Making sense of loss through spirituality: Perspectives of African American family members who have experienced the death of a close family member to cancer

Insights on spirituality and bereavement: A systematic review of qualitative studies

AIM

To describe a synthesis of the experience related to the spirituality of those living a bereavement journey in primary qualitative studies.

DESIGN

A systematic review of qualitative studies.

DATA SOURCE

A systematic review was carried out in March 2019 and was updated in January 2023. Searching was accomplished by an online database, such as CINAHL, MEDLINE, PsycINFO, MedicLatina, LILACS, SciELO and Academic Search Complete. The search strategy did not consider a timeline as an eligibility criterion. The quality of the studies was assessed, and a thematic synthesis was performed in this review.

METHODS

A systematic review of qualitative studies was conducted according to Saini and Shlonsky's methodology.

REPORTING METHOD

PRISMA checklist.

RESULTS

The review included 33 articles. Most of the studies were phenomenological and focused on parents' and family experiences of bereavement. Seven significant categories emerged, which match unmet spiritual needs during the grieving process. Two major categories were identified regarding the role of spirituality in bereavement: Spirituality as a process and spirituality as an outcome.

CONCLUSION

In clinical practice, attention to spirituality and providing spiritual care is critical to guarantee a holistic approach for those experiencing bereavement.

IMPLICATIONS

The findings of our study could foster awareness that healthcare professionals should include the spiritual dimension in their clinical practice to provide holistic care to individuals, enhancing the healing process in bereavement.

NO PATIENT OR PUBLIC CONTRIBUTION

This is a systematic review.

Spirituality in Brazilian family caregivers of patients with cancer from the end-of-life care to bereavement

Although spirituality can be a source of support during end-of-life and engage a transformative experience after loss, few studies report family members' spiritual and existential needs considering their experiences over time. We conducted a longitudinal interpretative phenomenological analysis from audio-recorded interviews of 10 family caregivers while providing end-of-life care for cancer patients and during bereavement. Participants' spirituality experiences were presented in three superordinate themes: connectedness with religious beliefs and the deceased; re-signifying relationships, life, and loss; suffering and the family caregiver's needs. Finding connection through relationships, greater existential and spiritual suffering post-loss were important issues involved in expressing their spirituality.

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

OBJECTIVES

Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks.

METHODS

The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks.

DISCUSSION

Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.

Rigor in Qualitative Methods: An Evaluation of Strategies Among Underrepresented Rural Communities

Achieving rigor using selected criteria to determine trustworthiness using qualitative methods has been without critical evaluation. In this article, strategies such as prolonged engagement and thick, rich description; negative case analysis; peer review or briefing; clarifying researcher bias; member checking; and, investigator triangulation and intercoder reliability are evaluated for appropriateness among an African American Appalachian rural population. Achieving rigor using qualitative methods among participants living in rural communities is time intensive requiring attention to quality versus quantity of time spent in interviews, building trusting relationships, an awareness of interviewer bias and assumptions, and appropriately evaluated strategies that enhance validity. Strategies to achieve rigor in qualitative methods should not be used as a one size fits all approach as this practice might actually diminish rigor. Among underrepresented populations, strategies should be adapted or not used at all.