5 6 S p i r i t ua l i t y S t u d i e s 7 - 1 S p r i n g 2 0 2 1 Experiencing of spirituality moderately predicts positive changes after one year of being ill. The spirituality is seemingly able to support posttraumatic growth, since it provides the community with a meaning or supports the community and faith, which support the meaning-making process (Prati and Pietrantoni 2009). Religious coping represents one of the ways of coping with traumatic events (Pargament, Koenig and Perez 2000). Several studies support the correlation between health and religious practice, such as prayer, attending services (Pargament et al. 2004), faith maturity, and posttraumatic growth (Galea 2014, 1068). Although situational factors and personality play an important role, the significance of faith maturity and posttraumatic growth in relation with the development of subjective well-being in people affected by trauma have been emphasized. Spirituality helps when facing hopelessness and presents an important buffer in difficult situations (Galea 2014, 1068). results of a study by Rzesutek, oniszczenko, and Kwiatkowska (2017, 1083) showed positive correlation between specific coping strategies focused on meaning (return to religion and acceptance) and posttraumatic growth. It has also been found that experiencing of spirituality correlates positively with the level of posttraumatic growth and it also mediates a relationship between return to religion and posttraumatic growth. The aim of the study was to search for the relations between the importance of spirituality and posttraumatic growth in cancer survivors, as well as to explore whether there were any differences in the levels of posttraumatic growth with respect to practicing of spirituality in cancer survivors. The study also aimed to find any differences in the levels of posttraumatic growth with respect to religious identity of cancer survivors. 2 Method 2.1 Sample and Procedure The questionnaires were administered to cancer survivors in four hospitals and five different cancer support groups in the different regions of Slovakia from July 2019 to July 2020. Ethical approvals were granted by the University Ethical Committee, National Cancer Institute and management of the hospitals. The research was conducted following the Declaration of Helsinki. Participation in the study was voluntary and patients could stop participation at any stage without any consequences. Patients confirmed their participation in the study by giving informed consent. The questionnaire did not include any mandatory questions and patients did not have to provide response, if they did not want to. The questionnaires were administered individually or in groups. Data collection was mostly carried out in person, or in form of online data collection in case around 100 patients participated in the study. Three different version of the questionnaire with three different random orders of questionnaire parts (measures) were administered with the aim to reduce bias, which might occur due to the effect of order of questionnaire parts on participants’ responses (e.g. , Chan 1991; Krosnick and Alwin 1987). After completing the questionnaires, the participants were provided with a short debriefing. Inclusion criteria were as follows: Age of 18 or older, cancer diagnosis, without severe mental health or physical condition, and not being terminally ill – data collection was not carried out in a palliative care unit. 2.2 Selection of Cancer Survivors Cancer survivorship is defined as a process that begins at the moment of diagnosis and continues throughout life (Marzorati et al. 2016). National Coalition for Cancer Survivorship (2014) defines cancer survivorship as cancer continuum – living with, through, and beyond a cancer diagnosis. On this continuum, three phases of survivorship can be identified: acute, which refers to the diagnosis and treatment of cancer; extended, related to the period following treatment; and permanent; survivorship as equivalent to complete recovery (Mullan 1985). Due to our effort to reduce selection bias (range restriction) (Pedhazur and Schmelkin 1991), we included patients into data collection regardless of the fact, whether their treatment had been finished or not. From the same reasons and with the aim to capture natural heterogeneity of cancer diagnosis present in Slovakia. 2.3 Measures Religious identity of cancer survivors was determined through an open question “What is your religion?” Spirituality was measured by two simple items – 1) Spirituality is important in my life; 2) Practicing of spirituality is important in my life – with Seven-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). By asking these two questions we want-
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