Spirituality has become a subject of interest in health care, and an increasing number of studies, commentaries and reviews examine the connection between religiosity/spirituality and health, its potential to prevent, heal or cope with diseases [1–10]. Moreover, research has confirmed that spiritual well-being is positively associated with quality of life, fighting-spirit, but also fatalism, yet negatively correlated with helplessness/hopelessness, anxious preoccupation, and cognitive avoidance . Indeed, there is evidence that spirituality is important in coping with illness, as spiritual well-being offers some protection against hopelessness and despair in terminally ill patients [12–16].
However, although religiosity and spirituality were interchangeable words, these constructs may not be identical. It is well established to divide Religiosity into three sub-constructs: Intrinsic, Extrinsic, and Quest Religiosity [17–20], while the construct Spirituality was divided into the following sub-constructs: Cognitive Orientation Towards Spirituality, Experiential/Phenomenological Dimension of Spirituality, Existential Well-Being, Paranormal Beliefs, and Religiousness .
The measurability and operability of spirituality and religiosity remains a problem and thus several questionnaires address this topic. Most of them measure beliefs of specific religious groups, and ask about the relationship with God (i.e. the Spiritual Well-Being Scale , the Daily Spiritual Experience Scale , or the Santa Clara Strength of Religious Faith Questionnaire , while only a few took into account that several patients are offended by institutional religion, but may have an interest in distinct forms of spirituality, respectively in a more personal search for spiritual fulfilment [25, 26]. The Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being (FACIT-Sp) scale has a much more open design , but, however, the 12 items of this instrument which made up 2 main factors (labelled "Meaning/Peace" and "Faith") may not really meet the situation of patients with severe and life-threatening diseases. In the post-treatment orientation phase of cancer patients, more existentialistic issues in the patients' attempt to manage the implications of their disease in daily life are of outstanding importance [28, 29] The same is true for hospitalised cancer patients .
There is less doubt that values and goals are important contributors to life satisfaction, physical and psychological health, and that goals are what gives meaning and purpose to people's lives [31–33]. Moreover, health can be conceptualized as a competence to gain control for the design of the biography . But in face of a life-threatening diseases, do patients find meaning and purpose in their life? Many of them rely on religious beliefs to relieve stress, retain a sense of control, maintain hope and their sense of meaning and purpose in life , while others may lose faith in their religious beliefs, and seek for alternatives [28, 29]. There is as yet but limited understanding of how patients themselves view the impact of spirituality on their health and well-being, and whether they are convinced that spirituality may offer some beneficial effects.
To raise these questions and to more precisely survey the basic attitudes of those patients towards spirituality/religiosity (SpR) and their adjustment to their illness, we developed the SpREUK questionnaire [28, 29, 36–39]. We defined the multi-dimensional construct "Spirituality" as an "individual and open approach in the search for meaning and purpose in life, as a search for transcendental truth which may include a sense of connectedness with others, nature, and/or the divine" . The main sub-scales of our instrument may thus correspond to MacDonald's spirituality constructs of an "Existential Well-Being"  which describes a meaning and purpose for existence, and the perception of self as being competent and able to cope with the difficulties of life and limitations of human existence, and to the construct of an "Cognitive Orientation Towards Spirituality" which is identified by beliefs, attitudes, and perceptions regarding the nature and significance of spirituality, as well as having relevance and importance for personal functioning.
In this article we report the re-validation of the SpREUK 1.1 questionnaire (SpREUK is an acronym of the German translation of "Spiritual and Religious Attitudes in Dealing with Illness"), an instrument designed to examine attitudes of patients with life-threatening and chronic diseases towards spirituality/religiosity.