Effect of spiritual reminiscence on death anxiety, loneliness, and spiritual well-being in older patients with cancer: a randomized controlled trial

The rapid growth of the older adult population in Iran, alongside the increasing prevalence of cancer, has led to substantial physical, psychological, and spiritual challenges. Older patients with cancer are particularly vulnerable to death anxiety and feelings of social isolation. Spiritual reminiscence may serve as a supportive intervention to improve psychological and spiritual outcomes by enhancing meaning and hope. To examine the effects of spiritual reminiscence on death anxiety, loneliness, and spiritual well-being in older patients with cancer. To examine the effects of spiritual reminiscence on death anxiety, loneliness, and spiritual well-being in older patients with cancer. A two-arm, parallel-group randomized controlled trial (retrospectively registered). The study was conducted in oncology-related clinical settings during chemotherapy treatment. A total of 110 Older patients with cancer were randomly assigned to intervention and control groups. The intervention group received weekly one-hour spiritual reminiscence therapy sessions for six weeks during chemotherapy, while the control group received routine care. Data were collected using validated questionnaires measuring death anxiety, loneliness, and spiritual well-being before the intervention and after the sixth session. Data were analyzed using multiple linear regression. In adjusted analyses, spiritual reminiscence was associated with lower Finitude scores (B = −3.31, 95% CI −6.41 to −0.21; p = .037), whereas the between-group difference in the Death subscale was not statistically significant (B = −1.14, 95% CI −3.15 to 0.86; p = .260). The intervention was also associated with lower romantic loneliness (B = −3.00, 95% CI −4.06 to −1.94), family loneliness (B = −4.51, 95% CI −5.72 to −3.31), social loneliness (B = −4.74, 95% CI −5.73 to −3.77), and emotional loneliness scores (B = −6.61, 95% CI −8.39 to −4.83), as well as higher religious well-being (B = 8.92, 95% CI 6.21 to 11.64) and existential well-being scores (B = 10.08, 95% CI 7.87 to 12.30; all p < .001). In this trial of older patients receiving chemotherapy, short-term findings favored spiritual reminiscence for loneliness and spiritual well-being. Adjusted death-anxiety findings differed by domain: a nominal difference was observed for Finitude, but not for the Death subscale. Retrospective registration, analysis of participants with observed follow-up data, the absence of an attention-matched control, and brief follow-up limit interpretation. Larger, prospectively registered trials are needed to establish the robustness, clinical importance and durability of these findings. A six-week spiritual reminiscence program was linked to less loneliness and better spiritual well-being in older patients with cancer; effects on death anxiety were limited to finitude-related distress. Iranian Registry of Clinical Trials (IRCT), IRCT20260802070488N1; registered on 16 August 2026. Retrospectively registered.