Personal Relationships and Communication Messages at the End of Life

Forgiveness facilitation in palliative care: a scoping review

OBJECTIVE

The objective of this review is to map the nature and extent of forgiveness facilitation intervention implemented and evaluated in palliative care contexts.

INTRODUCTION

Spiritual beliefs often include reconciliation and forgiveness, which are critical to patients and families in palliative care. Forgiveness facilitation can represent a valuable response as a multidisciplinary and non-pharmacological intervention to reduce suffering.

INCLUSION CRITERIA

Studies including palliative care patients aged 18 years or over and assisted by palliative care teams, including all healthcare professionals, chaplains, and volunteers, were included in this review.

METHODS

This scoping review is based on JBI methodology. The search was conducted in June 2017 and updated in December 2018 using international databases and gray literature in English, Spanish, German, Italian, and Portuguese.

RESULTS

A total of 23 articles were included in this review. The results suggest a growing interest in forgiveness facilitation in palliative care in different spiritual and religious traditions. Most studies are based on a psychological perspective. Several activities related to the intervention have been identified, but few details or characteristics are described. Social workers, nurses, doctors, and psychologists were most identified as healthcare staff involved in forgiveness facilitation. The outcomes related to the intervention are mental, physical, and relational well-being; quality of life, decision-making and communication; self-esteem and hope; depression, anger, and anxiety; and inner peace.

CONCLUSIONS

Forgiveness facilitation is critical in palliative care and is grounded in a multidisciplinary approach, but further evidence is needed to inform clinical implementation. These results open new perspectives for research and training on palliative healthcare staff.

Forgiveness: Moving on can be healthy

Forgiveness as a procedure has been gaining prominence. The objective of this article is to provide the basics of forgiveness as an intervention so primary care clinicians can facilitate its use. These clinicians include but are not limited to physicians, nurses, medical assistants, pharmacy professionals, physical therapists, social workers, psychologists, case managers, and clergy. This narrative explains the rationale for understanding forgiveness as a procedure and ways to explain it. To assist clinicians and patients in making informed decisions, samples of forgiveness research are included that describe its positive relationship to specific physical health situations. The article also describes an evidence-based forgiveness therapy, circumstances in which it is harmful to forgive oneself or others, describes the limitations of this article, and suggests future directions.

Nurses' responses to requests for forgiveness at the end of life

CONTEXT

Patients or family members facing serious illness often express regrets over life events or the need for forgiveness. Professionals, including nurses as the prominent discipline at the bedside, witness these expressions of regret or needs for forgiveness but may not be adequately prepared to optimally address patient concerns regarding forgiveness.

OBJECTIVES

The objectives of this descriptive study were to 1) identify contexts in which nurses have witnessed expressions of regret or the need for forgiveness and 2) describe nurses' responses to these clinical experiences related to forgiveness.

METHODS

Nurses attending palliative care educational programs shared narratives of their experiences in caring for patients who expressed regret or the need for forgiveness. Study narratives were analyzed qualitatively, using content analysis. Themes were identified.

RESULTS

Narratives were provided by 339 nurses from courses throughout the U.S. and Belize, India, the Philippines, and Romania.

CONCLUSION

Nurses provide clinical care for patients with advanced illness who struggle with issues of forgiveness. Nurses would benefit from additional education regarding how best to address these concerns.

Providing a "good death" for oncology patients during the final hours of life in the intensive care unit

Cancer is a leading cause of death in the United States. Aggressiveness of cancer care continues to rise in parallel with scientific discoveries in the treatment of a variety of malignancies. As a result, patients with cancer often require care in intensive care units (ICUs). Although growth in hospice and palliative care programs has occurred nationwide, access to these programs varies by geographic region and hospital type. Thus, critical care nurses may be caring for patients with cancer during the final hours of life in the ICU without the support of palliative care experts. This article provides an overview of the meaning of the final hours of life for cancer patients and uses principles of a "good death" and the tenets of hospice care to organize recommendations for critical care nurses for providing high quality end-of-life care to patients with cancer in the ICU.

Sacred healing stories told at the end of life

INTRODUCTION

Cancer is a challenging disease to diagnose and treat, and oftentimes even with the best medical intervention, it spreads and is deemed incurable, requiring a shift from cure to end-of-life care. This study used a spirituality measure and the PATS© storytelling intervention developed by the principal investigator to better understand the experience of being diagnosed with cancer and being told no further curative treatments are warranted.

PURPOSE

The purpose of this exploratory study was to implement a storytelling approach to explore the experience of living with terminal cancer. Second, the study documented the presence of spirituality and healing in the narratives.

METHOD

The qualitative data were analyzed by narrative analysis developed by Riessman.

FINDINGS

Seven synoptic stories were written and later sorted into healing categories. The narrative analysis yielded three themes. There were instances of religion and spirituality found in the transcribed stories. The participants' scores on the Spiritual Health Inventory indicated the presence of spirituality.

CONCLUSION

Storytelling allowed the seven study participants to share personal experiences and achieve a sense of connectedness and intimacy. The use of the PATS© intervention is a way to facilitate physical, emotional, and spiritual healing and provide holistic end-of-life care.