Cancer is the third most common cause of death (after cardiovascular disease and traumatic events) in Iran. More than 30,000 people die each year from cancer, and more than 80,000 new cases are presented [1,2]. According to World Health Organization (2015), the number of cancer patients will increase from 14 million in 2012 to 19.3 million in 2025 and 24 million in 2035 [3].
Cancer, one of the most bitter human experiences, affects various aspects of one's life such as family relationships, social interactions, marriage, and occupational and economic status [6] and is associated with many stressors [7].
Human dignity, which is one of the essential aspects of the patient-centered methods aimed at promoting the physical, psychological, social, and spiritual status of the patient [14], is an intrinsic characteristic that affects the nature of the illness and its role in one's life and identity. It should be noted that loss of independence, security and control among cancer patients causes loss of dignity [15-16].
This term has been defined by various scholars in a variety of ways, but in general the most widely accepted definition is the four parameters of respect, independence, empowerment and relevance [19].
According to the human dignity model developed by Chochinove in 2002, the most important factors affecting the human dignity of cancer patients are disease-related concerns (pain, anxiety, fear of death and insecurity about the disease and its treatment), preservation of human dignity (hope, independence, and self-esteem) and social factors (social support and interaction with others, especially family and health care providers) [20].
According to the results of numerous studies, the use of spirituality and religion resources is very effective in the process of adapting to cancer and its negative consequences [24]. Similarly, Pargament et al. (2000) have outlined five important spiritual functions to cope with life stressors, such as fatal cancer including defining a meaning for accidents, providing a framework for achieving a sense of control over difficult situations, providing comfort in difficult times, keeping in touch with other people and helping others make important changes in their lives [25].
In this regard, Zohar and Marshal discovered the existence of intelligence called spiritual intelligence, which is one of the practical aspects of the concept of spirituality and is effective in interpreting one's stressful life issues, so that since 2000 spiritual intelligence is one of the newest constructs in Islamic psychology and the management science set at the center of attention and the training courses are being applied in different organizations [27].
Therefore, given the increasing prevalence of cancer patients in Iran and the associated physical and psychological problems, it seems that their mental health is at risk due to the threatening nature of this disease, which requires effective measures in this regard. Human dignity which is rooted in the existential distress caused by cancer and affects the mental health of cancer patients has been underestimated in Iran and studies in this field are limited.

 

This randomized clinical trial with control group was performed on 50 cancer patients admitted to Omid Hospital in Mashhad in 2018 – 2019 (May -Jun). The patients were selected by available method from among patients with cancer and randomly assigned to two groups of intervention (23 patients) and control (n=27). Data gathering tool was demographic questionnaire which included 7 questions related to age, sex, marital status, and so on. The Chochinov et al. Human Dignity Questionnaire consisted of 25 questions with a Likert scale of 1 to 5 (score 1 = no problem, score 2 = low difficulty, score 3 = medium difficulty, score 4 = high difficulty, and score 5 = very high difficulty) was used. The validity and reliability of the questionnaire was confirmed. The reliability of this questionnaire after translation in this study in hemodialysis patients was confirmed by test-retest with a correlation coefficient of 84% [38].
The intervention group underwent spiritual intelligence training according to King's (2008) model during ten sessions of one and a half hours. The control group received routine care. The questionnaires were completed in two steps before intervention and 8 weeks after intervention. Data was analyzed using SPSS 21 (SPSS Inc., Chicago, Ill., USA), t-paired and t-independent test.

Both groups were homogeneous for demographic variables and there was no statistically significant difference between the two groups. There was no significant difference between the scores of both groups before entering the study (P=0.68). There was a significant difference between the mean scores of the two groups before intervention and 8 weeks after intervention (P<0.001), but this difference was not statistically significant in the control group (P=0.36) (Table 1).

Table 1. Comparison of difference between mean human dignity and its dimensions in cancer patients before and after intervention between control and intervention groups

Comparing the two groups before and after the intervention, only the atmospheric scale had a significant difference (P=0.016) with an increase of 13.64%. Changes in other scales were not significant despite the increase or decrease. Employee satisfaction level increased by 1.56% but this value was not statistically significant (P=0.513).
In the significant analysis of comparison between the two states, before and after the components of job recognition profile, the independence dimension increased significantly (P=0.024) with a 0.48-unit increase. Potential motivational power also showed a significant change (P=0.013) with an increase of 8.4 points.

According to the results of the present study, after the intervention, the mean score of total human dignity and its different dimensions in the spiritual intelligence training group was significantly improved compared to the control group. The intra-group comparisons also showed that the mean score of human dignity and its different dimensions in the spiritual intelligence training group after the intervention was significantly improved, but not in the control group.
In interpreting the results of the present study, it can be said that human dignity in cancer patients is often affected by fear of dying and uncontrollability [20], it seems that spiritual intelligence training can enhance spirituality in cancer patients and promote human dignity in them.
Based on the searches, no study was found to be in conflict with the results of the present study.

 

Spiritual intelligence training can enhance human dignity in cancer patients. Therefore, it is recommended to use it in hospitals.
Acknowledgement
This article is the result of a Master's thesis in Islamic Psychology with the approval code 4034/1224 / d of Payam-e Noor University of Gonabad, approved by the Code of Ethics IR.MUMS.REC.1397.047 in the Ethics Committee of Mashhad University of Medical Sciences. It has also been documented and approved by IRCT20180509039597N1 at the Iranian Registry for Clinical Trials Center. I hereby acknowledge the financial support of the Vice Chancellor for Research of Payam-e Noor Gonabad University and Mashhad University of Medical Sciences. We also thank all the professors of Payam-e Noor Gonabad University, Mashhad University of Medical Sciences, Omid Oncology Hospital staff and respected patients who helped us with this study.

The authors thank all those who helped them writing this paper.

 

The authors declared that there are no conflicts of interest.