Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Susan C. McMillan, Ph.D., A.R.N.P.

Committee Member

Brent J. Small, Ph.D.

Committee Member

Carmen Rodriguez, Ph.D., A.N.P-B.C.

Committee Member

Cindy Tofthagen, Ph.D., A.R.N.P


Cancer, Christian, Distress, Muslims


Cancer is an illness that knows no international boundaries. There are more than eight million global cancer deaths each year. A life-threatening diagnosis generates significant emotional problems for many patients across cultures. Death distress—consisting of death depression, death anxiety and death obsession—often results in poorer treatment adherence and lower overall health and quality of life. The purpose of this study was to determine whether religiosity has a moderating effect on the relationship between death distress and quality of life among patients facing a life-threatening cancer diagnosis.

The study sample consisted of 118 cancer patients: 82 cancer patients from a National Guard hospital in Saudi Arabia and 36 cancer patients from H. Lee Moffitt Cancer Center, Tampa, Florida. Three validated scales were used to obtain data from study participants: the Death Distress Scale, the Belief into Action Scale; and the Functional Assessment of Cancer Therapy Scale. After a Pearson correlation were conducted and results indicated a moderately strong inverse relationship between death distress and quality of life among both the Christian (r=-.45, p <.001) and Muslim (r=-.39, p <.001) patient samples. The degree of religiosity among study participants did not alter the effect of death distress on quality of life. Results reveal that the interaction term was not statistically significant (b=.005, p=.32). However, quality of life correlated with degree of religiosity in both the Christian(r=.39, p=.018) and Muslim patient groups ( r=.24, p=0.034)). This finding reinforces the importance of religious involvement among cancer patients found in earlier research.

The current study highlights the importance of a holistic treatment approach that includes a spiritual component for these vulnerable individuals and their loved ones. This holistic emphasis is particularly important for nurses, who often spend more time with cancer patients than other health care professionals. By proactively discussing common issues surrounding death distress with patients and families, nurses can provide much needed education and emotional support and make appropriate referral. Given that death distress appears to be a nearly universal experience among cancer patients regardless of religious affiliation, future research should develop evidence-based nursing protocols to address this vital topic.