Cite this asMorsi H, Morsi N (2022) Holistic cancer management as a model for the emergence of a personalized bio-psycho-socio-spiritual model of diseases, development and management. Ann Psychiatry Treatm 6(1): 013-016. DOI: 10.17352/apt.000039
Copyright© 2022 Morsi H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Psycho-social support lies at the core of Patient and Family-Centered Care (PFCC) that health care systems aim to transform. The objective is to comprehensively inform patients and families of their health issues, empower them to take charge of their illness, and participate in making choices about managing their health and wellbeing .
For PFCC, bio-psycho-social services represent a core pillar in the management of physical and mental stress and have been linked to top killer diseases including cancer [2-5].
However, it was not until the conceptualization of the bio-psycho-social model of disease by George Engel in 1977, that the existence of psychological illnesses was accepted and acknowledged by healthcare professionals [5,6] and since then the field of psychiatry has witnessed a major shift leading to the establishment of mental illnesses classification, diagnostic manuals (see DSM history on APA, www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm) and mental state examination .
Nevertheless, the biopsychosocial model of diseases has been criticized for its limitations and its shift in conceptualization has been dangling on the horizon since the end of the last millennium [8,9]. One important limitation worth mentioning is the lack of personalized psychological management of patients with a mental illnesses. Diagnostic manuals such as DSM V diagnose patients with psychopathology once deviating from known norms . In such an approach it leaves limited or no space for the identification of healthy individuals who experience extreme life circumstances and appropriately develop congruent extreme coping skills. To deal with this problem psychodynamic and humanistic psychotherapists might employ the psychodynamic diagnostic manual [11,12]. Moreover, employing the dynamic sensitive assessment tool “Change State Indicator” developed by G. W Graves that assesses the dynamic coping of individuals to life circumstances offers a scope of personalizing the psychological assessment of healthy individuals who deviate from the psychological norms and yet do not suffer from psychopathology . However, none of these strategies take into consideration the spiritual domain.
On the other hand, in transpersonal psychology, spirituality is placed on the far end of the spectrum continuum with psychology being at the leading end of the spectrum. A quick literature search in PubMed and a grey literature database, carried out for this opinion, utilizing the words “psycho-socio-spiritual and cancer” yielded a ~133 hits, 18 of which were eligible full texts (16 published articles and 2 Ph.D. dissertations). Googling writers who champion the need for a spiritual domain for the bio-psycho-social models of diseases and development show tens of books about the spiritual root causes of disease. Table 1 suggests the need to focus on spiritual needs, care, and research among cancer patients.
Of interest, the articles and book chapters of Harold G. Koenig of Duke University, the hope assessment of Brown University  and the book by Michael F. Cantwell  are paving the way for establishing a scientific framework for the spiritual state examination and spiritual development and disease diagnostic and classifications manuals. In a decade or two, the bio-psycho-socio-spiritual dynamic model of disease and development would probably be well established.
While Dr. Koenig emphasizes the importance and significance of spirituality and religiosity in patients’ management, Brown University proposed a qualitative assessment schema of patient’s spirituality and religiosity and Dr. Cantwell proposed a semi-quantitative assessment tool of spiritual root causes of refractory diseases and monitoring patients’ progress [4,13,14].
His proposal of a triad model, universal to all human beings and not dictated or limited by any one religion, which is useful as an assessment tool and helps to explain the links between spirituality and health, is a step in the right direction to establishing the spiritual state clinical examination.
Meanwhile, we would have to rely on case reports, observational studies, the existing advances, and guidelines of medical and royal colleges, institutes of medicine, and psychology associations [15,16] advice and guidelines for getting the spiritual history of patients and addressing their spiritual needs to gain more in-depth experience, understanding, knowledge, and conceptualization of the bio-psycho-socio-spiritual issues until longitudinal controlled clinical trials determine the true essence of root causes and personalized spiritual management of diseases.
As comprehensive data search is beyond the scope of this opinion. However, it was conducted as recommended by the PRISMA guidelines through one database “PubMed” for published literature, and the grey literature database “ProQuest” from inception to date. The search terms were direct four terms “Psycho, socio, spiritual and cancer” with no restrictions.
The PubMed database returned 54 hits, 36 of which were excluded through title and abstract screening and 2 through full-text screening. 79 hits were returned through the grey literature database “ProQuest”, 72 of which were excluded through their title and abstract, and 5 more full theses were excluded after reviewing their text. The results of the 18 eligible studies are summarized in Table 1 and the conclusion, discussion, and recommendations are presented above.
As mentioned above, this is not a comprehensive review of the literature. It was just conducted to support this presented opinion. Thus, a brief time was spent carrying it out and a simple methodology that complies with the PRISMA guidelines was followed to support the synthesis of an evidence-based opinion.
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