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Seiler A, Amann M, Hertler C, Christ SM, Schettle M, Kaeppeli BM, Jung-Amstutz J, Nigg C, Pestalozzi BC, Imesch P, Dummer R, Blum D, Jenewein J. Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers - a randomized controlled study. BMC Palliat Care 2024; 23:73. [PMID: 38486192 PMCID: PMC10938771 DOI: 10.1186/s12904-024-01408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND This study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs. METHODS In this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADStot ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention. RESULTS The coalesced group (DT and DT +) revealed a significant increase in patients' perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADStot of patients in the intervention group remained stable over the pre-post period, the control group's HADStot increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation. CONCLUSIONS The DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter most to them over their loved one's final days. TRIAL REGISTRATION This study was registered with Clinical Trial Registry (ClinicalTrials.gov -Protocol Record NCT02646527; date of registration: 04/01/2016). The CONSORT 2010 guidelines were used for properly reporting how the randomized trial was conducted.
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Affiliation(s)
- Annina Seiler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Manuel Amann
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian M Christ
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | | | | | | | - Bernhard C Pestalozzi
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patrick Imesch
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Josef Jenewein
- Privatklinik Hohenegg, Meilen, Switzerland
- University of Zurich, Zurich, Switzerland
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Seiça Cardoso C, Rita Matos J, Prazeres F, Gomes B. Non-pharmacological interventions in primary care to improve the quality of life of older patients with palliative care needs: a systematic review of randomised controlled trials. BMJ Open 2023; 13:e073950. [PMID: 38070901 PMCID: PMC10729137 DOI: 10.1136/bmjopen-2023-073950] [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: 03/24/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Our systematic review aimed to summarise non-pharmacological interventions applicable in primary care that improve the quality of life of older patients with palliative care needs. DESIGN Systematic review. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was patients' quality of life. Secondary outcomes were symptoms relief and patients' well-being measures. METHODS AND ANALYSIS We searched MEDLINE, EMBASE, PsycINFO, Cochrane and CINAHL up to October 2022 for randomised controlled trials (RCTs). We also handsearched abstract books of relevant congresses and scientific meetings in the last 5 years. Screening, data extraction and quality evaluation (Cochrane risk-of-bias (RoB) V.2.0 tool and Grading of Recommendations, Assessment, Development and Evaluations (GRADE)) were done independently by two reviewers, with disagreements solved by a third reviewer. Findings were narratively synthesised. RESULTS We identified 4 RCTs, including 268 patients. One study used a broad criteria of palliative care needs ('progressive, life-threatening disease'), two studies focused on advanced cancer and one study on heart failure. The non-pharmacological interventions evaluated were advance care planning conducted by general practitioners (GPs); social worker-aided palliative care; online primary palliative care training for GPs and spiritual history taking by nurses and GPs. No intervention showed a statistically significant impact on quality of life and the evidence was low according to GRADE. CONCLUSION The results highlight a dearth of evidence on what non-pharmacological interventions can be effectively done in primary care to improve the quality of life of older persons with palliative care needs. The results should be interpreted with caution, as the search more comprehensively covers interventions delivered by GPs. PROSPERO REGISTRATION NUMBER CRD42020154216.
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Affiliation(s)
- Carlos Seiça Cardoso
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | | | - Filipe Prazeres
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Faculty of Health Sciences, Universidade da Beira Interior Faculdade de Ciencias da Saude, Covilha, Portugal
| | - Barbara Gomes
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Macciò A, Sanna E, Piras R, Lavra F, Vallerino V, Maricosu G, Giglio E, Mura A, Tidore M, Madeddu C. Survival as a clinical outcome and its spiritual significance in a cohort of patients with advanced central pelvic neoplastic disease undergoing total pelvic evisceration: a poorly debated issue. Front Med (Lausanne) 2023; 10:1173687. [PMID: 37359011 PMCID: PMC10288149 DOI: 10.3389/fmed.2023.1173687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background Patients with either treatment-resistant or relapsing advanced central pelvic neoplastic disease present with a condition responsible for debilitating symptoms and consequently poor quality of life (QoL). For these patients, therapeutic strategies are very limited and total pelvic evisceration is the only option for relieving the symptoms and increasing survival. Of note, taking charge of these patients cannot be limited to increasing their lifespan but must also be aimed at improving the clinical, psychological, and spiritual conditions. This study aimed to prospectively evaluate the improvement in survival and QoL, focusing on spiritual wellbeing (SWB), in patients with poor life expectancy who underwent total pelvic evisceration for advanced gynecological cancers at our center. Patients and methods The QoL and SWB were assessed using the European Organisation for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30), EORTC QLQ-SWB32, and SWB scale, which were repeatedly administered: 30 days before surgery, 7 days after the procedure, 1 and 3 months after surgery, and then every 3 months until death or the last follow-up assessment. Operative outcomes (blood loss, operative time, hospitalization, and incidence of complications) were evaluated as secondary endpoints. The patients and their families were included in a dedicated psycho-oncological and spiritual support protocol, which was managed by specifically trained and specialized personnel who accompanied them during all phases of the study. Results A total of 20 consecutive patients from 2017 to 2022 were included in this study. Of these patients, 7 underwent total pelvic evisceration by laparotomy and 13 underwent laparoscopy. The median survival was 24 months (range: 1-61 months). After a median follow-up of 24 months, 16 (80%) and 10 patients (50%) were alive at 1 year and 2 years after surgery, respectively. The EORTC-QLQ-C30 scores significantly improved yet at 7 days and at 1, 3, 6, and 12 months, as compared with the preoperative values. In particular, an early improvement in pain, overall QoL, and physical and emotional functions was observed. With respect to the SWB, the global SWB item score of the EORTC QLQ-SWB32 questionnaire significantly increased after 1 month and 3 months, as compared with preoperative values (p = 0.0153 and p = 0.0018, respectively), and remained stable thereafter. The mean SWB scale score was 53.3, with a sense of low overall SWB in 10 patients, a sense of moderate SWB in eight patients, and a sense of high SWB in two patients. The SWB scale score significantly increased after 7 days, 1 month, and 3 months, as compared with the preoperative value (p = 0202, p = 0.0171, and p = 0.0255, respectively), and remained stable thereafter. Conclusion Total pelvic evisceration is a valid approach for improving both survival and QoL in selected patients with advanced pelvic neoplasms and poor life expectancy. Our results particularly underline the importance of accompanying the patients and their families during the journey with dedicated psychological and spiritual support protocols.
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Affiliation(s)
- Antonio Macciò
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Elisabetta Sanna
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Roberta Piras
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Fabrizio Lavra
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Valerio Vallerino
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Giovanni Maricosu
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Emanuela Giglio
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | | | | | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Goyarrola R, Lipsanen J, Saarelainen SM, Suviranta R, Rahko E, Lamminmäki A, Klaavuniemi T, Ahtiluoto S, Ohvanainen A, Metso P, Pöyhiä R. Spiritual well-being correlates with quality of life of both cancer and non-cancer patients in palliative care - further validation of EORTC QLQ-SWB32 in Finnish. BMC Palliat Care 2023; 22:33. [PMID: 36991431 PMCID: PMC10061907 DOI: 10.1186/s12904-023-01153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The European Organisation for Research and Treatment of Cancer (EORTC) has developed the Spiritual Well-being Questionnaire (EORTC QLQ-SWB32), a measure of spiritual well-being validated with people receiving palliative care for cancer, although its usefulness is not restricted to that population. We aimed to translate and validate this tool in Finnish and to study the relationship between spiritual well-being (SWB) and quality of life (QOL). METHODS A Finnish translation was produced according to the guidelines of EORTC and included forward- and back-translations. Face, content, construct and convergence/divergence validity and reliability were studied in a prospective manner. QOL was assessed with EORTC QLQ-C30 and 15D questionnaires. Sixteen individuals participated in the pilot testing. 101 cancer patients drawn from oncology units, and 89 patients with other chronic diseases drawn from religious communities in different parts of the country participated in the validation stage. Retest was obtained from 16 individuals (8 cancer and 8 non-cancer patients). Inclusion criteria included patients with either a well-defined palliative care plan, or who would benefit from palliative care, as well as the capacity to understand and communicate in Finnish. RESULTS The translation appeared understandable and acceptable. Factorial analysis identified four scoring scales with high Cronbach alfa values: Relationship with Self (0.73), Relationship with Others (0.84), Relationship with Something Greater (0.82), Existential (0.81), and, additionally, a scale on Relationship with God (0.85). There was a significant correlation between SWB and QOL in all participants. CONCLUSIONS The Finnish translation of EORTC QLQ-SWB32 is a valid and reliable measure both for research and clinical practice. SWB is correlated with QOL in cancer and non-cancer patients undergoing palliative care or who are eligible for it.
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Affiliation(s)
- Raimo Goyarrola
- School of Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Jari Lipsanen
- Department of Statistics, University of Helsinki, Helsinki, Finland
| | - Suvi-Maria Saarelainen
- School of Theology, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Raili Suviranta
- Diaconia Journal, Evangelical Lutheran Church of Finland, Helsinki, Finland
| | - Eeva Rahko
- Department of Oncology, University Hospital, Oulu, Finland
| | | | | | | | - Antti Ohvanainen
- Palliative care unit and hospital at home, Siun sote, Joensuu, Finland
| | - Pekka Metso
- School of Theology, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Reino Pöyhiä
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Palliative Center, Essote, Mikkeli, Finland
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Baczewska B, Wojciechowska K, Antoszewska B, Malm M, Leśniewski K. The Cognitive Aspect of Hope in the Semantic Space of Male Patients Dying of Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1094. [PMID: 36673850 PMCID: PMC9858655 DOI: 10.3390/ijerph20021094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
The aim of this study is to characterize the cognitive aspect of the semantic space of hope in patients in the terminal stage of cancer. This was confirmed in the research on hope by C. R. Snyder and B. Schrank. Hope is of great importance in all the great world religions and belief systems, both as regards a personal God or impersonal deities. Hoping is a human capacity with varying affective, cognitive and behavioral dimensions. Psychological, pedagogical (particularly in the framework of special needs pedagogy and thanatological pedagogy) and theological reflection on hope can provide support for dying people. In order to conduct the research, the semantic differential research method was selected. The research technique employed was a therapeutic conversation, and the research tool was the B.L. Block's DSN-3 test. The DSN-3 test allows one to assess hope in the semantic space in three aspects: cognitive, emotional and functional. For the purposes of this study, only the cognitive aspect was taken into account. The study was begun on 1 April 2010 and ended in the last days of December 2020. It included 110 male patients in the terminal stage of cancer. The youngest respondent was 19 years old and the oldest was 94 years old. The surveyed men most often perceived hope in the semantic space in the cognitive aspect as more true, wise, meaningful and real than false, stupid, meaningless and deceptive. Their attitude to hope was, therefore, more affirmative than negative. The research did not reveal the importance of the age of the respondents on the degree of affirmation/negation of hope in the cognitive aspect in the semantic space; however, men in the period of late maturity and professional activity expressed the lowest level of the affirmation of hope. It is worthwhile to conduct further research concerning hope in other aspects (especially emotional and functional) in the semantic space in order to use the obtained results to consider what to take into account when providing patients in the terminal stage of cancer with better personalized holistic care than before.
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Affiliation(s)
- Bożena Baczewska
- Department of Internal Medicine and Internal Medicine in Nursing, Faculty of Health Sciences, Medical University of Lublin, Chodźki 7, 20-093 Lublin, Poland
| | - Krystyna Wojciechowska
- Department of Strategy and Business Planning, Lublin University of Technology, Nadbystrzycka 38 Street, 20-618 Lublin, Poland
| | - Beata Antoszewska
- Department of Special Needs Pedagogy and Resocialization, Faculty of Social Sciences, The University of Warmia and Mazury in Olsztyn, Żołnierska 14, 10-561 Olsztyn, Poland
| | - Maria Malm
- Department of Medical Informatics and Statistics with e-Health Lab, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland
| | - Krzysztof Leśniewski
- Department of Orthodox Theology, Faculty of Theology, The John Paul II Catholic University of Lublin, Al. Racławickie 14, 20-950 Lublin, Poland
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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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7
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Best MC, Jones K, Merritt F, Casey M, Lynch S, Eisman J, Cohen J, Mackie D, Beilharz K, Kearney M. Australian Patient Preferences for the Introduction of Spirituality into their Healthcare Journey: A Mixed Methods Study. JOURNAL OF RELIGION AND HEALTH 2022:10.1007/s10943-022-01616-3. [PMID: 35918566 PMCID: PMC9345780 DOI: 10.1007/s10943-022-01616-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 05/29/2023]
Abstract
While patients value engagement concerning their spirituality as a part of holistic healthcare, there is little evidence regarding the preferred way to engage in discussions about spirituality. This study investigated inpatient preferences regarding how they would like spirituality to be raised in the hospital setting. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). There was high approval for all proposed spiritual history prompts (94.0-99.8%). In interviews, the context dictated the appropriateness of discussions. Findings indicated a high level of patient acceptability for discussing spirituality in healthcare. Further research and more detailed analysis is required and proposed to be undertaken.
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Affiliation(s)
- Megan C Best
- Institute for Ethics and Society, University of Notre Dame Australia, Broadway, PO Box 944, Sydney, NSW, 2007, Australia.
| | - Kate Jones
- Institute for Ethics and Society, University of Notre Dame Australia, Broadway, PO Box 944, Sydney, NSW, 2007, Australia
| | - Frankie Merritt
- The School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Michael Casey
- The School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Sandra Lynch
- Institute for Ethics and Society, University of Notre Dame Australia, Broadway, PO Box 944, Sydney, NSW, 2007, Australia
| | - John Eisman
- Garvan Institute of Medical Research, Sydney, Australia
| | - Jeffrey Cohen
- The School of Medicine, The University of Notre Dame, Sydney, Australia
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Dos Santos FC, Macieira TG, Yao Y, Hunter S, Madandola OO, Cho H, Bjarnadottir RI, Dunn Lopez K, Wilkie DJ, Keenan GM. Spiritual Interventions Delivered by Nurses to Address Patients' Needs in Hospitals or Long-Term Care Facilities: A Systematic Review. J Palliat Med 2022; 25:662-677. [PMID: 35085471 PMCID: PMC8982123 DOI: 10.1089/jpm.2021.0578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction: Despite increasing evidence of the benefits of spiritual care and nurses' efforts to incorporate spiritual interventions into palliative care and clinical practice, the role of spirituality is not well understood and implemented. There are divergent meanings and practices within and across countries. Understanding the delivery of spiritual interventions may lead to improved patient outcomes. Aim: We conducted a systematic review to characterize spiritual interventions delivered by nurses and targeted outcomes for patients in hospitals or assisted long-term care facilities. Methodology: The systematic review was developed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and a quality assessment was performed. Our protocol was registered on PROSPERO (Registration No. CRD42020197325). The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to June 2020. Results: We screened a total of 1005 abstracts and identified 16 experimental and quasi-experimental studies of spiritual interventions delivered by nurses to individuals receiving palliative care or targeted at chronic conditions, such as advanced cancer diseases. Ten studies examined existential interventions (e.g., spiritual history, spiritual pain assessment, touch, and psychospiritual interventions), two examined religious interventions (e.g., prayer), and four investigated mixed interventions (e.g., active listening, presence, and connectedness with the sacred, nature, and art). Patient outcomes associated with the delivery of spiritual interventions included spiritual well-being, anxiety, and depression. Conclusion: Spiritual interventions varied with the organizational culture of institutions, patients' beliefs, and target outcomes. Studies showed that spiritual interventions are associated with improved psychological and spiritual patient outcomes. The studies' different methodological approaches and the lack of detail made it challenging to compare, replicate, and validate the applicability and circumstances under which the interventions are effective. Further studies utilizing rigorous methods with operationalized definitions of spiritual nursing care are recommended.
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Affiliation(s)
- Fabiana Cristina Dos Santos
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Tamara G.R. Macieira
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Samantha Hunter
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Olatunde O. Madandola
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Hwayoung Cho
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Ragnhildur I. Bjarnadottir
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | | | - Diana J. Wilkie
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Gail M. Keenan
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
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9
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Daneault S, Azri M, Ummel D, Vinit F, Côté A, Leclerc-Loiselle J, Laperle P, Gendron S. Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives. J Palliat Care 2022; 37:518-525. [PMID: 35234108 PMCID: PMC9465553 DOI: 10.1177/08258597221083421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Suffering is intimately linked to the experience of
illness, and its relief is a mandate of medicine. Advances in knowledge around
terminal illness have enabled better management of the somatic dimension.
Nevertheless, there is what can be called “non-somatic” suffering which in some
cases may take precedence. Inspired by Paul Ricoeur's thinking on human
suffering, our aim in this qualitative study was to better understand the
experience of non-somatic suffering. Methods: Semi-structured
interviews were conducted with 19 patients. The results were qualitatively
analyzed following a continuous comparative analysis approach inspired by
grounded theory. Results: Three key themes synthesize the
phenomenon: “the being enduring the suffering”, “the being whose agency is
constrained”, and “the being in relationship with others.” The first describes
what patients endure, the shock and fears associated with their own finitude,
and the limits of what can be tolerated. The second refers to the experience of
being restricted and of mourning the loss of their capacity to act. The last
describes a residual suffering related to their interactions with others, that
of loneliness and of abandoning their loved ones, two dimensions that persist
even when they have accepted their own death. Conclusions:
Non-somatic suffering can be multifarious, even when minimized by the patient.
When evaluating suffering, we must keep in mind that patients can reach a
“breaking point” that signals the state of unbearable suffering. In managing it,
we probably need to make more room for family and friends, as well as a posture
of caring based more on presence and listening.
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Affiliation(s)
- Serge Daneault
- Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - Mehdi Azri
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Deborah Ummel
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Canada
| | - Florence Vinit
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Andréanne Côté
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Philippe Laperle
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Sylvie Gendron
- Faculty of Nursing Science, Université de Montréal, Montreal, Canada
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10
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Antunes ML, Reis-Pina P. The Physician and End-of-Life Spiritual Care: The PALliatiVE Approach. Am J Hosp Palliat Care 2022; 39:1215-1226. [PMID: 35044883 DOI: 10.1177/10499091211068819] [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] Open
Abstract
Spiritual care is universally acknowledged as a cornerstone of palliative care, yet most healthcare professionals find it difficult to address. The present work aims to provide a simple educational tool that may help physicians address spirituality in their clinical practice. We found articles written in both Portuguese and English through PubMed, using the combination of MeSH terms: "Spirituality" and "Palliative Care." The research was complemented by relevant monographs previously known to the authors, consultation of selected references of the main bibliography, and interviews to an experienced spiritual care provider. In order to help physicians to incorporate spiritual care in their clinical practice, a flexible yet standardized approach is long overdue. This is the aim of the PALliatiVE approach, which compiles the literature in a set of 5 attitudes that may aid the clinician in the delivery of spiritual care: Prepare (P), Ask (A), Listen (L), Validate (V), and consult an Expert (E). This approach is based on a synthesis of a broad literature review, which motivated the five-layered approach. There is a significant literature coverage supporting each attitude of this five-layered approach, including at least one randomized control trial or systematic review per attitude. Though still requiring external validation, the PALliatiVE approach can be a guide to the physician on how to provide spiritual care, a practice rooted in compassion and in simply being-with the one who suffers.
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Affiliation(s)
| | - Paulo Reis-Pina
- Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal.,Faculty of Medicine, Ringgold:37809University of Lisbon, Lisboa, Portugal
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Wysocka M, Wawrzyniak M, Jarosz J, Hordowicz M, Klimkiewicz A. Is There a Connection Between Spiritual Transcendence and Quality of Life? A Cross-Sectional Survey Study in Patients Under the End-of-Life Care. J Palliat Care 2021; 38:10-16. [PMID: 34397294 DOI: 10.1177/08258597211034642] [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
Background: There is limited data available on the spiritual dimension of palliative care in Eastern Europe. In countries such as Poland, investigating spirituality and its essential aspects is further complicated because in a predominantly Catholic country, spirituality is mistakenly thought to be identical to religiousness. Aim: This study investigated the connection between spiritual transcendence, meaning in life, altruism, and the quality of life of cancer patients in end-of-life care in an Eastern Europe Country (Poland). Design: This cross-sectional study was based on 4 surveys. The Quality of Life Questionnaire MQOL-R, the Scale of Spiritual Transcendence, the Purpose in Life Questionnaire PIL-6, and the Altruism Scale were used. Setting/Participants: Data from 41 oncology patients receiving end-of-life care at home and in a stationary hospice was obtained. Results: Results indicate that there is a significant positive correlation between transcendence, spiritual growth, and global quality of life. There is also a positive correlation between altruism and the meaning of life, as well as between the meaning of life, spirituality and quality of life, while altruism is positively associated exclusively with spirituality. Conclusion: This study revealed that spiritual transcendence can be understood, according to Piedmont's theory, as a personality trait that allows the patients to cross the boundaries of their existence and identify subjectively important values in their life. It can be examined and developed not only in the context of the need but also as a predisposition and a resource of personhood.
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Affiliation(s)
- Maria Wysocka
- Department of Social Psychology and Personality, SWPS University, Poland.,St. Christopher Oncology Hospice Foundation, Poland.,Department of Medical Ethics and Palliative Medicine, Medical University of Warsaw, Poland
| | | | - Jerzy Jarosz
- St. Christopher Oncology Hospice Foundation, Poland
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12
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Valdés-Stauber J, Stabenow U, Böttinger J, Kramer S, Kilian R. Divergent patterns of confrontation with death using the Anticipated Farewell to Existence Questionnaire (AFEQT): a cross-sectional comparative study of four samples with increasing proximity to death. BMC Palliat Care 2021; 20:125. [PMID: 34365973 PMCID: PMC8349498 DOI: 10.1186/s12904-021-00818-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Based on the concept of "Daseinsverabschiedung", an anthropological theory of "Anticipated Farewell to Existence" (AFE) was suggested on the basis of six grounding dimensions: selfhood, interpersonality, temporality, corporeality, worldliness, and transcendence, which are activated in a genuine manner facing death. The purpose of the study is to quantitatively compare the extent of confrontation with death between dying people in palliative care and those in other stages of life by means of the Anticipated Farewell to Existence Questionnaire" (AFEQT), based on these dimensions. METHODS The sample (N = 485) consists of dying individuals in palliative wards and hospices (n = 121); old people living in nursing homes not suffering from a mortal disease (n = 62); young adults (n = 152), and middle-aged adults (n = 150). The design is cross-sectional and analytical. The relevance of anticipated farewell to existence was measured by means of the AFEQT. The internal consistency of the AFEQT was assessed using Cronbach's alpha and convergent validity by means of dimensions of the Life Attitude Profile-Revised (LAP-R). Differences between groups and associations with control variables were estimated by means of multiple regression models, including propensity scores. RESULTS Cronbach's alpha for AFEQT was > 0.80 for the whole test and all subsamples, but < 0.70 for most dimensions in dying people. Correlations between each dimension and corresponding two factors was almost overall r > 0.80, p < 0.001. Good convergent validity between dimensions of AFEQT and of Life Attitude Profile-Revised in young and middle-aged participants showed correlations for superordinate indices between -0.23 and 0.72, and an overall p < 0.001. Dying people scored significantly higher for all dimensions, especially "altruistic preoccupation" and "reconciliation with existence" than people in other life stages (p < 0.01- < 0.001). Personality traits of "openness" and "agreeableness" are positively associated with higher scoring of AFEQT dimensions. About 77% of dying participants reported a personal benefit through the interview questions. CONCLUSIONS With proximity to death, the anthropological dimensions proposed scored significant higher than in other stages of life, reflecting a stronger awareness, confrontation and reconciliation with the end of their own life. These dimensions, especially preoccupation for related persons and coexistence of acceptance and struggle with death have to be taken into account in a sensitive way by supporting dialogues with dying people and their relatives. TRIAL REGISTRATION Observational cross-sectional study.
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Affiliation(s)
- Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, University of Ulm, Ulm, Germany
- Zentrum für Psychiatrie Südwürttemberg, Weingartshofer Strasse 2, 88214 Ravensburg, Germany
| | - Ursula Stabenow
- Department of Psychosomatic Medicine and Psychotherapy, Diakonissenkrankenhaus Karlsruhe Rüppurr, Diakonissenstrasse 28, 76199 Karlsruhe, Germany
| | - Jakob Böttinger
- Department of Psychiatry and Psychotherapy I, University of Ulm, Ulm, Germany
| | - Sarah Kramer
- Department of Psychiatry and Psychotherapy I, University of Ulm, Ulm, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, University of Ulm, Ulm, Germany
- Bezirkskrankenhaus Günzburg, Lindenallee 2, 89312 Günzburg, Germany
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Galbadage T, Peterson BM, Wang DC, Wang JS, Gunasekera RS. Biopsychosocial and Spiritual Implications of Patients With COVID-19 Dying in Isolation. Front Psychol 2020; 11:588623. [PMID: 33281686 PMCID: PMC7706115 DOI: 10.3389/fpsyg.2020.588623] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/22/2020] [Indexed: 11/29/2022] Open
Abstract
Critically ill patients with the Coronavirus disease 2019 (COVID-19) are dying in isolation without the comfort of their family or other social support in unprecedented numbers. Recently, healthcare teams at COVID-19 epicenters have been inundated with critically ill patients. Patients isolated for COVID-19 have had no contact with their family or loved ones and may have likely experienced death without closure. This situation highlights concerns about patients’ psychological and spiritual well-being with COVID-19 and their families, as they permanently part ways. While palliative care has advanced to adequately address these patients’ needs, the COVID-19 pandemic presents several barriers that force healthcare teams to deprioritize these essential aspects of patient care. The severe acute respiratory syndrome (SARS) outbreak in 2003 gave us a glimpse of these challenges as these patients were also isolated in hospitals. Here, we discuss the importance of the biopsychosocial spiritual model in end-of-life care and its implications on patients dying with COVID-19. Furthermore, we outline an integrative approach to address the unique and holistic needs of critically ill patients dying with COVID-19. These include intentional and increased coordination with trained palliative care staff, early and frequent goals of care including discussion of end-of-life plans, broader use of technology to improve connectedness, and shared decision making with patients’ families.
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Affiliation(s)
- Thushara Galbadage
- Department of Kinesiology and Health Science, Biola University, La Mirada, CA, United States
| | - Brent M Peterson
- Department of Kinesiology and Health Science, Biola University, La Mirada, CA, United States
| | - David C Wang
- Rosemead School of Psychology, Biola University, La Mirada, CA, United States
| | - Jeffrey S Wang
- Southern California Permanente Medical Group, Department of Infectious Diseases, Anaheim, CA, United States
| | - Richard S Gunasekera
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
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14
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Soto-Rubio A, Perez-Marin M, Rudilla D, Galiana L, Oliver A, Fombuena M, Barreto P. Responding to the Spiritual Needs of Palliative Care Patients: A Randomized Controlled Trial to Test the Effectiveness of the Kibo Therapeutic Interview. Front Psychol 2020; 11:1979. [PMID: 32973614 PMCID: PMC7472743 DOI: 10.3389/fpsyg.2020.01979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
Context The WHO recognizes the need to attend to patients’ spiritual needs as being fundamental to comprehensive and high-quality end-of-life care. Spiritual needs must be attended to since the resolution of biological and psychosocial issues is insufficient to reduce patients’ suffering. Associations have been found between spiritual needs and other variables of importance for patients in palliative care. Despite the consensus that exists regarding the importance of assessing and attending to spiritual needs, professionals encounter many difficulties in attempting to do so. Objectives Our study aims to demonstrate the benefits that the Kibo therapeutic interview in palliative care patients can have for spirituality, demoralization, and resilience. Methods A parallel randomized controlled trial of two groups was undertaken. Information on 60 palliative care patients during pre- and post-intervention time points was gathered. Results ANOVAs showed a statistically significant effect of the intervention on the dimension of transpersonal spirituality. The ANCOVA for the effect of the intervention on resilience also pointed to its effectiveness. When the means of demoralization were examined, a higher decrease in the levels of demoralization for patients in the intervention group was observed, when compared to patients in the control group. Conclusion Our findings point to this interview as an effective means to attend to the spiritual needs of palliative patients, reducing demoralization and increasing resilience. Future research could focus on a broader sample and on the effects of this interview on family caregivers, mourners, and health care professionals. Clinical Trial Registration Number https://clinicaltrials.gov/ct2/show/ Identifier NCT03995095.
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Affiliation(s)
- Ana Soto-Rubio
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Marian Perez-Marin
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Laura Galiana
- Department of Methodology of Experimental and Social Sciences, University of Valencia, Valencia, Spain
| | - Amparo Oliver
- Department of Methodology of Experimental and Social Sciences, University of Valencia, Valencia, Spain
| | | | - Pilar Barreto
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
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15
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Iani L, De Vincenzo F, Maruelli A, Chochinov HM, Ragghianti M, Durante S, Lombardo L. Dignity Therapy Helps Terminally Ill Patients Maintain a Sense of Peace: Early Results of a Randomized Controlled Trial. Front Psychol 2020; 11:1468. [PMID: 32670169 PMCID: PMC7330164 DOI: 10.3389/fpsyg.2020.01468] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction: Dignity Therapy (DT) is a brief, individualized, narrative psychotherapy developed to reduce psychosocial and existential distress, and promote dignity, meaning, and hope in end of life patients. Previous studies have shown that DT was effective in reducing anxiety and depression, and improving dignity-related distress. However, less is known about its efficacy on spiritual well-being. The aim of this study is to contribute to the existing literature by investigating the effects of DT on specific dimensions of spiritual well-being, demoralization and dignity-related distress in a sample of terminally ill patients. Methods: A randomized, controlled trial was conducted with 64 terminally ill patients who were randomly assigned to the intervention group (DT + standard palliative care) or the control group (standard palliative care alone). The primary outcome measures were Meaning, Peace, and Faith whereas the secondary outcome measures were (loss of) Meaning and purpose, Distress and coping ability, Existential distress, Psychological distress, and Physical distress. All measures were assessed at baseline (before the intervention), 7-10 and 15-20 days after the baseline assessment. The trial was registered with ClinicalTrials.gov (Protocol Record NCT04256239). Results: The MANOVA yielded a significant effect for the Group X Time interaction. ANOVA with repeated measures showed a significant effect of time on peace and a significant Group X Time interaction effect on peace. Post hoc comparisons revealed that, while there was a decrease in peace from pre-treatment to follow-up and from post-treatment to follow-up in the control group, there was no such trend in the intervention group. Discussion: This study provides initial evidence that patients in the DT intervention maintained similar levels of peace from pre-test to follow-up, whereas patients in the control group showed a decrease in peace during the same time period. We did not find significant longitudinal changes in measures of meaning, faith, loss of meaning and purpose, distress and coping ability, existential, psychological and physical distress. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of DT, since they offer evidence for the importance of this intervention in maintaining peace of mind for terminally ill patients.
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Affiliation(s)
- Luca Iani
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | - Alice Maruelli
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | | | - Matilde Ragghianti
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | - Sieva Durante
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Luigi Lombardo
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
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16
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Sohail MM. Belief in God's Help During Hepatitis C: A Qualitative Study on Muslim Patients in Pakistan. JOURNAL OF RELIGION AND HEALTH 2020; 59:928-945. [PMID: 30229413 DOI: 10.1007/s10943-018-0700-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Religious/spiritual beliefs play an important role in nursing of patients during chronic condition. Religion comprises an institutionalized set of transcendent ideas, while spirituality is personal and subjective dimension of religious experience in search of sacred (Hill and Pargament in Psychol Relig Spiritual S(1):3-17, 2008). The prevailing literature describes the influential impact of religiosity/spirituality on coping with chronic disease, but specifically patients with chronic liver disease (CLD) have not been studied in Pakistani context. This study examined the patients' belief in religious/spiritual coping, role of religious/spiritual beliefs and prayer as coping strategy. Furthermore, it explored the importance of religious/spiritual beliefs in diverting attention from pain and other needs of CLD patient. A total of 20 patients with chronic liver disease were selected through an appropriate screening process. Subsequently, in-depth detailed interviews were conducted to gather experiences of the hepatitis patients. Religious/spiritual beliefs put forth multiple positive effects that help in coping with chronic hepatitis C. It has been found that patients of hepatitis C use prayer as a coping strategy. Religious/spiritual beliefs have been found as source of diverting attention from pain for the patients suffering from chronic hepatitis C.
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Affiliation(s)
- Malik Muhammad Sohail
- University of Sargodha, Sargodha, Pakistan.
- Department of Anthropology, Harvard University, Tozzer Anthropology Building, 21 Divinity Avenue, Cambridge, MA, 02138, USA.
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17
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Abstract
This review proposes that the end of life is a uniquely contemporary life course stage. Epidemiologic, technological, and cultural shifts over the past two centuries have created a context in which dying has shifted from a sudden and unexpected event to a protracted, anticipated transition following an incurable chronic illness. The emergence of an end-of-life stage lasting for months or even years has heightened public interest in enhancing patient well-being, autonomy, and the receipt of medical care that accords with patient and family members' wishes. We describe key components of end-of-life well-being and highlight socioeconomic and race disparities therein, drawing on fundamental cause theory. We describe two practices that are critical to end-of-life well-being (advance care planning and hospice) and identify limitations that may undermine their effectiveness. We conclude with recommendations for future sociological research that could inform practices to enhance patient and family well-being at the end of life.
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Affiliation(s)
- Deborah Carr
- Department of Sociology, Boston University, Boston, Massachusetts 02215, USA
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18
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Lee GL, Ramaswamy A. Physical, psychological, social, and spiritual aspects of end-of-life trajectory among patients with advanced cancer: A phenomenological inquiry. DEATH STUDIES 2018; 44:292-302. [PMID: 30569828 DOI: 10.1080/07481187.2018.1541944] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/03/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
The study examined and described the perspectives of people living with advanced cancer and the changes over time in their needs and experiences. This paper reports the accounts of 11 terminally-ill people who gave a total of 25 in-depth interviews. Participants were recruited when they began receiving home hospice care service, and they were followed up over time, as their disease progressed. Framework method was used to organize the data and identify themes. The findings highlighted that end-of-life care needs to be holistic, encompassing physical, psychological, social, and spiritual needs, as well as dynamic along the course of disease progression.
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Affiliation(s)
- Geok Ling Lee
- Department of Social Work, National University of Singapore, Singapore, Singapore
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19
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Affiliation(s)
- David Kuhl
- Centre for Practitioner Renewal, Providence Health Care/University of British Columbia, Vancouver, British Columbia. Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia; and Hornby Site, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6
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20
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Heyland DK, Frank C, Tranmer J, Paul N, Pichora D, Jiang X, Day AG. Satisfaction with End-Of-Life Care: A Longitudinal study of Patients and Their Family Caregivers in the Last months of Life. J Palliat Care 2018. [DOI: 10.1177/082585970902500402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To determine whether and how ratings of satisfaction with end-of-life (EOL) care change over time and across settings, we administered a satisfaction questionnaire to patients 55 years and older with advanced medical disease and their family caregivers (FCGs). We re-interviewed approximately every two months for a maximum of four visits. Overall, 97 patients and 68 FCGs completed a baseline interview; 57 and 40 completed two interviews, 35 and 22 completed three, and 15 and 10 completed four. Patient satisfaction increased over time and in three of the six questionnaire domains, but this was largely confounded with the location of interview. Satisfaction scores were greater among patients whose baseline interviews occurred at home. FCGs reported increased satisfaction over time; members of the subgroup that cared for patients who died during the study were less satisfied in the spirituality domain during bereavement than prior to their relative's death. Satisfaction with care tends to vary based on location of interview and may vary across time with respect to certain aspects of EOL care.
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Affiliation(s)
- Daren K. Heyland
- D Heyland (corresponding author): Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, Canada K7L 2V7
| | - Christopher Frank
- N Paul, X Jiang, A Day: Clinical Evaluation Research Unit, Kingston General Hospital
| | - Joan Tranmer
- D Heyland: Department of Medicine, Kingston General Hospital
| | - Nancy Paul
- D Heyland, J Tranmer, D Pichora: Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Deborah Pichora
- C Frank: Department of Medicine, Division of Geriatric Medicine, St. Mary's of the Lake Hospital, Queen's University
| | - Xuran Jiang
- J Tramer, D Pichora: School of Nursing, Kingston General Hospital
| | - Andrew G. Day
- N Paul, X Jiang, A Day: Clinical Evaluation Research Unit, Kingston General Hospital
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Ryu JS, Choi SW, Yun SS, Koo BH, Choi IS, Kim SJ, Park JS, Seok JH, Yoon DS. Preliminary Findings on the Effectiveness of Meaning-Centered Psychotherapy in Patients with Pancreatobiliary Cancer. Yonsei Med J 2018; 59:1107-1114. [PMID: 30328326 PMCID: PMC6192895 DOI: 10.3349/ymj.2018.59.9.1107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study investigated the effectiveness of meaning-centered psychotherapy (MCP), which is known to be a helpful psychotherapeutic intervention in distressing conditions, for patients with pancreatobiliary cancer. MATERIALS AND METHODS We recruited 37 patients with pancreatobiliary cancer from three university general hospitals and assessed their psychological characteristics. Patients who reported clinically significant emotional distress were recommended to undergo MCP. Patients who consented to MCP were provided four sessions of the therapy. Patient psychological characteristics were assessed again 2 months after MCP. For statistical comparison, outcome variables included anxiety, depression, mental adjustment to cancer, and quality of life (QoL), as well as the degree of stress and physical symptoms. RESULTS Sixteen patients completed the MCP and the final assessment 2 months later. In the initial assessment, the patients receiving MCP showed higher levels of anxiety and depression than those not receiving MCP, and QoL was also lower in terms of role function, emotional function, social function, and global QoL. At the 2-month follow-up, the MCP group showed a significant improvement in anxiety (p=0.007), depression (p=0.010), and anxious preoccupation (p<0.001). In addition, QoL significantly improved in the MCP group, while there was no significant change in the non-MCP group. CONCLUSION In this study, MCP showed potential therapeutic benefits against emotional distress in patients with pancreatobiliary cancer, improving their QoL.
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Affiliation(s)
- Jin Sun Ryu
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Woo Choi
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Su Yun
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Bon Hoon Koo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - In Seok Choi
- Department of Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Seung Jun Kim
- Department of Psychiatry, Konyang University College of Medicine, Daejeon, Korea
| | - Joon Seong Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Ho Seok
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.
| | - Dong Sup Yoon
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
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Affiliation(s)
- Mark T. Hughes
- Berman Institute of Bioethics, Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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23
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Movafagh A, Heidari MH, Abdoljabbari M, Mansouri N, Taghavi A, Karamatinia A, Mehrvar N, Hashemi M, Ghazi M. Spiritual Therapy in Coping with Cancer as a Complementary Medical Preventive Practice. J Cancer Prev 2017; 22:82-88. [PMID: 28698861 PMCID: PMC5503219 DOI: 10.15430/jcp.2017.22.2.82] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/03/2017] [Accepted: 06/08/2017] [Indexed: 02/03/2023] Open
Abstract
There are many of methods of treating cancer. However, the concept of curing the cancer is beyond our current knowledge. Some patients who have the cancer may seek an alternative manner of curing their disease. Alternative medicines, such as spiritual and complementary therapy, are able to cure the cancer and, at the least, are safe. Research on the importance of spirituality in cancer care has mainly been performed in geographically heterogeneous populations. The results are limited to these specific religious-cultural contexts and enlightened by contributions from ethnicity and religion. This article focused on the religiousness and spiritual support of cancer patients from diverse and heterogeneous groups around the globe. An electronic search of peer-reviewed articles was systematically performed to obtain the relevant literature with the CINAHL, PsycINFO, and PubMed databases. The keywords included religion, cancer, illness, psychotherapy, and spiritual and alternative treatment/therapies. The inclusion criteria for the reviews were that the documents were original quantitative research and published in English. Articles that were not directly relevant to the present objective were excluded. The present outcome of these review resources suggest that it may be helpful for clinicians to address spirituality, particularly with regard to prevention, healing, and survival of cancer patients. This article indicates that it may be useful for clinical oncologists to be informed of the prevalence of the use of spiritual medicine in their specialized field. In addition, patients should routinely be asked about the use of spiritual medicine as part of every cancer patient's evaluation.
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Affiliation(s)
- Abolfazl Movafagh
- Department of Medical Genetics, Cancer Research Center, Shohada Referral Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Morteza Abdoljabbari
- Department of Moaref, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Mansouri
- Department of Medical Genetics, Cancer Research Center, Shohada Referral Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsoon Taghavi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aliasghar Karamatinia
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narjes Mehrvar
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Hashemi
- Department of Molecular Genetics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Mona Ghazi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Doram K, Chadwick W, Bokovoy J, Profit J, Sexton JD, Sexton JB. Got spirit? The spiritual climate scale, psychometric properties, benchmarking data and future directions. BMC Health Serv Res 2017; 17:132. [PMID: 28189142 PMCID: PMC5303307 DOI: 10.1186/s12913-017-2050-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizations that encourage the respectful expression of diverse spiritual views have higher productivity and performance, and support employees with greater organizational commitment and job satisfaction. Within healthcare, there is a paucity of studies which define or intervene on the spiritual needs of healthcare workers, or examine the effects of a pro-spirituality environment on teamwork and patient safety. Our objective was to describe a novel survey scale for evaluating spiritual climate in healthcare workers, evaluate its psychometric properties, provide benchmarking data from a large faith-based healthcare system, and investigate relationships between spiritual climate and other predictors of patient safety and job satisfaction. METHODS Cross-sectional survey study of US healthcare workers within a large, faith-based health system. RESULTS Seven thousand nine hundred twenty three of 9199 eligible healthcare workers across 325 clinical areas within 16 hospitals completed our survey in 2009 (86% response rate). The spiritual climate scale exhibited good psychometric properties (internal consistency: Cronbach α = .863). On average 68% (SD 17.7) of respondents of a given clinical area expressed good spiritual climate, although assessments varied widely (14 to 100%). Spiritual climate correlated positively with teamwork climate (r = .434, p < .001) and safety climate (r = .489, p < .001). Healthcare workers reporting good spiritual climate were less likely to have intentions to leave, to be burned out, or to experience disruptive behaviors in their unit and more likely to have participated in executive rounding (p < .001 for each variable). CONCLUSIONS The spiritual climate scale exhibits good psychometric properties, elicits results that vary widely by clinical area, and aligns well with other culture constructs that have been found to correlate with clinical and organizational outcomes.
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Affiliation(s)
| | - Whitney Chadwick
- Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA USA
- Residency Office MC 5906, Lucile Packard Children’s Hospital Room 0111, 725 Welch Rd, Palo Alto, CA 94304 USA
| | | | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA USA
| | - Janel D. Sexton
- Duke Patient Safety Center, Duke University Health System, Durham, NC USA
| | - J. Bryan Sexton
- Duke Patient Safety Center, Duke University Health System, Durham, NC USA
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC USA
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Lee BS, Kwak SY. Experience of Spiritual Conflict in Hospice Nurses: A Phenomenological Study. J Korean Acad Nurs 2017; 47:98-109. [DOI: 10.4040/jkan.2017.47.1.98] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/18/2016] [Accepted: 12/02/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | - Su Young Kwak
- Department of Nursing, Keimyung College University, Daegu, Korea
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Da Rocha Rodrigues MG, Pautex S, Shaha M. Revie ⊕: the influence of a life review intervention including a positive, patient-centered approach towards enhancing the personal dignity of patients with advanced cancer-a study protocol for a feasibility study using a mixed method investigation. Pilot Feasibility Stud 2016; 2:63. [PMID: 27965878 PMCID: PMC5154126 DOI: 10.1186/s40814-016-0101-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is generally recognized that existential concerns must be addressed to promote the dignity of patients with advanced cancer. A number of interventions have been developed in this regard, such as dignity therapy and other life review interventions (LRI). However, so far, none have focused on a positive approach or evaluated its effects on dignity and personal growth. This study aims to explore the feasibility of Revie ⊕, a life review intervention comprising a positive, patient-centered approach, and to determine potential changes of patients' sense of dignity, posttraumatic growth, and satisfaction with life. METHODS A mixed method study will be performed, which includes specialized nurses and 40 patients with advanced cancer in an ambulatory and in-patient setting of a Swiss university hospital. Quantitative methods involve a single group, pre- and post-intervention, and outcome measurements include the Patient Dignity Inventory, the Posttraumatic Growth Inventory, and the Satisfaction with Life Scale. Feasibility data relating to process, resource, and scientific elements of the trial will also be collected. A semi-directed interview will be used to collect qualitative data about the process and the participants' experiences of the intervention. In this way, enhanced quantitative-qualitative evidence can be drawn from outcome measures as well as individual, contextualized personal views, to help inform researchers about the plausibility of this complex intervention before testing its effectiveness in a subsequent full trial. DISCUSSION Patient dignity is a goal of quality end-of-life care. To our knowledge, this is the first trial to evaluate the role of a life review intervention that is focused on personal growth and on changes relating to the experience of having cancer. This study will evaluate the feasibility of a novel intervention, Revie ⊕, which we hope will contribute to promote the dignity, personal growth, and overall life satisfaction of patients with advanced cancer. TRIAL REGISTRATION ISRCTN, ISRCTN12497093.
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Affiliation(s)
- Maria Goreti Da Rocha Rodrigues
- Institute of Higher Education and Research in Healthcare, University of Lausanne and University Hospital of Lausanne, 10 Route de la Corniche, 1010 Lausanne, Switzerland ; School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, 47 Avenue de Champel, 1206 Genève, Switzerland
| | - Sophie Pautex
- Department of Community Medicine, Geneva University Hospitals and Geneva University, 4 rue Gabrielle-Perret-Gentil, Genève, 14 1211 Switzerland
| | - Maya Shaha
- Institute of Higher Education and Research in Healthcare, University of Lausanne and University Hospital of Lausanne, 10 Route de la Corniche, 1010 Lausanne, Switzerland ; Inselspital, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland
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Goldhagen J, Fafard M, Komatz K, Eason T, Livingood WC. Community-based pediatric palliative care for health related quality of life, hospital utilization and costs lessons learned from a pilot study. BMC Palliat Care 2016; 15:73. [PMID: 27487770 PMCID: PMC4971636 DOI: 10.1186/s12904-016-0138-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/22/2016] [Indexed: 11/12/2022] Open
Abstract
Background Children with chronic complex-medical conditions comprise a small minority of children who require substantial healthcare with major implications for hospital utilization and costs in pediatrics. Community-Based Pediatric Palliative Care (CBPPC) provides a holistic approach to patient care that can improve their quality of life and lead to reduced costs of hospital care. This study's purpose was to analyze and report unpublished evaluation study results from 2007 that demonstrate the potential for CBPPC on Health Related Quality of Life (HRQoL) and hospital utilization and costs in light of the increasing national focus on the care of children with complex-medical conditions, including the Affordable Care Act's emphasis on patient-centered outcomes. Methods A multi-method research design used primary data collected from caregivers to determine the Program's potential impact on HRQoL, and administrative data to assess the Program's potential impact on hospital utilization and costs. Caregivers (n=53) of children enrolled in the Northeast Florida CBPPC program (Community PedsCare) through the years 2002-2007 were recruited for the Health Related Quality of Life (HRQoL) study. Children (n=48) enrolled in the Program through years 2000-2006 were included in the utilization and cost study. Results HRQoL was generally high, and hospital charges per child declined by $1203 for total hospital services (p=.34) and $1047 for diagnostic charges per quarter (p=0.13). Hospital length of stay decreased from 2.92 days per quarter to 1.22 days per quarter (p<.05). Conclusion The decrease in hospital utilization and costs and the high HRQoL results indicate that CBPPC has the potential to influence important outcomes for the quality of care available for children with complex-medical conditions and their caregivers. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0138-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, Department of Pediatrics, UF College of Medicine - Jacksonville, 841 Prudential Drive, Suite 1330 m, Jacksonville, FL, 32207, USA
| | - Mark Fafard
- Baptist Health Research Institute, Baptist Health System, 836 Prudential Drive, Pavilion 6th Floor, Jacksonville, FL, 32207, USA.
| | - Kelly Komatz
- Division of Community and Societal Pediatrics, Department of Pediatrics, UF College of Medicine - Jacksonville, 841 Prudential Drive, Suite 1330 m, Jacksonville, FL, 32207, USA
| | - Terry Eason
- Community PedsCare, Community Hospice of Northeast Florida, 4266 Sunbeam Rd., Jacksonville, FL, 32257, USA
| | - William C Livingood
- Center for Health Equity and Quality Research, UF College of Medicine-Jacksonville, 580 W. 8th St., Tower II, Room 6015, Jacksonville, FL, 32209, USA
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Robinson MR, Thiel MM, Shirkey K, Zurakowski D, Meyer EC. Efficacy of Training Interprofessional Spiritual Care Generalists. J Palliat Med 2016; 19:814-21. [DOI: 10.1089/jpm.2015.0373] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mary R. Robinson
- Department of Chaplaincy, Boston Children's Hospital, Boston, Massachusetts
| | - Mary Martha Thiel
- Department of Religious and Chaplainy Services, Hebrew Senior Life/Hebrew Rehabilitation Center, Boston, Massachusetts
| | - Kezia Shirkey
- Department of Psychology, North Park University, Chicago, Illinois
| | - David Zurakowski
- Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Elaine C. Meyer
- Department of Psychology, Harvard Medical School, Boston, Massachusetts
- Institute for Professionalism and Ethical Practice, Boston, Massachusetts
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29
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Cohen CC, Auslander G, Dror YF, Breuer GS. Functional and Existential Tasks of Family Caregiving for End-of-Life, Hospitalized Older Adults. J Gerontol Nurs 2016; 42:55-64. [DOI: 10.3928/00989134-20160406-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 02/22/2016] [Indexed: 11/20/2022]
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30
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Thompson GN, McArthur J, Doupe M. Identifying Markers of Dignity-Conserving Care in Long-Term Care: A Modified Delphi Study. PLoS One 2016; 11:e0156816. [PMID: 27304853 PMCID: PMC4909197 DOI: 10.1371/journal.pone.0156816] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 05/19/2016] [Indexed: 11/19/2022] Open
Abstract
Ensuring that people living in nursing homes (NHs) are afforded with dignity in their daily lives is an essential and humane concern. Promoting dignity-conserving care is fundamentally important. By nature, however, this care is all-encompassing and holistic, and from current knowledge it is challenging to create explicit strategies for measuring dignity-conserving care. In practice the majority of current NH indicators of quality care are derived from information that is routinely collected on NH residents using the RAI-Minimum Data Set (MDS). In this regard, issues that are more tangible to resident dignity such as being treated with respect, compassion, and having opportunities to engage with others are not adequately captured in current NH quality of care indicators. An initial set of markers was created by conducting an integrative literature review of existing markers and indicators of dignity in the NH setting. A modified Delphi process was used to prioritize essential dignity-conserving care markers for use by NH providers, based on factors such as the importance to fostering a culture of dignity, the impact it may have on the residents, and how achievable it is in practice. Through this consensus building technique, we were able to develop a comprehensive set of markers that capture the range and diversity of important dignity-conserving care strategies for use in NHs. The final 10 markers were judged as having high face validity by experts in the field and have explicit implications for enhancing the provision of daily dignified care to NH residents. These markers make an important addition to the traditional quality indicators used in the NH setting and as such, bridge an important gap in addressing the psychosocial and the less easily quantified needs of NH residents.
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Affiliation(s)
- Genevieve N. Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, MB, Canada
- * E-mail:
| | | | - Malcolm Doupe
- College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Siddall PJ, McIndoe L, Austin P, Wrigley PJ. The impact of pain on spiritual well-being in people with a spinal cord injury. Spinal Cord 2016; 55:105-111. [PMID: 27241444 DOI: 10.1038/sc.2016.75] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/30/2016] [Accepted: 04/20/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN The study uses a cross-sectional, group comparison, questionnaire-based design. OBJECTIVES To determine whether spinal cord injury and pain have an impact on spiritual well-being and whether there is an association between spiritual well-being and measures of pain and psychological function. SETTING University teaching hospital in Sydney, New South Wales, Australia. METHODS Questionnaires evaluating pain, psychological and spiritual well-being were administered to a group of people with a spinal cord injury (n=53) and a group without spinal cord injury (n=37). Spiritual well-being was assessed using the Functional Assessment of Chronic Illness and Therapy - Spirituality Extended Scale (FACIT-Sp-Ex). Pain and psychological function were also assessed using standard, validated measures of pain intensity, pain interference, mood and cognition. RESULTS Levels of spiritual well-being in people with a spinal cord injury were significantly lower when compared with people without a spinal cord injury. In addition, there was a moderate but significant negative correlation between spiritual well-being and pain intensity. There was also a strong and significant negative correlation between depression and spiritual well-being and a strong and significant positive correlation between spiritual well-being and both pain self-efficacy and satisfaction with life. CONCLUSION Consequences of a spinal cord injury include increased levels of spiritual distress, which is associated, with higher levels of pain and depression and lower levels of pain self-efficacy and satisfaction with life. These findings indicate the importance of addressing spiritual well-being as an important component in the long-term rehabilitation of any person following spinal cord injury. SPONSORSHIP This study was supported by grant funding from the Australian and New Zealand College of Anaesthetists, and the National Health and Medical Research Council of Australia.
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Affiliation(s)
- P J Siddall
- Department of Pain Management, Greenwich Hospital, HammondCare, Sydney, New South Wales, Australia.,Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - L McIndoe
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - P Austin
- Department of Pain Management, Greenwich Hospital, HammondCare, Sydney, New South Wales, Australia
| | - P J Wrigley
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia.,Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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Curry J, McCallum M, Rodriguez V JJ. Spiritual Care Education and Rural Systems in Swan River. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2016; 70:53-62. [PMID: 26956751 DOI: 10.1177/1542305015619631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The provision of spiritual care, and the training of spiritual care providers, must be embedded within the larger systems (economic, social, generational, and environmental) and communities within which clients reside. This study analyzes the results of a systems approach to CPE training that focused on the rural context of Swan River, Manitoba. It addresses the need for new approaches to contextualizing CPE training and for understanding the uniqueness of rural contexts in particular.
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Nelson LE, Wilton L, Zhang N, Regan R, Thach CT, Dyer TV, Kushwaha S, Sanders REC, Ndoye O, Mayer KH. Childhood Exposure to Religions With High Prevalence of Members Who Discourage Homosexuality Is Associated With Adult HIV Risk Behaviors and HIV Infection in Black Men Who Have Sex With Men. Am J Mens Health 2016; 11:1309-1321. [PMID: 26758708 DOI: 10.1177/1557988315626264] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Exposure to childhood religious affiliations where the majority of members discourage homosexuality may have negative psychological impacts for Black men who have sex with men. This study tested the hypothesis that exposures to these environments during childhood were associated with adulthood human immunodeficiency virus (HIV)/sexually transmitted infection (STI) behavioral risk and HIV infection, because these exposures influenced HIV/STI risk by undermining race/sexual identity congruence and increasing internalized homophobia and interpersonal anxiety. Structural equation modeling as well as logistic and Poisson regressions were performed using baseline data from HIV Prevention Trials Network 061 ( N = 1,553). Childhood religion affiliations that were more discouraging of homosexuality were associated with increased likelihood of HIV infection; however, the association was no longer significant after adjusting for age, income, and education. Having a childhood religion affiliation with high prevalence of beliefs discouraging homosexuality was associated with increased numbers of sexual partners (adjusted odds ratio = 4.31; 95% confidence interval [3.76, 4.94], p < .01). The hypothesized path model was largely supported and accounted for 37% of the variance in HIV infection; however, interpersonal anxiety was not associated with HIV/STI risk behaviors. Structural interventions are needed that focus on developing affirming theologies in religious institutions with Black men who have sex with men congregants.
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Affiliation(s)
| | - Leo Wilton
- 2 State University of New York at Binghamton, NY, USA.,3 University of Johannesburg, Johannesburg, South Africa
| | - Nanhua Zhang
- 4 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rotrease Regan
- 5 University of California, Los Angeles, CA, USA.,6 Emory University, Atlanta, GA, USA
| | | | | | | | | | - Omar Ndoye
- 1 University of Rochester, Rochester, NY, USA.,11 Chiekh Anta Diop University, Dakar, Senegal
| | - Kenneth H Mayer
- 12 The Fenway Institute, Boston, MA, USA.,13 Beth Israel Deaconess Medical Center, Boston, MA, USA
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Adorno G. Between Two Worlds: Liminality and Late-Stage Cancer-Directed Therapy. OMEGA-JOURNAL OF DEATH AND DYING 2015; 71:99-125. [PMID: 26625508 DOI: 10.1177/0030222815570589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disease-directed therapy near death is a growing trend among persons living with late-stage cancer. As a sociocultural phenomenon, cancer-directed therapy (e.g., chemotherapy) when given for very advanced disease is a process that offers questionable benefits and portends further suffering, but also suggests potential for growth and transcendence. Theories and concepts drawn from cultural anthropology, sociology, and existentialism illustrate how contextual factors contribute to the creation of a "liminal space"; the latter part of the cancer trajectory where living and dying can overlap. When applied to clinical practice, this theoretical framework gives the patient, family, and health care provider a way of "unmasking" a period of transition during terminal illness when aggressive disease-directed care continues to be provided. The liminal space may function as an existential plane; a gateway or threshold with inherent potential for psychospiritual development during the final stage of life.
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Gomez-Castillo BJ, Hirsch R, Groninger H, Baker K, Cheng MJ, Phillips J, Pollack J, Berger AM. Increasing the Number of Outpatients Receiving Spiritual Assessment: A Pain and Palliative Care Service Quality Improvement Project. J Pain Symptom Manage 2015; 50:724-9. [PMID: 26166183 PMCID: PMC4624036 DOI: 10.1016/j.jpainsymman.2015.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 05/28/2015] [Accepted: 05/31/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spirituality is a patient need that requires special attention from the Pain and Palliative Care Service team. This quality improvement project aimed to provide spiritual assessment for all new outpatients with serious life-altering illnesses. MEASURES Percentage of new outpatients receiving spiritual assessment (Faith, Importance/Influence, Community, Address/Action in care, psychosocial evaluation, chaplain consults) at baseline and postinterventions. INTERVENTION Interventions included encouraging clinicians to incorporate adequate spiritual assessment into patient care and implementing chaplain covisits for all initial outpatient visits. OUTCOMES The quality improvement interventions increased spiritual assessment (baseline vs. postinterventions): chaplain covisits (25.5% vs. 50%), Faith, Importance/Influence, Community, Address/Action in care completion (49% vs. 72%), and psychosocial evaluation (89% vs. 94%). CONCLUSIONS/LESSONS LEARNED Improved spiritual assessment in an outpatient palliative care clinic setting can occur with a multidisciplinary approach. This project also identifies data collection and documentation processes that can be targeted for improvement.
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Affiliation(s)
- Blanca J Gomez-Castillo
- Georgetown University Medical Center, Washington, DC; Pain and Palliative Care Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Rosemarie Hirsch
- Pain and Palliative Care Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Hunter Groninger
- Pain and Palliative Care Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Karen Baker
- Pain and Palliative Care Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - M Jennifer Cheng
- Pain and Palliative Care Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Jayne Phillips
- Pain and Palliative Care Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - John Pollack
- Pain and Palliative Care Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA; Spiritual Care Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Ann M Berger
- Pain and Palliative Care Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
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Montross-Thomas LP, Irwin SA, Meier EA, Gallegos JV, Golshan S, Roeland E, McNeal H, Munson D, Rodseth L. Enhancing legacy in palliative care: study protocol for a randomized controlled trial of Dignity Therapy focused on positive outcomes. BMC Palliat Care 2015; 14:44. [PMID: 26391775 PMCID: PMC4578680 DOI: 10.1186/s12904-015-0041-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 09/07/2015] [Indexed: 11/29/2022] Open
Abstract
Background Dignity Therapy is a brief psychotherapy that can enhance a sense of legacy while addressing the emotional and existential needs of patients receiving hospice or palliative care. In Dignity Therapy, patients create a formalized “legacy” document that records their most cherished memories, their lessons learned in life, as well as their hopes and dreams for loved ones in the future. To date, this treatment has been studied for its impact on mitigating distress within hospice and palliative care populations and has provided mixed results. This study will instead focus on whether Dignity Therapy enhances positive outcomes in this population. Methods/Design In this study, 90 patients with cancer receiving hospice or palliative care will complete a mixed-methods randomized controlled trial of Dignity Therapy (n = 45) versus Supportive Attention (n = 45). The patients will be enrolled in the study for 3 weeks, receiving a total of six study visits. The primary outcomes examine whether the treatment will quantitatively increase levels of positive affect and a sense of life closure. Secondary outcomes focus on gratitude, hope, life satisfaction, meaning in life, resilience, and self-efficacy. Using a fixed, embedded dataset design, this study will additionally use qualitative interviews to explore patients’ perceptions regarding the use of positive outcome measures and whether these outcomes are appropriately matched to their experiences in therapy. Discussion Dignity Therapy has shown mixed results when evaluating its impact on distress, although no other study to date has solely focused on the potential positive aspects of this treatment. This study is novel in its use of mixed methods assessments to focus on positive outcomes, and will provide valuable information about patients’ direct experiences in this area. Trial registration ISRCTN91389194
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Affiliation(s)
- Lori P Montross-Thomas
- San Diego Moores Cancer Center, Psychiatry & Psychosocial Services; Patient & Family Support Services, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. .,San Diego Department of Psychiatry, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. .,San Diego Department of Family & Preventive Medicine, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA.
| | - Scott A Irwin
- San Diego Moores Cancer Center, Psychiatry & Psychosocial Services; Patient & Family Support Services, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. .,San Diego Department of Psychiatry, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA.
| | - Emily A Meier
- San Diego Moores Cancer Center, Psychiatry & Psychosocial Services; Patient & Family Support Services, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. .,San Diego Department of Psychiatry, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA.
| | - Jarred V Gallegos
- San Diego Department of Family & Preventive Medicine, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA. .,University of San Diego, San Diego, USA.
| | - Shahrokh Golshan
- San Diego Department of Psychiatry, University of California, 9500 Gilman Drive #0664, La Jolla, San Diego, CA, 92093-0664, USA.
| | - Eric Roeland
- San Diego Moores Cancer Center, Doris A. Howell Palliative Care Service, University of California, San Diego, USA.
| | - Helen McNeal
- California State University Institute for Palliative Care, San Diego, USA.
| | - Diane Munson
- Family Health Centers of San Diego, San Diego, USA.
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Park HY, Maitra K, Martinez KM. The Effect of Occupation-based Cognitive Rehabilitation for Traumatic Brain Injury: A Meta-analysis of Randomized Controlled Trials. Occup Ther Int 2015; 22:104-16. [PMID: 25808426 DOI: 10.1002/oti.1389] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 11/07/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability among people younger than 35 years in the United States. Cognitive difficulty is a common consequence of TBI. To address cognitive deficits of patients with TBI, various cognitive rehabilitation approaches have been used for the clinical setting. The purpose of this study was to investigate the overall effect of occupation-based cognitive rehabilitation on patients' improvement in cognitive performance components, activity of daily living (ADL) performance, and values, beliefs and spirituality functions of patients with TBI. The papers used in this study were retrieved from the Cochrane Database, EBSCO (CINAHL), PsycINFO, PubMed and Web of Science published between 1997 and 2014. The keywords for searching were cognitive, rehabilitation, occupation, memory, attention, problem-solving, executive function, ADL, values, beliefs, spirituality, randomized controlled trials and TBI. For the meta-analysis, we examined 60 effect sizes from nine studies that are related to the occupation-based cognitive rehabilitation on persons with TBI. In persons with TBI, overall mental functions, ADL, and values, beliefs and spirituality were significantly improved in the groups that received occupation-based cognitive rehabilitation compared with comparison groups (mean d = 0.19, p < .05). Evidence from the present meta-analytic study suggests that occupation-based cognitive rehabilitation would be beneficial for individuals with TBI for improving daily functioning and positively be able to affect their psychosocial functions. Collecting many outcome measures in studies with relatively few participants and the final data are less reliable than the whole instrument itself. Future research should evaluate the effectiveness of specific occupation-based cognitive rehabilitations programmes in order to improve consistency among rehabilitation providers.
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Affiliation(s)
- Hae Yean Park
- Occupational Therapy, Florida International University, 11200 SW 8th St., AHC 3, 443, Miami, FL, 33199, USA; Occupational Therapy, Yonsei University, 106ho, Backun-kwan, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, 220-710, South Korea
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Fitchett G, Emanuel L, Handzo G, Boyken L, Wilkie DJ. Care of the human spirit and the role of dignity therapy: a systematic review of dignity therapy research. BMC Palliat Care 2015; 14:8. [PMID: 25844066 PMCID: PMC4384229 DOI: 10.1186/s12904-015-0007-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/04/2015] [Indexed: 12/03/2022] Open
Abstract
Background Dignity Therapy (DT), an intervention for people facing serious illness, focuses on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document for loved ones. Research on DT began more than a decade ago and has been conducted in 7 countries, but a systematic review of DT research has not been published. Methods Using a PubMed search with key terms of ‘dignity therapy’, ‘dignity psychotherapy’, ‘Chochinov’, and ‘dignity care’, we found 29 articles on DT and retained 25 after full-text review. Results Of these, 17 articles representing 12 quantitative studies establish that patients who receive DT report high satisfaction and benefits for themselves and their families, including increased sense of meaning and purpose. The effects of DT on physical or emotional symptoms, however, were inconsistent. Conclusions Conclusions point to three areas for future research on DT, to determine: (1) whether the DT intervention exerts an impact at a spiritual level and/or as a life completion task; (2) how DT should be implemented in real world settings; and (3) if DT has an effect on the illness experience within the context of not only the patient, but also the family and community. Building on this body of DT research, investigators will need to continue to be sensitive as they involve participants in DT studies and innovations to facilitate the generation and delivery of legacy documents to participants near the end of life.
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Affiliation(s)
- George Fitchett
- Rush University Medical Center, 630 S. Hermitage Ave. Suite 505, Chicago, IL 60612 USA
| | - Linda Emanuel
- Buehler Center on Health, Aging & Society Northwestern University, 750N Lake Shore Dr. Suite 601, Chicago, IL 60611 USA
| | - George Handzo
- HealthCare Chaplaincy Network, 65 Broadway, 12th Floor, New York, NY 10006 USA
| | - Lara Boyken
- Buehler Center on Health, Aging & Society Northwestern University, 750N Lake Shore Dr. Suite 601, Chicago, IL 60611 USA
| | - Diana J Wilkie
- Center of Excellence for End-of-Life Transition Research, University of Illinois at Chicago College of Nursing, 845S. Damen Ave., M/C 802, Chicago, IL 60612 USA
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The association between religiosity and resuscitation status preference among patients with advanced cancer. Palliat Support Care 2015; 13:1435-9. [DOI: 10.1017/s1478951515000140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:The potential influence of patient religious and spiritual beliefs on the approach to end-of-life care and resuscitation status preferences is not well understood. The aim of this study was to assess the association between religiosity and resuscitation preferences in advanced-cancer patients.Method:We performed a secondary analysis of a randomized controlled trial that evaluated the influence of physician communication style on patient resuscitation preferences. All patients completed the Santa Clara Strength of Religious Faith Questionnaire–Short Form (SCSRFQ–SF) and expressed their resuscitation preferences. We determined the frequency of resuscitation preferences and its association with intensity of religiosity.Results:A total of 78 patients completed the study. The median age was 54 years, with a range of 18–78. Some 46 (59%) were women; 57 patients (73%) were Caucasian, 15 (19%) African American, and 5 (7%) Hispanic. A total of 46 patients (56%) were Protestant and 13 (17%) Catholic. Some 53 of 60 patients who chose Do Not Resuscitate status (DNR) (88%) and 16 of 18 patients who refused DNR (89%) for a video-simulated patient were highly religious (p = 0.64). When asked about a DNR for themselves after watching the videos, 43 of 48 who refused DNR (90%) and 26 of 30 patients who chose DNR (87%) were highly religious (p = 0.08). The Spearman correlation coefficient for patients choosing DNR for themselves and intensity of religiosity was r = –0.16 (p = 0.16). Some 30 patients (38%) who chose DNR for the video patient refused DNR for themselves, and 42 who chose DNR for both the video patient and themselves (54%) were highly religious (p = NS).Significance of Results:There was no significant association between intensity of patient religiosity and DNR preference for either the video patient or the patients themselves. Other beliefs and demographic factors likely impact end-of-life discussions and resuscitation status preferences.
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Siddall PJ, Lovell M, MacLeod R. Spirituality: what is its role in pain medicine? PAIN MEDICINE 2014; 16:51-60. [PMID: 25159525 DOI: 10.1111/pme.12511] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND For many years, spirituality has been regarded as an integral aspect of patient care in fields closely allied to pain medicine such as palliative and supportive care. Despite this, it has received relatively little attention within the field of pain medicine itself. Reasons for this may include a lack of understanding of what spirituality means, doubtfulness of its relevance, an uncertainty about how it may be addressed, or a lack of awareness of how addressing spirituality may be of benefit. METHODS A review of the literature was conducted to determine the changing conceptual frameworks that have been applied to pain medicine, the emergence of the biopsychospiritual approach and what that means as well as evidence for the benefits of incorporation of this approach for the management of pain. RESULTS Although the concept of spirituality is broad, there is now greater consensus on what is meant by this term. Many authors and consensus panels have explored the concept and formulated a conceptual framework and an approach that is inclusive, accessible, relevant, and applicable to people with a wide range of health conditions. In addition, there is accumulating evidence that interventions that address the issue of spirituality have benefits for physical and emotional health. CONCLUSIONS Given the firm place that spirituality now holds within other fields and the mounting evidence for its relevance and benefit for people with pain, there is increasing evidence to support the inclusion of spiritual factors as an important component in the assessment and treatment of pain.
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Affiliation(s)
- Philip J Siddall
- Department of Pain Management, Greenwich Hospital, HammondCare, Sydney, New South Wales, Australia; Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
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An interpretative phenomenological analysis exploring the lived experience of individuals dying from terminal cancer in Ireland. Palliat Support Care 2014; 13:641-51. [DOI: 10.1017/s1478951514000285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:The experience of living with dying has attracted limited research. We utilized interpretive phenomenological analysis to explore the lived experience of individuals with terminal cancer receiving palliative care in Ireland.Method:Participants were purposely selected from public interviews that had been conducted between 2006 and 2011. The study included the accounts of eight participants (N = 8; six females and two males) with a diagnosis of terminal cancer. Participant ages ranged from 36 to 68 years.Results:Three master themes emerged from the analysis: the personal impact of diagnosis, the struggle in adjusting to change, and dying in context. The results revealed that participants were still living while simultaneously dying. Interestingly, participants did not ascribe new meaning to their lives. The terminal illness was understood within the framework of the life that had existed before diagnosis. They strove to maintain their normal routines and continued to undertake meaningful activities. Management of unfinished business and creation of a legacy were salient tasks. Social withdrawal was not present; rather, participants engaged in emotional labor to sustain valued roles. However, we found that within the public domain there is a paucity of education and discourse supporting individuals at the end of life. The hospice was noted as an important external resource. Each participant experienced a unique dying process that reflected their context.Significance of Results:Healthcare professionals need to recognize the subjectivity of the dying process. Dying individuals require support and options to maintain their personhood.
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Vilalta A, Valls J, Porta J, Viñas J. Evaluation of spiritual needs of patients with advanced cancer in a palliative care unit. J Palliat Med 2014; 17:592-600. [PMID: 24745870 DOI: 10.1089/jpm.2013.0569] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Spiritual needs play an important role in palliative care as both a clinical dimension and a therapeutic strategy. However, recent studies have shown that the management of this dimension still remains a challenge at the clinical level of palliative care. GOALS Our goal was to evaluate the spiritual needs of patients diagnosed with advanced and terminal cancer by the palliative care unit of a hospital in Barcelona, Spain. METHODS An observational study was conducted that involved 50 patients who were recruited between May 2007 and January 2008. A questionnaire was used which included 28 items selected from a review of the literature; the responses were analyzed using a five-point Lickert scale. The results were grouped in 11 categories corresponding to different spiritual needs. RESULTS Two spiritual needs emerged as the most relevant for the patients: their need to be recognized as a person until the end of their life and their need to know the truth about their illness. The least important spiritual needs were identified as those: for continuity and an afterlife; to get rid of obsessions; to achieve freedom from blame and to be able to forgive others; and the need for reconciliation and to feel forgiven by others. CONCLUSIONS When patients knew the truth about their illnesses and they were treated with dignity, their most important needs were likely to be covered. These results suggest that patients receiving palliative care wish to live for the present with as much normality as possible and show only minor concern for their past and future.
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Affiliation(s)
- Aleix Vilalta
- 1 Religious Service, University Hospital Arnau de Vilanova , Lleida, Spain
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Park CL, Lim H, Newlon M, Suresh DP, Bliss DE. Dimensions of religiousness and spirituality as predictors of well-being in advanced chronic heart failure patients. JOURNAL OF RELIGION AND HEALTH 2014; 53:579-590. [PMID: 23616124 DOI: 10.1007/s10943-013-9714-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We examined relationships between seven dimensions of religion/spirituality (RS) (forgiveness, daily spiritual experiences, belief in afterlife, religious identity, religious support, public practices, and positive RS coping) and three dimensions of well-being (physical, mental, and existential) in a sample of 111 patients with advanced chronic heart failure. Participants completed questionnaires at baseline and 3 months later. Results showed that fairly high levels of RS were reported on all seven dimensions. Furthermore, RS dimensions were differentially related to well-being. No aspect of RS was related to physical well-being, and only a few aspects were related to mental well-being. Forgiveness was related to less subsequent depression, while belief in afterlife was related to poorer mental health. All aspects of RS were related to at least one aspect of existential well-being. In particularly, daily spiritual experiences were linked with higher existential well-being and predicted less subsequent spiritual strain. These results are consistent with the view that in advanced disease, RS may not affect physical well-being but may have potent influences on other aspects of well-being, particularly existential aspects.
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Affiliation(s)
- Crystal L Park
- Department of Psychology, University of Connecticut, Storrs, CT, 06269-1020, USA,
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Scott K, Thiel MM, Dahlin CM. The National Agenda for Quality Palliative Care: The Essential Elements of Spirituality in End-of-life Care. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/10999183.2008.10767356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Anquinet L, Rietjens J, van der Heide A, Bruinsma S, Janssens R, Deliens L, Addington-Hall J, Smithson WH, Seymour J. Physicians' experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life. Psychooncology 2013; 23:539-46. [PMID: 24307235 PMCID: PMC4282582 DOI: 10.1002/pon.3450] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/07/2013] [Accepted: 10/21/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The use of continuous sedation until death for terminally ill cancer patients with unbearable and untreatable psychological and existential suffering remains controversial, and little in-depth insight exists into the circumstances in which physicians resort to it. METHODS Our study was conducted in Belgium, the Netherlands, and the UK in hospitals, PCUs/hospices, and at home. We held interviews with 35 physicians most involved in the care of cancer patients who had psychological and existential suffering and had been continuously sedated until death. RESULTS In the studied countries, three groups of patients were distinguished regarding the origin of their psychological and existential suffering. The first group had preexisting psychological problems before they became ill, the second developed psychological and existential suffering during their disease trajectory, and the third presented psychological symptoms that were characteristic of their disease. Before they resorted to the use of sedation, physicians reported that they had considered an array of pharmacological and psychological interventions that were ineffective or inappropriate to relieve this suffering. Necessary conditions for using sedation in this context were for most physicians the presence of refractory symptoms, a short life expectancy, and an explicit patient request for sedation. CONCLUSIONS Physicians in our study used continuous sedation until death in the context of psychological and existential suffering after considering several pharmacological and psychological interventions. Further research and debate are needed on how and by whom this suffering at the end of life should be best treated, taking into account patients' individual preferences.
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Affiliation(s)
- Livia Anquinet
- VUB-UGent End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Kim K, Yong NJ. Spirituality, Death Anxiety and Burnout Levels among Nurses Working in a Cancer Hospital. ACTA ACUST UNITED AC 2013. [DOI: 10.14475/kjhpc.2013.16.4.264] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kyungjin Kim
- Graduate School of The Catholic University, Seoul, Korea
| | - N. Jinsun Yong
- College of Nursing, The Catholic University of Korea, Research Institute for Hospice and Palliative Care, Seoul, Korea
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Jafari N, Farajzadegan Z, Zamani A, Bahrami F, Emami H, Loghmani A, Jafari N. Spiritual therapy to improve the spiritual well-being of Iranian women with breast cancer: a randomized controlled trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:353262. [PMID: 24023572 PMCID: PMC3759260 DOI: 10.1155/2013/353262] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 06/26/2013] [Accepted: 07/18/2013] [Indexed: 02/03/2023]
Abstract
Purpose. The aim of this study was to investigate the role of spiritual therapy intervention in improving the spiritual well-being and quality of life (QOL) of Iranian women with breast cancer. Methods. This randomized controlled clinical trial (RCT) recruited 65 women with breast cancer, randomly assigned to a 6-week spirituality-based intervention (n = 34) or control group (n = 31). Before and after six-week spiritual therapy intervention, spiritual well-being and quality of life (QOL) were assessed using Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp12) and cancer quality-of-life questionnaire (QLQ-C30), respectively. t-test, Paired t-test, pearson's correlation, and hierarchical regression analyses were used for analysis using Predictive Analytic software (PASW, version 18) for Windows. Results. After six spiritual therapy sessions, the mean spiritual well-being score from 29.76 (SD = 6.63) to 37.24 (SD = 3.52) in the intervention group (P < 0.001). There was a significant difference between arms of study (F = 22.91, P < 0.001). A significant positive correlation was detected between meaning and peace with all subscales of functional subscales on European Organization for Research and Treatment of Cancer quality of Life (EORTC QLQ-C30) (P < 0.05). Hierarchical regression analyses of participants indicated that the study arm, pain, and financial impact were significant predictors of spiritual well-being and overall QOL. Social functioning was another significant predictor of spiritual well-being. Conclusion. The results of this randomized controlled trial study suggest that participation in spiritual therapy program is associated with improvements in spiritual well-being and QOL. Targeted interventions to acknowledge and incorporate spiritual needs into conventional treatment should be considered in caring of Iranian patients with breast cancer.
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Affiliation(s)
- Najmeh Jafari
- Community Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, Iran
| | - Ziba Farajzadegan
- Community Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, Iran
| | - Ahmadreza Zamani
- Community Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, Iran
| | - Fatemeh Bahrami
- Consultation Department, Psychology school, Isfahan University, Hezar Jerib Street, Isfahan, Iran
| | - Hamid Emami
- Radiotherapy Department, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, Iran
| | - Amir Loghmani
- Community Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, Iran
| | - Nooshin Jafari
- Anesthesiology Department, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, Iran
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Ford DW, Koch KA, Ray DE, Selecky PA. Palliative and end-of-life care in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e498S-e512S. [PMID: 23649453 DOI: 10.1378/chest.12-2367] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In the United States, lung cancer is a major health problem that is associated with significant patient distress and often limited survival, with some exceptions. The purpose of this article is to address the role of palliative and end-of-life care in the management of patients with lung cancer and to address the need for good communication skills to provide support to patients and families. METHODS This article is based on an extensive review of the medical literature up to April 2012, with some articles as recent as August 2012. The authors used the PubMed and Cochrane databases, as well as EBESCO Host search, for articles addressing palliative care, supportive care, lung neoplasm, and quality of life in cancer or neoplasm, with no limitation on dates. The research was limited to human studies and the English language. RESULTS There was no "definitive" work in this area, most of it being concurrence based rather than evidence based. Several randomized controlled trials were identified, which are reviewed in the text. The article focuses on the assessment and treatment of suffering in patients with lung cancer, as well as the importance of communication in the care of these patients over the course of the disease. The aim of medical care for patients with terminal lung cancer is to decrease symptom burden, enhance the quality of remaining life, and increase survival benefit. A second objective is to emphasize the importance of good communication skills when addressing the needs of the patient and his or her family, starting at the time of diagnosis, which in itself is a life-changing event. Too often we do it poorly, but by using patient-centered communication skills, the outcome can be more satisfactory. Finally, the article addresses the importance of advance care planning for patients with lung cancer, from the time of diagnosis until the last phase of the illness, and it is designed to enhance the physician's role in facilitating this planning process. CONCLUSIONS This article provides guidance on how to reduce patient distress and avoid nonbeneficial treatment in patients with lung cancer. The goal is to decrease symptom burden, enhance quality of life, and increase survival benefit. Good communication and advance care planning are vital to the process.
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Affiliation(s)
- Dee Walker Ford
- Division of Pulmonary, Critical Care Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
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Surprising results regarding MASCC members' beliefs about spiritual care. Support Care Cancer 2013; 21:2991-8. [PMID: 23775154 DOI: 10.1007/s00520-013-1863-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Through our survey of Multinational Association of Supportive Care in Cancer (MASCC) members and its analysis, we sought to gain a broader, more inclusive perspective of physicians' understanding of patients' spiritual care needs and improve our approach to providing spiritual care to patients. METHODS We developed a 16-question survey to assess spiritual care practices. We sent 635 MASCC members four e-mails, each inviting them to complete the survey via an online survey service. Demographic information was collected. The results were tabulated, and summary statistics were used to describe the results. RESULTS Two hundred seventy-one MASCC members (42.7 %) from 41 countries completed the survey. Of the respondents, 50.5 % were age ≤50 years, 161 (59.4 %) were women and 123 (45.4 %) had ≥20 years of cancer care experience. The two most common definitions of spiritual care the respondents specified were "offering emotional support as part of addressing psychosocial needs" (49.8 %) and "alleviating spiritual/existential pain/suffering" (42.4 %). Whether respondents considered themselves to be "spiritual" correlated with how they rated the importance of spiritual care (p ≤ 0.001). One hundred six respondents (39.1 %) reported that they believe it is their role to explore the spiritual concerns of their cancer patients, and 33 respondents (12.2 %) reported that they do not feel it is their role. Ninety-one respondents (33.6 %) reported that they seldom provide adequate spiritual care, and 71 respondents (26.2 %) reported that they did not feel they could adequately provide spiritual care. CONCLUSIONS The majority of MASCC members who completed the survey reported that spiritual care plays an important role in the total care of cancer patients, but few respondents from this supportive care-focused organization actually provide spiritual care. In order to be able to provide a rationale for developing spiritual care guidelines, we need to understand how to emphasize the importance of spiritual care and, at minimum, train MASCC members to triage patients for spiritual crises.
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