire (QLQ-MY20). A patient advocate reviewed all questions for clarity and cultural appropriateness. The survey was distributed anonymously via X/Twitter and the electronic health record system. Survey scores were calculated using standard instrument-specific scoring algorithms. Group comparisons were made using the Mann-Whitney U-test. Correlations between spirituality scores and QLQ-MY20 subscales were assessed using Spearman’s rank correlation.

Results

Of 281 respondents, 176 (63%) completed all survey components and were included in the analysis. The median age was 65 years; 64% were female and 82% were married or in a committed partnership. The cohort was predominantly Non-Hispanic (NH) White (85%), with 8.5% identifying as NH Black. Most participants identified as Christian (70%), followed by atheist/agnostic (11%), spiritual but not religious (10%), Jewish (6%), and other (3%). Among Christian patients (n=123), both catholic (n=44) and protestant (n=63) denominations were represented.

Most respondents (140/176, 80%) believed that clinicians should consider religious factors when presenting treatment recommendations, and 75 (42%) expressed interest in receiving spiritual care services or inspirational resources as part of their care plan. However, only 19% of respondents had discussed their spiritual beliefs with their care team. This interest was especially high among Black respondents (12/15, 80%) compared to non-Black respondents (p<0.001).

The median FACIT-Sp-12 score was 33 and the median CRS score was 3.73. Black respondents had significantly higher FACIT-Sp-12 (37 vs 33, p=0.0085) and CRS scores (4.4 vs 3.67, p=0.0092), indicating stronger spiritual identity. Atheist/agnostic patients had significantly lower FACIT-Sp-12 (median 22.5 vs 35, p<0.001) and CRS scores (median 1.33 vs 3.87, p<0.001) compared to all other respondents, reflecting lower spiritual well-being and religiosity. These patients also reported lower body image scores on the QLQ-MY20 (66.67 vs 83.34, p=0.01). Spearman correlation analysis showed a weak but significant positive correlation between CRS and the QLQ-MY20 disease symptoms subscale (ρ = 0.17, p < 0.05). No other significant correlations were observed between spirituality measures and QLQ-MY20 subscales.

Conclusion

Spirituality and religiosity vary widely among patients with multiple myeloma. Black patients reported higher levels of spiritual identity, while atheist/agnostic patients reported lower spiritual scores and diminished body image. Nearly half of respondents expressed interest in integrating spiritual care into their treatment experience, including 80% of Black patients. These findings support efforts to advance patient-centered care by incorporating spiritual care services into routine myeloma care to address patients’ diverse needs and preferences.