Background: Assessment of spiritual wellbeing contributes unique variance to quality-of-life (QOL) assessment often with clinical utility. The domain ‘peace’ appears the most important contributor, to date.
Aim: Using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being-Expanded, we further investigated the stability/reliability of the Peace subscale; its unique contribution to QOL; clinical utility; and convergent validity.
Methods: As part of an Australian, online survey, 1,045 cancer survivors completed the 23-item FACIT-Sp-Ex; the Functional Assessment of Cancer Therapy-General (FACT-G); the Depression Anxiety Stress Scale (DASS21); the Purpose-in-Life Test (PIL-Form A); the Brief Serenity Scale; Integrative Hope Scale (IHS); the Self-Compassion Scale; and the Gratitude Questionnaire-Six Item Form (GQ-6).
Results: A principal components analysis of the FACIT-Sp-Ex, using oblique rotation, explained 65.9% of the variance, revealing four domains; Meaning, Faith, Peace, and Positive Interaction (eigenvalues>1). Like analyses of the 12-item FACIT-Sp, the original 4-item Peace subscale structure was retained, showing good reliability (α=.84). A hierarchical multiple regression revealed Peace uniquely contributed 1.9% (R2 Change) to QOL assessment, after controlling the additional three FACIT-Sp-Ex domains (p<.001). Survivors reporting high life enjoyment (n=481) reported elevated Peace despite high fatigue (ф=.91), nausea, (ф=.50), and pain (ф=.37), all p<.001. These findings were only evident for the high Peace/high symptom groups, supporting clinical usefulness of assessing and enhancing peace. Using an arbitrary cut-off (r=.60), Peace evidenced convergent validity with hope (r=.72), serenity (r=.68), purpose-in-life (r=.66), QOL (r=.65), depression (r= -.65), self-compassion (r=.62), and five correlations r>.60 with associated subscales; more associations than any other domain.
Conclusions: This 4-item Peace subscale appears unique, reliable, stable across FACIT-Sp versions, and its convergent validity improves our understanding of peace’s resilience against psychological morbidity and chronic physical manifestations of cancer, replicating and extending previous work. Current third-wave psychological therapies emphasise existential growth but may be improved through greater focus on peace enhancement.