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Yılmaz S, Ordu Y, Atalay F. Determination of Comfort Levels and Spiritual Care Needs of Gynecologic Cancer Patients with Abdominal Drains: A Cross-Sectional Descriptive Study in Turkey. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02139-9. [PMID: 39347915 DOI: 10.1007/s10943-024-02139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/17/2024] [Indexed: 10/01/2024]
Abstract
This study was conducted to determine the comfort levels and spiritual care needs of gynecologic cancer patients with abdominal drains. The study was conducted with 61 gynecologic cancer patients with abdominal drains at the gynecologic oncology surgery clinic of a state hospital in Turkey. Data were collected using the "Participant Information Form," "Perianesthesia Comfort Questionnaire (PCQ)", and "Spiritual Care Needs Inventory". Kolmogorov-Smirnov test and Mann-Whitney U test were used to analyze the data. It was found that the postoperative comfort of the patients in this study was above a moderate level. Patients who did not need spiritual care, did not fulfil religious rituals regularly and did not receive social support had a high level of comfort in the early postoperative period. Patients with gynecologic cancer were found to have high spiritual care needs. Patients without chronic diseases, possessing a single abdominal drain, familiar with the concept of spiritual care, expressing a need for spiritual care, engaging in regular religious rituals, and enjoying social support were identified as having elevated spiritual care needs. Within the framework of holistic nursing care provided to gynecologic cancer patients with abdominal drains, the results reveal the necessity of spiritual care and the importance of comfort.
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Affiliation(s)
- Sakine Yılmaz
- Faculty of Health Sciences, Midwifery Department, Çankırı Karatekin University, Çankırı, Turkey.
| | - Yadigar Ordu
- Faculty of Nursing, Department of Nursing, Necmettin Erbakan University, Konya, Turkey
| | - Funda Atalay
- Department of Gynecological Oncology Surgery, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Picot S, Harrington A, Fuller J. Finding the Hidden Professional Culture of Mental Health Nursing-Spiritual Care for Individuals with a Co-morbid Life-Limiting Illness. Issues Ment Health Nurs 2023; 44:951-959. [PMID: 37734156 DOI: 10.1080/01612840.2023.2246064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
People with severe mental illness are dying up to thirty years earlier than the general population. The limited literature on their experience of dying indicates that they often suffer from inequities in their access to healthcare services, and further, what care they do receive is frequently poor. Living with both a mental illness and facing death can engender spiritual concerns and dying at a younger age is a risk factor for spiritual despair. Hence, addressing spiritual concerns can be an important dimension of mental health nursing care. The aim of this ethnographic study of 11 senior and experienced mental health nurses was to determine if the culture of the mental health service impacted their spiritual care for those patients who were facing death. The data highlighted that the nurses felt comfortable in providing spiritual care when the person was suffering from psychosis. Yet, the results also revealed that nurses felt disempowered by the dominance of the biomedical culture, in which they felt unable to articulate their care. However, it was identified that their spiritual care was inherent within the professional values, knowledge, and skills of mental health nursing and framed through their therapeutic relationships. Therefore, strategies need to be used by the organization to assist nurses to reclaim their power and assist the mental health service to further develop and engage in spiritual care practices.
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Affiliation(s)
- Sharon Picot
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Ann Harrington
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Charles Sturt University, Barton, Australia
| | - Jeffrey Fuller
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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3
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Wong PTP, Laird D. Varieties of suffering in the clinical setting: re-envisioning mental health beyond the medical model. Front Psychol 2023; 14:1155845. [PMID: 37275717 PMCID: PMC10237014 DOI: 10.3389/fpsyg.2023.1155845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
In this paper, we argue for the need to rethink mental health beyond the medical model because much of human suffering cannot be diagnosed by the DSM-5. During the pandemic and post-pandemic, people have learned to accept the fact that no one is immune from suffering. Given the universality and complexity of human suffering, it is natural for people to wrestle with existential questions such as "Why struggle when all life end in death?" and "How can one flourish when life is so hard?" Existential positive psychology (EPP or PP2.0) was developed to address these existential concerns. After explaining the inherent limitations of the medical model and the need for EPP as an alternative vision for mental health, we provide illustrative clinical cases to demonstrate the advantages of this broader existential framework for both case conceptualization and interventions. According to EPP, mental illness is reconceptualized as both deficiency in knowledge and skills in coping with the demands of life and deficiency in meeting the basic needs for livelihood and mental health, the Soul's yearnings for faith, hope, and love. Finally, we introduce integrative meaning therapy as a therapeutic framework which can equip people with the needed skills to achieve healing, wholeness, and total wellbeing.
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Affiliation(s)
- Paul T. P. Wong
- Department of Psychology, Trent University, Peterborough, ON, Canada
| | - Don Laird
- Department of Psychology, Counseling & Criminology, Carlow University, Pittsburgh, PA, United States
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Amonoo HL, Johnson PC, Nelson AM, Clay MA, Daskalakis E, Newcomb RA, Deary EC, Mattera EF, Yang D, Cronin K, Boateng K, Lee SJ, LeBlanc TW, El-Jawahri A. Coping in caregivers of patients with hematologic malignancies undergoing hematopoietic stem cell transplantation. Blood Adv 2023; 7:1108-1116. [PMID: 36398978 PMCID: PMC10111355 DOI: 10.1182/bloodadvances.2022008281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Caregivers of patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) must cope with substantial caregiving burden, high rates of psychological distress, and diminished quality of life (QOL). However, data describing coping strategies before HSCT and the association between coping, QOL, and psychological outcomes in this population are lacking. We conducted a secondary analysis of data collected during a multisite randomized clinical trial of a supportive care intervention in HSCT recipients and their caregivers. Caregivers completed the Brief COPE, Hospital Anxiety and Depression Scale, and the Caregiver Oncology Quality of Life Questionnaire to measure coping strategies, psychological distress, and QOL, respectively. We grouped coping into 2 higher-order domains: approach-oriented (ie, emotional support and active coping) and avoidant (ie, self-blame and denial). We used the median split method to describe the distribution of coping and multivariate linear regression models to assess the relationship between coping and caregiver outcomes. We enrolled 170 caregivers, with a median (range) age of 53 (47-64) years. Most were White (87%), non-Hispanic (96%), and female (77%). Approach-oriented coping was associated with less anxiety (β = -0.210, P = .003), depression symptoms (β = -0.160, P = .009), and better QOL (β = 0.526, P = .002). In contrast, avoidant coping was associated with more anxiety (β = 0.687, P<.001), depression symptoms (β = 0.579, P < .001), and worse QOL (β = -1.631, P < .001). Our findings suggest that coping is related to distress and QOL among caregivers of HSCT recipients even before transplant. Hence, caregivers of patients with hematologic malignancies undergoing HSCT may benefit from resources that facilitate adaptive coping with the demands of caregiving.
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Affiliation(s)
- Hermioni L. Amonoo
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - P. Connor Johnson
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ashley M. Nelson
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Madison A. Clay
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Richard A. Newcomb
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Emma C. Deary
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
| | - Elizabeth F. Mattera
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Daniel Yang
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Katherine Cronin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kofi Boateng
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Stephanie J. Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, and Division of Medical Oncology, University of Washington, Seattle, WA
| | - Thomas W. LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
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5
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Ehman JW, Edgar JR. Spirituality and Chaplaincy Supporting ICU Survivorship: A Practical Overview and Strategy for Clinicians. JOURNAL OF RELIGION AND HEALTH 2023; 62:65-82. [PMID: 36583768 DOI: 10.1007/s10943-022-01730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- John W Ehman
- Department of Pastoral Care, Penn Presbyterian Medical Center, Chaplain's Office (CU1 206), 51 N. 39 St., Philadelphia, PA, 19104, USA.
| | - Joshua R Edgar
- Department of Pastoral Care, Penn Presbyterian Medical Center, Chaplain's Office (CU1 206), 51 N. 39 St., Philadelphia, PA, 19104, USA
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Leidl BF, Fox-Davis D, Walker FO, Gabbard J, Marterre B. Layers of Loss: A Scoping Review and Taxonomy of HD Caregivers' Spiritual Suffering, Grief/Loss and Coping Strategies. J Pain Symptom Manage 2023; 65:e29-e50. [PMID: 36198334 PMCID: PMC9790041 DOI: 10.1016/j.jpainsymman.2022.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Bethany Faith Leidl
- Wake Forest University School of Medicine, (B.F.L., B.M.) Winston-Salem, North Carolina
| | | | - Francis O Walker
- Department of Neurology, Emeritus, Winston-Salem, (F.O.W.) North Carolina, USA
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatrics (Palliative Care), (J.G., B.M.) Winston-Salem, North Carolina
| | - Buddy Marterre
- Wake Forest University School of Medicine, (B.F.L., B.M.) Winston-Salem, North Carolina; Department of Internal Medicine, Section on Gerontology and Geriatrics (Palliative Care), (J.G., B.M.) Winston-Salem, North Carolina; Department of General Surgery, (B.M.) Winston-Salem, North Carolina.
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7
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Damen A, Raijmakers NJH, van Roij J, Visser A, Beuken-Everdingen MVD, Kuip E, van Laarhoven HWM, van Leeuwen-Snoeks L, van der Padt-Pruijsten A, Smilde TJ, Leget C, Fitchett G. Spiritual Well-Being and Associated Factors in Dutch Patients With Advanced Cancer. J Pain Symptom Manage 2022; 63:404-414. [PMID: 34656652 DOI: 10.1016/j.jpainsymman.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT Palliative care aims to support patients' spiritual needs with the intention of promoting their spiritual well-being (SWB), an important dimension of quality of life. SWB is one of the less-studied dimensions of QoL, particularly in a secular country such as the Netherlands. OBJECTIVES In this study we aimed to get a better understanding of SWB in Dutch patients with advanced cancer. We therefore examined its prominence and associated factors. METHODS We used the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), which included 1,103 patients with advanced cancer. In addition to sociodemographic and religious/spiritual characteristics, study measures comprised the SWB subscales Meaning, Peace, and Faith of the revised FACIT-Sp-12, spiritual problems and needs (PNPCsv), quality of life (EORTC-QLQ-C30) and satisfaction with healthcare professionals' interpersonal skills (INPATSAT-32). RESULTS On average, patients experienced quite a bit of Meaning (8.9, SD 2.3), a little bit to somewhat Peace (6.8, SD 2.7), and very low levels of Faith (2.9, SD 3.7). Two-thirds (71%) of patients reported one or more spiritual problems, for which the majority (54%) wanted to receive attention. In the final multivariable models, only a few factors were associated with SWB, such as greater spiritual needs with lower levels of Meaning and Peace. CONCLUSION Dutch patients with advanced cancer experience medium to low levels of Meaning, Peace, and Faith. More attention for their SWB is warranted.
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Affiliation(s)
- Annelieke Damen
- Netherlands Comprehensive Cancer Organisation (A.D., N.J.H.R.), Utrecht, The Netherlands.
| | - Natasja J H Raijmakers
- Netherlands Comprehensive Cancer Organisation (A.D., N.J.H.R.), Utrecht, The Netherlands; Netherlands Association for Palliative Care (N.J.H.R.), Utrecht, The Netherlands
| | - Janneke van Roij
- Netherlands Comprehensive Cancer Organization (IKNL) (J.V.R.), Department of Research & Development, Utrecht, The Netherlands; CoRPS - Center of Research on Psychology in Somatic Diseases (J.V.R.), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Netherlands Association for Palliative Care (PZNL) (J.V.R.), Utrecht, The Netherlands; Libra Rehabilitation and Audiology (J.V.R.), Tilburg, The Netherlands
| | - Anja Visser
- Faculty of Theology and Religious Studies (A.V.), University of Groningen, Groningen, The Netherlands
| | | | - Eveline Kuip
- Department of Medical Oncology and Anesthesiology (E.K.), Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology (H.W.M.L.), Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Tineke J Smilde
- Department of Oncology (T.J.S.), Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Carlo Leget
- Department of Care Ethics (C.L.), University of Humanistic Studies, Utrecht, The Netherlands
| | - George Fitchett
- Department of Religion (G.F.), Health and Human Values, Rush University Medical Center, Chicago, IL
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Antunes ML, Reis-Pina P. The Physician and End-of-Life Spiritual Care: The PALliatiVE Approach. Am J Hosp Palliat Care 2022; 39:1215-1226. [PMID: 35044883 DOI: 10.1177/10499091211068819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spiritual care is universally acknowledged as a cornerstone of palliative care, yet most healthcare professionals find it difficult to address. The present work aims to provide a simple educational tool that may help physicians address spirituality in their clinical practice. We found articles written in both Portuguese and English through PubMed, using the combination of MeSH terms: "Spirituality" and "Palliative Care." The research was complemented by relevant monographs previously known to the authors, consultation of selected references of the main bibliography, and interviews to an experienced spiritual care provider. In order to help physicians to incorporate spiritual care in their clinical practice, a flexible yet standardized approach is long overdue. This is the aim of the PALliatiVE approach, which compiles the literature in a set of 5 attitudes that may aid the clinician in the delivery of spiritual care: Prepare (P), Ask (A), Listen (L), Validate (V), and consult an Expert (E). This approach is based on a synthesis of a broad literature review, which motivated the five-layered approach. There is a significant literature coverage supporting each attitude of this five-layered approach, including at least one randomized control trial or systematic review per attitude. Though still requiring external validation, the PALliatiVE approach can be a guide to the physician on how to provide spiritual care, a practice rooted in compassion and in simply being-with the one who suffers.
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Affiliation(s)
| | - Paulo Reis-Pina
- Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal.,Faculty of Medicine, Ringgold:37809University of Lisbon, Lisboa, Portugal
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Kestenbaum A, Fitchett G, Galchutt P, Labuschagne D, Varner-Perez SE, Torke AM, Kamal AH. Top Ten Tips Palliative Care Clinicians Should Know About Spirituality in Serious Illness. J Palliat Med 2021; 25:312-318. [PMID: 34871044 DOI: 10.1089/jpm.2021.0522] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Allison Kestenbaum
- Spiritual Care Services, UC San Diego Health, San Diego, California, USA
| | - George Fitchett
- Department of Religion, Health & Human Values, Rush University Medical Center, Chicago, Illinois, USA
| | - Paul Galchutt
- Spiritual Health Services, M Health Fairview, Minneapolis, Minnesota, USA
| | - Dirk Labuschagne
- Supportive Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Shelley E Varner-Perez
- Indiana University (IU) Health, Indianapolis, Indiana, USA.,IU Center for Aging Research, Regenstrief Institute, Inc., Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA
| | - Alexia M Torke
- Indiana University School of Medicine, Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA
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10
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Spirituality in a Doctor's Practice: What Are the Issues? J Clin Med 2021; 10:jcm10235612. [PMID: 34884314 PMCID: PMC8658590 DOI: 10.3390/jcm10235612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: It is becoming increasingly important to address the spiritual dimension in the integral care of the people in order to adequately assist them in the processes of their illness and healing. Considering the spiritual dimension has an ethical basis because it attends to the values and spiritual needs of the person in clinical decision-making, as well as helping them cope with their illness. Doctors, although sensitive to this fact, approach spiritual care in clinical practice with little rigour due to certain facts, factors, and boundaries that are assessed in this review. Objective: To find out how doctors approach the spiritual dimension, describing its characteristics, the factors that influence it, and the limitations they encounter. Methodology: We conducted a review of the scientific literature to date in the PubMed, Scopus, and CINAHL databases of randomised and non-randomised controlled trials, observational studies, and qualitative studies written in Spanish, English, and Portuguese on the spiritual approach adopted by doctors in clinical practice. This review consisted of several phases: (i) the exclusion of duplicate records; (ii) the reading of titles and abstracts; (iii) the assessment of full articles and their methodological quality using the guidelines of the international Equator Network. Results: A total of 1414 publications were identified in the search, 373 of which were excluded for being off-topic or repeated in databases. Of the remaining 1041, 962 were excluded because they did not meet the inclusion criteria. After initial screening, 79 articles were selected, from which 17 were collected after reading the full text. A total of 8 studies were eligible for inclusion. There were three qualitative studies and five cross-sectional observational studies with sufficient methodological quality. The results showed the perspectives and principal characteristics identified by doctors in their approach to the spiritual dimension, with lack of training, a lack of time, and fear in addressing this dimension in the clinic the main findings. Conclusions: Although more and more scientific research is demonstrating the benefits of spiritual care in clinical practice and physicians are aware of it, efforts are needed to achieve true holistic care in which specific training in spiritual care plays a key role.
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11
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Peng-Keller S, Moergeli H, Hasenfratz K, Naef R, Rettke H, Hefti R, Ljutow A, Rittmeyer I, Sprott H, Rufer M. Including the Spiritual Dimension in Multimodal Pain Therapy. Development and Validation of the Spiritual Distress and Resources Questionnaire (SDRQ). J Pain Symptom Manage 2021; 62:747-756. [PMID: 33631326 DOI: 10.1016/j.jpainsymman.2021.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 01/19/2023]
Abstract
CONTEXT Valid instruments for assessing spiritual resources and distress in pain therapy are scarce. The Spiritual Distress and Resources Questionnaire (SDRQ) was developed to fill this gap. GOALS The objective of this study was to investigate the SDRQ's psychometric properties. METHODS We presented the SDRQ to 219 patients with chronic pain conditions and examined its measurement properties, namely reliability and structural, convergent and discriminant validity. To investigate test-retest reliability, the SDRQ was presented a second time to a subsample of 58 randomly selected participants. RESULTS Factor analysis required a grouping of the 22 SDRQ items into four subscales: spiritual distress, spiritual coping, immanence and transcendence, the latter two representing spiritual resources. Cronbach's alpha was high for spiritual distress (0.93), transcendence (0.85), and immanence (0.81) while it was somewhat lower but still satisfactory for spiritual coping (0.70). The construct validity of the SDRQ was shown by correlations with established measures in the field. Higher levels of spiritual distress were associated with signs of more severe illness, such as emotional distress and pain intensity. CONCLUSION The results from this study suggest that the SDRQ is an easy-to-use, reliable and valid screening instrument for assessing spiritual distress, spiritual resources and spiritual coping in patients with chronic pain. The SDRQ has the potential to be used with patients suffering from other chronic diseases and to disseminate the palliative approach to pain treatment to other areas of medicine.
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Affiliation(s)
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Rahel Naef
- University Hospital Zurich, Centre of Clinical Nursing Science, Zurich, Switzerland; University of Zurich, Institute for Implementation Science in Health Care, Zurich, Switzerland
| | - Horst Rettke
- University Hospital Zurich, Centre of Clinical Nursing Science, Zurich, Switzerland; University of Zurich, Institute for Implementation Science in Health Care, Zurich, Switzerland
| | - René Hefti
- Clinic SGM Langenthal und Research Institute for Spirituality and Health, Langenthal, Switzerland
| | - André Ljutow
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | | | - Haiko Sprott
- University of Zurich and Arztpraxis Hottingen, Zurich, Switzerland
| | - Michael Rufer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
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12
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Palmer JA, Hilgeman M, Balboni T, Paasche-Orlow S, Sullivan JL. The spiritual experience of dementia from the health care provider perspective: Implications for intervention. THE GERONTOLOGIST 2021; 62:556-567. [PMID: 34498084 DOI: 10.1093/geront/gnab134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Spiritual care aims to counter negative outcomes from spiritual distress and is beneficial to persons living with dementia. Such care needs dementia-appropriate customization. We explored the salient spiritual needs in dementia to inform future intervention development. Health care providers are well-situated to observe the nature of spiritual needs across and within medical conditions. RESEARCH DESIGN AND METHODS We conducted semi-structured qualitative interviews with providers. We sampled purposively by discipline (chaplains, nursing staff, social workers, activities professionals) and religious tradition (for chaplains). Our interview guide inquired about, e.g., the nature of spiritual needs in dementia and stakeholders' roles in addressing them. Inductive / deductive thematic analysis was employed. RESULTS Twenty-four providers participated. The thematic structure consisted of two themes: 1) spiritual experience in dementia differs from that in other medical conditions (sub-themes: fear, profound loss of self, progressive and incurable nature, and impacted ability to access faith); and 2) the need for spiritual intervention at the mild stage of dementia (sub-themes: awareness in mild dementia and its influence on spiritual distress, and a window of opportunity). DISCUSSION AND IMPLICATIONS We learned about the potential "what" of spiritual needs and "who" and "when" of implementing spiritual care. Implications included the imperative for dementia-specific spiritual assessment tools, interventions targeting fear and loss of self early in symptom progression, and stakeholder training. Researchers should study additionally the "how" of dementia-appropriate spiritual care. Conjointly, these efforts could promote spiritual well-being in persons living with dementia worldwide.
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Affiliation(s)
- Jennifer A Palmer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA USA
| | - Michelle Hilgeman
- Research and Development Service, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL USA.,Department of Psychology & Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL USA
| | - Tracy Balboni
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | | | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA USA
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13
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Woggon F, Arlyck M, Maddox Hill S, Small Stokes L. The development of an outcome oriented and research informed spiritual care assessment and documentation form for the electronic health record in an adult hospital setting. J Health Care Chaplain 2021; 28:400-414. [PMID: 33983871 DOI: 10.1080/08854726.2021.1916333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Standards for professional chaplaincy expect chaplains to document their work in patients' medical records, but no agreed upon standard for the content or format of such documentation exists. With the adoption of Electronic Health Records (EHRs) in many hospitals, chaplains may utilize a provided electronic form or one that can be customized from a basic format to departmental specifications. Ideally, the documentation form supports and reflects the work of chaplains in their specific clinical context. Outcome oriented models of chaplaincy and an increasing focus on a research informed practice of spiritual care should determine the format and content of chaplains' documentation in the EHR. This article describes how a chaplaincy department in an adult academic Level I trauma center designed and implemented a spiritual care documentation form for the EHR. The documentation template is informed by clinical expertise and by research about patients' meaning-making activities and patients' experience of connectedness in the context of illness. It integrates a consensus-based assessment form with narrative documentation options, searchable selections, and an outcome-oriented plan of care.
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Affiliation(s)
- Frank Woggon
- UofL Health-University Medical Center, Louisville, KY, USA
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Enhancing meaning in the face of advanced cancer and pain: Qualitative evaluation of a meaning-centered psychosocial pain management intervention. Palliat Support Care 2021; 18:263-270. [PMID: 32115006 DOI: 10.1017/s1478951520000115] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objectives of this study were to obtain patient evaluations of the content, structure, and delivery modality of Meaning-Centered Pain Coping Skills Training (MCPC), a novel psychosocial intervention for patients with advanced cancer and pain. MCPC aims to help patients connect with valued sources of meaning in their lives (e.g., family relationships), while providing training in evidence-based cognitive and behavioral skills (e.g., guided imagery) to reduce pain. METHODS Semi-structured interviews were conducted with 12 patients with stage IV solid tumor cancers and persistent pain. Transcripts were analyzed using methods from applied thematic analysis. RESULTS When evaluating MCPC's educational information and skills training descriptions, participants described ways in which this content resonated with their experience. Many coped with their pain and poor prognosis by relying on frameworks that provided them with a sense of meaning, often involving their personally held religious or spiritual beliefs. They also expressed a need for learning ways to cope with pain in addition to taking medication. A few participants offered helpful suggestions for refining MCPC's content, such as addressing common co-occurring symptoms of sleep disturbance and fatigue. Concerning MCPC's structure and delivery modality, most participants preferred that sessions include their family caregiver and described remote delivery (i.e., telephone or videoconference) as being more feasible than attending in-person sessions. SIGNIFICANCE OF RESULTS Participants were interested in an intervention that concurrently focuses on learning pain coping skills and enhancing a sense of meaning. Using remote delivery modalities may reduce access barriers (e.g., travel) that would otherwise prevent many patients from utilizing psychosocial services.
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Siler S, Arora K, Doyon K, Fischer SM. Spirituality and the Illness Experience: Perspectives of African American Older Adults. Am J Hosp Palliat Care 2021; 38:618-625. [PMID: 33461330 DOI: 10.1177/1049909120988280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Disparities in hospice and palliative care (PC) for African Americans have been linked to mistrust toward the healthcare system, racial inequalities, and cultural preferences. Spirituality has been identified as important to African Americans in general. Less is known about the influence of spirituality on African American illness experiences. OBJECTIVE The goal of this study was to understand older African Americans' perspectives on how spirituality influences chronic illness experiences to inform the development of a culturally tailored PC intervention. METHODS In partnership with 5 churches in the Denver metropolitan area, we conducted focus groups with African American older adults (n = 50) with chronic health conditions and their family caregivers. Transcripts were analyzed using a deductive approach. The theoretical framework for this study draws on psychology of religion research. RESULTS Themes referenced participants' spiritual orienting systems, spiritual coping strategies, and spiritual coping styles. Psycho-spiritual struggles, social struggles, and sources of social support were also identified. Findings suggest African Americans' spirituality influences chronic illness experiences. Participants relied on their spirituality and church community to help them cope with illness. In addition, social struggles impacted the illness experience. Social struggles included mistrust toward the healthcare system and not being connected to adequate resources. Participants expressed a need to advocate for themselves and family members to receive better healthcare. Churches were referred to as a trusted space for health resources, as well as spiritual and social support.
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Affiliation(s)
- Shaunna Siler
- School of Medicine, 12225University of Colorado, Anschutz Medical Campus, CO, USA
| | - Kelly Arora
- University of Colorado, Anschutz Medical Campus, CO, USA
| | - Katherine Doyon
- School of Medicine, 12225University of Colorado, Anschutz Medical Campus, CO, USA
| | - Stacy M Fischer
- Division of General Internal Medicine, Department of Medicine, 12225University of Colorado, Anschutz Medical Campus, CO, USA
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16
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McNamara LC, Okoniewski W, Maurer SH, Moehling K, Hall DE, Schenker Y. "Give them the door but don't push them through it": Family Attitudes Toward Physician-Led Spiritual Care in Pediatric Palliative Medicine. JOURNAL OF RELIGION AND HEALTH 2020; 59:2899-2917. [PMID: 32052280 DOI: 10.1007/s10943-020-00991-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Little is known about pediatric caregivers' perceptions of religious or spiritual (R/S) care provided by physicians. We conducted a qualitative, semistructured interview study to understand perceptions of pediatric caregivers toward physician-led R/S care. Participants were 20 primary caregivers whose children were hospitalized and receiving palliative care services. Interviews were audio recorded, transcribed verbatim, and analyzed using constant comparative methods. Three recurrent themes emerged regarding physician-led R/S care: (1) Most caregivers view providing R/S care as a positive sign of physician empathy, while a minority (3/20) prefer to keep R/S and medical care separate, (2) many caregivers prefer R/S care from a physician with whom they have a close relationship and/or share a faith background, and (3) physicians should open the door, but allow families to lead conversations about R/S care. Caregivers have mixed perceptions on physicians engaging in R/S care; most prefer that families set the direction of R/S care for themselves and their loved ones. Physicians should be trained to evaluate families' spiritual backgrounds and needs in ways that respectfully open the door to these conversations.
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Affiliation(s)
- Laura C McNamara
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | | | - Scott H Maurer
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of Palliative Medicine and Supportive Care, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Krissy Moehling
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA, USA
- Wolff Center at UPMC, UPMC, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Yael Schenker
- Palliative Research Center (PaRC), Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA
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17
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[Increased attention of radiotherapy patients to religiousness and spirituality - a comparison with patients in a psychosomatic outpatient clinic]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2020; 66:149-163. [PMID: 32552584 DOI: 10.13109/zptm.2020.66.2.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Increased attention of radiotherapy patients to religiousness and spirituality - a comparison with patients in a psychosomatic outpatient clinic Objectives: The aim of this study is to prove both hypothesis, that patients of radiation therapy are different to patients of a psychosomatic outpatient unit in case of their spirituality and religiosity and that these attitudes have an influence of their own lives. Methods: In a cross-sectional study, a data set of the Department of Psychosomatic and Psychotherapy of the University Hospital Münster in 2013 (n = 1110) was compared to data from 2017 by the Department of Radiation Therapy - Radiation oncology of the University Münster (n = 275) in terms of their religiosity and spirituality. The survey was carried out by a questionnaire on religious attitudes (FRA-RE, Heuft 2016). An age- and gender-controlled statistical analysis has been made by means of partial correlations and mean comparisons. Results: The results are consistent with the hypothesis that patients of radiotherapy, in contrast to psychosomatic patients, are more religious, more spiritual, show more private, but also public religious/spiritual practice, have a stronger desire for more religiosity in their lives and belief that religiosity helps to overcome times of crisis. Conclusions: Thus, it is of particular importance to provide this burdened patient clientele spiritual/religious offers for coping with their disease.
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18
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O'Callaghan CC, Georgousopoulou E, Seah D, Clayton JM, Kissane D, Michael N. Spirituality and religiosity in a palliative medicine population: mixed-methods study. BMJ Support Palliat Care 2020; 12:316-323. [PMID: 32499406 DOI: 10.1136/bmjspcare-2020-002261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/09/2020] [Accepted: 05/02/2020] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- Clare C O'Callaghan
- Palliative and Supportive Care Research Department, Cabrini Health, Melbourne, Victoria, Australia.,Institute of Ethics and Society, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Ekavi Georgousopoulou
- School of Medicine Sydney Campus, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Davinia Seah
- School of Medicine Sydney Campus, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,Sacred Heart Health Service, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Josephine M Clayton
- Hammond Care, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - David Kissane
- School of Medicine Sydney Campus, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,Sacred Heart Health Service, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Natasha Michael
- Palliative and Supportive Care Research Department, Cabrini Health, Melbourne, Victoria, Australia .,School of Medicine Sydney Campus, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
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19
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Vigna PM, de Castro I, Fumis RRL. Spirituality alleviates the burden on family members caring for patients receiving palliative care exclusively. BMC Palliat Care 2020; 19:77. [PMID: 32493301 PMCID: PMC7271458 DOI: 10.1186/s12904-020-00585-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/27/2020] [Indexed: 12/01/2022] Open
Abstract
Background Spirituality can give meaning to life, providing support and guidance in complex situations. Despite its importance in palliative care, the role of spirituality for family caregivers of patients under exclusive palliative care has not received enough attention in the literature. We aimed to address the correlation between spirituality and the emotional burden of family members of patients under exclusive palliative care. Methods This transversal study was conducted in a tertiary private teaching hospital, in São Paulo, Brazil. The study comprised family members of patients receiving palliative care exclusively. Only one caregiver who cared for the patient for at least 2 months was invited to participate. Family members answered the following questionnaires: WHOQOL spirituality, religiousness and personal beliefs (SRPB), Zarit Burden Interview (ZBI) and Self-Reporting Questionnaire (SRQ-20). They were excluded if patients were residing in a Long Stay Institution. Continuous variables were expressed by median and quartiles and analyzed with the Kruskal-Wallis test with Muller-Dunn post-test adjusted by Bonferroni or with the Mann-Whitney test for two groups. We used multivariable linear regression to identify independent predictors of caregiver burden. Results A total of 178 family members were interviewed in a median of 8 [4–13.25] days after patient admission. Almost 40% of families presented high score of burden. Faith and Meaning in Life were the facets that scored the highest, with a median of 4.50 [4.00–5.00] for both facets. There was an inverse correlation between Zarit score and all of the WHOQOL-SRPB facets, indicating that the lower the spirituality, the greater the emotional burden. Inner peace was the strongest protective factor associated with burden. Conclusions Psycho-socio-spiritual interaction can improve the coping ability of family caregivers of patients under exclusive palliative care, addressing a critical gap in the provision of holistic palliative care services.
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Affiliation(s)
| | - Isac de Castro
- Division of Nephrology and Molecular Medicine, Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Renata Rego Lins Fumis
- Intensive Care Unit, Hospital Sírio-Libanês - São Paulo, Rua Dona Adma Jafet, 115 - Bela Vista, São Paulo, SP, 01308-050, Brazil.
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Rego F, Gonçalves F, Moutinho S, Castro L, Nunes R. The influence of spirituality on decision-making in palliative care outpatients: a cross-sectional study. BMC Palliat Care 2020; 19:22. [PMID: 32085765 PMCID: PMC7035674 DOI: 10.1186/s12904-020-0525-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Decision-making in palliative care can be complex due to the uncertain prognosis and general fear surrounding decisions. Decision-making in palliative care may be influenced by spiritual and cultural beliefs or values. Determinants of the decision-making process are not completely understood, and spirituality is essential for coping with illness. Thus, this study aims to explore the influence of spirituality on the perception of healthcare decision-making in palliative care outpatients. METHODS A cross-sectional study was developed. A battery of tests was administered to 95 palliative outpatients, namely: sociodemographic questionnaire (SQ), Decisional Conflict Scale (DCS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp), and a semi-structured interview (SSI) to study one's perception of spirituality and autonomy in decision-making. Statistical analyses involved descriptive statistics for SQ and SSI. The Mann-Whitney test was used to compare scale scores between groups and correlations were used for all scales and subscales. The analysis of patients' definitions of spirituality was based on the interpretative phenomenological process. RESULTS Spiritual wellbeing significantly correlated with greater levels of physical, emotional and functional wellbeing and a better quality of life. Greater spiritual wellbeing was associated with less decisional conflict, decreased uncertainty, a feeling of being more informed and supported and greater satisfaction with one's decision. Most patients successfully implemented their decision and identified themselves as capable of early decision-making. Patients who were able to implement their decision presented lower decisional conflict and higher levels of spiritual wellbeing and quality of life. Within the 16 themes identified, spirituality was mostly described through family. Patients who had received spiritual care displayed better scores of spiritual wellbeing, quality of life and exhibited less decisional conflict. Patients considered spirituality during illness important and believed that the need to receive spiritual support and specialised care could enable decision-making when taking into consideration ones' values and beliefs. CONCLUSION The impact of spiritual wellbeing on decision-making is evident. Spirituality is a key component of overall wellbeing and it assumes multidimensional and unique functions. Individualised care that promotes engagement in decision-making and considers patients' spiritual needs is essential for promoting patient empowerment, autonomy and dignity.
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Affiliation(s)
- Francisca Rego
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Florbela Gonçalves
- Portuguese Institute of Oncology-Coimbra, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Susana Moutinho
- Portuguese Institute of Oncology-Porto, Instituto Português de Oncologia do Porto Francisco Gill E.P.E., Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Luísa Castro
- Institute for Systems and Computer Engineering, Technology and Science, INESCTEC, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
- Center for Health Technology and Services Research - CINTESIS, University of Porto, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
| | - Rui Nunes
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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21
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O'Callaghan C, Brooker J, de Silva W, Glenister D, Melia Cert A, Symons X, Kissane D, Michael N. Patients' and Caregivers' Contested Perspectives on Spiritual Care for Those Affected by Advanced Illnesses: A Qualitative Descriptive Study. J Pain Symptom Manage 2019; 58:977-988. [PMID: 31404641 DOI: 10.1016/j.jpainsymman.2019.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Clare O'Callaghan
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia; Institute for Ethics & Society, The University of Notre Dame Australia, New South Wales, Australia; Departments of Psychosocial Cancer Care and Medicine, St. Vincent's Hospital Fitzroy, The University of Melbourne, Victoria, Australia.
| | - Joanne Brooker
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - William de Silva
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - David Glenister
- Centre for Clinical Pastoral Education, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Adelaide Melia Cert
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia
| | - Xavier Symons
- Institute for Ethics & Society, The University of Notre Dame Australia, New South Wales, Australia
| | - David Kissane
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia; Szalmuk Family Psycho-oncology Research Unit, Cabrini Health, Malvern, Melbourne, Victoria, Australia; School of Medicine, The University of Notre Dame Australia, New South Wales, Australia
| | - Natasha Michael
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; School of Medicine, The University of Notre Dame Australia, New South Wales, Australia
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22
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Marterre B, Clayville K. Navigating the Murky Waters of Hope, Fear, and Spiritual Suffering: An Expert Co-Captain's Guide. Surg Clin North Am 2019; 99:991-1018. [PMID: 31446923 DOI: 10.1016/j.suc.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Buddy Marterre
- Surgical Palliative Care, Department of General Surgery, Wake Forest Baptist Health, 5th Floor, Watlington Hall, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Kristel Clayville
- Zygon Center for Religion and Science, MacLean Center for Clinical Medical Ethics, 1100 East 55th Street, Chicago, IL 60615, USA
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Abstract
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.
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Affiliation(s)
- Shaunna Siler
- School of Medicine, University of Colorado, Aurora, CO
| | - Tami Borneman
- Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
| | - Betty Ferrell
- Nursing Research and Education, City of Hope National Medical Center, Duarte, CA.
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