Determining best methods to screen for religious/spiritual distress

Providing spiritual care to cancer patients in the outpatient context: a pilot study

The aim of this pilot study was to test an effort to provide spiritual care (SC) to oncology outpatients in the Ascension healthcare system. Medical providers referred patients who would benefit from spiritual and emotional support. Twenty-seven cancer outpatients from 5 states were enrolled in the project. Based on the chaplain assessment, 45% of the patients had moderate or severe spiritual concerns. On average patients had 4 sessions with a chaplain (range 2-9). Of the 136 chaplain sessions, 56% were in-person in the clinic and 35% were by phone. The most common chaplain activities were active listening (87% of the sessions) and demonstrate caring and concern (55%). For the 20 patients who provided follow-up data, there were decreases in all measures of religious/spiritual distress, though statistically insignificant, and a marginally significant increase (p < .054) in well-being. The study adds to the emerging literature that describes the importance of SC in the outpatient context.

Chaplaincy and outpatient cancer care in a faith-based health system: lessons learned when imbedding two full time chaplain positions in a cancer institute with a faith-based heritage

There is interest in chaplains devoted to outpatient cancer care, informed by a growing body of research as well as recommendations of accreditors. Simultaneously, a growing share of U.S. healthcare is faith-based and possesses a foundational interest in religious/spiritual (R/S) care due to institutional culture. In that milieu, few articles describe how religious organizational cultures influence the creation and implementation of FTEs intended to meet the evidence-based recommendations of accreditors. This is a lacuna, given that board certified chaplains are measured on their ability to integrate spiritual care into the life and service of their institutions. In response, this article describes the creation and implementation of two chaplain positions devoted to a group of outpatient cancer clinics in a large Catholic healthcare system. This includes lessons learned when navigating R/S aspects of organizational cultures while implementing and executing chaplain practice to meet accreditor recommendations.

Connecting Families to Bereavement Resources: A Hospital-Based, Bereavement Follow-Up Pilot During First-Wave COVID-19

Background: Hospitals often lack bereavement programs. Bereaved families often navigate grief support on their own. This problem was complicated by the early COVID-19 pandemic. Objective: Describe a cost neutral pilot to support next of kin (NOK) of deceased patients from our communicable disease response unit (CDRU) and palliative care unit (PCU). Design: Ad hoc pilot leveraging chaplains and a social worker (SW) to call NOK for grief support using a templated guide, referring interested NOK to bereavement support agencies. Setting/Subjects: NOK of patients who died in the CDRU and PCU at a metropolitan, quaternary care, hospital over five months. Results: One hundred eighty-six patients died. Eighty-one NOK were called, 51 calls were considered complete. Fourteen NOK accepted a referral for bereavement support. Conclusions: This cost neutral pilot successfully connected 81 NOK with either a pilot chaplain or SW for bereavement support. Fourteen NOK accepted referral for a community bereavement resource.

Screening for Palliative Care Need in Oncology: Validation of Patient-Reported Outcome Measures

CONTEXT

Leading oncology societies recommend monitoring symptoms and support needs through patient-reported outcome measures (PROMs), but their use for assessing specialist palliative care (SPC) need has not yet been explored. Research on SPC integration has focused on staff-assessed screening tools, which are time-consuming.

OBJECTIVES

This study aimed to assess the diagnostic validity of the Integrated Palliative Outcome Scale (IPOS) and NCCN Distress Thermometer (NCCN DT) in identifying need for SPC in patients with incurable cancer.

METHODS

In a cross-sectional study, patients with incurable cancer (prognosis <2 years) completed PROMs. In an independent process, the palliative care consultation service (PCCS) assessed the need for SPC in each patient through multiprofessional case review, and this was used as the reference standard. ROC analyses were employed to determine diagnostic validity.

RESULTS

Of the 208 participants, 71 (34.1 %) were classified as having SPC need by the PCCS. Aiming for a minimum sensitivity of 80%, a cut-off of ≥2 items with high/very high burden in the IPOS resulted in a 90.2% sensitivity (specificity = 50; AUC = 0.791; CI 95%= 0.724-0.858). A cut-off of ≥5 resulted in a sensitivity of 80 % for NCCN DT (specificity = 49.5 %; AUC = 0.687; CI 95% = 0.596-0.777).

CONCLUSION

PROMs are useful for identifying SPC need in cancer patients. Their implementation might facilitate timely integration of SPC. Future research should focus on an integrated assessment approach with PROMs that combines the requirements of the different specialties to save patient and staff resources.

Spirituality in Surgery-A Double-Edged Scalpel

Investigating, respecting, and working with surgical patients' spiritualities is as critical a skill as the proficient technical performance of operations. When spirituality is ignored, sacred patient values remain undiscovered, authentic trust is hindered, and healthy shared decision-making processes suffer. These are instances when the other edge of the spiritual scalpel comes back to cut us as surgeons, but more importantly, upon withdrawal of spiritual understanding, it deeply injures our patients and their families. Spiritual screening, spiritual history taking, engaged, active listening, and big-picture prognostic truth-telling while promoting hope are critical skills for efficacious whole-person surgical care and the healing of our surgical patients' suffering-in all aspects of their humanity. These skills require surgeon introspection and vulnerability, however, as well as regular practice, and can be quite difficult; frequently leading to understandable discomfort, particularly when the surgeon does not share the patient's spiritual orientation or religious commitments. This literature-based essay addresses all of these issues, providing surgeons with a variety of new spiritual tools for their holistic armamentarium to promote healing, rather than further injury.

Spirituality and Chaplaincy Supporting ICU Survivorship: A Practical Overview and Strategy for Clinicians

This overview of the current literature of spirituality and health and the role of professional chaplains specifically considers intensive care unit survivorship, instead of the more common focus on end-of-life circumstances or family support on an ICU. The purpose is to enhance clinicians' understanding and use of spiritual resources for patient care and outcomes. It is a product of comprehensive daily monitoring of the Medline database from 2002 to 2022 for all publications indexed by the terms "spiritual," "religion," and "chaplain." A case will be used throughout, to illustrate spirituality dynamics. Also, a practical strategy, developed by the authors from clinical experience, will be outlined for clinicians' spiritual support of patients, requiring little time or specialized knowledge and avoiding the blurring of professional roles and boundaries, while potentially yielding clinical benefits suggested in the medical literature.

Layers of Loss: A Scoping Review and Taxonomy of HD Caregivers' Spiritual Suffering, Grief/Loss and Coping Strategies

CONTEXT

Huntington's disease (HD), an incurable, multi-generational, autosomal dominant disorder, creating unique challenges and a myriad of spiritually-related stressors in those affected and their familial caregivers. Spiritual suffering, experiences of grief/loss, and coping strategies have not been systematically studied in HD caregivers.

OBJECTIVES

To comprehensively define spiritual suffering, grief/loss, and coping strategies used by HD caregivers.

METHODS

A PRISMA-ScR scoping literature review was conducted. Data from included research articles were organized thematically using induction and open coding. A grounded, deductive approach was used to delineate a demarcated taxonomy of themes, which encompasses all three over-arching domains. Four reviewers, employing a modified Delphi approach, ascertained which themes were demonstrated by research participants in each study.

RESULTS

36 of 583 articles met the review criteria; none were published in the palliative care literature. Investigations primarily focused on intrapersonal (self-image) distress and existential angst; only rarely looking deeper into divine/transpersonal suffering, disrupted religious relationships, or meaning distress. HD caregivers experience profound grief/loss, expressed as disenfranchised grief that is associated with the ambiguous loss of their loved one, loss of family structure, social connectedness, and personal losses. Half of the studies reported maladaptive HD caregiver coping strategies-characterized by dysfunctional escape schemes; in contrast, transcendent/creative strategies were often unexplored.

CONCLUSION

HD caregivers experience prolonged grief and other forms of spiritual suffering as they progressively lose their loved ones and disruption to their own lives. With an improved assessment tool, teams with spiritual and palliative care experts will better be able to support HD family caregivers.

Integrating Spiritual Care in Population Health and Care Management: Two Case Examples

PURPOSE/OBJECTIVES

The purpose of this case study is to describe the movement of spiritual care into outpatient, managed care and population health settings, as it has evolved in a major not-for-profit health care system in the United States. The objective is to begin to establish the effectiveness of integrating spiritual care as a part of the interdisciplinary team (IDT) in these contexts.

PRIMARY PRACTICE SETTINGS

The case study presents two practice settings: a remote patient monitoring program for patients with complex medical conditions, and integration into population health as a part of a Medicare Advantage Insurance program that is a cooperative venture between the health care system (Ascension) and an established insurance program (Centene).

FINDINGS/CONCLUSIONS

The cases presented suggest that the integration of spiritual care into the outpatient, managed care and population health contexts has a threefold benefit: enhancing patient care, increasing the effectiveness of the IDT, and providing for the care and support of the members of the IDTs themselves.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

The cases presented suggest inclusion of spiritual care in the care management/population health approach to patient care is viable and valuable both for the benefit of the patient and the functioning of the care team.

Mental and Spiritual Health Needs of Cognitively Enhanced People: A Therapeutic and Spiritual Care Model for Responding

Cognitively enhanced people will have mental and possibly spiritual health needs that merit therapeutic and spiritual care response. This article addresses people who, although significantly enhanced, overlap with ordinary or “normal” (i.e., non-enhanced) people such that their status as humans is not questioned. Effective therapeutic and spiritual care approaches for these cognitively enhanced individuals will have a strong cognitive component. Cognitive therapy, originated by Aaron Beck, is an example of a therapeutic model that could prove useful with people cognitively enhanced. Four relevant elements of the cognitive therapy modality are explored: a developed cognitive structure, little consideration to unconscious factors, minimum attention to family of origin, and collaboration. Two psychological challenges with religious dimensions and import, which could be faced by individuals as a consequence of their cognitive enhancements, are concerns about physicality and fitting into community with ordinary humans and other enhanced humans.

Examining Factors Associated with Utilization of Chaplains in the Acute Care Setting

Hospitalized persons want their spiritual needs addressed and discussed by the healthcare team, but medical providers and nurses lack the necessary training. Patients want chaplaincy care, but very few receive it, and little is known about utilization factors. To identify the population characteristics associated with the utilization of chaplaincy services, hospitalization data from March 2012 to July 2017 were analyzed (N = 15,242 patients). Religiously affiliated individuals and those with the most acute health needs were more likely to receive chaplaincy care and received more total care. Patient-centered healthcare models may need to evaluate strategic integration of spiritual care beyond reactive spiritual care provision.

The role of religion and spirituality in caregiver decision-making about tracheostomy for children with medical complexity

Children with medical complexity (CMC) receive life-sustaining treatments such as tracheostomy. The objective of this paper is to explore the roles of religion and spirituality (R&S) of caregivers of children with medical complexity (CMC) in their decision to pursue tracheostomy for their children. We conducted 41 in-depth interviews of caregivers of CMC who had received tracheostomies in the prior 5 years. Four themes emerged: (1) Caregivers believed R&S to be powerful for their children's healing, and helped them cope with their children's illnesses; (2) Spirituality was an important factor for caregivers in the decision to pursue tracheostomy for their children; (3) Many caregivers did not discuss their spirituality with clinicians for a variety of reasons; (4) Clergy and hospital chaplains played a major supportive role overall; however, they did not play a significant role in the decision-making process. Our study shows the importance of R&S, and the roles of clergy and chaplains in pediatric tracheostomy decision-making.

Top Ten Tips Palliative Care Clinicians Should Know About Spirituality in Serious Illness

Assessment of spiritual suffering and provision of spiritual care are a central component of palliative care (PC). Unfortunately, many PC clinicians, like most medical providers, have received limited or superficial training in spirituality and spiritual distress. This article, written by a group of spiritual care providers, and other PC and hospice clinicians, offers a more in-depth look at religion and spirituality to help to enhance readers' current skills while offering a practical roadmap for screening for spiritual distress and an overview of partnering with colleagues to ensure patients receive values-aligned spiritual care provision.

Development of a One-item Screening Question to Assess Spiritual Well-Being for Advanced Cancer Inpatients in Korea

CONTEXT

Spiritual well-being (SWB) is significant for patients with life-limiting illnesses. Thus, shortened versions of questions would be helpful in approaching SWB.

OBJECTIVES

Our goal was to develop a one-item screening question to assess the SWB of advanced cancer inpatients.

METHODS

This was a cross-sectional, multicenter study involving adult advanced cancer inpatients from seven palliative care units in South Korea. The candidate one-item questions were three questions scored using numeric rating scales from 0 to 10: feeling at peace (Are you at peace?), self-rated spirituality (Do you think of yourself as a spiritual person?), and self-rated religiosity (Do you think of yourself as a religious person?). The Functional Assessment of Chronic Illness Therapy-Spirituality 12 (FACIT-Sp-12) comprised of two subscales Meaning/Peace and Faith was used to assess SWB. Pearson's correlation test was conducted to determine the relationship between the three questions, the total FACIT-Sp-12 score, and its subscales.

RESULTS

A total of 202 patients were enrolled. A strong correlation was observed between self-rated spirituality (r = 0.732 and 0.790; P < 0.001 and < 0.001 respectively) and religiosity (r = 0.708 and 0.758; P < 0.001 and < 0.001 respectively) with the total FACIT-Sp-12 scores and faith subscale scores. Feeling at peace showed a moderate correlation with the total of FACIT-Sp-12 scores (r = 0.505, P < 0.01). All three questions had a moderate correlation with the meaning/peace subscale.

CONCLUSION

Self-rated spirituality and religiosity showed better convergence validity than feeling at peace. Therefore, we recommend self-rated spirituality or religiosity as a one-item question for screening SWB in inpatients with advanced cancer.

A systematic review and meta-analysis of effects of psychosocial interventions on spiritual well-being in adults with cancer

Objective

Spiritual well-being (SpWb) is an important dimension of health-related quality of life for many cancer patients. Accordingly, an increasing number of psychosocial intervention studies have included SpWb as a study endpoint, and may improve SpWb even if not designed explicitly to do so. This meta-analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on SpWb in adults with cancer and tested potential moderators of intervention effects.

Methods

Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which SpWb was an outcome. Doctoral-level rater pairs extracted data using Covidence following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Standard meta-analytic techniques were applied, including meta-regression with robust variance estimation and risk-of-bias sensitivity analysis.

Results

Forty-one RCTs were identified, encompassing 88 treatment effects among 3883 survivors. Interventions were associated with significant improvements in SpWb (g = 0.22, 95% CI [0.14, 0.29], p < 0.0001). Studies assessing the FACIT-Sp demonstrated larger effect sizes than did those using other measures of SpWb (g = 0.25, 95% CI [0.17, 0.34], vs. g = 0.10, 95% CI [-0.02, 0.23], p = 0.03]. No other intervention, clinical, or demographic characteristics significantly moderated effect size.

Conclusions

Psychosocial interventions are associated with small-to-medium-sized effects on SpWb among cancer survivors. Future research should focus on conceptually coherent interventions explicitly targeting SpWb and evaluate interventions in samples that are diverse with respect to race and ethnicity, sex and cancer type.

Prevalence, Predictors and Correlates of Religious and Spiritual Struggles in Palliative Cancer Patients

CONTEXT

Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. This concise measure allows for the assessment of multiple types of r/s struggles for people from different religious backgrounds or none.

OBJECTIVES

The aim of the present study was to examine the prevalence, predictors and correlates of r/s struggles as measured by the RSS-14 and its subdomains in a cancer population receiving palliative care.

METHODS

Data were collected from six outpatient palliative care services across the US. Inclusion criteria for patients were age 55 or older with a cancer diagnosis. In addition to demographic and r/s characteristics, study measures included the Edmonton Symptom Assessment Scale (ESAS), the Patient Dignity Inventory (PDI) and the Quality of Life at the End of Life (QUAL-E).

RESULTS

The study included 331 participants. Some r/s struggle was reported by 66%, moderate to high struggle for at least one item was reported by 20% of the patients. In bivariate analyses, r/s struggle was associated with greater symptom burden, greater dignity-related problems and poorer quality of life; in multivariable analyses, dignity-related problems remained a predictor of total r/s struggle.

CONCLUSION

R/S struggles may compromise well-being for cancer patients receiving palliative care. Clinicians should consider periodic screening for r/s struggles and referrals for spiritual care if indicated.

Implementing quality improvement efforts in spiritual care: outcomes from the interprofessional spiritual care education curriculum

The Interprofessional Spiritual Care Curriculum (ISPEC) was created to train interdisciplinary health care teams to recognize and address the spiritual needs of seriously or chronically ill patients. The curriculum, in a train-the-trainer format, employs didactic presentations, discussions, lab sessions, skill demonstrations, and video clips. In course applications, participants were required to submit goals to achieve and demonstrate institutional support. For the first ISPEC course, in July 2018, 48 clinician-chaplain teams attended. Following the 2½ day course, participants had access to online training modules for 1-year, ISPEC faculty mentoring support, and regular conference calls on goal implementation progress. Participants reported recognizing the importance of providing spiritual care and a new understanding of how collaborating as interprofessional teams enabled them to integrate this care into their home institution settings. In a mixed-methods evaluation survey completed 12 months after the ISPEC course, participants reported on the percentage of their goals completed, number and types of professionals they had educated in spiritual care, and personal confidence regarding spiritual care leadership skills. This data can serve as a model to guide other organizations striving to improve spiritual care, practiced collaboratively by clinicians and chaplains, as an essential aspect of overall QI efforts in palliative care.

Associations Between Religious/Spiritual Coping and Depression Among Adults with Cystic Fibrosis: A 12-Month Longitudinal Study

Individuals with cystic fibrosis (CF) face a challenging disease, and depression is a significant concern. Many patients draw on religious/spiritual resources to assist them in managing the demands of chronic illness; however, these coping efforts rarely have been evaluated among adults with CF. This longitudinal study examined relationships between distinct types of positive and negative religious/spiritual coping at baseline (assessed with the RCOPE) and depression screening outcomes 12 month later (assessed with the Hospital Anxiety and Depression Scale). In logistic regression analyses controlling for disease severity (FEV₁% predicted), lower likelihood of depression caseness at 12 months was predicted by higher general religiousness at baseline, greater use of benevolent religious reappraisal coping, greater use of spiritual connection coping, and lower spiritual discontent. Results suggest that distinct aspects religious/spiritual coping have differential associations with subsequent depression outcomes. Findings extend prior research to an important, understudied medical population, and address a clinically meaningful outcome.

[Religiosity and spirituality as ressources for head neck cancer patients]

OBJECTIVE

 Spiritual Care is a well established part of palliative medicine. Are religiosity / spirituality also ressources of patients during the arly phases of a head neck cancer (HNC) disease?

MATERIAL AND METHODS

 We included 113 HNC patients (27 women, 84 men, 2 divers) to a prospective study using questionnaires focused on actual burden (NRS), spirituality as ressource (SpREUK-15, spiritual needs (SpNQ-20), interpretation of illness (IIQ), and life satisfaction of patients (BMLSS-10, BMLSS-Support, WHO-5). 39 patients were still under therapy, 74 participants were cancer-survivors.

RESULTS

 Only 31/111 (28 %) patients feel themselve as spiritual and/or relgious. 72 % are neither spiritual nor religious. 51/111 see reflexion about their cancer disease as a specific ressource to overcome their actual cancer situation. Spiritual needs are religious in 35/112, existential in 67/112, inner peace in 90/112, and generativity in 84/112 patients. The accepted own religiosity and the actual stadium of disease are highly relevant impact factors on spiritual needs and ressources. HNC patients show a high part of depressive moods (WHO-5) and are (in trend) un-satisfied with their life and support situation.

CONCLUSION

 Up to 90 % of HNC patients have specific spiritual needs which are often hidden. Modern concepts of integrative oncology discover them, and enourage via these ressources the quality of life and the coping of cancer patients.

Essential Package of Palliative Care for Women With Cervical Cancer: Responding to the Suffering of a Highly Vulnerable Population

Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extreme suffering in this vulnerable population, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an essential package of palliative care for cervical cancer (EPPCCC). The EPPCCC consists of a set of interventions, medicines, simple equipment, social supports, and human resources, and is designed to be safe and effective for preventing and relieving all types of suffering associated with cervical cancer. It includes only inexpensive and readily available medicines and equipment, and its use requires only basic training. Thus, the EPPCCC can and should be made accessible everywhere, including for the rural poor. We provide guidance for integrating the EPPCCC into gynecologic and oncologic care at all levels of health care systems, and into primary care, in countries of all income levels.

A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation

Background

The COVID-19 pandemic has resulted in increased strain on health care systems and negative psychological effects on health care workers (HCWs). This is anticipated to result in long-term negative mental health effects on the population, with HCWs representing a particularly vulnerable group. The scope of the COVID-19 pandemic necessitates the development of a scalable mental health platform to provide services to large numbers of at-risk or affected individuals. The Mount Sinai Health System in New York City was at the epicenter of the pandemic in the United States.

Objective

The Center for Stress, Resilience, and Personal Growth (CSRPG) was created to address the current and anticipated psychological impact of the pandemic on the HCWs in the health system. The mission of the Center is to support the resilience and mental health of employees through educational offerings, outreach, and clinical care. Our aim was to build a mobile app to support the newly founded Center in its mission.

Methods

We built the app as a standalone digital platform that hosts a suite of tools that users can interact with on a daily basis. With consideration for the Center’s aims, we determined the overall vision, initiatives, and goals for the Wellness Hub app, followed by specific milestone tasks and deliverables for development. We defined the app’s primary features based on the mental health assessment and needs of HCWs. Feature definition was informed by the results of a resilience survey widely distributed to Mount Sinai HCWs and by the resources offered at CSRPG, including workshop content.

Results

We launched our app over the course of two phases, the first phase being a “soft” launch and the second being a broader launch to all of Mount Sinai. Of the 231 HCWs who downloaded the app, 173 (74.9%) completed our baseline assessment of all mental health screeners in the app. Results from the baseline assessment show that more than half of the users demonstrate a need for support in at least one psychological area. As of 3 months after the Phase 2 launch, approximately 55% of users re-entered the app after their first opening to explore additional features, with an average of 4 app openings per person.

Conclusions

To address the mental health needs of HCWs during the COVID-19 pandemic, the Wellness Hub app was built and deployed throughout the Mount Sinai Health System. To our knowledge, this is the first resilience app of its kind. The Wellness Hub app is a promising proof of concept, with room to grow, for those who wish to build a secure mobile health app to support their employees, communities, or others in managing and improving mental and physical well-being. It is a novel tool offering mental health support broadly.

Patients' and Loved Ones' Expectations of Chaplain Services

A study assessing the expectations patients and loved ones have of hospital chaplains was conducted at Ascension St. Vincent Indiana hospitals. In-person interviews were conducted with 452 patients and loved ones during an inpatient stay. The survey instrument was a modified version of a survey developed by Dr. Katherine Piderman of the Mayo Clinic. Participants answered questions regarding demographics, awareness of availability, expectations of visits, reasons for wanting to see a chaplain and gave feedback regarding visits if they had seen a chaplain. Results showed that patients and loved ones value chaplains with 93% saying they wanted a chaplain visit. This study was unique in seeking feedback from loved ones as well as patients. It may be equally important to reach out to loved ones during times of crisis when patients themselves are in surgery or sedated and loved ones are experiencing heightened anxiety.

Commentary on Chaplain-Physician Interactions From the Chaplain's Perspective: A Mixed Method Analysis

Gomez and her colleagues have presented a helpful study of the relationship of the chaplains in her health system to physicians which highlights several barriers to a well-integrated relationship and thus to more optimal patient care. We have seen these same barriers as we have consulted with health systems nationally and have also identified many best practices that mediate or even eliminate many of these barriers. This commentary describes some of what we have seen as chaplain-generated causes of those barriers and effective strategies that have been employed to overcome them. We also provide some resources for chaplains who wish to institute some of these best practices themselves.

Cross-cultural Validation of the Spiritual Interests Related to Illness Tool-Korean Version

Living with a terminal illness, whether as a patient or as the family member of a patient, often involves spiritual challenges. The ability to ascertain and meet the spiritual needs of terminally ill patients and their loved ones is an essential part of providing compassionate and competent whole person care. This study aimed to adapt the original Spiritual Interests Related to Illness Tool (SpIRIT) for use in Korea (SpIRIT-K) and to assess its reliability and validity as a tool to determine the spiritual needs of terminally ill Korean patients and their caregivers. After translation-back-translation and content validity indexing, SpIRIT-K was administered to 106 terminally ill patients and 105 family caregivers in 20 sites across South Korea. SPSS and AMOS were used for evaluating validity and reliability. The 37-item SpIRIT-K consisted of 8 factors (subscales), with each subscale consisting of between 3 and 8 items. Evidence for structural and convergent validity was observed. Internal reliability of the overall scale was 0.95. The findings showed patients and family caregivers reported no significant difference in 7 of the 8 subscales, demonstrating known-groups validity. The rigorous process of establishing cross-cultural validity for this scale provided evidence supporting its validity and reliability. The findings suggest that SpIRIT-K is suitable for research and for clinical purposes in palliative care settings in South Korea. This development also allows for comparisons between Korean and North American cultures in terms of spiritual needs among terminally ill patients and their caregivers.

Training Chaplains to Provide Communication-Board-Guided Spiritual Care for Intensive Care Unit Patients

Background: Chaplain-led communication-board-guided spiritual care may reduce anxiety and stress during an intensive care unit (ICU) admission for nonvocal mechanically ventilated patients, but clinical pastoral education does not teach the assistive communication skills needed to provide communication-board-guided spiritual care. Objective: To evaluate a four-hour chaplain-led seminar to educate chaplains about ICU patients' psychoemotional distress, and train them in assistive communication skills for providing chaplain-led communication-board-guided spiritual care. Design: A survey immediately before and after the seminar, and one-year follow-up about use of communication-board-guided spiritual care. Subjects/Setting: Sixty-two chaplains from four U.S. medical centers. Measurements: Multiple-choice and 10-point integer scale questions about ICU patients' mental health and communication-board-guided spiritual care best practices. Results: Chaplain awareness of ICU sedation practices, signs of delirium, and depression, anxiety, and post-traumatic stress disorder in ICU survivors increased significantly (all p < 0.001). Knowledge about using tagged yes/no questions to communicate with nonvocal patients increased from 38% to 87%, p < 0.001. Self-reported skill and comfort in providing communication-board-guided spiritual care increased from a median (interquartile range) score of 4 (2-6) to 7 (5-8) and 6 (4-8) to 8 (6-9), respectively (both p < 0.001). One year later, 31% of chaplains reported providing communication-board-guided spiritual care in the ICU. Conclusions: A single chaplain-led seminar taught chaplains about ICU patients' psychoemotional distress, trained chaplains in assistive communication skills with nonvocal patients, and led to the use of communication-board-guided spiritual care in the ICU for up to one year later.

The accuracy of measures in screening adults for spiritual suffering in health care settings: A systematic review

OBJECTIVE

Guidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence of the accuracy of measures used to screen adults for spiritual suffering.

METHODS

A systematic review of the literature. We searched five scientific databases to identify relevant articles. Two independent reviewers screened, extracted data, and assessed study methodological quality.

RESULTS

We identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the two-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82-87%), and the revised Rush protocol had the highest specificity (81-90%). The methodological quality of all included studies was low.

SIGNIFICANCE OF RESULTS

While most of the identified spiritual screening measures are brief (comprised 1 to 12 items), few had sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.

Testing of a (Spiritual) Self-Assessment Tool ((S)SAT) in a Community Hospital Setting

The (Spiritual) Self-Assessment Tool Study was designed to test the novel engagement tool's effectiveness. Providing the (Spiritual) Self-Assessment Tool Study to newly admitted medical patients led to few instances where the tool was completed. Nevertheless, the (Spiritual) Self-Assessment Tool Study patient questionnaire generated significant secondary findings: a third of responding patients consider their hospital care incomplete without their care team having access to (Spiritual) Self-Assessment Tool data. Nursing staff also desire this data, but are unable to access it without the (Spiritual) Self-Assessment Tool or an equivalent source.

Religious/Spiritual Coping in Young Adults with Cancer

Purpose: The study used a cross-sectional descriptive design to explore the prevalence and correlates of religious/spiritual (R/S) coping and struggle in young adults (YAs) during the first 2 months of cancer treatment. Methods: Self-report measures of R/S coping, R/S struggle, depression, quality of life (QoL), intensity of treatment experience, and spiritual/religious identification and practices were obtained using REDCap Survey. Self-report of selected demographic characteristics (age, ethnicity, race, gender, education, occupational status, marital status, parental status, and cancer diagnosis) was also obtained. Results: The prevalence of positive R/S coping was high and higher compared with negative R/S coping. Female gender was associated with more R/S struggle, lower QoL, and higher depression. The Religious and Spiritual Struggles Scale and both the negative and positive R/S coping scale of the Brief RCOPE were significantly positively correlated, despite focusing on differing types of spiritual struggle/distress. Conclusions: Both positive R/S coping and R/S struggle occur in YAs during the first 2 months of cancer treatment. Further research to elucidate the experiences of YAs with cancer, and interventions to promote effective coping, will promote holistic cancer care for this population.

Predictors of Self-Reported Growth Following Religious and Spiritual Struggles: Exploring the Role of Wholeness

Religious and spiritual (r/s) struggles have been robustly linked to negative outcomes, such as greater psychological distress, reduced well-being, and difficulty finding meaning in life. R/s struggles, however, do not inevitably lead to decline. Many people report post-traumatic and spiritual growth through their r/s struggles, even though correlational studies linking r/s struggles to perceptions of growth have produced mixed results. How do we make sense of this overall pattern of findings? Perhaps growth following r/s struggles occurs under certain conditions. Prior conceptual work by Pargament suggests that specific aspects of one’s orienting system (i.e., the confluence of r/s, dispositional, and psychosocial factors which help guide people in their search for significance and purpose) may play a pivotal role in predicting growth or decline in the wake of an r/s struggle. In the present empirical study, we expected to find that among r/s strugglers, those with orienting systems marked by greater wholeness would be more likely to report growth and less decline. Four dimensions of greater wholeness (purposiveness, breadth and depth, life affirmation, cohesiveness) were measured by the presence of meaning in one’s life, self-control, universality, optimism, compassion, openness to change while tolerating doubt, and a collaborative problem-solving relationship with God. We tested these hypotheses using data from a cross-sectional study (N = 1162) of undergraduates at three universities. Results generally supported our hypotheses, with a few exceptions. Greater wholeness was associated with reports of more growth and less decline after an r/s struggle.

Integrating Palliative Care for Patients on Clinical Trials: Opportunities for Oncology Nurses

The purpose of this article is to describe the lessons learned in the course of a 5-year research study on a palliative care intervention for persons on a Phase 1 clinical trial. Patients who are participating in Phase 1 trials and the families who care for them may be especially vulnerable and require special attention. The patients are generally experiencing the effects of advanced disease, and they also may soon experience unknown side effects, intense treatment regimens, and the emotional stress of an uncertain future as a result of clinical trial participation. Oncology nurses in all roles including clinical trials/research nurses, clinicians, educators, and advanced practice registered nurses play a critical role in addressing the quality-of-life concerns in this population. Palliative care can provide better symptom control and information on treatment options and facilitate a better understanding of patient/family goals. Attending to these factors can ultimately mean improved survival for the advanced cancer patient, and support for these patients can assist in advancing the field of oncology as these investigational therapies hold the promise for enhancing survival.

Spirituality in cancer patients on phase 1 clinical trials

OBJECTIVES

Patients with cancer who are at a transition to Phase I investigational treatments have been identified as an underserved population with regard to palliative care. This disease transition is often accompanied by spiritual and existential concerns. The study objective was to conduct a secondary analysis of data from a larger study testing a palliative care intervention. This paper reports the findings of this secondary focus on the spiritual needs of this population.

METHODS

Patients (n = 479) were accrued to this study prior to initiating a Phase I clinical trial with data collected at baseline, and 4, 12, and 24 week follow-up.

RESULTS

Qualitative data revealed that the transition to Phase 1 trial participation is a time of balancing hope for extended life with the reality of advancing disease. Quantitative results demonstrated increased spirituality over time in both religious- and non-religious-affiliated patients.

CONCLUSIONS

Patients entering Phase I trials have important spiritual needs as they face treatment decisions, advancing disease, and often mortality. Spiritual care should be provided to seriously ill patients as a component of quality care.

Initial Spiritual Screening and Assessment: Five Things to Remember

To deliver holistic and person-centered palliative care (PC), the spiritual dimension must also be assessed. However, many nurses do not screen for or assess patient spirituality. This article presents five things that PC nurses can consider in order to improve their spiritual screening and assessment practices. These points are as follows: (1) Understand that spirituality is manifest in a myriad of ways and is not the same thing as religiosity. (2) Screen for spiritual distress, and then later conduct a spiritual history or assessment. (3) Remember that spirituality is not just something to assess upon admission. (4) Know that there are many ways to assess spirituality (it is not merely how a patient verbally responds to a question about spirituality or religiosity). (5) Remember that assessment can also be therapeutic.

Navigating the Murky Waters of Hope, Fear, and Spiritual Suffering: An Expert Co-Captain's Guide

How can surgeons deliver compassionate, holistic care to patients who are beyond cure? Interacting emotionally and understanding hope, fear, and spiritual suffering is key. Responsibly reframing hope to underlying meanings, and away from specific outcomes, is critical. Facilitating moves from cure to comfort to a peaceful dying process requires some retooling of the surgical toolbox. Surgeons possess a unique set of skills, including imagination and an undying sense of hope. Surgeons who have the courage to delve into their emotions and sustain realistic hope for their patients, all the way to the end, will reap deep personal and professional rewards.

Mapping the Healthcare Chaplaincy Literature: An Analytical Review of Publications Authored by Chaplains and Theologians Between 2000 and 2018

The body of theoretical and empirical research led by chaplains and theologians between 2000 and 2018 is developing into a rich, diverse, and methodologically rigorous healthcare chaplaincy literature, which this review proposes to map. Online keyword and bibliographical searches and specialist recommendations yielded 199 relevant publications, which we analyzed in terms of methodology, topic, and results. On this basis, this article identifies and describes five key areas of the literature: chaplains' practices, spirituality, research, impact, and healthcare professionals' practices of spiritual care. The discussion further highlights that publications would benefit from greater conceptual clarity, common research standards, and more critical research designs.

Interprofessional spiritual care in oncology: a literature review

Spiritual care is recognised as an essential element of the care of patients with serious illness such as cancer. Spiritual distress can result in poorer health outcomes including quality of life. The American Society of Clinical Oncology and other organisations recommend addressing spiritual needs in the clinical setting. This paper reviews the literature findings and proposes recommendations for interprofessional spiritual care.

The cultural expression of spiritual distress in Israel

BACKGROUND

Although spiritual distress is present across cultures, the ways in which patients experience it vary between cultures. Our goal was to examine the cultural expression and key indicators of spiritual distress in Israel.

METHODS

We conducted a structured interview of 202 oncology outpatients in a cross-sectional study. Self-diagnosis of spiritual distress, which is a demonstrated gold standard for identifying its presence, was compared with the Facit-Sp-12 and a number of other items (from the Spiritual Injury Scale and newly developed Israeli items) hypothesized as Israeli cultural expressions of spiritual distress, demographic and medical data, and patient desire to receive spiritual care.

RESULTS

Significant variation was found between Israeli cultural expression of spiritual distress and that found in studies from other countries. Key expressions of spiritual distress in this study included lack of inner peace, grief, and an inability to accept what is happening. Items related to faith were not significant, and loss of meaning showed mixed results. Patients requesting spiritual care were more likely to be in spiritual distress. No demographic or medical data correlated with spiritual distress.

CONCLUSIONS

Specially designed interventions to reduce spiritual distress should address the expressions of the distress specific to that culture. Studies of the efficacy of spiritual care can examine the extent of spiritual distress in general or of its specific cultural expressions.

Religious/Spiritual Struggle in Young Adult Hematopoietic Cell Transplant Survivors

PURPOSE

This study describes the prevalence of religious and/or spiritual (R/S) struggle in long-term young adult (YA) survivors following hematopoietic cell transplantation (HCT) as well as existential concerns (EC), social support, and demographic, medical, and emotional correlates of R/S struggle.

METHODS

Data were collected as part of an annual survey of survivors of HCT aged 18-39 years at survey completion; age at HCT was 1-39 years. Study measures included measures of R/S struggle (defined as any non-zero response on the negative religious coping subscale from Brief RCOPE), quality of life (QOL), and depression. Factors associated with R/S struggle were identified using multivariable logistic regression models.

RESULTS

Fifty-two of the 172 respondents (30%), who ranged from less than a year to 33 years after HCT, had some R/S struggle. In bivariate analysis, depression was associated with R/S struggle. In a multivariable logistic regression model, individuals with greater EC were nearly five times more likely to report R/S struggle. R/S struggle was not associated with age at transplant, time since transplant, gender, race, R/S self-identification, or medical variables.

CONCLUSION

R/S struggle is common among YA HCT survivors, even many years after HCT. There is a strong correlation between EC and R/S struggle. Given the prevalence of R/S struggle and its associations with EC, survivors should be screened and referred to professionals with expertise in EC and R/S struggle as appropriate. Further study is needed to determine longitudinal trajectory, impact of struggle intensity, causal relationships, and effects of R/S struggle on health, mood, and QOL for YA HCT survivors.

Recent Progress in Chaplaincy-Related Research

In light of the continued growth of chaplaincy-related research this paper presents an overview of important findings. The review summarizes research in six broad areas: what chaplains do; the importance of religion and spiritual care to patients and families; the impact of chaplains' spiritual care on the patient experience; the impact of chaplain care on other patient outcomes; spiritual needs and chaplain care in palliative and end of life care; and chaplain care for staff colleagues. It concludes with a description of several innovative and important new studies of chaplain care and notes areas for future investigation.