Spiritual, Religious, and Existential Aspects of Palliative Care

End-of-life care for Filipino patients with cancer

Providing end-of-life care within the cultural context of a Filipino patient in the United States is a complex process for clinicians, patients, and their families. An inclusive approach is crucial, especially because a significant proportion of patients belong to minority groups such as Filipinos, who represent the fourth largest group of immigrants in the United States as of data available in 2019. The case provided in this paper highlights the importance of family, religion, and finances in guiding the best possible way of providing end-of-life care for Filipino patients with cancer. At the end of this review, we discuss concrete action points that may give a non-Filipino physician a deeper understanding of end-of-life care for Filipinos.

Spiritual Needs of Older Adults during Hospitalization: An Integrative Review

A hospital admission presents various challenges for a patient which often result in high or intense spiritual needs. To provide the best possible care for older adults during hospitalization, it is essential to assess patients’ spiritual needs. However, little research has been done into the spiritual needs of geriatric patients. This article seeks insight into what is known in the literature on the spiritual needs of geriatric patients. This integrative review presents a summary of the articles on this topic. To select eligible studies, the PRISMA Flow Diagram was used. This resulted in ten articles that have been reviewed. Results show (1) a wide interest in researching spiritual needs, using different research designs. In addition, (2) four subcategories of spiritual needs can be distinguished: (a) the need to be connected with others or with God/the transcendent/the divine, (b) religious needs, (c) the need to find meaning in life, and (d) the need to maintain one’s identity. Moreover, results show that (3) assessing spiritual needs is required to provide the best possible spiritual care, and that (4) there are four reasons for unmet spiritual needs. Further research is needed on the definition of spiritual needs and to investigate older patients’ spiritual needs and the relation with their well-being, mental health and religious coping mechanisms, in order to provide the best spiritual care.

Exploring Elder Neglect: New Theoretical Perspectives and Diagnostic Challenges

Background and Objectives

Neglect of older adults is a complex and important social problem which is difficult to detect. The aim of this review is to explore and categorize different characteristics of elder neglect, to facilitate a uniform conceptualization and provide recommendations for identification of the phenomenon.

Research Design and Methods

Articles published between January 1990 and February 2019, both from developed and developing countries, were taken into consideration. The literature search was performed in PubMed, Web of Science, and CINAHL using keywords related to elder abuse and neglect. Articles regarding the concept of elder neglect, identifying or measuring this phenomenon were reviewed. The identified indicators were presented according to the Maslow’s hierarchy of needs.

Results

From 7,207 articles found in the initial search, 63 relevant studies were selected for the final analysis. Indicators most frequently used by researchers (functionality, physical appearance and health, social and psychological background, mental health, and environment) correspond to different aspects of needs. Caregiver’s responsibility, satisfaction of needs, and risk of harm are the core elements to consider in identification of neglect.

Discussion and Implications

The identified elements and categories of indicators provide the framework for developing standard definitions and measures of elder neglect. The proposed diagram demonstrates gaps in identification and can be useful in detecting potential neglect in various categories of needs. Further research on perceptions and prevalence of elder neglect in different countries would be helpful for cross-country analysis as well as for adaptation of the instruments to cultural specifics.

The Role of Social Workers in Spiritual Care to Facilitate Coping With Chronic Illness and Self-Determination in Advance Care Planning

Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions. To the extent of their individual expertise and competence, social workers should assess and provide spiritual care to clients, including those who either are underserved or prefer not to seek assistance from clergy or chaplains because they feel alienated from religious institutions and representatives. They should also be aware of ethical dilemmas in consulting with spiritual care professionals in developing spiritual interventions. Social work education should address clients' humanistic and existential concerns, beliefs and behaviors of the major religions, and forms of nontraditional religious and spiritual experiences; it should also provide experiential opportunities for engaging with grief and earlier advance care planning. There should be attention to different theodical perspectives of the major religions regarding the problem of good and evil, which may preoccupy even clients who no longer participate in organized religion, because these unresolved existential issues may weaken client coping with chronic conditions and may diminish clarity and self-awareness for engaging authentically and effectively in advance care planning.

The Impact of a Novel Tool for Comprehensive Assessment of Palliative Care (MPCAT) on Assessment Outcome at 6- and 12-Month Follow-Up

CONTEXT

Assessment in palliative care settings should be focused, sensitive, specific, and effective to minimize discomfort to vulnerable and often highly morbid patients. This report describes the development of an admission assessment protocol for a Specialist Palliative Care Inpatient Unit and its implementation into clinical practice.

OBJECTIVES

The aim of this study was to develop and investigate the impact of the implementation of a Specialist Palliative Care admission assessment tool on documentation of key patient needs.

METHODS

The outcome of a systematic literature review was used to develop an admission assessment protocol (the intervention) in a Specialist Palliative Care Inpatient Unit. Mixed methods were used to facilitate a comprehensive evaluation pre- and post-intervention to test the effectiveness, feasibility, and acceptability of the intervention.

RESULTS

The documented evidence of pain assessment improved from a baseline rate of 71% to 100% post-intervention. This improvement was maintained 12 months post-introduction of the tool (P < 0.001). The documented evidence of screening for spiritual distress increased from a baseline rate of 23% to 70% at 6 months and to 82% at 12 months (P < 0.001). The number of referrals made in the first 24 hours after assessment increased post-intervention (physiotherapy, P = 0.001; occupational therapy, P = 0.001; social work, P = 0.005; pastoral care, P = 0.005); this was maintained at 12 months. Significantly, more clinicians (88%) agreed that palliative care domains were comprehensively assessed post-intervention in comparison with 59% pre-intervention (P = 0.01).

CONCLUSION

Introducing the Milford Palliative Care Assessment Tool was associated with significant improvement in assessment of multiple important aspects of patient need.

Spiritual care in the training of hospice volunteers in Germany

OBJECTIVE

Hospice volunteers often encounter questions related to spirituality. It is unknown whether spiritual care receives a corresponding level of attention in their training. Our survey investigated the current practice of spiritual care training in Germany.

METHOD

An online survey sent to 1,332 hospice homecare services for adults in Germany was conducted during the summer of 2012. We employed the SPSS 21 software package for statistical evaluation.

RESULTS

All training programs included self-reflection on personal spirituality as obligatory. The definitions of spirituality used in programs differ considerably. The task of defining training objectives is randomly delegated to a supervisor, a trainer, or to the governing organization. More than half the institutions work in conjunction with an external trainer. These external trainers frequently have professional backgrounds in pastoral care/theology and/or in hospice/palliative care. While spiritual care receives great attention, the specific tasks it entails are rarely discussed. The response rate for our study was 25.0% (n = 332).

SIGNIFICANCE OF RESULTS

A need exists to develop training concepts that outline distinct contents, methods, and objectives. A prospective curriculum would have to provide assistance in the development of training programs. Moreover, it would need to be adaptable to the various concepts of spiritual care employed by the respective institutions and their hospice volunteers.

Coping strategies for existencial and spiritual suffering in Israeli patients with advanced cancer

Coping with existential and spiritual concerns is inescapable in end-of-life care although not enough is known about the strategies and mechanisms involved. This pilot study focused on identifying the strategies for coping with existential and spiritual suffering at the end of life of secular Jews with advanced-stage cancer. Using the phenomenological approach to data collection, in-depth interviews were conducted with 22 patients receiving symptom relief care at a daycare oncology clinic. The interviews were recorded and transcribed verbatim, and the content was analyzed.

Advanced-stage cancer patients employ several approaches to cope with existential and spiritual concerns. The themes emerging from the interviews present five dimensions of coping strategies: openness and choosing to face reality, connectedness and the significance of family, pursuit of meaning, the connection of body, mind and spirit and, lastly, humor and a positive outlook.

Anger: a common form of psychological distress among patients at the end of life

Psychological distress is common in palliative care patients and their families, and anger is a complex component of distress experienced by many patients at the end of life. Anger can be a form of tension release, as well as a coping mechanism for the patient and a way to disguise fear and anxiety. The interdisciplinary team are responsible for recognising psychological distress in patients, assessing their needs, and providing adequate psychological support. Although a certain level of psychological distress such as anger is expected in terminally ill patients owing to their situation, such responses may also be dysfunctional. This paper aims to highlight the challenges and complexities of adequately assessing and supporting palliative care patients who are presenting with psychological distress in the form of anger, in order to relieve their suffering and assist them in resolving their issues and improving their quality of life. Anger can be difficult to treat, and for some patients can be more distressing than some physical symptoms. Hence this paper also aims to offer anger management guidance to palliative care practitioners.

Palliative care for children with cancer

Over the past two decades, paediatric palliative care has emerged as both a primary approach and as its own medical subspecialty, the overall aim of which is to ease suffering for children with life-threatening illness and their families through a concurrent model of care. However, most discussions have been focused on the transition to palliative care when no realistic hope for cure exists. We believe that, because the course of cancer is so unpredictable, this idea is misleading. Indeed, palliative care is increasingly being recognized as being about not just how to cope with the process of dying, but also about how to engage in living when faced with a life-threatening illness. This article will examine our current understanding of several areas of palliative care, with the ultimate message that palliative care is simply a novel term for the total care of a child and family, an approach that should be applied consistently and concurrently regardless of disease status. By improving familiarity with palliative care and building relationships with palliative care specialists, the paediatric oncology clinician will ensure that the best care possible for children and families is provided, regardless of outcome.

Beyond knowledge and skills: self-competence in working with death, dying, and bereavement

This study explored helping professionals' views on death work competencies. A total of 176 helping professionals were invited to state what the necessary competencies in death work are. Content analysis was conducted. Results showed that death work competencies can be categorized into 4 major areas: (a) knowledge competence, (b) practice competence, (c) self-competence, and (d) work-environment competence. Self-competence was the most frequently mentioned by the participants. Self-competence was further categorized into 3 themes: (a) personal resources, (b) existential coping, and (c) emotional coping. Findings reflect helping professionals' emphasis on the role of self and personal preparation in doing death work. Implications on future death education and training for helping professionals were discussed.

Religion and Spirituality as Important Components of Men’s Health and Wellness

Men’s health has been receiving increased attention in health care research and practice because of associated negative outcomes and men’s reluctance to seek help. Religion or religiosity, defined as involvement in an organized, structured community focused on moral code, and spirituality, defined as the subjective, mystical, and holistic interpretation of personal beliefs and behaviors, have been associated with positive health outcomes. Specifically, religion and spirituality mediate an increase in positive health outcomes and a decrease in risk factors through social and existential well-being. However, men seem to be less religious and spiritual compared with women, a potential problem as men may be missing an important pathway to health and wellness. This state-of-the-art review examines the intersections of religion, spirituality, and health and focuses on how religion and spirituality relate specifically to men’s health and health behaviors. Subsequently, 4 health problems with religious and spiritual implications are examined that have been identified in the literature as pertinent to men’s health: (a) prostate cancer screening and coping, (b) HIV/AIDS prevention and coping, (c) addictions, and (d) palliative care. Finally, suggestions are offered for clinicians to incorporate an understanding of religion and spirituality into their patient encounters.

Older Adults’ Spiritual Needs in Health Care Settings

Recognizing that spiritual needs often emerge in health care settings, the Joint Commission requires spiritual assessments in numerous organizations frequented by older adults. Given that many gerontological practitioners have received little training in identifying spiritual needs, a qualitative meta-synthesis ( N = 9 studies) was conducted to identify and describe older adults’ perceptions of their spiritual needs in health care settings. Five interrelated categories emerged: (a) spiritual practices; (b) relationship with God; (c) hope, meaning, and purpose; (d) interpersonal connection; and (e) professional staff interactions. The implications of the findings are discussed as they inform the spiritual assessment process.

Artificial nutrition and hydration at the end of life

Considerable controversy surrounds the issue of care at the end of life (EOL) for older adults. Technological advances and the legal, ethical, clinical, religious, cultural, personal, and fiscal considerations in the provision of artificial hydration and nutrition support to older adults near death are presented in this comprehensive review.

Existential suffering in the palliative care setting: an integrated literature review

CONTEXT

Existential and spiritual concerns in relation to palliative end-of-life care have received increasing attention over the past decade.

OBJECTIVES

To review the literature specifically related to existential suffering in palliative care in terms of the significance of existential suffering in end-of-life care, definitions, conceptual frameworks, and interventions.

METHODS

A systematic approach was undertaken with the aim of identifying emerging themes in the literature. Databases using CINAHL (1980-2009), MEDLINE (1970-2009), and PsychINFO (1980-2009) and the search engine of Google Scholar were searched under the key words existential suffering, existential distress, existential pain, palliative and end of life care.

RESULTS

The search yielded a total of 156 articles; 32% were peer-reviewed empirical research articles, 28% were peer-reviewed theoretical articles, and 14% were reviews or opinion-based articles. After manually searching bibliographies and related reference lists, 64 articles were considered relevant and are discussed in this review. Overall analysis identifies knowledge of the following: 1) emerging themes related to existential suffering, 2) critical review of those identified themes, 3) current gaps in the research literature, and 4) recommendations for future research. Findings from this comprehensive review reveal that existential suffering and deep personal anguish at the end of life are some of the most debilitating conditions that occur in patients who are dying, and yet the way such suffering is treated in the last days is not well understood.

CONCLUSION

Given the broad range of definitions attributed to existential suffering, palliative care clinicians may need to be mindful of their own choices and consider treatment options from a critical perspective.

Situated clinical encounters in the negotiation of religious and spiritual plurality: a critical ethnography

BACKGROUND

Despite increasingly diverse, globalized societies, little attention has been paid to the influence of religious and spiritual diversity on clinical encounters within healthcare.

OBJECTIVES

The purpose of the study was to analyze the negotiation of religious and spiritual plurality in clinical encounters, and the social, gendered, cultural, historical, economic and political contexts that shape that negotiation.

DESIGN

Qualitative: critical ethnography.

SETTINGS

The study was conducted in Western Canada between 2006 and 2009. Data collection occurred on palliative, hospice, medical and renal in-patient units at two tertiary level hospitals and seven community hospitals.

PARTICIPANTS

Participants were recruited through purposive sampling and snowball technique. Twenty healthcare professionals, seventeen spiritual care providers, sixteen patients and families and twelve administrators, representing diverse ethnicities and religious affiliations, took part in the study.

METHODS

Data collection included 65 in-depth interviews and over 150h of participant observation.

RESULTS

Clinical encounters between care providers and recipients were shaped by how individual identities in relation to religion and spirituality were constructed. Importantly, these identities did not occur in isolation from other lines of social classification such as gender, race, and class. Negotiating difference was a process of seeing spirituality as a point of connection, eliciting the meaning systems of patients and creating safe spaces for the expression of that meaning.

CONCLUSIONS

The complexity of religious and spiritual identity construction and negotiation raises important questions about language and about professional competence and boundaries in clinical encounters where religion and spirituality are relevant concerns.

Content and spiritual items of quality-of-life instruments appropriate for use in palliative care: a review

Despite the importance of palliative care and quality of life (QoL) as an outcome measure, little research evaluated the QoL instruments that are used in end-of-life situations. We evaluated the content of and domains measured by QoL instruments that are suitable for use in palliative care and how the domain of spirituality was operationalized in these instruments. We conducted two literature reviews. One identified the domains that are most important for the QoL of incurably ill patients and resulted in a framework of QoL domains. The other review identified 29 instruments measuring (at least one domain of) QoL that are appropriate for use in palliative care. Most of the instruments covered only one or two QoL domains, and none of the instruments covered all QoL domains included in the framework. Among the 29 instruments, 15 included items on spirituality. We also categorized the spirituality items contained in the instruments into the spirituality aspects in the framework. Most spirituality items concerned the meaning or purpose of life. This study provides information about the domains included in QoL instruments that are suitable for use in palliative care and provides insights into the differences in content, which can be helpful when choosing an instrument for use in palliative care.

Providers and types of spiritual care during serious illness

OBJECTIVE

Patients and palliative care experts endorse the importance of spiritual care for seriously ill patients and their families. However, little is known about spiritual care during serious illness, and whether it satisfies patients' and families' needs. The objective of this study was to describe spiritual care received by patients and families during serious illness, and test whether the provider and the type of care is associated with satisfaction with care.

METHODS

Cross-sectional interview with 38 seriously ill patients and 65 family caregivers about spiritual care experiences.

RESULTS

The 103 spiritual care recipients identified 237 spiritual care providers; 95 (41%) were family or friends, 38 (17%) were clergy, and 66 (29%) were health care providers. Two-thirds of spiritual care providers shared the recipient's faith tradition. Recipients identified 21 different types of spiritual care activities. The most common activity was help coping with illness (87%) and the least common intercessory prayer (4%). Half of recipients were very or somewhat satisfied with spiritual care, and half found it very helpful for facilitating inner peace and meaning making. Satisfaction with spiritual care did not differ by provider age, race, gender, role, or frequency of visits. Types of care that helped with understanding or illness coping were associated with greater satisfaction with care.

CONCLUSION

Seriously ill patients and family caregivers experience spiritual care from multiple sources, including health care providers. Satisfaction with this care domain is modest, but approaches that help with understanding and with coping are associated with greater satisfaction.

Religious Activities of Inpatients and Their Family Visitors in Taiwan

Purpose: The purpose was to investigate the contributing factors of practicing religious activities (prayer and attending religious services) that help in overcoming the health problems that had led to the current hospitalization. These activities may be a proxy measure for religious coping with health problems. Design: An exploratory survey study was used. Methods: A convenience sample was determined. Data were collected in 2005 in the inpatient wards of a Taiwanese hospital ( n = 1,031 patients and family visitors). Binary logistic regression analyses were used. Findings: Of the participants, 75% offered prayer to their god(s) for help and 57.4% attended a church/temple service. Being a patient and having a longer hospital stay contributed to the increased probability of offering prayer and attending religious services. Conclusions: Prayer and religious service attendance were practiced by the majority of those hospitalized patients and their family. Enriching our understanding of the religious needs of the patients and their family should be continued.