Spiritual care for children with cancer

The Relationship Between Spirituality and the Developing Brain: A Framework for Pediatric Oncology

Development, whether motor, language, social, or spiritual, is the functional expression of complex brain processes throughout one's life span, the foundations of which are laid in childhood. The effects of cancer, chemotherapy, radiation, and surgical procedures on early brain development have been measured using neuroimaging and developmental assessment tools. We propose that spiritual development may be substantially affected in children with oncological diseases that impact underlying brain processes. By drawing connections between science, spirituality, and medicine, we can better address the spiritual needs of children as they cope with oncological diseases, by mitigating emotional, cognitive, and physical symptoms and improving outcomes.

Pediatric Palliative Care in Oncology

Pediatric palliative care aims to alleviate suffering and improve the quality of life of children with serious disease and increase support for their parents and other family members. Integration of palliative care into the routine care of children, adolescents, and young adults with cancer has resulted in improved outcomes in patients and their families. The field of pediatric palliative oncology-encompassing primary palliative care provided by the multidisciplinary oncology team as well as subspecialty palliative care provided by the palliative care team for more complex cases-is unique from palliative care in adults given its focus on care of the child and the larger family. In this review, we focus on advancements in the specific domains within pediatric palliative oncology care including family-centered communication, assessment and management of physical symptoms and distress, psychosocial concerns, and spiritual considerations of the patient, parents, and siblings.

Spiritual Care: Define and Redefine Self

Spiritual care is deep rooted in the traditional ancient system of medicine. However, due to lack of high grade evidences, practitioners of modern system of medicine are hesitant to inculcate spirituality in their clinical practice. This paper is an attempt to basic understanding of spiritual care therapy, current evidences for it and the challenges for incorporation in the allopathic system of medicine.

Addressing Spirituality in Pediatric Hospice and Palliative Care

Hospice and palliative care principles mandate clinicians to provide “total” care to patients and their families. Such care incorporates not only physical, emotional, and psychosocial care, but spiritual care as well. Even though considerable attention has been directed to spiritual issues for adult patients in hospice and palliative care, spirituality in pediatric palliative care has been virtually neglected. The need for guidelines to assess spirituality in this population was identified as a priority issue by members of a subcommittee of the Children's International Project on Children's Palliative/Hospice Services, created under the auspices of the National Hospice Organization. Committee members, based on their clinical, research, and personal experiences, identified several aspects relevant to spirituality in general, and to spirituality in pediatric palliative care in particular, and developed guidelines for clinicians in pediatric palliative care. The purpose of this paper is to share the results of this committee's work and, in particular, to present their guidelines for addressing spiritual issues in children and families in pediatric hospice and palliative care.

Coping Strategies of Jordanian Adolescents With Cancer

Interpretive phenomenological analysis methodology was used to explore coping strategies used by hospitalized Jordanian adolescents with cancer. In-depth face-to-face interviews were conducted with 10 Jordanian adolescents, aged 13 to18 years, who were receiving chemotherapy for cancer. During treatment, participants were confronted with physical, psychosocial, and emotional distresses resulting from the disease process, the treatment, and its associated side-effects. To cope with the impact of their illness, participants utilized 4 coping strategies: “Strengthening spiritual convictions,” “Being optimistic and rebuilding hope,” “Enhancing appearance,” and “Finding self again.” The findings of this study can assist health team members to promote positive psychological care to Arab Muslim adolescents with cancer in a supportive and therapeutic treatment environment.

Recognizing and Caring for Spiritual Needs of Clients

Purpose: With increased attention in health care being given to the spiritual dimension of clients, nurses must be able to recognize clients’ spiritual concerns and intervene appropriately. This article proposes that nurses may find the concept of spiritual needs more useful than the term spirituality in guiding practice decisions and curriculum development. Methods: A review of nursing and theological literature addressing the spiritual dimension was conducted. Elements of the spiritual dimension and suggestions for nursing intervention were identified. Findings: Four case situations from the author’s past practice are analyzed. Conclusion: Utilization of the elements of the spiritual dimension is a useful means of recognizing spiritual needs of clients and planning spiritual care. Implications: Nursing faculty need to examine curricula for inclusion of assessment of and intervention for spiritual needs. Practicing nurses need to be supported in their role in meeting spiritual needs of clients.

Spirituality and Spiritual Care of Adolescents and Young Adults with Cancer

OBJECTIVES

To review research on spiritual perspectives and spiritual care of adolescents and young adults (AYA) living with cancer.

DATA SOURCES

Peer-reviewed publications, book chapters, and websites of professional organizations.

CONCLUSION

There is a paucity of research specifically investigating AYA spirituality and lack of AYA-sensitive instruments to measure spirituality. Research that applies robust scientific methods to the study of AYA spirituality is needed. Research that provides evidence on which to base best practices for spiritual care that supports AYA spiritual well-being is likewise necessary.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can influence AYA health-related outcomes and experiences by providing ethical and evidence-based spiritual nurture.

Spiritual care of the child with cancer at the end of life: a concept analysis

AIM

The aim of this paper is to report an analysis of the concept of spiritual care of a child with cancer at the end of life.

BACKGROUND

Spirituality is a vital dimension of a child's experience at the end of life; providing comfort; support; and a sense of connection. Spiritual care is paramount to address the substantial spiritual distress that may develop.

DESIGN

Rodgers' method of evolutionary concept analysis guided the review process.

DATA SOURCES

The literature search was not limited by start date and literature through the end of 2012 was included. English, peer-reviewed texts in the databases CINAHL, ATLA and PubMed were included.

METHODS

Critical analysis of the literature identified surrogate terms, related concepts, attributes, antecedents and consequences.

RESULTS

The analysis identified six attributes: assessing spiritual needs; assisting the child to express feelings; guiding the child in strengthening relationships; helping the child to be remembered; assisting the child to find meaning; and aiding the child to find hope. Antecedents include existential questions and spiritual distress. Consequences include a peaceful death, spiritual growth, a relationship of trust and enhanced end-of-life care.

CONCLUSION

Spiritual care is a vital aspect of holistic nursing care; however, gaps in knowledge and practice prevent children from receiving adequate spiritual care at the end of life. Nurses would benefit from increased awareness, skills and knowledge about spiritual care. Research is needed to identify interventions that exert the greatest effect on patient care outcomes.

Spiritual dimension of children and adolescents with cancer: an integrative review

OBJECTIVE: To review scientific literature relating to the spiritual dimension of children and adolescents with cancer. METHODS: We conducted an integrative literature review in the LILACS, SciELO, PsycINFO and MEDLINE databases in the period between 1990 to 2011. RESULTS: Twenty-one studies were analyzed and grouped into thematic categories: quality of life and elements of spirituality; alternative and complementary therapies: spirituality as a therapeutic resource; spirituality as a coping strategy and spirituality as an attribute of existential transformations. It was found that spirituality is present at different stages of the disease experience and that its forms of expression may vary, according to age and cognitive development. CONCLUSION: There is a scarcity of specific scales for this age range and a need for scientific production relating to the spiritual dimension of children and adolescents with cancer. Descriptors: Neoplasms; Children; Adolescents; Spirituality

Children with advanced cancer: responses to a spiritual quality of life interview

PURPOSE

The purpose of this study was to describe the responses of children with advanced cancer to a spiritual quality of life (SQL) interview.

DESIGN AND METHODS

Sixty children, ages 6-17, responded to an SQL interview every 2 weeks, for 5 months. The questionnaires were analyzed using content analysis.

RESULTS

Children's responses were primarily relational in nature, particularly to their parents. Seventy-eight percent of the interviewees reported they did something to "feel close to God." Children prayed for a "sense of normalcy" (59%) and relational concerns (31%).

PRACTICE IMPLICATIONS

Children's care will be enhanced when given the opportunity to express their spiritual and relational concerns.

Cuidado espiritual: componente essencial da prática da enfermeira pediátrica na oncologia

Este é um artigo que aborda o cuidado espiritual na enfermagem pediátrica oncológica, como parte dos pressupostos para a promoção da saúde de famílias que possuem crianças e adolescentes com câncer. Indica elementos sobre a formação do enfermeiro para o oferecimento desse cuidado, aliados ao conhecimento de sua própria espiritualidade. Apresenta-se como uma oportunidade para o debate sobre o tema, oferecendo subsídios para repensar a prática do enfermeiro na oncologia pediátrica, além de assinalar a necessidade de condução de pesquisas nessa área.

Beacon in the Storm: An Exploration of the Spirituality and Faith of Parents Whose Children Have Cancer

The purpose of this article is to describe the role of spirituality as a coping mechanism in the lives of parents of children with cancer. This exploratory study was conducted using a dominant-less dominant research design with phenomenology as the guiding theoretical orientation. Twelve parents (eight women and four men) were interviewed. Spirituality was described as playing a key role in the coping repertoire of these parents. In particular, spirituality's influence was described in both a religious and secularized manner with both aspects having a positive influence on coping behaviors among these parents. Health care professionals and nurses in particular have a role to play in facilitating access to spiritual resources as well as acknowledging and accepting the spiritual practices of the families they serve.

[Caregivers of children with cancer: aspects of life affected by the caregiver role]

This study aimed at demonstrating that the caregiving role affected the lives of caregivers of children with cancer the child's degree of dependence regarding the performance of daily life activities (DLA), the degree of help offered by others and the degree to which some aspects of the caregiver's life were affected by caregiving activities. Interviews were held with fifty caregivers of children between the ages of three and ten in a children's hospital, a referral center for cancer and hematological disorders in Campinas, Sao Paulo. These caregiving activities seriously affect the lives of the caregivers and, therefore, an assessment of these aspects may help the nurse detect the problems and plan the healthcare needed by the caregivers of children with cancer.

Hope and spiritual well-being in adolescents with cancer

This study examines the relationships of hope and spiritual well-being (SWB)--and its dimensions, religious well-being (RWB) and existential well-being (EWB)--to time since diagnosis among adolescents with cancer. A descriptive cross-sectional design was used. The sample of 78 adolescents diagnosed with cancer was recruited from two pediatric oncology clinics. Adolescents in the first two time periods reported significantly higher levels of SWB, RWB, and EWB than those in subsequent time periods. Hope did not significantly vary over time. Hence, time since diagnosis may influence adolescents' levels of SWB and its dimensions during the cancer experience. Adolescents' use of SWB, RWB, and EWB as coping resources should be examined in longitudinal studies from diagnosis through survivorship.

Parting gifts: the spiritual needs of children

This article discusses the spiritual lives of children who are facing severe illness or bereavement. Initially, it describes a children's story which had some impact on the author's spiritual views during childhood. The concept of children as spiritual beings is discussed and questions are raised as to why relatively little attention has been given to this as opposed to their religious affiliation. Asserting that children do have a spiritual dimension, the importance of addressing children's spirituality is considered. Discussion is given to ways of assessing and attending to children's spirituality, illustrated with case studies. It is identified that for carers, a degree of self-awareness is crucial in order to develop an open and flexible working definition of what spirituality is and means.

Relationships of age and gender to hope and spiritual well-being among adolescents with cancer

The purpose of this study was to examine hope and spiritual well-being, with its 2 dimensions of religious well-being and existential well-being, as they relate to age and gender among adolescents with cancer. A cross-sectional design was guided by the conceptual framework, Adolescent Psychosocial Adaptation to the Cancer Experience. A total of 78 adolescents with a diagnosis of cancer were enrolled from 2 pediatric oncology clinics. Middle adolescents (15-17 years of age) reported higher religious well-being than late adolescents (18-20 years of age). Middle-adolescent boys were more hopeful than were early adolescent boys (13- 14 years of age). Also, girls were more hopeful and reported higher spiritual well-being than age the boys. Developmental phase and/or gender may influence adolescents' levels of hope, spiritual well-being, religious well-being, and existential well-being as they cope during the cancer experience. The nurse should consider developmental phase and gender when planning interventions to foster hope and spiritual well-being in adolescents' adaptations to the cancer experience.

Multidisciplinary care of the dying adolescent

The adolescent at the end of life poses a unique combination of challenges resulting from the collision of failing health with a developmental trajectory meant to lead to attainment of personal independence. Because virtually all spheres of the dying adolescent's life are affected, optimal palliative care for these young persons requires a multidisciplinary team whose members have a good understanding of their complementary roles and a shared commitment to providing well-coordinated care. Members of the team include the physician (to initiate and coordinate palliative care management); the nurse (to work collaboratively with the physician and adolescent, especially through effective patient advocacy); the psychologist (to assess and manage the patient's neurocognitive and emotional status); the social worker (to assess and optimize support networks); the chaplain (to support the adolescent's search for spiritual meaning); and the child life specialist (to facilitate effective communication in preparing for death). A crucial area for dying adolescents is medical decision making, where the full range of combined support is needed. By helping the young person continue to develop personal autonomy, the multidisciplinary team will enable even the dying adolescent to experience dignity and personal fulfillment.

Developing a Plan for Pediatric Spiritual Care

During life-changing events, people turn to spirituality for comfort, hope, and relief. This article raises nurses' awareness of and intent to provide spiritual care for children and families as part of overall quality care. Essential nursing knowledge for the development of a plan of care that includes the child's spirituality, religion, and culture, developmental stage, age-appropriate spiritual care activities, and the needs of the family are presented.

Religious and spiritual assessment of the child and adolescent

Assessment in child and adolescent psychiatry is a complex process that involves developmental, environmental, and experiential perspectives. Recently, there has been interest in including spiritual and religious assessment in the psychiatric assessment of children, but no well-recognized guidelines for such an assessment have been established. This article proposes an approach to spiritual assessment of children and adolescents that begins with developing an understanding of the family's spiritual and religious life, followed by a developmentally informed method of observing and talking with children and adolescents about their spiritual and religious beliefs. The article concludes with a discussion of ethical issues involved when the psychiatrist addresses issues of spirituality and religion with child and adolescent patients and their families.

Spiritual care needs of hospitalized children and their families: a national survey of pastoral care providers' perceptions

OBJECTIVE

Although spirituality is viewed as a vital aspect of the illness experience by most Americans, little is known about this domain of pediatric health care. The objective of this study was to profile pastoral care providers' perceptions of the spiritual care needs of hospitalized children and their parents, barriers to better pastoral care, and quality of spiritual care in children's hospitals.

METHODS

A cross-sectional mail survey was conducted of pastoral care providers at children's hospitals throughout the United States, with a 67% response rate from 115 institutions.

RESULTS

Respondents estimated that, among patients they visited, 34% were chronically ill and 21% were clearly dying. Half or more of patients were thought to have spiritual care needs regarding feeling fearful or anxious, coping with pain or other physical symptoms, and regarding their relationship to their parents or the relationship between their parents. Among patients' parents, 60% to 80% were estimated to have felt fearful or anxious, had difficulty coping with their child's pain or other symptoms, sought more medical information about their child's illness, questioned why they and their child were going through this experience, asked about the meaning or purpose of suffering, and felt guilty. Respondents agreed on 3 barriers to providing spiritual care: inadequate staffing of the pastoral care office, inadequate training of health care providers to detect patients' spiritual needs, and being called to visit with patients and families too late to provide all the care that could have been provided. Overall, respondents judged that their hospitals were providing 60% of what they deemed as ideal spiritual care.

CONCLUSIONS

Pastoral care providers believe that the spiritual care needs of hospitalized children and their parents are diverse and extensive. With system-level barriers cited as limiting the quality of spiritual care, considerable improvement may be possible.

Culture & spirituality as an integrated concept in pediatric care

The purpose of this article is to propose an integrated approach to culture and spirituality in pediatric care. In the spirit of sensitive and respectful communication with patients, pediatric nurses have become increasingly concerned with the child's and family's culture, spirituality, and religion. As a result, various approaches and models have been created to help nurses initiate discussions surrounding these topics. These models have given rise to categorizations of culture, spirituality, and religion. It is important for pediatric nurses to understand that while delineations can be made, there are also many intersecting factors that make separation of these issues difficult and perhaps unnecessary for the purpose of culturally sensitive communication. Pediatric nurses should, perhaps, focus instead on understanding the individual child's or family's traditions, values, and beliefs and how these dimensions impact the health of the child. This article suggests three areas that can be used as an organizing framework for pediatric nurses to broach culturally sensitive issues within the context of pediatric primary healthcare: (1) Family beliefs/values, (2) Family daily practices, and (3) Community involvement.

Religious involvement, spirituality, and medicine: implications for clinical practice

Surveys suggest that most patients have a spiritual life and regard their spiritual health and physical health as equally important. Furthermore, people may have greater spiritual needs during illness. We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life, and other health outcomes. We also reviewed articles that provided suggestions on how clinicians might assess and support the spiritual needs of patients. Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health-related quality of life (even during terminal illness) and less anxiety, depression, and suicide. Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness. Discerning, acknowledging, and supporting the spiritual needs of patients can be done in a straightforward and noncontroversial manner. Furthermore, many sources of spiritual care (e.g., chaplains) are available to clinicians to address the spiritual needs of patients.