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Noe-Steinmüller N, Scherbakov D, Zhuravlyova A, Wager TD, Goldstein P, Tesarz J. Defining suffering in pain: a systematic review on pain-related suffering using natural language processing. Pain 2024; 165:1434-1449. [PMID: 38452202 PMCID: PMC11190900 DOI: 10.1097/j.pain.0000000000003195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 03/09/2024]
Abstract
ABSTRACT Understanding, measuring, and mitigating pain-related suffering is a key challenge for both clinical care and pain research. However, there is no consensus on what exactly the concept of pain-related suffering includes, and it is often not precisely operationalized in empirical studies. Here, we (1) systematically review the conceptualization of pain-related suffering in the existing literature, (2) develop a definition and a conceptual framework, and (3) use machine learning to cross-validate the results. We identified 111 articles in a systematic search of Web of Science, PubMed, PsychINFO, and PhilPapers for peer-reviewed articles containing conceptual contributions about the experience of pain-related suffering. We developed a new procedure for extracting and synthesizing study information based on the cross-validation of qualitative analysis with an artificial intelligence-based approach grounded in large language models and topic modeling. We derived a definition from the literature that is representative of current theoretical views and describes pain-related suffering as a severely negative, complex, and dynamic experience in response to a perceived threat to an individual's integrity as a self and identity as a person. We also offer a conceptual framework of pain-related suffering distinguishing 8 dimensions: social, physical, personal, spiritual, existential, cultural, cognitive, and affective. Our data show that pain-related suffering is a multidimensional phenomenon that is closely related to but distinct from pain itself. The present analysis provides a roadmap for further theoretical and empirical development.
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Affiliation(s)
- Niklas Noe-Steinmüller
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Tanzi S, Artioli G, De Panfilis L, Ghirotto L, Rabitti E, Sacchi S. A qualitative study with Italian patients exploring the spiritual dimension during a chronic disease. Chronic Illn 2024; 20:335-348. [PMID: 37248628 DOI: 10.1177/17423953231178236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Spirituality is a vast dimension influenced by cultural and personal differences. Little is known about the spirituality of patients suffering from a chronic disease in Italy from palliative care hospital settings. AIM To investigate patients' perspectives about their spirituality during their illness. METHOD The research question was: 'How does living with chronic disease inform/shape the spiritual dimension of patients?'. To address it, we conducted a qualitative interview study with thematic analysis. RESULTS We enrolled 21 participants among patients suffering from rheumatic, haematologic, neurodegenerative and respiratory chronic diseases. Participants generally had great difficulty answering the questions researchers posed and often could not define 'spirituality'. We found different topics grouped under four main themes: definition of spirituality, internal dialogue, expression of spirituality in everyday life and take stock. Religion is not reported as an answer to spiritual suffering, even in a country that is felt religious-driven like Italy. DISCUSSION Patients are generally not cognizant of this dimension even living with a chronic disease; consequently, they cannot express spiritual needs because they can't recognise them. Health professionals should identify this dimension and its characteristics to recognise potential spiritual suffering.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Rabitti
- Psycho-oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Sacchi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Thomas C, Kulikowksi JD, Breitbart W, Alici Y, Bruera E, Blackler L, Sulmasy DP. Existential suffering as an indication for palliative sedation: Identifying and addressing challenges. Palliat Support Care 2024:1-4. [PMID: 38419195 DOI: 10.1017/s1478951524000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Columba Thomas
- Kennedy Institute of Ethics, Georgetown University, Washington, DC, USA
| | - Julia D Kulikowksi
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liz Blackler
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel P Sulmasy
- Kennedy Institute of Ethics, Georgetown University, Washington, DC, USA
- Departments of Medicine and Philosophy and the Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC, USA
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Ichihara K, Nishiyama C, Kiyohara K, Morita T, Tamura K. Nursing Care for Spiritual Pain in Terminal Cancer Patients: A Non-Randomized Controlled Trial. J Pain Symptom Manage 2024; 67:126-137. [PMID: 37852454 DOI: 10.1016/j.jpainsymman.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT Spiritual well-being is important for terminal cancer patients; however, appropriate interventions remain to be established. OBJECTIVES To evaluate the effectiveness of nursing care to alleviate spiritual pain in daily clinical practice using a Spiritual Pain Assessment Sheet-based spiritual care program for nurses (SpiPas-SCP-N). METHODS A nonrandomized controlled trial was conducted in five palliative care units in Japan. The intervention group received spiritual care based on SpiPas-SCP-N by ward nurses. The primary outcome was the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp). Secondary outcomes included: Hospital Anxiety and Depression Scale (HADS), Comprehensive Quality of life Outcome (CoQoLo), and the Japanese version of the M.D. Anderson Symptom Inventory (MDASI-J). Propensity score matching was used for adjustment. RESULTS Terminal cancer patients were assigned to the control and intervention groups (n = 140 and 157, respectively); of whom, 97 (69.8%) and 106 (68.0%), respectively, completed two weeks. Seventy-three patients were matched in each group. The total score of FACIT-Sp increased in the intervention group and decreased in the control group; however, there was no significant difference (95% CI, -3.98, 1.41, P = 0.347). HADS total score significantly increased (95% CI, 0.15, 3.87, P = 0.035), whereas there were no significant changes in CoQoLo and MDASI-J scores. The effect size of changes in FACIT-Sp subscales were 0.25 in the meaning/peace subscale and 0.04 in the faith subscale. CONCLUSION SpiPas-SCP-N for spiritual pain may have a positive impact on terminal cancer patients. Future research using larger samples, randomized design, and the meaning/peace subscale of FACIT-Sp as the primary outcome is necessary as well as supervision and continuous training in daily nursing practice.
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Affiliation(s)
- Kaori Ichihara
- Department of Nursing (K.I.), Yodogawa Christian Hospital, Osaka, Japan; Department of Palliative Nursing (K.I., K.T.), Kyoto University Graduate School of Human Health Science, Kyoto, Japan.
| | - Chika Nishiyama
- Department of Critical Care Nursing (C.N.), Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Kosuke Kiyohara
- Department of Food Science (K.K.), Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care and Seirei Hospice (T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Keiko Tamura
- Department of Palliative Nursing (K.I., K.T.), Kyoto University Graduate School of Human Health Science, Kyoto, Japan; Division of Regional Medical Cooperation (K.T.), Center for Industrial Research and Innovation, Translational Research Institute for Medical Innovation, Osaka Dental University, Osaka, Japan
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Yeh A, Chernicoff H. Existential distress: identification and management by hospice and palliative medicine fellows. BMJ Support Palliat Care 2024; 13:e765-e766. [PMID: 36931695 DOI: 10.1136/spcare-2023-004239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Angela Yeh
- Department of Medicine, Palliative Care Section, University of California - Los Angeles, Los Angeles, CA, USA
- Department of Medicine, Division of Geriatrics, University of California - Los Angeles, Los Angeles, CA, USA
| | - Helen Chernicoff
- Department of Medicine, Integrated Geriatrics and Palliative Medicine Fellowship, University of California - Los Angeles, Los Angeles, California, USA
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Wang W, Yang J, Bai D, He J, Cai M, Gong X, Lu X, Hou C, Gao J. Instruments for assessing the spiritual needs of cancer patients: A systematic review of psychometric properties. J Clin Nurs 2023; 32:7956-7969. [PMID: 37788077 DOI: 10.1111/jocn.16888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023]
Abstract
AIMS AND OBJECTIVES To identify available instruments for assessing cancer patients' spiritual needs and to examine their psychometric properties using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. BACKGROUND Cancer patients frequently have significant spiritual needs. The nurse plays an integral role in assessing the patient's spiritual needs as part of providing holistic care. It is crucial to assess these needs using appropriate and reliable instruments. DESIGN A systematic review based on COSMIN methodology. METHODS Seven electronic databases (PubMed, EMBASE, CINAHL, Web of Science, ProQuest, CNKI and WANFANG) were systematically searched from inception until 14 February 2023. Two authors independently screened eligible literature, extracted data and evaluated methodological and psychometric quality. This systematic review was conducted following the PRISMA checklist. RESULTS Sixteen studies have reported 16 different versions of the instruments. None of the instruments were properly assessed for all psychometric properties, nor were measurement error, responsiveness and cross-cultural validity/measurement invariance reported. All of the instruments failed to meet the COSMIN quality criteria for content validity. The quality of evidence for structural validity and/or internal consistency in five instruments did not meet the COSMIN criteria. Eventually, five instruments were not recommended, and 11 were only weakly recommended. CONCLUSION Instruments to assess spiritual needs exhibited limited reliability and validity. The Spiritual Care Needs Scale is provisionally recommended for research and clinical settings, but its limitations regarding content validity and cross-cultural application must be considered in practice. Future research should further revise the content of available instruments and comprehensively and correctly test their psychometric properties. RELEVANCE TO CLINICAL PRACTICE The review findings will provide evidence for healthcare professionals to select instruments for recognising spiritual needs in cancer patients. NO PATIENT OR PUBLIC CONTRIBUTION This study is a systematic review with no patient or public participation.
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Affiliation(s)
- Wei Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Yang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dingxi Bai
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiali He
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingjin Cai
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoyan Gong
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xianying Lu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chaoming Hou
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Gao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Baptista Peixoto Befecadu F, Stirnemann J, Guerreiro I, Fusi-Schmidhauser T, Jaksic C, Larkin PJ, da Rocha Rodrigues G, Pautex S. PANDORA dyadic project: hope, spiritual well-being and quality of life of dyads of patients with chronic obstructive pulmonary disease in Switzerland - a multicentre longitudinal mixed-methods protocol study. BMJ Open 2023; 13:e068340. [PMID: 37173103 PMCID: PMC10186441 DOI: 10.1136/bmjopen-2022-068340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is responsible for 2.9 million deaths annually in Europe. Symptom burden and functional decline rise as patients reach advanced stages of the disease enhancing risk of vulnerability and dependency on informal caregivers (ICs).Evidence shows that hope is an important psycho-social-spiritual construct that humans use to cope with symptom burden and adversity. Hope is associated with increased quality of life (QoL) comfort and well-being for patients and ICs. A better understanding of the meaning and experience of hope over time as patients transition through chronic illness may help healthcare professionals to plan and deliver care more appropriately. METHODS AND ANALYSIS This is a longitudinal multicentre mixed-methods study with a convergent design. Quantitative and qualitative data will be collected from dyads of advanced COPD patients and their ICs in two university hospitals at two points in time. The Herth Hope Index, WHO Quality of Life BREF, Functional Assessment of Chronic Illness Therapy-Spiritual Well-being and the French version of the Edmonton Symptom Assessment Scale will be used to collect data. Dyadic interviews will be conducted using a semi-structured interview guide with five questions about hope and their relationship with QoL.Statistical analysis of data will be carried out using R V.4.1.0. To test whether our theoretical model as a whole is supported by the data, structural equation modelling will be used. The comparison between T1 and T2 for level of hope, symptom burden, QoL and spiritual well-being, will be carried out using paired t-tests. The association between symptom burden, QoL, spiritual well-being and hope will be tested using Pearson correlation. ETHICS AND DISSEMINATION This study protocol received ethical approval on 24 May 2022 from the Commission cantonale d'éthique de la recherche sur l'être humain-Canton of Vaud. The identification number is 2021-02477.
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Affiliation(s)
- Filipa Baptista Peixoto Befecadu
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
- Chair of Palliative Care Nursing, Palliative and supportive care service, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Ivan Guerreiro
- Division of Pneumology, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja Fusi-Schmidhauser
- Palliative and Supportive Care Clinic and Department of Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
- University of Geneva, Geneva, Switzerland
| | - Cyril Jaksic
- Geneva University Hospitals, Geneva, Switzerland
| | - Philip J Larkin
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Chair of Palliative Care Nursing, Palliative and supportive care service, Lausanne University Hospital, Lausanne, Switzerland
| | - Gora da Rocha Rodrigues
- HES-SO University of Applied Sciences and Arts Western Switzerland, HESAV School of Health Sciences, Lausanne, Switzerland
| | - Sophie Pautex
- Dpt of Readaptation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
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Schipper S, Nigam K, Piechotta V, Ljuslin M, Beaussant Y, Schwarzer G, Boehlke C. Psychedelic/entactogen‐assisted therapy for treatment of anxiety, depression and existential distress in adult palliative care. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022; 2022:CD015383. [PMCID: PMC9677948 DOI: 10.1002/14651858.cd015383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of psychedelic/entactogen‐assisted therapy compared to placebo or active comparators (e.g. antidepressants) for treatment of anxiety, depression, and existential distress in adult palliative care.
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Affiliation(s)
| | | | - Kabir Nigam
- Department of PsychiatryBrigham and Women’s HospitalBostonUSA
| | - Vanessa Piechotta
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane HaematologyFaculty of Medicine and University Hospital Cologne, University of CologneCologneGermany
| | - Michael Ljuslin
- Palliative Medicine Division, Department of Rehabilitation and GeriatricsGeneva University HospitalsGenevaSwitzerland,Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA,Harvard Medical SchoolBostonUSA
| | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA
| | - Guido Schwarzer
- Institute of Medical Biometry and StatisticsFaculty of Medicine and Medical Center, University of FreiburgFreiburgGermany
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Tan SB, Tan TT, Tan MP, Loo KK, Lim PK, Ng CG, Loh EC, Lam CL. Contributing and Relieving Factors of Suffering in Palliative Care Cancer Patients: A Descriptive Study. OMEGA-JOURNAL OF DEATH AND DYING 2022; 85:732-752. [DOI: 10.1177/0030222820942642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To palliate suffering, understanding the circumstances leading to suffering and its amelioration could be helpful. Our study aimed to explore contributing and relieving factors of suffering in palliative care. Adult palliative care stage III or IV cancer in-patients were recruited from University of Malaya Medical Centre. Participants recorded their overall suffering score from 0 to 10 three times daily, followed by descriptions of their contributing and relieving factors. Factors of suffering were thematically analysed with NVIVO. Descriptive data were analysed with SPSS. 108 patients participated. The most common contributing factor of suffering was health factor (96.3%), followed by healthcare factor (78.7%), psychological factor (63.0%) and community factor (20.4%). The most common relieving factor was health factor (88.9%), followed by psychological factor (78.7%), community factor (75.9%) and healthcare factor (70.4%). Self-reported assessment of suffering offers a rapid approach to detect bothering issues that require immediate attention and further in-depth exploration.
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Affiliation(s)
- Seng Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Ting Ting Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Kim Kee Loo
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Poh Khuen Lim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Ee Chin Loh
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Chee Loong Lam
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
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Befecadu FBP, Perrenoud B, Behaghel G, Jaques C, Pautex S, Rodrigues MGDR, Larkin PJ. Experience of hope in adult patients with advanced chronic disease and their informal caregivers: a qualitative systematic review protocol. JBI Evid Synth 2022; 20:2025-2031. [DOI: 10.11124/jbies-21-00364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Haufe M, Leget C, Glasner T, Teunissen S, Potma M. Spiritual conversation model for patients and loved ones in palliative care: a validation study. BMJ Support Palliat Care 2022:bmjspcare-2022-003569. [PMID: 35710709 DOI: 10.1136/bmjspcare-2022-003569] [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: 02/02/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In palliative care, validated tools for professionals that facilitate day-to-day spiritual conversations with patients and loved ones are scarce. The objective of this study was to validate the Diamond spiritual conversation model across different palliative care settings as well as professional and educational levels. METHODS An online survey was filled in by 387 professionals providing palliative care for patients in hospice, home care, hospital and nursing home settings. The five polarities of the Diamond model: holding on-letting go, doing-undergoing, remembering-forgetting, me-the other and believing-knowing were operationalised and evaluated on reported occurrence. RESULTS In conversations with patients, palliative care professionals reported letting go of loved ones (81.8%), dealing with pain and suffering (88.1%), dealing with issues from the past (67.2%), dealing with own versus loved one's wishes (69.4%) and giving meaning to death (66.7%) as themes occurring regularly to very often. In conversations with loved ones, this was 70.8%, 78.5%, 55.4%, 68,8% and 62%, respectively. Respondents working in hospices reported these themes significantly more than those working in home care settings, nursing homes or hospitals. Nurse assistant respondents reported the themes significantly less than nurses or chaplains. CONCLUSION From the perspective of professionals providing palliative care in different palliative care settings, the Diamond model offers a validated framework for addressing relevant spiritual themes for patients and loved ones.
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Affiliation(s)
- Marc Haufe
- Department of Care Ethics, University for Humanistic Studies, Utrecht, The Netherlands
| | - Carlo Leget
- Department of Care Ethics, University for Humanistic Studies, Utrecht, The Netherlands
| | - Tina Glasner
- Department of Research Methodology, University for Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Center of Expertise Palliative Care Utrecht, Julius Center for Healthcare Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke Potma
- Department of Care Ethics, University for Humanistic Studies, Utrecht, The Netherlands
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Robinson KL, Connelly CD, Georges JM. Pain and Spiritual Distress at End of Life: A Correlational Study. J Palliat Care 2022; 37:526-534. [PMID: 35535413 DOI: 10.1177/08258597221090482] [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: 11/16/2022]
Abstract
Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.
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Affiliation(s)
| | | | - Jane M Georges
- Hahn School of Nursing and Health Science, University of San Diego, USA
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Spiritual pain as part of the hospitalization experience of children and adolescents with acute lymphoblastic leukemia: A phenomenological study. Eur J Oncol Nurs 2022; 58:102141. [DOI: 10.1016/j.ejon.2022.102141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 02/07/2023]
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“Keeping the Light On”: A Qualitative Study on Hope Perceptions at the End of Life in Portuguese Family Dyads. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031561. [PMID: 35162582 PMCID: PMC8834832 DOI: 10.3390/ijerph19031561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
Hope performs an important role in how patients and their families cope with suffering and stressful events. To better inform practice and theory on hope, palliative care research should include both patients and their family carers, given their strong interdependence. The aim of this study was to explore how hope is experienced in dyads formed by end-of-life patients and their family carers. In this qualitative study, data were collected by in-depth interviews with seven Portuguese family dyads. Analysis followed a thematic analysis approach. The analysis of the interviews shed light on the importance of hope for all participants, and the challenges involved. Family dyads noted several barriers and facilitators to perceptions of hope. Barriers to hope included limitations imposed by illness, feelings of anguish and helplessness, and poor communication with clinicians. Hope facilitators included supportive others, positive thinking and sense of humour, connection with nature, faith in religion and science, and a sense of compassion with others and altruism. Given the multidimensional scope of hope, the main challenge for family dyads is to look beyond the disease itself. Thus, palliative care teams should be encouraged to support and foster realistic hope, helping families prepare for death, in the context of advanced cancer.
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Abstract
BACKGROUND Patients with psychiatric disorders (as well as general medical conditions) often describe their lives in terms of suffering. Although suffering is honored as a central focus of physicians' concerns, it is not even indexed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Generally connoting severe, prolonged distress, suffering can be distinguished from pain, depression, and anxiety. The aims of this article are to consider whether attending to suffering per se in psychiatric patients merits attention independent of other commonly assessed psychiatric symptoms such as anxiety, depression, and conventional distress, and how targeting suffering per se might add value to psychiatric patient care. METHODS Sources for this article were obtained via a selective literature search in PubMed using the terms "suffering" in the title and the terms "psychiatric disorder," "mental illness," "assessment," "measurement," "scale," "existential suffering," and "unbearable suffering." Articles of interest were followed up using a snowball technique to examine "similar articles" and "cited by" titles to find additional pertinent articles. RESULTS Definitions of suffering in the medical literature stress its subjectivity, particularity, complexity, and connection to a wide variety of noxious sensations, as well as real and anticipated deficits, losses, and thwarted motivations. These can affect the entire spectrum of universal human needs, from basic biological issues through intrapsychic, interpersonal, and social issues, encompassing existential concerns of meaning, purpose, and transcendence. Based on these factors, a definition of suffering in patients with psychiatric disorders is proposed. Although efforts to measure suffering have been limited and numerous gaps in the literature are evident, several scales may offer suitable bases for the study of suffering in patients with psychiatric disorders. CONCLUSIONS AND IMPLICATIONS Ascertaining sources of suffering may require new types of inquiry and additional time. Well-described, evidence-informed strategies and time-honored psychotherapy techniques are available for addressing the numerous concerns that contribute to suffering. Patients with psychiatric disorders whose distinct, multidimensional sources of suffering are identified, acknowledged, and addressed may experience better treatment quality, greater treatment satisfaction, and possibly better outcomes than those whose clinicians' attention is limited to conventional psychiatric signs and symptoms.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, MC A011-04, University of Colorado School of Medicine, Aurora, Colorado
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Sensky T. Mental Pain and Suffering: The "Universal Currencies" of the Illness Experience? PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:337-344. [PMID: 32781446 DOI: 10.1159/000509587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Tom Sensky
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom,
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Comparison of Perceptions of Spiritual Care Among Patients With Life-Threatening Cancer, Primary Family Caregivers, and Hospice/Palliative Care Nurses in South Korea. J Hosp Palliat Nurs 2021; 22:532-551. [PMID: 33044420 DOI: 10.1097/njh.0000000000000697] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study aimed to compare perceptions of spiritual care among patients with life-threatening cancer, their primary family caregivers, and hospice/palliative care nurses.Data were collected using both structured and unstructured approaches. Structured questionnaire data were examined using statistical analysis methods, and unstructured data were examined using content analysis to compare the 3 participant groups. The questionnaire revealed that among all 3 groups, spiritual care was commonly perceived to relate to "having the opportunity for internal reflection," "finding meaning," "encouraging hope," and "listening to and being with patients." Content analysis of the unstructured data revealed 5 themes: "Caring with sincerity," "Strengthening spiritual resources," "Alleviating physical pain and discomfort" (among patients and primary family caregivers only), "Improving spiritual care service," and "Multifaceted cooperation" (among hospice/palliative care nurses only). Our findings suggest that for patients with life-threatening illnesses such as terminal cancer, spiritual care should not be limited to religious practice but should also satisfy inner existential needs, for example, by encouraging hope, providing empathy, and helping patients find meaning in their circumstances.
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Kunsmann-Leutiger E, Straßner C, Schalhorn F, Stolz R, Stotz-Ingenlath G, Buhlinger-Göpfarth N, Bentner M, Joos S, Valentini J, Frick E. Training General Practitioners and Medical Assistants Within the Framework of HoPES3, a Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity, and Self-Care into Disease Management in Primary Care. J Multidiscip Healthc 2021; 14:1853-1861. [PMID: 34285503 PMCID: PMC8286253 DOI: 10.2147/jmdh.s312778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background This study presents a concept for training general practitioners (GPs) in taking a spiritual history. In the same workshop, medical assistants (MAs) were trained in counselling elderly, chronically ill patients on social activities and home remedies. After the training, GPs and MAs will apply the acquired skills in their practices within the scope of the HoPES3 intervention study, which aims at raising patients’ self-efficacy. Methods Sixteen GPs and 18 MAs were trained in a 5-hour workshop and completed an evaluation questionnaire. Results All participants reported great satisfaction. In particular, 85% of GPs (n=11) affirmed increased capacity to address patients’ spiritual needs. About 88% (n=15) of MAs were satisfied with the training, yet expressed difficulties in integrating theoretical knowledge into daily professional routine. Discussion While the evaluation of the workshop is promising, the results of the randomized-controlled trial evaluating the effectiveness of the complete HoPES3 intervention have to be awaited. Conclusion To our knowledge, this is the first interdisciplinary, holistic care training in primary care in Germany. It fosters GPs’ and MAs’ competency in providing a proactive support in spirituality, social activities, and home remedies to their patients. If the concept proves to be effective, it could be integrated into existing care models and curriculums and provide clear guidance on how to consider elderly patients’ spiritual needs and strengthen their self-efficacy in primary care settings. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/hcz-CKYOk8s
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Affiliation(s)
- Elke Kunsmann-Leutiger
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Cornelia Straßner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Friederike Schalhorn
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Regina Stolz
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Gabriele Stotz-Ingenlath
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Nicola Buhlinger-Göpfarth
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Martina Bentner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Jan Valentini
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Eckhard Frick
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
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The accuracy of measures in screening adults for spiritual suffering in health care settings: A systematic review. Palliat Support Care 2020; 18:89-102. [PMID: 31387655 DOI: 10.1017/s1478951519000506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Guidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence of the accuracy of measures used to screen adults for spiritual suffering. METHODS A systematic review of the literature. We searched five scientific databases to identify relevant articles. Two independent reviewers screened, extracted data, and assessed study methodological quality. RESULTS We identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the two-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82-87%), and the revised Rush protocol had the highest specificity (81-90%). The methodological quality of all included studies was low. SIGNIFICANCE OF RESULTS While most of the identified spiritual screening measures are brief (comprised 1 to 12 items), few had sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.
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Haufe M, Leget C, Potma M, Teunissen S. How can existential or spiritual strengths be fostered in palliative care? An interpretative synthesis of recent literature. BMJ Support Palliat Care 2020:bmjspcare-2020-002379. [PMID: 32928785 DOI: 10.1136/bmjspcare-2020-002379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/21/2020] [Accepted: 08/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients receiving palliative care may benefit greatly when their existential or spiritual strengths are fostered. To date however, there has not been a comprehensive literature review of patient and care professional approaches that are available. AIMS To describe and synthesise existential or spiritual strength-based approaches within the context of palliative care. METHODS Literature search of 2436 articles between January 1999 and March 2019 in Scopus, Web of Science, CINAHL and PsycINFO. Articles were included if they deal with a palliative care situation, focus on the patient, specific existential/spiritual strength, discernible strength approach and an analysis of the workings of that approach. The interpretative synthesis consisted of a thematic analysis of the included articles and an integration of themes. RESULTS In the 14 included articles, 5 different strengths were found to be fostered by 16 approaches: (1) Meaning was fostered by: maintaining normalcy, experiencing sanctuaries, reassessing importance and reconstructing positive self; (2) Connection by: opening up, giving/receiving care and envisioning continuation; (3) Agency by: maintaining control, refocusing goals and continuous adaptation; (4) Hope through: setting special targets, imagining alternate outcomes, building a collection and extending wishes; (5) Faith through: living the tradition and relating to a benevolent force. Strengths and approaches are visualised in an overarching analytical framework: 'the Propeller'. CONCLUSIONS The constructed Propeller framework can be used to become aware of, apply and further develop approaches to foster existential or spiritual strengths among patients receiving palliative care.
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Affiliation(s)
- Marc Haufe
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Carlo Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Marieke Potma
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Department of General Practice, Center of Expertise Palliative Care Utrecht, Julius Center for Healthcare Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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The religious/spiritual beliefs and needs of cancer survivors who underwent cancer-directed surgery. Palliat Support Care 2020; 19:175-181. [DOI: 10.1017/s1478951520000772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveWe sought to characterize patients’ preferences for the role of religious and spiritual (R&S) beliefs and practices during cancer treatment and describe the R&S resources desired by patients during the perioperative period.MethodA cross-sectional survey was administered to individuals who underwent cancer-directed surgery. Data on demographics and R&S beliefs/preferences were collected and analyzed.ResultsAmong 236 participants, average age was 58.8 (SD = 12.10) years; the majority were female (76.2%), white (94.1%), had a significant other or spouse (60.2%), and were breast cancer survivors (43.6%). Overall, more than one-half (55.9%) of individuals identified themselves as being religious, while others identified as only spiritual (27.9%) or neither (16.2%). Patients who identified as religious wanted R&S integrated into their care more often than patients who were only spiritual or neither (p < 0.001). Nearly half of participants (49.6%) wanted R&S resources when admitted to the hospital including the opportunity to speak with an R&S leader (e.g., rabbi; 72.1%), R&S texts (64.0%), and journaling materials (54.1%). Irrespective of R&S identification, 68.0% of patients did not want their physician to engage with them about R&S topics.Significance of resultsAccess to R&S resources is important during cancer treatment, and incorporating R&S into cancer care may be especially important to patients that identify as religious. R&S needs should be addressed as part of the cancer care plan.
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Palmer Kelly E, Paredes AZ, Tsilimigras DI, Hyer JM, Pawlik TM. The role of religion and spirituality in cancer care: An umbrella review of the literature. Surg Oncol 2020; 42:101389. [PMID: 34103240 DOI: 10.1016/j.suronc.2020.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/22/2020] [Accepted: 05/16/2020] [Indexed: 01/09/2023]
Abstract
Although some studies have suggested a strong relationship between religion and spirituality (R&S) and patient outcomes in cancer care, other data have been mixed or even noted adverse effects associated with R&S in the healthcare setting. We sought to perform an umbrella review to systematically appraise and synthesize the current body of literature on the role of patient R&S in cancer care. A systematic search of the literature was conducted that focused on "cancer" (neoplasm, malignant neoplasm, malignancy), "spirituality" (beliefs, divine), and "religion" (specific practices like Christianity, faith, faith healing, prayer, Theology). A total of 41 review articles published from 1995 to 2019 were included: 8 systematic reviews, 6 meta-analyses, 4 systematic reviews and meta-analysis, and 23 other general reviews. The number of studies included in each review ranged from 7 to 148, while 10 studies did not indicate sample size. Most articles did not focus on a specific cancer diagnosis (n = 36), stage of cancer (n = 32), or patient population (n = 34). Many articles noted that R&S had a positive impact on cancer care, yet some reviews reported inconclusive or negative results. Marked variation in methodological approaches to studying R&S among cancer patients, including operational definitions and measurement, were identified. Resolving these issues will be an important step to understanding how patients seek to have R&S integrated into their patient-centered cancer care experience.
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Affiliation(s)
- Elizabeth Palmer Kelly
- Department of Surgery, The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH, USA.
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Validation of the Spiritual Distress Scale in Portuguese Cancer Patients Undergoing Chemotherapy: A Methodological Study. RELIGIONS 2019. [DOI: 10.3390/rel10110599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Spiritual distress may ascend from unmet spiritual needs. The use of instruments to measure spiritual distress seems to facilitate the approach to spirituality, such as the Spiritual Distress Scale (SDS) that has been used worldwide. No instrument to assess spiritual distress in cancer patients is currently available in Portugal. This study aims to conduct the translation, adaptation and validation of the SDS in Portuguese cancer patients undergoing chemotherapy. Methodological study based on Sousa and Rojjanasrirat (2011), a seven-step approach, started with the linguistic translation to the psychometric tests. The main participants (55.4%) were older than 60 years; about 64.7% were females, married (68.0%), and 86.7% were Catholic. Moderate spiritual distress was experienced by 49.3% of the participants. Linguistic and conceptual equivalences were obtained. The SDS European Portuguese version has an overall Cronbach’s alpha of 0.91, and the subscales were as follows: “relationship with self” (0.92), “relationship with others” (0.63), “relationship with God” (0.64) and “facing death” (0.85). Four factors emerged after Varimax rotation. Overall, these results indicate that the SDS European Portuguese version has good psychometric characteristics and can used in assessing spiritual distress in cancer patients.
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Pérez-Cruz PE, Langer P, Carrasco C, Bonati P, Batic B, Tupper Satt L, Gonzalez Otaiza M. Spiritual Pain Is Associated with Decreased Quality of Life in Advanced Cancer Patients in Palliative Care: An Exploratory Study. J Palliat Med 2019; 22:663-669. [PMID: 30649985 DOI: 10.1089/jpm.2018.0340] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Improving quality of life (QOL) is important in cancer palliative care (PC) patients. "Spiritual pain" (SP) is common in this population, but it is unknown how it affects QOL. Objective: To study the associations between SP and QOL in cancer patients in PC. Design: Cross-sectional. Settings/Subjects: Cancer patients assessed at a PC clinic in Puente Alto, Chile, were enrolled in a longitudinal study to characterize patients' end of life. Inclusion criteria included age ≥18, a primary caregiver, not having delirium, and a Karnofsky performance status (KPS) ≤80. Measurements: After consenting patients completed baseline surveys that included demographics, single-item questions to assess SP (0-10), financial distress, spirituality-related variables and questionnaires to assess QOL (0-100), and physical (Global distress score-physical) and psychological distress (Hospital Anxiety and Depression Scale), baseline data analyses to explore associations between SP and QOL were adjusted for potential confounders. Results: Two hundred and eight patients were enrolled: mean age was 64, 50% were female, and 67% had SP. In univariate analysis, SP was significantly associated with lower QOL (coefficient [95% confidence interval]: -1.88 [-2.93 to -0.84], p < 0.001). Lower QOL was also associated with being younger, lower KPS, higher physical distress, having anxiety or depression, and decreased religiosity and religious coping. In the multivariate analysis, QOL remained independently associated with SP (-1.25 [-2.35; to -0.15], p < 0.026), religious coping (11.74 [1.09 to 22.38], p < 0.031), and physical distress (-0.52 [-0.89 to -0.16], p < 0.005). Conclusions: SP is associated with QOL in cancer patients in PC. SP should be regularly assessed to plan for interventions that could impact QOL. More research is needed.
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Affiliation(s)
- Pedro E Pérez-Cruz
- 1 Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,2 Núcleo Milenio para el Estudio del Curso de Vida y la Vulnerabilidad, Santiago, Chile.,3 Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paola Langer
- 4 Instituto de Sociología, Facultad de Ciencias Sociales, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Carrasco
- 3 Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pilar Bonati
- 3 Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bogomila Batic
- 3 Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Laura Tupper Satt
- 5 Unidad Cuidados Paliativos, Complejo Asistencial Dr. Sótero del Río, Servicio de Salud Metropolitano Sur Oriente, Puente Alto, Chile
| | - Marcela Gonzalez Otaiza
- 5 Unidad Cuidados Paliativos, Complejo Asistencial Dr. Sótero del Río, Servicio de Salud Metropolitano Sur Oriente, Puente Alto, Chile
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Abstract
Cancer affects individuals in all human dimensions. Cancer patients are more susceptible to spiritual distress. Several studies have addressed spiritual distress using quantitative designs; however, a qualitative approach to the experience of spiritual distress could provide a deeper understanding of the phenomenon. This study aims to synthesis the experience of spiritual distress as lived by cancer patients in qualitative primary studies. This is a literature review based on electronic databases search. A total of 4075 citations was identified and 23 studies were included. The most frequent qualitative research method was phenomenology (n = 15), and interviews were the main data collection method (n = 20). Two major themes have been identified related to the experience of spiritual distress: suffering and coping. Spiritual distress is an intimate, deep and suffering experience in life, which requires coping strategies and involves spiritual values and beliefs. Healthcare providers should be aware of this experience and recognize spiritual distress in cancer patients, as it is critical in providing holistic nursing care.
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Garcia ACM, Simão-Miranda TP, Carvalho AMP, Elias PCL, Pereira MDG, de Carvalho EC. The effect of therapeutic listening on anxiety and fear among surgical patients: randomized controlled trial. Rev Lat Am Enfermagem 2018; 26:e3027. [PMID: 30110103 PMCID: PMC6091387 DOI: 10.1590/1518-8345.2438.3027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 05/06/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate the effect of therapeutic listening on state anxiety and surgical fears in preoperative colorectal cancer patients. METHOD A randomized controlled trial with 50 patients randomly allocated in the intervention group (therapeutic listening) (n = 25) or in the control group (n = 25). The study evaluated the changes in the variables state anxiety, surgical fears and physiological variables (salivary alpha-amylase, salivary cortisol, heart rate, respiratory rate and blood pressure). RESULTS In the comparison of the variables in the control and intervention groups in pre- and post-intervention, differences between the two periods for the variables cortisol (p=0.043), heart rate (p=0.034) and surgical fears (p=0.030) were found in the control group, which presented reduction in the values of these variables. CONCLUSION There was no reduction in the levels of the variables state anxiety and surgical fears resulting from the therapeutic listening intervention, either through the physiological or psychological indicators. However, the contact with the researcher during data collection, without stimulus to reflect on the situation, may have generated the results of the control group. Clinical Trial Registration: NCT02455128.
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Affiliation(s)
| | - Talita Prado Simão-Miranda
- Doctoral student, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil. Scholarship holder at Conselho Nacional de
Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Ana Maria Pimenta Carvalho
- PhD, Senior Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
| | - Paula Condé Lamparelli Elias
- PhD, Physician, Hospital das Clínicas, Faculdade de Medicina de
Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Emilia Campos de Carvalho
- PhD, Senior Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
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Bauereiß N, Obermaier S, Özünal SE, Baumeister H. Effects of existential interventions on spiritual, psychological, and physical well-being in adult patients with cancer: Systematic review and meta-analysis of randomized controlled trials. Psychooncology 2018; 27:2531-2545. [DOI: 10.1002/pon.4829] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Natalie Bauereiß
- Department of Clinical Psychology and Psychotherapy; Ulm University; Germany
| | - Stefanie Obermaier
- Department of Clinical Psychology and Psychotherapy; Ulm University; Germany
| | - Selçuk Erol Özünal
- Department of Clinical Psychology and Psychotherapy; Ulm University; Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy; Ulm University; Germany
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Roze des Ordons AL, Sinuff T, Stelfox HT, Kondejewski J, Sinclair S. Spiritual Distress Within Inpatient Settings-A Scoping Review of Patients' and Families' Experiences. J Pain Symptom Manage 2018; 56:122-145. [PMID: 29548894 DOI: 10.1016/j.jpainsymman.2018.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
CONTEXT Spiritual distress contributes to patients' and families' experiences of care. OBJECTIVES To map the literature on how seriously ill patients and their family members experience spiritual distress within inpatient settings. METHODS Our scoping review included four databases using search terms "existential" or "spiritual" combined with "angst," "anxiety," "distress," "stress," or "anguish." We included original research describing experiences of spiritual distress among adult patients or family members within inpatient settings and instrument validation studies. Each study was screened in duplicate for inclusion, and the data from included articles were extracted. Themes were identified, and data were synthesized. RESULTS Within the 37 articles meeting inclusion criteria, we identified six themes: conceptualizing spiritual distress (n = 2), diagnosis and prevalence (n = 7), assessment instrument development (n = 5), experiences (n = 12), associated variables (n = 12), and barriers and facilitators to clinical support (n = 5). The majority of studies focused on patients; two studies focused on family caregivers. The most common clinical settings were oncology (n = 19) and advanced disease (n = 19). Terminology to describe spiritual distress varied among studies. The prevalence of at least moderate spiritual distress in patients was 10%-63%. Spiritual distress was experienced in relation to self and others. Associated variables included demographic, physical, cognitive, and psychological factors. Barriers and facilitators were described. CONCLUSION Patients' and families' experiences of spiritual distress in the inpatient setting are multifaceted. Important gaps in the literature include a narrow spectrum of populations, limited consideration of family caregivers, and inconsistent terminology. Research addressing these gaps may improve conceptual clarity and help clinicians better identify spiritual distress.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jane Kondejewski
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Kruizinga R, Scherer-Rath M, Schilderman HJBAM, Puchalski CM, van Laarhoven HHWM. Toward a Fully Fledged Integration of Spiritual Care and Medical Care. J Pain Symptom Manage 2018; 55:1035-1040. [PMID: 29169995 DOI: 10.1016/j.jpainsymman.2017.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 11/21/2022]
Abstract
In this article, we aimed to set out current problems that hinder a fully fledged integration of spiritual and medical care, which address these obstacles. We discuss the following five statements: 1) spiritual care requires a clear and inclusive definition of spirituality; 2) empirical evidence for spiritual care interventions should be improved; 3) understanding patients' experiences of contingency is paramount to deliver effective spiritual care; 4) attention to spiritual needs of patients is a task for every health care practitioner; 5) courses on spirituality and spiritual care should be mandatory in the medical curriculum. Current problems might be overcome by speaking each other's language, which is crucial in interdisciplinary research and in good interdisciplinary collaboration. Using a clear and inclusive definition of spirituality and substantiating spiritual care using medical standards of evidence-based practice is a way to speak each other's language and to increase mutual understanding. Furthermore, including spirituality in the medical curriculum would raise awareness of medical practitioners for their task of attending to patients' spiritual needs and, subsequently, to better and more appropriate referral for spiritual care.
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Affiliation(s)
- Renske Kruizinga
- Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Michael Scherer-Rath
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands, The Netherlands
| | - Hans J B A M Schilderman
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands, The Netherlands
| | - Christina M Puchalski
- Department of Medicine and Health Science, The George Washington Institute for Spirituality and Health, The George Washington University, Washington, District of Columbia, USA
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Grech A, Marks A. Existential Suffering Part 1: Definition and Diagnosis #319. J Palliat Med 2017; 20:93-94. [DOI: 10.1089/jpm.2016.0422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Support for using five attributes to describe spirituality among families with a parent in hospice. Palliat Support Care 2016; 15:320-327. [PMID: 27804915 DOI: 10.1017/s1478951516000778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The importance of spirituality in the dying process is well documented. However, what spirituality means in these situations is hard to discern because few people (patients, families, researchers, or caregivers) will view spirituality in the same way. The present research supports the use of a spiritual framework consisting of five common attributes (meaning, beliefs, connections, self-transcendence, and value) as a mechanism for viewing spirituality for people nearing the end of life. Using qualitative interviews from two related studies, our study aims to describe the prevalence of spirituality and its nature according to these five spiritual attributes. METHODS Data from two previous studies were analyzed. The first employed the methods of grounded theory to understand the strategies adolescents used to manage the impending death of a parent. Some 61 participants from 26 families were interviewed, including ill parents/patients, well parents/caregivers, and adolescents. The second study consisted of 15 interviews with the surviving parent and adolescents from 6 of these families after the death of the parent. RESULTS The original research from which these data were drawn did not seek to describe spirituality. However, spiritual themes were prevalent in the stories of many participants and included each of the five spiritual attributes. SIGNIFICANCE OF RESULTS Our findings demonstrate the prevalence of spirituality in the everyday lives of these families and supports the use of the spiritual framework according to the five common attributes to describe spirituality.
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Palliative care specialists’ beliefs about spiritual care. Support Care Cancer 2016; 24:3295-306. [DOI: 10.1007/s00520-016-3135-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 02/22/2016] [Indexed: 11/24/2022]
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Kruizinga R, Helmich E, Schilderman JBAM, Scherer-Rath M, van Laarhoven HWM. Professional identity at stake: a phenomenological analysis of spiritual counselors' experiences working with a structured model to provide care to palliative cancer patients. Support Care Cancer 2016; 24:3111-8. [PMID: 26917229 PMCID: PMC4877411 DOI: 10.1007/s00520-016-3115-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
Abstract
Background Good palliative care requires excellent interprofessional collaboration; however, working in interprofessional teams may be challenging and difficult. Aim The aim of the study is to understand the lived experience of spiritual counselors working with a new structured method in offering spiritual care to palliative patients in relation to a multidisciplinary health care team. Design Interpretive phenomenological analysis of in-depth interviews, was done using template analysis to structure the data. We included nine spiritual counselors who are trained in using the new structured method to provide spiritual care for advanced cancer patients. Results Although the spiritual counselors were experiencing struggles with structure and iPad, they were immediately willing to work with the new structured method as they expected the visibility and professionalization of their profession to improve. In this process, they experienced a need to adapt to a certain role while working with the new method and described how the identities of the profession were challenged. Conclusions There is a need to concretize, professionalize, and substantiate the work of spiritual counselors in a health care setting, to enhance visibility for patients and improve interprofessional collaboration with other health care workers. However, introducing new methods to spiritual counselors is not easy, as this may challenge or jeopardize their current professional identities. Therefore, we recommend to engage spiritual counselors early in processes of change to ensure that the core of who they are as professionals remains reflected in their work.
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Affiliation(s)
- R Kruizinga
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, F4-261, 1105 AZ, Amsterdam, The Netherlands.
| | - E Helmich
- Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Meibergdreef 15, J1A, 1105 AZ, Amsterdam, The Netherlands
| | - J B A M Schilderman
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Erasmusplein 1, 6500 HD, Nijmegen, The Netherlands
| | - M Scherer-Rath
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Erasmusplein 1, 6500 HD, Nijmegen, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, F4-261, 1105 AZ, Amsterdam, The Netherlands
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Best M, Aldridge L, Butow P, Olver I, Price MA, Webster F. Treatment of holistic suffering in cancer: A systematic literature review. Palliat Med 2015; 29:885-98. [PMID: 25895536 DOI: 10.1177/0269216315581538] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Holistic suffering is a debilitating problem for cancer patients. Although many treatments have been suggested for its alleviation, they have not been compared for effectiveness. AIM This literature review seeks to identify what interventions are effective in treatment of holistic suffering of cancer patients. DESIGN A systematic review was conducted to identify and evaluate studies of interventions for holistic suffering in adult cancer patients. Search terms were generated iteratively from the literature. DATA SOURCES MEDLINE, EMBASE, the Cochrane Library and PsycINFO databases were searched for the years 1992-2015. Included studies were peer-reviewed, English language reports of either a controlled trial or a randomised controlled trial focusing on therapies aimed at relieving suffering in adult cancer patients. Articles were excluded if focused predominantly on spiritual or existential issues or concerns not leading to suffering. Studies were graded for quality using the QualSyst quantitative checklist. Levels of evidence were ascertained by completing the National Health and Medical Research Council criteria. Results are reported according to AMSTAR guidelines. RESULTS The studies represented seven intervention types. Meaning-centred, hope-centred and stress-reduction interventions were found to be effective. Results of both psycho-educational and spiritual interventions in improving spiritual well-being were mixed. Supportive-expressive interventions - with the exception of forgiveness therapy - were not efficacious. There was little or no evidence for the efficacy of creative and healing arts and other assessed interventions such as animal therapy and haptotherapy. CONCLUSION This systematic review found that spiritual well-being, meaning, hope and benefit finding can be positively impacted by a variety of treatment modalities.
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Affiliation(s)
- Megan Best
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW, Australia
| | - Lynley Aldridge
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW, Australia
| | - Ian Olver
- Cancer Council Australia, Sydney, NSW, Australia
| | - Melanie A Price
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW, Australia
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Oliver A, Benito E, Sansó N, Galiana L. Cuestionarios de atención espiritual en cuidados paliativos: revisión de la evidencia para su aplicación clínica. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.54443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objetivo: Revisar los cuestionarios de evaluación de necesidades y recursos espirituales en cuidados paliativos más recientes y evaluar su aplicabilidad clínica en nuestro entorno.Método: Revisión sistemática, siguiendo las guías PRISMA de las publicaciones realizadas durante 2015-2016 de trabajos sobre espiritualidad. Los artículos debían estar centrados en el cuidado espiritual o la evaluación de la espiritualidad, basados en población de cuidados paliativos; y sometidos a revisión por pares.Resultado: de los 42 artículos identificados, tras evaluación independiente de dos observadores, 15 cumplieron criterios de selección. Estos se analizan respecto sus características, propiedades psicométricas y aplicabilidad.Conclusiones: La necesidad de mejorar la atención espiritual en el proceso de morir ha llevado a la aparición de múltiples herramientas de evaluación y acompañamiento espiritual. Su uso debe ponderarse con la experiencia del clínico y su aplicabilidad según el entorno cultural en el que se ha construido y sus propiedades psicométrica
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