[Narrator]

According to research, about 75% of people see spirituality and/or religion as important in their lives. When life is limited or ending, spirituality may become even more important.

Spirituality is a term used to define that which gives meaning to our lives. For many people, a religion is an expression of spirituality. For others, spirituality may be expressed through a faith community or a love of nature. These can all be ways to find meaning when the end of life is nearing.

Many spiritual questions can arise as life draws to a close, including "Why is this happening to me?" and "What has been my purpose in life?" These questions are common and can lead to meaningful conversations with your family or clergy.

For some, spirituality is also closely linked with culture. People from the same cultural groups may practice the same religion or join together in a spiritual community. This can be a great source of strength and support in times of stress or loss. Yet, spirituality is also specific to each person. Even those within the same family may have different spiritual beliefs or expressions.

A few of the survivors introduced in other modules of the Cancer Survival Toolbox illustrate the influence spirituality and culture can have and the differences seen even within families.

Alice and her husband and their children are all coping in different ways with Alice's leukemia, which has returned after a three-year remission. Alice's Baptist faith is very strong and she's found comfort in the prayers and visits of her minister and members of her church. Alice says, "I feel fortunate to have had the time I did and now am placing my life in God's hands. I know I'll be with him soon and I'll be loved and cared for in his kingdom." Her husband wishes Alice would try more treatments but understands that her faith is providing her comfort, and supports her decision to come home with hospice care so she can spend time with her family and faith community. Her eldest son, however, is questioning his own faith in the face of his mother's illness. He's been meeting with the family's pastor to discuss his concerns.

Another survivor, Hein, is from Vietnam and has had liver cancer singe age 42.  She is married to Tran and they have a four year-old-son. The family came to the U.S. five years ago. Hein's cancer has not responded well to treatment and the doctor has spoken with the family about hospice care. Hein quietly cried, and Tran thanked the doctor and said he would consider it. Tran believes a special clinic in California which uses Buddhist teaching and provides herbal treatments and healing can help his wife. Hein's doctor is concerned, because Hein is not speaking to anyone but Tran. The doctor would like to understand how Hein is feeling about this, but she will not speak for herself or about hospice or dying.