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Mehta NH, Prajapati M, Aeleti R, Kinariwala K, Ohri K, McCabe S, Buller Z, Leskinen S, Nawabi NL, Bhatt V, Yerigeri K, Babaria V. The Power of a Belief System: A Systematic Qualitative Synthesis of Spiritual Care for Patients with Brain Tumors. J Clin Med 2024; 13:4871. [PMID: 39201013 PMCID: PMC11355862 DOI: 10.3390/jcm13164871] [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: 07/30/2024] [Revised: 08/13/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Diagnosis with a brain tumor is a critical event in the lives of patients and their families due to poor medical prognoses and complex clinical care. Spiritual care interventions have been known to have meaningful effects in morbid diagnoses and palliative medicine, but their role in the neuro-oncologic patient's experience is poorly understood. This systematic review explores the role of spirituality and its relevance to patient care in the diverse setting of brain tumors. Methods: A comprehensive systematic review was conducted following PRISMA-SR guidelines. PUBMED was queried for studies on spirituality and neuro-oncology. Identified studies included RCTs, interviews, surveys, and case reports that examined spirituality in neuro-oncological clinical care, quality of life, and patient experience. Of 214 articles identified, 21 studies met the inclusion criteria, and the results were narratively synthesized. Results: Spirituality may play a significant role in mental well-being by reconciling existential questions faced by both patients and caregivers, and can serve as a valuable resource to improve mental well-being and reduce rates of palliative caregiver burnout. However, the paucity of studies examining the education and integration of spiritual awareness within the clinical literature warrants further study. Conclusions: While spiritual care interventions may improve the quality of life and mental wellness of patients and their caregivers, it is unclear how spiritual awareness and education should best be implemented. Further research is needed to better understand how key components of spiritual awareness can be integrated into medical education to deepen the patient-physician relationship and improve clinical experiences.
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Affiliation(s)
- Neel H. Mehta
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Megh Prajapati
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA;
| | - Rishi Aeleti
- Department of Biology, Cornell University, Ithaca, NY 14850, USA;
| | - Kush Kinariwala
- Texas College of Osteopathic Medicine, Fort Worth, TX 7107, USA;
| | - Karina Ohri
- Department of Pediatrics, Norton College of Medicine, SUNY Upstate, Syracuse, NY 13210, USA;
| | - Sean McCabe
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA;
| | - Zachary Buller
- Department of Chemistry, Harvard University, Cambridge, MA 02138, USA;
| | - Sandra Leskinen
- State University of New York Downstate Medical Center, New York, NY 11203, USA;
| | - Noah L. Nawabi
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Vatsal Bhatt
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - Keval Yerigeri
- Department of Internal Medicine-Pediatrics, Case Western Reserve University/The MetroHealth System, Cleveland, OH 44109, USA
| | - Vivek Babaria
- Orange County Spine and Sports, Interventional Physiatry, Newport Beach, CA 92660, USA;
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Hirsh CD, Grossoehme DH, Tsirambidis H, Richner G, Friebert S. End of Life Therapeutic Videography in Pediatrics: Feasibility and Acceptability. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:465-476. [PMID: 35105195 DOI: 10.1177/00302228211046793] [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] [Indexed: 11/17/2022]
Abstract
Purpose: This study aimed to determine the feasibility and acceptability of using videography to alleviate the stress of anticipatory mourning in pediatric palliative care patients. A secondary aim was to expand palliative/end of life care research by performing a more comprehensive examination of children's experiences with life-shortening illness. Methods: Eligible patients ages eight and older made a legacy video with the assistance of investigative staff and completed a questionnaire to evaluate their emotional states before and after making the video. Bereaved parents also received a questionnaire to assess the impact of the legacy. Results: Nine patients enrolled and eight completed the study through the therapeutic exit interview. Most reported decreased anxiety and a positive experience. Conclusion: Therapeutic videography is feasible and acceptable to accomplish and can improve the emotional state of participants. Conducting research requiring active participation of patients very near the end of life proved to be challenging.
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Affiliation(s)
- Cassandra D Hirsh
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH, USA
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Daniel H Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH, USA
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, OH, USA
- Department of Family & Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Haralambos Tsirambidis
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH, USA
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Gwendolyn Richner
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH, USA
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH, USA
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, OH, USA
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
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Rhee JY, Strander S, Podgurski A, Chiu D, Brizzi K, Forst DA. Palliative Care in Neuro-oncology: an Update. Curr Neurol Neurosci Rep 2023; 23:645-656. [PMID: 37751050 DOI: 10.1007/s11910-023-01301-2] [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] [Accepted: 09/02/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW While the benefits of palliative care for patients with cancer are well established, palliative care in neuro-oncology is still in its early stages. However, in recent years, there has been increasing attention drawn to the need for better palliative care for patients with brain tumors. RECENT FINDINGS There is a growing body of literature demonstrating the high symptom burden and significant supportive care and information needs of these patients and their caregivers. In the area of caregiver needs, the last 3 years has seen a more rapid growth in recognizing and characterizing these needs. However, there remains a knowledge gap regarding the optimal means of addressing these needs. In this article, we outline important recent advances in the literature on palliative care for patients with brain tumors and highlight areas in need of greater attention and investigation.
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Affiliation(s)
- John Y Rhee
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA.
- Department of Neuro-Oncology, Dana Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Alyx Podgurski
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA
| | - Daniel Chiu
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA
- Department of Neuro-Oncology, Dana Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kate Brizzi
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah A Forst
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Boles JC, Jones MT. Legacy perceptions and interventions for adults and children receiving palliative care: A systematic review. Palliat Med 2021; 35:529-551. [PMID: 33487090 DOI: 10.1177/0269216321989565] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Legacy has been invoked as a means for strengthening human attachments, continuing bonds, and ensuring that individuals will be remembered; however, little is known about the spectrum of approaches to, outcomes associated with, and best practices for legacy interventions. AIM To systematically review research on legacy perceptions and interventions in pediatric and adult palliative care recipients. DESIGN A systematic mixed studies review synthesizing quantitative, qualitative, and mixed-methods study findings using PRISMA guidelines. DATA SOURCES PubMed, PsycINFO, and CINAHL databases were searched on October 1, 2020. GRADE criteria were used to assess quality of quantitative reports, and the Johns Hopkins Evidence Level and Quality Guide was used to rate qualitative, mixed methods, and review articles. Data were synthesized using integrative thematic analysis. RESULTS The 67 studies reviewed describe a variety of legacy perceptions and interventions with adult and pediatric patients receiving palliative care. Statistically significant improvements in various dimensions of wellbeing are documented, with significant reduction in incidence and symptoms of depression in adults. Studies highlight the utility, feasibility, and perceived benefits of legacy interventions according to adult patients and their caregivers, and parents/caregivers of pediatric patients. CONCLUSIONS Though future research with high-quality, experimental designs is needed, the positive outcomes associated with legacy interventions are documented in adult patient populations; additionally, the application of legacy interventions for children with serious illnesses receiving palliative care is reasonable based on the existing body of evidence. A consistent and operational concept of legacy is still needed for future research and practice.
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Affiliation(s)
- Jessika C Boles
- Child Life Department, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Maile T Jones
- Child Life Department, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Thakkar P, Greenwald BD, Patel P. Rehabilitation of Adult Patients with Primary Brain Tumors: A Narrative Review. Brain Sci 2020; 10:brainsci10080492. [PMID: 32751074 PMCID: PMC7464729 DOI: 10.3390/brainsci10080492] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 11/16/2022] Open
Abstract
Rehabilitative measures have been shown to benefit patients with primary brain tumors (PBT). To provide a high quality of care, clinicians should be aware of common challenges in this population including a variety of medical complications, symptoms, and impairments, such as headaches, seizures, cognitive deficits, fatigue, and mood changes. By taking communication and family training into consideration, clinicians can provide integrated and patient-centered care to this population. This article looks to review the current literature in outpatient and inpatient rehabilitation options for adult patients with PBTs as well as explore the role of the interdisciplinary team in providing survivorship care.
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Affiliation(s)
- Parth Thakkar
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA; (P.T.); (P.P.)
| | - Brian D. Greenwald
- JFK Johnson Rehabilitation Institute, Edison, NJ 08820, USA
- Correspondence:
| | - Palak Patel
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA; (P.T.); (P.P.)
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Piderman KM, Radecki Breitkopf C, Jenkins SM, Ingram C, Sytsma TT, Lapid MI, Tata BS, Chatterjee K, Egginton JS, Jatoi A. Hearing and Heeding the Voices of those With Advanced Illnesses. J Palliat Care 2020; 35:248-255. [PMID: 32466734 DOI: 10.1177/0825859720928623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the feasibility of a chaplain-led spiritually focused life review interview and the development of a spiritual legacy document (SLD) for patients with advanced diseases and to describe changes in spiritual well-being (SWB), spiritual coping strategies (SC), and quality of life (QOL) after receiving the SLD. PATIENTS AND METHODS In all, 130 patients and support person (SP) pairs were recruited from July 2012 to January 2019. Following enrollment, demographic information was gathered and baseline questionnaires were administered. Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) and a linear analog scale assessment (LASA) measured SWB. LASAs also measured QOL and emotional well-being (EWB). Positive Religious Coping Scale (RCOPE) measured SC. After completion of baseline forms, participants were interviewed (individually) by a chaplain. Interviews were digitally recorded, transcribed, and verified. Transcripts were edited and participants were given the opportunity to make adaptations. The participant-approved draft was then developed into a professionally printed SLD. Follow-up questionnaires were administered to assess change. RESULTS Significant improvements from baseline to post-SLD follow-up were found for patients on the LASAs: SWB (average 7.7-8.3, P = .01), QOL (average 6.7-7.3, P = .03), EWB (average 6.9-7.5, P = .01), and on the positive RCOPE (average 1.8-2.0, P = .007). Effect sizes were approximately 0.25. Considering any improvement, 61.0% improved their positive RCOPE score, 46.6% improved EWB, and 39.7% improved SWB. No significant changes were found on the FACIT-Sp-12. No significant changes were found for SPs. CONCLUSION The results suggest that the primary participants who completed the study benefited by significantly increasing their QOL, SWB, EWB, and SC.
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Affiliation(s)
- Katherine M Piderman
- Department of Chaplain Services, 4352Mayo Clinic, Rochester, MN, USA.,Department of Psychiatry and Psychology, 4352Mayo Clinic, Rochester, MN, USA
| | | | - Sarah M Jenkins
- Statistician III, Division of Biostatistics and Informatics, 4352Mayo Clinic, Rochester, MN, USA
| | - Cory Ingram
- Department of Family Medicine, 4352Mayo Clinic, Rochester, MN, USA
| | - Terin T Sytsma
- Community Internal Medicine, Instructor in Medicine, 4352Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, 4352Mayo Clinic, Rochester, MN, USA
| | - Beba S Tata
- Department of Chaplain Services, 4352Mayo Clinic, Rochester, MN, USA
| | | | - Jason S Egginton
- Center for Science of Health Care Delivery, 4352Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- Department of Medical Oncology, 4352Mayo Clinic, Rochester, MN, USA
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Piderman KM. On These Holy Mountains. J Health Care Chaplain 2020; 28:63-68. [PMID: 32251607 DOI: 10.1080/08854726.2020.1745488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Chaplains are charged with the essential task of reflecting on their experiences and developing their insights into formats that can be shared with others. This brief report summarizes the spiritual distress and coping of four participants in the Hear My Voice pilot study for patients with advanced diseases, and includes questions for reflection on spiritual care and further research. It emphasizes the importance of taking time to listen deeply to one's experiences and the work of others to gain insight and perspective, contribute to the knowledge of others in writing, teaching and research, and advance best practices in spiritual care.
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Affiliation(s)
- Katherine M Piderman
- Departments of Chaplain Services and Pschiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Fitchett G. Recent Progress in Chaplaincy-Related Research. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2017; 71:163-175. [PMID: 28893170 DOI: 10.1177/1542305017724811] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In light of the continued growth of chaplaincy-related research this paper presents an overview of important findings. The review summarizes research in six broad areas: what chaplains do; the importance of religion and spiritual care to patients and families; the impact of chaplains' spiritual care on the patient experience; the impact of chaplain care on other patient outcomes; spiritual needs and chaplain care in palliative and end of life care; and chaplain care for staff colleagues. It concludes with a description of several innovative and important new studies of chaplain care and notes areas for future investigation.
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Affiliation(s)
- George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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Dose AM, Rhudy LM. Perspectives of newly diagnosed advanced cancer patients receiving dignity therapy during cancer treatment. Support Care Cancer 2017; 26:187-195. [PMID: 28733697 DOI: 10.1007/s00520-017-3833-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Dignity therapy is a psychosocial intervention that has been used primarily at the end of life to improve quality of life and other patient outcomes, but many individuals are unable to complete it due to health decline and death. The purpose of this study was to identify what individuals with advanced pancreatic or lung cancer with limited life expectancy, undergoing active cancer treatment describe during the dignity therapy intervention as important to them when not immediately facing end of life. METHODS Twenty patients undergoing chemotherapy for advanced cancer participated in a dignity therapy intervention study. Initial interviews were analyzed using descriptive content analysis. RESULTS Family provided the overall context and background for emerging themes of defining events, accomplishments, and God's plan, which led to lessons learned, and resulted in messages of hope. Interviews were often autobiographical in nature and contained much reminiscence, consistent with dignity therapy's intent. Few participants spoke about their cancer diagnoses during the interview. CONCLUSIONS This study adds unique insight into the use of dignity therapy for those still receiving active cancer treatment, different from work by others in which it was offered only at end of life. As part of supportive care, clinicians need to validate the importance of family to those with advanced cancer and to provide opportunities for patients to share what they have learned throughout life and to impart messages of hope to those closest to them.
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Affiliation(s)
- Ann Marie Dose
- Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Lori M Rhudy
- Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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