Empirical data on the spiritual lives of the seriously ill are sparse and this is specifically true for people diagnosed with metastatic melanoma. Researchers and practitioners know little about people confronting this illness in terms of their spiritual well-being; the effects of spiritual coping on psychological adjustment, spiritual adjustment, and physical health status outcomes; or the potential benefits of a spiritually-focused psychotherapeutic intervention in terms of psychological and spiritual well-being, and health status outcomes. Because spiritual well-being may be an important aspect of quality of life for the seriously ill, and because spiritually-focused interventions may be beneficial and important to include as part of complementary medicine practices, systematic investigation of spiritual and religious variables in advanced cancer populations is an urgent priority. The proposed study will address these gaps in the literature in two ways. First, it will collect descriptive data across a six-month period for people with metastatic melanoma to detect changes in spiritual and religious well-being. It is expected that involvement in organized religious practices will decrease across time due to illness variables like pain and fatigue. However, private practices and spiritual well-being are expected to increase across time due to shifts in perceived control, the need to adopt alternatives to problem-focused coping strategies, and an increase awareness of mortality and reliance on spiritual resources to cope. Second, this study will conduct one of the first random trials of a spiritually-focused intervention for people coping with cancer. Approximately 150 people diagnosed with metastatic melanoma will be randomly assigned to one of three conditions: spiritually-focused therapy (SFF), cognitive behavioral therapy (CBT), or usual-care control (UCC). Both the SFF and CBT interventions will include five one-hour sessions initiated upon diagnosis and extended across a two-month period. Outcomes will be measured in terms of psychological and spiritual well-being and health status (e.g., pain, fatigue, and disease progression) through a comprehensive questionnaire administered before and after the intervention, and two and four months latex as follow-up. The questionnaire will include both standardized widely used instruments and a few items designed for this study. The questionnaire will also connect data to control for stable burdens and resources (e.g., demographics and personal attitudes like optimism) and medical factors (e.g., treatments). It is expected that the SFT intervention will have a more positive effect on psychological and spiritual well-being and health status relative to the other two conditions.
