Patients' and caregivers' needs, experiences, preferences and research priorities in spiritual care: A focus group study across nine countries

Research Literature on the Intersection of Dementia, Spirituality, and Palliative Care: A Scoping Review

CONTEXT

Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care.

OBJECTIVES

We conducted the first scoping review examining the nature and breadth of peer-reviewed studies across these three topics to guide future research.

METHODS

The scoping review followed methods from The Joanna Briggs Institute Reviewers' Manual (2015). We developed a priori a scoping review protocol outlining the population, concept, and context for study; data sources; search strategy; inclusion/exclusion criteria; and procedure for screening, extracting, and analyzing data.

RESULTS

The final sample consisted of 19 studies with the following themes: characterizing spiritual needs, preferences, and resources; characterizing palliative or spiritual care; predicting provision of spiritual care; and assessing spiritual care interventions. Eighteen studies were published in the past decade, and 11 studies were based in Europe. Most studies focused on long-term care settings, grouped stages of dementia or did not specify dementia stage, and investigated interventions indirectly related to spiritual care. Many studies were limited in sample size and generalizability/transferability and used less sophisticated research designs.

CONCLUSION

Research across dementia, spirituality, and palliative care needs to examine settings beyond long-term care, distinct stages of dementia, and formal spiritual care interventions plus use rigorous study designs (e.g., randomized clinical trials). Such research could advance practice and policy that enhance quality of life for tens of millions of persons with dementia and their family members worldwide.

Spirituality and religiosity in a palliative medicine population: mixed-methods study

BACKGROUND

Spiritual care allows palliative care patients to gain a sense of purpose, meaning and connectedness to the sacred or important while experiencing a serious illness. This study examined how Australian patients conceptualise their spirituality/religiosity, the associations between diagnosis and spiritual/religious activities, and views on the amount of spiritual support received.

METHODS

This mixed-methods study used anonymous semistructured questionnaires, which included the Functional Assessment of Chronic Illness Therapy-Spiritual Scale-12 (FACIT-SP-12) and adapted and developed questions examining religion/spirituality's role and support.

RESULTS

Participants numbered 261, with a 50.9% response rate. Sixty-two per cent were affiliated with Christianity and 24.2% with no religion. The mean total FACIT-SP-12 score was 31.9 (SD 8.6). Patients with Christian affiliation reported a higher total FACIT-SP-12 score compared with no religious affiliation (p=0.003). Those with Christian and Buddhist affiliations had higher faith subscale scores compared with those with no religious affiliation (p<0.001). Spirituality was very important to 39.9% and religiosity to 31.7% of patients, and unimportant to 30.6% and 39.5%, respectively. Following diagnosis, patients prayed (p<0.001) and meditated (p<0.001) more, seeking more time, strength and acceptance. Attendance at religious services decreased with frailty (p<0.001), while engagement in other religious activities increased (p=0.017). Patients who received some level of spiritual/religious support from external religious/faith communities and moderate to complete spiritual/religious needs met by the hospitals reported greater total FACIT-SP-12 spirituality scores (p<0.001).

CONCLUSION

Respectful inquiry into patients spiritual/religious needs in hospitals allows for an attuned approach to addressing such care needs while considerately accommodating those disinterested in such support.

"Dying With Dignity": A Qualitative Study With Caregivers on the Care of Individuals With Terminal Cancer

This study aimed to examine family members' attitudes and perceptions regarding their choice of care in the event of terminal illness, based on their experience in a caregiver's role, while a loved one was terminally ill. All participants (N = 10) had cared for an immediate family member with terminal cancer. Snowball sampling was used. Qualitative data were collected through in-depth, semi-structured interviews. The data were transcribed verbatim and analyzed using thematic analysis. Five themes were identified from the data. These included two themes relating to participants' experience of care, two themes in relation to participants' attitudes toward the type of care they experienced and a final theme related to the role of religion and spirituality in dealing with loss. The findings of this study support the integration of multidisciplinary healthcare teams and the introduction of holistic care as early as possible within hospitals for individuals with terminal cancer, using the biopsychosocial-spiritual model.

Family Caregiving in Serious Illness in the United States: Recommendations to Support an Invisible Workforce

Family caregivers provide the vast majority of care for individuals with serious illness living in the community but are not often viewed as full members of the healthcare team. Family caregivers are increasingly expected to acquire a sophisticated understanding of the care recipient's condition and new skills to execute complex medical or nursing tasks, often without adequate preparation and support, and with little choice in taking on the role. This review draws on peer-reviewed literature, government reports, and other publications to summarize the challenges faced by family caregivers of older adults in the context of serious illness and to identify opportunities to better integrate them into the healthcare workforce. We discuss promising approaches such as inclusion of family caregivers in consensus-based practice guidelines; the "no wrong door" function, directing consumers to needed resources, regardless of where initial contact is made; and caregiver-friendly workplace policies allowing flexible arrangements. We present specific recommendations focusing on research, clinical practice, and policy changes that promote family-centered care and improve outcomes for caregivers as well as persons with serious illness. J Am Geriatr Soc 67:S451-S456, 2019.

Spiritual needs and communicating about death in nonreligious theistic families in pediatric palliative care: A qualitative study

BACKGROUND

Spiritual support should be offered to all patients and their families regardless of their affiliated status with an organized religion.

AIM

To understand nonreligious theistic parents' spirituality and to explore how parents discuss death with their terminally ill children in mainland China.

DESIGN

Qualitative study.

SETTING/PARTICIPANTS

This study was conducted in the hematology oncology center at Beijing Children's Hospital. Participants in this study included 16 bereaved parents.

RESULTS

Participants described themselves as nonreligious but showed a tendency toward a particular religion. Parents sought religious support in the face of the life-threatening conditions that affected their child and regarded the religious belief as an important way to get psychological and spiritual comfort after experiencing the death of their child. Religious support could partially address parents' spiritual needs. Parents' spiritual needs still require other supports such as bereavement services, death education, and family support groups. Some parents stated that it was difficult to find a way to discuss death with their children. For patients who come from nonreligious theistic families, their understanding of death was more complex and may be related to atheism.

CONCLUSION

Religious support could be an element of spiritual support for nonreligious theistic parents of terminally ill children. Multiple strategies including religious supports and nonreligious supports should be rationally integrated into spiritual support of nonreligious theistic family. Patient's personal belief in death should be assessed before discussing death with them.

Exploring spiritual health practitioners' roles and activities in critical care contexts

Family members of patients admitted to the intensive care unit (ICU) experience multidimensional distress. Many clinicians lack an understanding of spiritual health practitioners' role and approaches to providing spiritual support. Through semi-structured interviews and focus groups with 10 spiritual health practitioners, we explored how spiritual health practitioners support families of patients in the ICU to better understand their scope of practice and role within an interdisciplinary critical care team. Spiritual health practitioners' work was described through clinical roles (family support, clinician support, bridging family members and clinicians), activities (companioning, counseling, facilitating difficult conversations, addressing individual needs), tensions (within and between roles and activities, navigating between hope and anticipated clinical trajectory, balancing supportive care and workload) and foundational principles (holistic perspective, resilience). A more comprehensive understanding of these roles and skills may enable clinicians to better integrate spiritual health practitioners into the fabric of care for patients, families, and clinicians themselves.

Religious Belief and Social Support Among Cancer Patients in Saudi Arabia

Background People with cancer usually experience some degree of depression, anxiety, and fear, as if embracing the fact that cancer has become part of their lives. Additionally, religious beliefs can influence a patient's support system, as well as the patient's own emotional response, behavior, and decision-making, which can create a conflict with medical treatment. The objective of this study was to assess cancer patients' religious beliefs and social support. Methods A cross-sectional study was conducted in 294 adult patients at the Comprehensive Cancer Center of King Fahad Medical City in Riyadh, Saudi Arabia. Patients were interviewed using the System of Belief Inventory (SBI-15R) questionnaire, and responses were noted in the survey form. Results The majority (82.3%) of patients were newly diagnosed with cancer and in the treatment phase, whereas 9.9% were in the metastatic phase. The total mean score of the SBI-15R scale was 27.9. The mean score of the social support subscale was 13.1 ± 1.68, whereas the mean score for the beliefs and practice subscale was 29.7 ± 0.81. For the social support subscale, a statistically significant difference was found in age (P < 0.001), gender (P < 0.001), and occupation (P = 0.009). However, for the beliefs and practice subscale, a statistically significant difference was found only with gender (P = 0.001).  Conclusions This study concluded that social support is important for the study participants, and they were attached to their beliefs and cultural practices, as indicated by the high total mean score on the SBI-15R. Understanding this topic is important in order for healthcare organizations to provide holistic patient care.

End of life in acute hospital setting-A systematic review of families' experience of spiritual care

AIMS AND OBJECTIVES

To systematically review qualitative studies exploring families' experiences of spiritual care at the end of life in acute hospital settings.

BACKGROUND

Although there is a widespread belief that the consideration of spiritual and religious needs is outdated in the context of secularism, from a practical perspective patients and families appear to benefit from spiritual support at the end of life.

METHODS

Six key databases, CINAHL, MEDLINE, EMBASE, Global Health Library, Web of Science and Applied Social Sciences Index and Abstracts (ASSIA), were searched, and three reviewers independently extracted the data and coded them into themes and subthemes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used as a reporting framework.

RESULTS

Five main themes emerged: anticipating needs; honouring the family by honouring the patient; personal connection; lack of sensitivity; and making space for religious and spiritual practices.

CONCLUSIONS

Families experiencing end-of-life care in acute hospital settings may benefit from spiritual care. While this can also be considered as fundamental care, understanding this through the lenses of spiritual care allows for incorporation of religious and spiritual practices that many seek at this time, irrespective of their faith perspectives.

RELEVANCE TO CLINICAL PRACTICE

Although hospice care is well established internationally, many families experience end-of-life care in acute hospital settings. Nurses usually get to know families well during this time; however, the demands of the clinical environment place restrictions on family care and perceptions of lack of communication, limited support and/or limited sensitivity can compound families' suffering. Consideration of families' spiritual needs can help to support families during this time. Nurses are ideally placed for this and can anticipate and plan for patient and family needs in this regard, or refer to a specialist, such as the Healthcare Chaplain.

An EAPC white paper on multi-disciplinary education for spiritual care in palliative care

BACKGROUND

The EAPC White Paper addresses the issue of spiritual care education for all palliative care professionals. It is to guide health care professionals involved in teaching or training of palliative care and spiritual care; stakeholders, leaders and decision makers responsible for training and education; as well as national and local curricula development groups.

METHODS

Early in 2018, preliminary draft paper was written by members of the European Association for Palliative Care (EAPC) spiritual care reference group inviting comment on the four core elements of spiritual care education as outlined by Gamondi et al. (2013) in their paper on palliative care core competencies. The preliminary draft paper was circulated to experts from the EAPC spiritual care reference group for feedback. At the second stage feedback was incorporated into a second draft paper and experts and representatives of national palliative care organizations were invited to provide feedback and suggest revisions. The final version incorporated the subsequent criticism and as a result, the Gamondi framework was explored and critically revised leading to updated suggestions for spiritual care education in palliative care.

RESULTS

The EAPC white paper points out the importance of spiritual care as an integral part of palliative care and suggests incorporating it accordingly into educational activities and training models in palliative care. The revised spiritual care education competencies for all palliative care providers are accompanied by the best practice models and research evidence, at the same time being sensitive towards different development stages of the palliative care services across the European region.

CONCLUSIONS

Better education can help the healthcare practitioner to avoid being distracted by their own fears, prejudices, and restraints and attend to the patient and his/her family. This EAPC white paper encourages and facilitates high quality, multi-disciplinary, academically and financially accessible spiritual care education to all palliative care staff.

Patients' and Caregivers' Contested Perspectives on Spiritual Care for Those Affected by Advanced Illnesses: A Qualitative Descriptive Study

CONTEXT

Spiritual care refers to practices and rituals addressing spiritual/religious concerns. It supports coping with loss and finding hope, meaning, and peace. Although integral to palliative care, its implementation is challenging.

OBJECTIVE

To understand an Australian cohort of patients' and caregivers' perspectives about experiencing and optimizing spiritual care in the context of advanced illness.

METHODS

Patients and caregivers of patients with ≤12 month prognosis were recruited from a broader spiritual study via criterion sampling and agreed to opt-in interviews. Participants from an Australian, metropolitan health service received a spiritual care definition and were interviewed. Transcripts were analyzed using qualitative description.

RESULTS

30 patients (17 male; mean age 70 years) and 10 caregivers (six male; mean age 58.9 years) participated. 27 identified as Christian, and 10 had no religion. Participants described multifaceted and contested beliefs about spirituality. Many queried the tangibility of spirituality, but all valued respectful staff who affirmed personhood, that is, each individual's worth, especially when care exceeded expectations. They also resonated with positive organizational and environmental tones that improved holistic well-being. Participants stressed the importance of the hospital's welcoming context and skilled care, which comforted and reassured.

CONCLUSION

Although many patients and caregivers did not resonate with the term "spiritual care," all described how the hospital's hospitality could affirm their values and strengthen coping. The phrase "spiritual care and hospitality" may optimally articulate and guide care in similar, pluralist inpatient palliative care contexts, recognizing that such care encompasses an interplay of generalist and specialist pastoral care staff and organizational and environmental qualities.

Mediation effects of depression and anxiety on social support and quality of life among caregivers of persons with severe burns injury

OBJECTIVE

Caregiving is associated with several psychosocial challenges including stress, depression and anxiety. These challenges have been found to have significant negative impacts on the health and wellbeing of caregivers, but the mechanisms of these effects are poorly understood. This study examined whether depression and anxiety serve as mediators between social support and quality of life caregivers of persons with severe burns injury.

RESULTS

A sample of 100 caregivers of persons with severe burns injury were administered questionnaires to assess their depression, anxiety, social support and quality of life. Findings show that depression and anxiety were negatively correlated with quality of life whereas social support was positively correlated with quality of life. Results further showed that only depression significantly mediated the link between social support and quality of life among the caregivers. These findings emphasize the need to screen caregivers for common mental health problems and provide them support in the caregiving process to promote their health and wellbeing.

Patients' spirituality perspectives at the end of life: a qualitative evidence synthesis

BACKGROUND

Understanding patient perceptions of their spiritual needs when approaching the end of life is essential to support the delivery of patient-centred care.

AIM

To conduct a qualitative evidence synthesis on spirituality and spiritual care needs at the end of life in all healthcare settings from the patients' perspective.

DESIGN

Studies were included where they were primary qualitative studies exploring spirituality in patients with a life expectancy of 12 months or less in any setting. Two reviewers independently screened titles, extracted data and conducted methodological quality appraisal. A thematic synthesis was conducted. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) - Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to summarise the certainty of the evidence.

DATA SOURCES

Six databases (Medline, Embase, Cochrane, CINAHL, PsycINFO, Applied Social Science Index and Abstracts) were searched from inception up to January 2019.

RESULTS

Fifty papers (42 unique datasets), incorporating data from 710 patients were included. Studies recruited from a mix of inpatient, outpatient, hospice and community settings across 12 different countries. Three overarching themes were generated: the concept of spirituality, spiritual needs and distress, and spiritual care resources. Relationships were an intrinsic component of spirituality.

CONCLUSION

Meeting patients' spiritual needs is an integral part of end-of-life care. This work emphasises that supporting relationships should be a central focus of spiritual care for patients at the end of life.

PROSPERO REGISTRATION NUMBER

CRD42019122062.

Effectiveness of spiritual care training to enhance spiritual health and spiritual care competency among oncology nurses

Background

Although spiritual care is a basic element of holistic nursing, nurses’ spiritual care knowledge and abilities are often unable to satisfy patients’ spiritual care needs. Therefore, nurses are in urgent need of relevant training to enhance their abilities to provide patients with spiritual care.

Design

A nonrandomized controlled trial.

Objective

To establish a spiritual care training protocol and verify its effectiveness.

Methods

This study recruited 92 nurses at a cancer treatment hospital in a single province via voluntary sign-up. The nurses were divided into two groups—the study group (45 people) and the control (wait-listed) group (47 people)—using a coin-toss method. The study group received one spiritual care group training session every six months based on their routine nursing education; this training chiefly consisted of lectures by experts, group interventions, clinical practice, and case sharing. The control group participated in monthly nursing education sessions organized by the hospital for 12 continuous months.

Results

After 12 months of intervention, the nurses in the study group had significantly higher overall spiritual health and spiritual care competency scores as well as significantly higher scores on all individual dimensions compared with those in the control group (P < 0.01).

Conclusions

A spiritual care training protocol for nurses based on the concept of mutual growth with patients enhances nurses’ spiritual well-being and spiritual care competencies.

Translation, Cultural, and Clinical Validation of the Lithuanian Version of the Spiritual Needs Questionnaire among Hospitalized Cancer Patients

Background and Objectives: The aim was to translate and validate the spiritual needs questionnaire for its use in the Lithuanian context. Materials and Methods: A descriptive, cross-sectional survey design was applied. Structural individual interview method (face-to-face) was employed to collect data on spiritual needs of cancer patients. Responses were obtained from 247 patients hospitalized in nursing and supportive treatment units at public hospitals. Data were analyzed using the Statistical Package for Social Sciences (IBM SPSS Statistics) version 22.0. To assess the psychometric properties of the scale, Cronbach’s alpha, split half test, average inter-item, and item-total correlations were calculated for internal consistency. Exploratory factor analysis was used to confirm the construct validity of the translated version of instrument. Results: Lithuanian version of The Spiritual Needs Questionnaire (27 items) had a good internal consistency (Cronbach’s alpha = 0.94). The existential and connectedness with family needs factor had the lowest Cronbach’s alpha (0.71) in relation to other factors: Religious needs (0.93), giving/generativity and forgiveness needs (0.88), and inner peace needs (0.74). Split-half test showed strong relationship between the both halves of the test. The item difficulty (1.47 (mean value)/3) was 0.49; while all values were in acceptable range from 0.20 to 0.80. Item-total correlations were inspected for the items in each of the four SpNQ-27 factors. Conclusions: The Lithuanian version of Spiritual needs questionnaire demonstrated adequate psychometric properties of the instrument. This instrument, as a screening tool and conversational model, is recommended for clinicians in health care practice to identify patients with spiritual needs.

Perceptions of Spiritual Care Education, Competence, and Barriers in Providing Spiritual Care Among Registered Nurses

Purpose: The purpose of the study was to explore registered nurses’ (RNs) perceptions of their spiritual care competence (SCC), preparedness, and barriers to providing spiritual care and frequency of provision of spiritual care. Additionally, the study aimed to examine associations between spiritual care education, preparedness, competence, and frequency. Method: A descriptive, cross-sectional study included demographic questions, the Spiritual Care Competency scale, the Nurses’ Spiritual Care Therapeutics scale, the Spiritual Care Practice questionnaire subscale II, and three open-ended questions. Findings: This online survey was completed by 391 RNs enrolled in postlicensure programs at a public state university in southeastern United States. A majority of participants reported not feeling prepared to provide spiritual care. There were strong associations between receiving spiritual care education in prelicensure programs or at work, and self-reported feelings of preparedness, as well as overall SCC. The level of SCC was positively correlated with spiritual care frequency and number of years working as an RN. Conclusions: The results of this study highlight the need for spiritual care education in prelicensure programs as well as on the job training for RNs.

Psychometric properties of the Chinese version of the spiritual care competency scale in nursing practice: a methodological study

OBJECTIVES

To determine the validity and reliability of the Spiritual Care Competency Scale (SCCS) among nurses in China.

DESIGN

Methodological research.

METHODS

After the SCCS was translated into Chinese, the validity and reliability of the Chinese version of the SCCS (C-SCCS) were evaluated using a convenience sample of 800 nurses recruited from different healthcare centres. The construct validity of the C-SCCS was determined by an exploratory factor analysis (EFA) with promax rotation. Pearson's correlation coefficients of the C-SCCS and the Palliative Care Spiritual Care Competency Scale (PCSCCS-M) were computed to assess the concurrent validity and construct validity of the C-SCCS. To verify the quality of the component structure, we conducted a confirmatory factor analysis (CFA). We tested the internal consistency and stability of the measure using Cronbach's alpha coefficient and the Guttman split-half coefficient, respectively, and a factorial analysis was performed.

RESULTS

A total of 709 participants completed the questionnaire (response rate: 88.63%), and all completed questionnaires were suitable for analysis. Three factors were abstracted from the EFA and explained 58.19% of the total variance. The Cronbach's alpha coefficients of the three subscales were .93, .92, and .89, and the Guttman split-half coefficient for the C-SCCS was .84. The CFA indicated a well-fitting model, and the significant correlations between the C-SCCS and the PCSCCS-M (r=0.67, p<0.01) showed adequate concurrent validity. Nurses' education and income level showed a significant association with the C-SCCS score.

CONCLUSION

The C-SCCS was shown to be a psychometrically sound instrument for evaluating Chinese nurses' spiritual care competencies.

Attachment Patterns Affect Spiritual Coping in Palliative Care

Research has shown that spiritual coping is essential for palliative care patients in enhancing quality of life and that attachment patterns affect the emotional well-being of the terminally ill. This is the first study evaluating how spiritual coping and attachment are associated in palliative care patients. Four different attachment patterns-secure, dismissive, preoccupied, and unresolved-were examined, as well as how they relate to three different spiritual coping strategies-search, trust, and reflection. In a cross-sectional, correlative design, 80 patients were recruited from German palliative care wards and hospices. Attachment patterns were determined using the Adult Attachment Projective System and spiritual coping strategies by SpREUK questionnaire, measuring spiritual and religious attitudes in dealing with illness. The results indicate that there is an association between attachment style and spiritual coping. Preoccupied patients had the lowest score in spiritual coping, with the strategy "reflection" being significantly lowest (t = 2.389, P = .019). Securely and dismissively attached patients presented equally high scores, raising the question of what mechanisms underlie spiritual coping. Furthermore, the unresolved group scored high in spiritual coping. Heightening awareness for ways in which attachment styles influence spiritual coping can contribute significantly to the quality of life in terminally ill patients, enabling health care professionals to tailor to individual needs in this vulnerable stage of life.

Palliative Caregivers' Spirituality, Views About Spiritual Care, and Associations With Spiritual Well-Being: A Mixed Methods Study

BACKGROUND

Spiritual care is integral to palliative care. It engenders a sense of purpose, meaning, and connectedness to the sacred or important and may support caregiver well-being.

AIM

To examine caregivers' spirituality, religiosity, spiritual well-being, and views on spiritual/religious support.

DESIGN

A mixed-methods study across 4 Australian sites, recruiting caregivers of patients with a life expectancy of under 12 months. The anonymous semistructured questionnaire used included research team developed and adapted questions examining religion/spirituality's role and support and views on hospitals supporting spiritual/religious requirements. It additionally included the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12).

RESULTS

One hundred nine caregivers participated (47.4% responded). Median spiritual well-being was 30.5 on FACIT-Sp-12. Religious affiliation was associated with higher Faith subscores (P < .001). Spirituality was very important to 24.5%, religiosity to 28.2%, and unimportant to 31.4% and 35.9%, respectively. Caregivers prayed (P = .005) and meditated (P = .006) more following patients' diagnoses, gaining comfort, guidance, and strength. Caregivers whose spiritual/religious needs were met to moderate/full extent by external religious/faith communities (23.8%) reported greater spiritual well-being (P < .001). Hospitals supported moderate/full caregiver spiritual needs in 19.3%. Pastoral care visits comforted 84.4% of those who received them (n = 32) but elicited discomfort in 15.6%. Caregivers also emphasized the importance of humane staff and organizational tone in supporting spiritual care.

CONCLUSIONS

Hospital-based spiritual care providers should seek to identify those who seek pastoral or religiously orientated care. Genuine hospitality of showing concern for the other ensures the varied yet inevitably humanist requirements of the caregiver community are met.

Evaluation of the Quality of Dying and Death Questionnaire in Kenya

PURPOSE

A culturally appropriate, patient-centered measure of the quality of dying and death is needed to advance palliative care in Africa. We therefore evaluated the Quality of Dying and Death Questionnaire (QODD) in a Kenyan hospice sample and compared item ratings with those from a Canadian advanced-cancer sample.

METHODS

Caregivers of deceased patients from three Kenyan hospices completed the QODD. Their QODD item ratings were compared with those from 602 caregivers of deceased patients with advanced cancer in Ontario, Canada, and were correlated with overall quality of dying and death ratings.

RESULTS

Compared with the Ontario sample, outcomes in the Kenyan sample (N = 127; mean age, 48.21 years; standard deviation, 13.57 years) were worse on 14 QODD concerns and on overall quality of dying and death (P values ≤ .001) but better on five concerns, including interpersonal and religious/spiritual concerns (P values ≤ .005). Overall quality of dying was associated with better patient experiences with Symptoms and Personal Care, interpersonal, and religious/spiritual concerns (P values < .01). Preparation for Death, Treatment Preferences, and Moment of Death items showed the most omitted ratings.

CONCLUSION

The quality of dying and death in Kenya is worse than in a setting with greater PC access, except in interpersonal and religious/spiritual domains. Cultural differences in perceptions of a good death and the acceptability of death-related discussions may affect ratings on the QODD. This measure requires revision and validation for use in African settings, but evidence from such patient-centered assessment tools can advance palliative care in this region.

Spirituality, Social Support, and Diabetes: A Cross-Sectional Study of People Enrolled in a Nurse-Led Diabetes Management Program in Peru

INTRODUCTION

In Peru, people living with diabetes mellitus (PLDM) represent 7% of the adult population, each with a $54,000 lifetime cost. For Latinos, spirituality provides meaning and purpose of life while social support affects behavioral choices and adherence decisions. The purpose of this study was to determine the relationship between spirituality and social support for PLDM participating in a nurse-led diabetes management program in a public hospital in Lima, Peru.

METHOD

This cross-sectional study included adult PLDM (N = 54). The instrument included demographic items and the Spanish versions of the social/vocational concern dimension of the Diabetes Quality of Life Questionnaire and the Reed's scale of spiritual perspective.

RESULTS

There was an inverse relation between social support and spiritually practices (p = .020) and spiritual beliefs (p = .005). PLDM with 5 years or more in the program had significantly higher scores in social support (p = .020) and spiritual practices (p = .010).

CONCLUSION

Spirituality and social support are important factors for managing PLDM. Nurse-led diabetes management programs with Latino participants should consider targeted spiritual and social support strategies to expand the holistic management. Future studies should explore the impact and effectiveness of spiritual and social support interventions on clinical outcomes.

Pain and Suffering

OBJECTIVE

To review literature on the relationship of pain, spirituality, and suffering as it relates to the patient with cancer who is experiencing pain.

DATA SOURCES

Peer-reviewed articles, textbooks, internet.

CONCLUSION

Pain and suffering are distinct and yet closely related in patients with cancer. Oncology nurses are important in assessing a patient's pain, including dimensions of spirituality and suffering.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses are the front line of pain management for patients. This includes recognizing existential distress and suffering and responding to suffering.

Spiritual Care at the End of Life: Does Educational Intervention Focused on a Broad Definition of Spirituality Increase Utilization of Chaplain Spiritual Support in Hospice?

Background: Research shows that religion and spirituality are important when persons cope with serious and life-threatening illness. Patients who receive good spiritual care report greater quality of life and better coping, and such support is strongly associated with greater well-being, hope, optimism, and reduction of despair at end of life. Despite these benefits, evidence shows that many patients and caregivers (P/C) refuse spiritual care when a hospice team offers it, possibly resulting in unnecessary suffering. Objective: To better understand what contributes to spiritual support acceptance in hospice care. Design: Quasi-experimental quantitative study. Setting/Subjects: 200 patients admitted to hospice. Measurements: Participants were divided equally into intervention and control arms. Control participants received standard information about the availability of chaplain support and an offer for referral to chaplain services. Intervention participants received educational intervention that explained hospice chaplain services and the evidence-based benefits of spiritual support. The association of chaplain acceptance was measured with treatment group, patient age, disease, church affiliation and support, sex, bereavement risk, and place of residence. Results: Among intervention participants, 64 (64%) accepted spiritual support versus 52 (52%) of control participants. The intervention arm's acceptance rate was higher than the control arm after adjustment for other variables. The variables associated with acceptance were age, primary diagnosis, and place of residence. Conclusions: This research suggests that educational intervention that explains spiritual care in hospice and its benefits contributes importantly to greater acceptance and allows P/C to gain the benefits of spiritual support during end-of-life care.

Spiritual care in nursing: an overview of the measures used to assess spiritual care provision and related factors amongst nurses

Background and aim of the work:

Spiritual wellbeing has important implications for an individual’s health and wellbeing. Whilst the provision of spiritual care and assessment of spiritual needs is a vital part of the nurse’s role, literature suggests that nurses do not always engage in spiritual care with their patients or assess their spiritual needs. This review aims to ascertain wider reasons for this inconsistent spiritual care delivery by nurses to their patients.

Methods:

A review of the literature was conducted to identify instruments available relating to nursing professionals spiritual care and assessment.

Results:

14 measures relating to spiritual care and assessment were identified covering the key domains of: ‘Beliefs and values and attitudes around spiritual care,’ ‘Frequency of provision or extent to which they provide spiritual care or willingness,’ ‘Respondents’ level of knowledge around spirituality and spiritual care,’ ‘Ability to respond to spiritual pain,’ and ‘Multiple Domains: beliefs and attitudes around spirituality and spiritual care, amount of preparation, training and knowledge, spiritual care practices, perceived ability and comfort with provision and perceived barriers to provision.’

Conclusions:

A lack of standardisation in the conceptualisation and assessment of spiritual care causes challenges in reviewing, however several themes do emerge. In general student and qualified nurses are aware of the importance of providing spiritual care and are hindered by a lack of education about how best to implement such care. The religiosity of individual nurses or their training institutions seems to be of less importance than training in spiritual care interventions. (www.actabiomedica.it)

Current Advances in Palliative & Hospice Care: Problems and Needs of Relatives and Family Caregivers During Palliative and Hospice Care-An Overview of Current Literature

Palliative and hospice care aims to improve quality of life of patients’ relatives, but still little is known about their specific problems and needs. We present a comprehensive literature update. Narrative review to present an expert overview of peer-reviewed, English-written original research publications and reviews on psychosocial and existential problems, supportive needs as well as interventions for relatives during the patients’ disease trajectory published between January 2017 and November 2018. A total of 64 publications were included. Relatives report high rates of psychological and existential distress, burden and psychological morbidity during the total disease trajectory of the patient. In addition, relatives report an alarmingly high number of unmet needs with information being the central issue. Relatives’ problems and needs are part of complex systems influenced by various socio-demographic factors and patient–relatives-interactions and dependency between different psychological phenomena. First support interventions for relatives during disease trajectory have proven feasible and secondary data from randomized studies suggest beneficial effects of providing early palliative care also for relatives. Relatives should be addressed to a still larger extent in the daily practice of palliative and hospice care, thus further research to reveal more detailed systematic information is needed to improve relatives’ psychological burden and quality of life.

Defining Essential Elements of Caregiver Support in Gynecologic Cancers Using the Modified Delphi Method

PURPOSE

Family caregivers are instrumental to patients with gynecologic cancer and can be deeply affected by the demands of caregiving. Our aims were as follows: (1) increase awareness of unmet needs of caregivers and (2) identify and prioritize the unmet needs of caregivers and essential support services to be provided in gynecologic cancer centers.

METHODS

From July 2017 to June 2018, a 16-person steering committee and 40 stakeholders, including caregivers, patients, and clinicians, participated in a modified Delphi approach to generate, review, and prioritize a set of essential elements for caregiver support. Stakeholders prioritized caregiver needs and brainstormed, discussed, and prioritized essential support services to meet those needs, using three rounds of a consensus-building protocol. Basic descriptive statistics were performed to feed means and rankings back to stakeholders before each round.

RESULTS

The top three caregiver needs were as follows: (1) to obtain information about their loved one's cancer, (2) how to provide support and comfort to their loved one, and (3) how to maintain their own emotional health and well-being. Fifteen essential elements of support for caregivers of patients with gynecologic cancer were identified and ranged from elements currently attainable (eg, information on managing symptoms, skilled-care training, a point person to help navigate the system) to more aspirational elements (eg, integrative services to promote caregiver well-being).

CONCLUSION

To ensure comprehensive quality care, clinicians and health care providers should strive to provide caregivers with the identified essential elements of support. Health care settings should work to incorporate caregiver needs into cancer care delivery.

Interconnections: Spirituality, Spiritual Care, and Patient-Centered Care

The interconnections of spirituality, spiritual care (SC), and patient-centered care (PCC) have implications for advanced practice nurses (APNs) and specialty care nurses (SNs) in their everyday practice. Spirituality has been identified as an inner resource for health, promoting hope, coping, and resilience during illness concerns; encouraging health promotion and maintenance; and improving patient outcomes. SC supports this inner resource and is provided by others. Systems can help facilitate SC by supporting the inter-personal relationships as well as transdisciplinary collaborations of PCC models. SC and PCC occur within inter-personal relationships and specific healthcare environments or systems when implementing them within a spirituality framework. This article provides a brief review on conceptual definitions of spirituality, SC, and PCC models and their relationship to each other within the inter-personal connections. Exploration of implementing such care in practice is presented. Search parameters for this review included manuscripts which provided conceptual as well as quantitative and qualitative research between 1990 and 2018, in English only, with keywords of spirituality, SC, PCC, nurse, nurse practitioner, APNs, and systems. Databases searched included CINHAL, Medline, PubMed, ALTA Religion, Psych-INFO, and Ovid. Articles included in this review were based on research of the above concepts as well as operationalizing the concepts into practice.

Patient Perspectives about Spirituality and Spiritual Care

Objective:

This study was undertaken to explore the perspectives regarding spirituality and spiritual care held by individuals with advanced disease. The aim was to gain a deeper understanding about their viewpoints surrounding spiritual care and the role of health-care professionals in providing such care.

Methods:

Sixteen individuals with advanced disease and a prognosis of <12 months underwent an in-depth interview. Transcripts were subjected to a qualitative descriptive analysis to identify salient content and themes.

Results:

Four overall themes were identified: Spirituality is personal, spiritual distress is about separation, spiritual care is about connecting, and conversations about spirituality must align with the patient's beliefs. Subthemes emphasized the individuality of spiritual expression, the potential for illness impacting spiritual beliefs, and the value of connections to one's spiritual community. Participants thought healthcare providers needed to be able to identify individuals who were experiencing a spiritual struggle, acknowledge the reality of that struggle, and connect the individual with the appropriate resource or person.

Conclusions:

Patients with advanced disease are likely to express their spirituality in unique ways. Being able to talk about their spiritual beliefs and doubts during illness without judgment was seen as a benefit to them. Healthcare providers ought to be able to identify those patients who require assistance in connecting to appropriate spiritual care resources.

Moving Toward Openness: Blackfeet Indians' Perception Changes Regarding Talking About End of Life

This study was conducted to examine cultural appropriateness and readiness for the Blackfeet people in the United States talking about end of life. In the past, a taboo perception of Blackfeet traditional belief in end-of-life discussion was identified as a core barrier for hospice use. However, a recent anecdotal increase in hospice interest triggered the research team to investigate community-wide interest as well as traditional appropriateness of hospice introduction. The community-based participatory research approach was used to conduct the study. Using convenience sampling, we interviewed 10 tribally recognized Elders and surveyed 102 tribal members who were over 18 years old using a modified Duke End-of-Life Care Survey. Here, our report focused on the perception changes on end-of-life discussion. The elders' statements were divided into two, saying that an end-of-life discussion was not against tradition and that sickness and death would break the living spirit, thus no such discussion. Despite, the importance of a family gathering and the need for knowledge about end-of-life care were confirmed. The survey (response rate 100%; n = 92) showed that 90% of the respondents thought dying was a normal part of life and 76% felt comfortable talking about death. In conclusion, there was a shift in the Blackfeet Indians' attitude toward end-of-life discussion from reluctance to at ease. Recommendations specific to the Blackfeet-related entities are presented.

Nurse Spiritual Care: Prevalence and Correlates

Many nurses embrace spiritual care as integral to holistic care. Evidence documenting the frequency of spiritual care provided in acute care settings, however, is sparse and weak. For this cross-sectional, correlational study, data were collected from N = 554 tertiary care nurses using the Nurse Spiritual Care Therapeutics Scale (NSCTS) measuring their self-reported spiritual care with patients/family members over the last 72 to 80 hours at work. While the most frequently endorsed practices centered on presence, listening, and spiritual assessment, the overall NSCTS score remained modest ( M = 37; SD = 12; possible range = 17-85). Several associations were found; 32.4% of the variance in frequency of spiritual care provision was explained by nurse perception that spiritual issues come up often in the work setting, high nurse spirituality score, not working in pediatrics, and having received education about spiritual care. Findings allow for benchmarking of nursing practices that have often been invisible.

Stakeholder views on the role of spiritual care in Australian hospitals: An exploratory study

Research increasingly demonstrates the contribution of spiritual care to patient experience, wellbeing and health outcomes. Responsiveness to spiritual needs is recognised as a legitimate component of quality health care. Yet there is no consistent approach to the models and governance of spiritual care across hospitals in Australia. This is consistent with the situation in other developed countries where there is increased attention to identifying best practice models for spiritual care in health. This study explores the views of stakeholders in Australian hospitals to the role of spiritual care in hospitals. A self-completion questionnaire comprising open and closed questions was distributed using a snowball sampling process. Analysis of 477 complete questionnaires indicated high levels of agreement with ten policy statements and six policy objectives. Perceived barriers to spiritual care related to: terminology and roles, education and training, resources, and models of care. Responses identified the issues to inform a national policy agenda including attention to governance and policy structures and clear delineation of roles and scope of practice with aligned education and training models. The inclusion of spiritual care as a significant pathway for the provision of patient-centred care is noted. Further exploration of the contribution of spiritual care to wellbeing, health outcomes and patient experience is invited.