The Role of Spirituality and 12 Step Groups in Addressing Treatment Fear and Worry Among Head and Neck Cancer Patients

Diagnosis of head and neck squamous cell carcinoma (HNSCC) presents a multifarious problem. Because of uncertainty regarding appropriate clinical treatment, as well as the high potential for disfigurement and functional loss resulting in diminished quality of life (QOL), satisfactory patient participation in quality decision-making is critical. Previous research has consistently revealed that older adults frequently defer decisionmaking to their physician and make decisions more quickly than younger adults. Research also suggests that lay health beliefs, past experiences and various strategies of emotional regulation, based on perceptions of the quantity and quality of remaining time till death, may influence the decisionmaking process. This qualitative study sought to explore the treatment decision making experience of adults with newly diagnosed head and neck squamous cell carcinoma, including laryngeal, esophageal, and oral cancers (N=41). In depth interviews were conducted at the time of diagnosis and after treatment completion. Interviews were transcribed and analyzed using the constant comparative method. Participants cited negative changes in appearance, resources, or relationships as well as pain, suffering, and the development or exacerbations of other health concerns as the most feared or worrisome aspect of treatment. Additionally, spirituality and spiritual practices as learned through 12 step group programs assisted participants in alleviating these fears and worries and provided a framework for navigating treatment decisions and the overall lived cancer experience. Principles of 12 step programs such as life review and reconciliation may provide valuable and useful benefits to patients across the illness experience.

Keywords:Cancer; Treatment decision making; Spirituality; 12 step group