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Garcia ACM, Maia LO, Reed PG. Exploring Psychedelics for Alleviating Existential and Spiritual Suffering in People With Serious Illnesses: Links to the Theory of Self-Transcendence. J Holist Nurs 2024:8980101241257836. [PMID: 38809663 DOI: 10.1177/08980101241257836] [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: 05/31/2024]
Abstract
The fields of palliative and holistic Nursing are dedicated to providing comprehensive care for the person, emphasizing special attention to the existential and spiritual aspects of care. Psychedelic-assisted therapy has emerged as a promising approach for symptom management in individuals with serious illnesses, particularly those of existential and spiritual origin. People who undergo challenging experiences, as is the case with serious illnesses, often undergo an identity crisis and question the purpose of their lives. Psychedelic therapy, when conducted properly by trained professionals, can facilitate self-exploration and self-transcendence, opening doors to states of expanded consciousness and fostering a profound connection with oneself. This experience can help patients develop a greater sense of self-awareness and a deeper understanding of their existential and spiritual issues, enabling them to find meaning and inner peace. The Theory of Self-Transcendence theory provides a Nursing framework for understanding how psychedelic-assisted therapy can facilitate, through self-transcendence, the journey of spiritual and existential healing, offering the possibility of achieving wellbecoming from a state of vulnerability.
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Affiliation(s)
| | - Lucas Oliveira Maia
- Federal University of Alfenas University of Campinas Federal University of Rio Grande do Norte
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Martins H, Silva RS, Bragança J, Romeiro J, Caldeira S. Spiritual Distress, Hopelessness, and Depression in Palliative Care: Simultaneous Concept Analysis. Healthcare (Basel) 2024; 12:960. [PMID: 38786372 PMCID: PMC11121139 DOI: 10.3390/healthcare12100960] [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: 03/17/2024] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Spiritual distress, hopelessness, and depression are concepts that are often used in palliative care. A simultaneous concept analysis (SCA) of these concepts is needed to clarify the terminology used in palliative care. Therefore, the aim of this study is to conduct a SCA of spiritual distress, hopelessness, and depression in palliative care. A SCA was performed using the methodology of Haase's model. A literature search was conducted in March 2020 and updated in April 2022 and April 2024. The search was performed on the following online databases: CINAHL with Full-Text, MEDLINE with Full-Text, MedicLatina, LILACS, SciELO, and PubMed. The search was achieved without restrictions on the date of publication. A total of 84 articles were included in this study. The results highlight that the three concepts are different but also share some overlapping points. Spiritual distress is embedded in the rupture of their spiritual/religious belief systems, a lack of meaning in life, and existential issues. Hopelessness is a sense of giving up and an inability to control and fix the patient's situation. Finally, depression is a state of sadness with a multi-impaired situation. In conclusion, refining the three concepts in palliative care is essential since it promotes clarification and enhances knowledge development towards intervention.
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Affiliation(s)
- Helga Martins
- Postdoctoral Program in Integral Human Development, Católica Doctoral School, 1649-023 Lisbon, Portugal;
- Health School, Polytechnic Institute of Beja, 7800-000 Beja, Portugal
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
| | - Rita S. Silva
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| | - Joana Bragança
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| | - Joana Romeiro
- Postdoctoral Program in Integral Human Development, Católica Doctoral School, 1649-023 Lisbon, Portugal;
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| | - Sílvia Caldeira
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
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3
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Dos Santos FC, Macieira TGR, Yao Y, Ardelt M, Keenan GM. The impact of spiritual care delivered by nurses on patients' comfort: A propensity score matched cohort utilizing electronic health record data. Int J Med Inform 2024; 183:105319. [PMID: 38163394 PMCID: PMC11165318 DOI: 10.1016/j.ijmedinf.2023.105319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Spiritual care has been associated with better health outcomes. Despite increasing evidence of the benefits of spiritual care for older patients coping with illness and aggressive treatment, the role of spirituality is not well understood and implemented. Nurses, as frontline holistic healthcare providers, are in a position to address patients' spiritual needs and support them in finding meaning in life. This study aimed to identify spiritual care by analyzing nursing data and to compare the psychological and physical comfort between older chronically ill patients who received spiritual care versus those who did not receive spiritual care. MATERIAL AND METHODS A propensity score matched cohort utilizing nursing care plan data was used to construct balanced groups based on patient characteristics at admission. 45 older patients (≥65 years) with chronic illnesses received spiritual care with measured psychological or physical comfort and 90 matched controls. To ensure the robustness of our results, two sensitivity analyses were performed. Group comparisons were performed to assess the average treatment effect of spiritual care on psychological and physical comfort outcomes. RESULTS The mean psychological comfort was 4.3 (SD = 0.5) for spiritual care receivers and 3.9 (SD = 0.9) for non-receivers. Regression analysis showed that spiritual care was associated with better psychological comfort (estimate = 0.479, std. error = 0.225, p = 0.041). While its effect on physical comfort was not statistically significant (estimate = -0.265, std. error = 0.234, p = 0.261). This study provides suggestive evidence of the positive impact of nurses' spiritual care in improving psychological comfort for older patients with chronic illnesses. CONCLUSION Using interoperable nursing data, our findings suggest that spiritual care improves psychological comfort in older patients facing illness. This finding suggests that nurses may integrate spiritual care into their usual care to support patients experiencing distress.
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Affiliation(s)
| | - Tamara G R Macieira
- Department of Family, Community, and Health Systems Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Monika Ardelt
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL, United States
| | - Gail M Keenan
- Department of Family, Community, and Health Systems Science, College of Nursing, University of Florida, Gainesville, FL, United States
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Freitas MJ, Remondes-Costa S, Veiga E, Macedo G, Teixeira RJ, Leite M. Life beyond Loss: A Retrospective Analysis of the Impact of Meaning of Life Therapy on the Grieving Process of Cancer Patients' Family Caregivers. Healthcare (Basel) 2024; 12:471. [PMID: 38391846 PMCID: PMC10887668 DOI: 10.3390/healthcare12040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/18/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Oncological disease in the palliative stage is a huge challenge for patients and their family caregivers (FCs) due to the fact that it confronts them with death, as well as physical, psychological, and existential suffering. Meaning of Life Therapy (MLT) is a brief structured psycho-existential intervention aiming to help patients in a meaning-making life review process, promoting end-of-life adaptation. The Life Letter (LL) resulting from MLT is an element that facilitates communication between the patient and their caregivers. The goal of this study was to understand the impact of MLT on the grieving processes of eight FCs and to study their perceptions of the role of the LL on grief through semi-structured interviews. The results of our qualitative analysis indicate that MLT was perceived by the FCs as a positive experience despite the conspiracy of silence being identified as a drawback. The LL was interpreted as a communicational element, promoting emotional closeness with the cancer patients and serving as a valuable tool in the FCs' adaptation to loss. Our research findings show that the needs of FCs, especially after experiencing the loss of their relative, are dynamic and specific. This is why it is urgent to develop interventions that consider the idiosyncrasies of end-of-life cancer patients and their FCs in order to avoid frustrated farewells, lonely deaths, and maladaptive grieving processes. This is the direction in which MLT should evolve.
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Affiliation(s)
- Maria João Freitas
- Department of Social and Behavioural Sciences, University Institute of Health Sciences (IUCS-CESPU), 4585-116 Gandra, Portugal
| | - Sónia Remondes-Costa
- Department of Education and Psychology, University of Trás-os-Montes e Alto Douro, 5000-622 Vila Real, Portugal
| | - Elisa Veiga
- Research Centre for Human Development, Faculty of Education and Psychology, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - Gerly Macedo
- Clinical and Health Psychology Unit, Psychiatry and Mental Health Service, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Ricardo João Teixeira
- REACH-Mental Health Clinic, 4000-138 Porto, Portugal
- CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Intervention), Faculty of Psychology and Education Sciences, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Manuela Leite
- Department of Social and Behavioural Sciences, University Institute of Health Sciences (IUCS-CESPU), 4585-116 Gandra, Portugal
- iHealth4Well-Being-Innovation in Health and Well-Being-Research Unit, Instituto Politécnico de Saúde do Norte, CESPU, 4560-462 Penafiel, Portugal
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Miccinesi G, Ripamonti C, Leoni S, Gandelli M, Di Pede P, Visani V, Ambrosini P, De Feo G, Bellandi L, Toffolatti L, Chelazzi C, Trinci C, Chiesi F. Assessing suffering of patients on cancer treatment and of those no longer treated using ESAS-Total Care (TC). Support Care Cancer 2023; 31:579. [PMID: 37715838 PMCID: PMC10505109 DOI: 10.1007/s00520-023-08035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023]
Abstract
AIM The aim of the study was to assess the suffering of patients on oncologic treatment and of those no longer on treatment. Preliminarily, we aimed to confirm the psychometric properties of Edmonton Symptom Assessment System-Total Care (ESAS-TC) in different stages of the disease. The ESAS-TC screens physical and psychological symptoms, but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS A sample of consecutive advanced cancer patients on oncologic therapies treated at the Internistic and Geriatric Supportive Care Unit (IGSCU) of Istituto Nazionale dei Tumori, Milano, and of terminal patients no longer on treatment and cared for by the Fondazione ANT palliative home care team were asked to fill the ESAS-TC. In order to strengthen the previous validation study of the ESAS-TC, 3-ULS (to assess social isolation), JSWBS (to assess spiritual well-being), COST-IT (to assess financial distress), and KPS (to assess functional status) were administered too. RESULTS The questionnaires were self-reported by 108 patients on treatment (52% >60 years old, female 53%, and 61% with KPS 90-100) and by 94 home care patients (71% >60 years old, female 51%, and 68% with KPS 10-50). The sound psychometric characteristics of ESAS-TC were confirmed. Patients on treatment showed lower total ESAS-TC score (19.3 vs 52.7, p<.001) after controlling for age and functional status, and lower financial distress (p.<001). Financial distress, spiritual suffering, and social isolation, after controlling for age, showed a significantly higher score in home care patients. CONCLUSIONS Only through an adequate routine assessment with validated tools is it possible to detect total suffering, the "Total pain" of patients, and treat it through a multidisciplinary approach. The study confirms the reliability and validity of the Italian version of ESAS-TC and the importance of supportive and early palliative care fully integrated with oncological treatment.
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Affiliation(s)
- Guido Miccinesi
- Clinical Epidemiology Unit, Oncological Network Prevention and Research Institute (ISPRO), Florence, Italy
| | - Carla Ripamonti
- Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita' degli Studi di Brescia, Brescia, Italy.
| | | | - Monica Gandelli
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Patricia Di Pede
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Paolo Ambrosini
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia De Feo
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Luisa Toffolatti
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Cosimo Chelazzi
- Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita' degli Studi di Brescia, Brescia, Italy
| | | | - Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child's Health (NEUROFARBA), Section of Psychology, University of Florence, Florence, Italy
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Yoosefee S, Cheraghi MA, Asadi Z, Bahramnezhad F. A Concept Analysis of Spiritual Pain at the End-of-Life in the Iranian-Islamic Context: A Qualitative Hybrid Model. JOURNAL OF RELIGION AND HEALTH 2023; 62:1933-1949. [PMID: 36149613 PMCID: PMC9510200 DOI: 10.1007/s10943-022-01654-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to explore the spiritual pain concept in the Iranian-Islamic context using a hybrid research model during 2020-2021. During the first phase, international and Iranian-Islamic literature was systematically searched and reviewed. During the second phase, the researchers referred to oncology wards, palliative care centers, and intensive care units and conducted unstructured interviews with 19 dying patients. In the third phase, attributes, and final analysis of spiritual pain was extracted from the first phase, and following the second phase, the definition of spiritual pain was finalized. The results showed that spiritual pain is a type of unique transcendental pain in the context of a continuum, rooted in human nature. At the one end of the continuum, there is the pain of deprivation from worldly pleasures (oneself, the family, and others). At the other end, there is the pain of breaking away from and striving to return to one's origin (God). Exploring spiritual pain in the Iranian-Islamic context can help develop tools and clinical guidelines and plan for the presence of specialists at the bedside to relieve this pain.
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Affiliation(s)
- Sadegh Yoosefee
- Spiritual health research center, Neuroscience research center, Qom University of Medical Sciences, Qom, Iran
| | - Mohammad Ali Cheraghi
- Department of ICU and Nursing managment, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Asadi
- Department of Critical Care Nursing, School of Nursing and Midwifery, Nursing, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bahramnezhad
- School of Health and Religion, Qom University of Medical Sciences, Qom, Iran.
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- School of Nursing a Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq., Tehran, 141973317, Iran.
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Illueca M, Bradshaw YS, Carr DB. Spiritual Pain: A Symptom in Search of a Clinical Definition. JOURNAL OF RELIGION AND HEALTH 2023; 62:1920-1932. [PMID: 36083524 PMCID: PMC9461389 DOI: 10.1007/s10943-022-01645-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
We conducted a literature search to identify and compare definitions of the experiential dimension of spiritual pain. Key databases were searched, up to the year 2021 inclusive, for papers with a definition of "spiritual" or "existential" pain/distress in a clinical setting. Of 144 hits, seven papers provided theoretical definitions/descriptions; none incorporated clinical observations or underlying pathophysiological constructs. Based on these findings, we propose a new definition for "spiritual pain" as a "self-identified experience of personal discomfort, or actual or potential harm, triggered by a threat to a person's relationship with God or a higher power." Our updated definition can inform future studies in pain assessment and management.
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Affiliation(s)
- Marta Illueca
- The Episcopal Diocese of Delaware, 913 Wilson Rd, Wilmington, DE, 19806, USA.
| | - Ylisabyth S Bradshaw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
| | - Daniel B Carr
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
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8
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Christie AJ, Lopez G, Nguyen CH, Chen M, Li Y, Cohen L, Delgado-Guay MO. "A Pain Deep in Your Soul (Being) that is Not Physical:" Assessing Spiritual Pain in Integrative Oncology Consultations. J Pain Symptom Manage 2023; 65:562-569. [PMID: 36804423 DOI: 10.1016/j.jpainsymman.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
CONTEXT Spiritual pain contributes to the suffering of cancer patients. However, it is unclear whether patients seen outside of palliative care report spiritual pain and its relationship with symptom burden. OBJECTIVES Characteristics of patients reporting spiritual pain were examined, as well as the association of spiritual pain with symptom burden and how spiritual pain affected the factor structure of the Edmonton Symptom Assessment System (ESAS). METHODS A retrospective chart review was conducted of integrative oncology patients who completed the PROMIS10 and a modified ESAS (ESAS-FS) including financial distress and spiritual pain (pain deep in your soul/being that is not physical). Multiple logistic regression was used to assess associations between demographics and spiritual pain. T-tests compared ESAS-FS symptoms and global health for patients endorsing spiritual pain (0 vs. ≥1). Principal component analyses (oblique rotation) were also used to determine ESAS-FS symptom clusters. RESULTS The sample (N = 1662) was mostly women (65%) and 39% endorsed spiritual pain at least ≥one. Men and older individuals were less likely to endorse spiritual pain (ps < 0.05). Presence of spiritual pain was associated with worse symptoms on the ESAS-FS and global health (ps < 0.001). The ESAS-FS had two symptom clusters, with the psychological factor including depression, anxiety, wellbeing, sleep, financial distress, and spiritual pain (Cronbach's alpha 0.78). CONCLUSION Assessing spiritual pain and understanding the effects of its presence or absence in the context of other physical and psychosocial symptoms may provide additional opportunities for preventing exacerbation of symptoms, improving quality of life, and enhancing overall experience of care.
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Affiliation(s)
- Aimee J Christie
- Department of Palliative (A.J.C., G.L., C.H.N., L.C., M.O.D-G.), Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Lopez
- Department of Palliative (A.J.C., G.L., C.H.N., L.C., M.O.D-G.), Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Chandler Hieu Nguyen
- Department of Palliative (A.J.C., G.L., C.H.N., L.C., M.O.D-G.), Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Minxing Chen
- Department of Biostatistics (M.C., Y.L.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yisheng Li
- Department of Biostatistics (M.C., Y.L.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative (A.J.C., G.L., C.H.N., L.C., M.O.D-G.), Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marvin O Delgado-Guay
- Department of Palliative (A.J.C., G.L., C.H.N., L.C., M.O.D-G.), Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Marterre B, Hinshaw DB, Shinall MC. Spirituality in Surgery-A Double-Edged Scalpel. Am Surg 2023:31348231157805. [PMID: 36786501 DOI: 10.1177/00031348231157805] [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: 02/15/2023]
Abstract
Investigating, respecting, and working with surgical patients' spiritualities is as critical a skill as the proficient technical performance of operations. When spirituality is ignored, sacred patient values remain undiscovered, authentic trust is hindered, and healthy shared decision-making processes suffer. These are instances when the other edge of the spiritual scalpel comes back to cut us as surgeons, but more importantly, upon withdrawal of spiritual understanding, it deeply injures our patients and their families. Spiritual screening, spiritual history taking, engaged, active listening, and big-picture prognostic truth-telling while promoting hope are critical skills for efficacious whole-person surgical care and the healing of our surgical patients' suffering-in all aspects of their humanity. These skills require surgeon introspection and vulnerability, however, as well as regular practice, and can be quite difficult; frequently leading to understandable discomfort, particularly when the surgeon does not share the patient's spiritual orientation or religious commitments. This literature-based essay addresses all of these issues, providing surgeons with a variety of new spiritual tools for their holistic armamentarium to promote healing, rather than further injury.
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Affiliation(s)
- Buddy Marterre
- Departments of Internal Medicine (Section on Palliative Care) and General Surgery, 528756Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Daniel B Hinshaw
- Department of Surgery, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Myrick C Shinall
- Department of Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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10
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Yu V, Yilmaz S, Freitag J, Loh KP, Kehoe L, Digiovanni G, Bauer J, Sanapala C, Epstein RM, Yousefi-Nooraie R, Mohile S. The role of social networks in prognostic understanding of older adults with advanced cancer. PATIENT EDUCATION AND COUNSELING 2023; 106:135-141. [PMID: 36270857 PMCID: PMC10069282 DOI: 10.1016/j.pec.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Explore how older patients utilize their social networks to inform prognostic understanding. METHODS In a pilot study of adults (≥65 years old) with advanced cancer, 16 patients completed surveys, social network maps, and semi-structured interviews exploring with whom they preferred to communicate about their illness. Interviews were analyzed using open-coding, and codes were categorized into emergent themes. Social network maps and themes were analyzed via mixed-methods social network analysis (MMSNA). Three case examples with diverse network characteristics and communication patterns were selected for further analysis. RESULTS Three overarching themes (i.e., prognostic understanding, social support, and therapeutic alliance) revealed that patients' prognostic understanding was strongly influenced by the quality of the social support patients perceived from members of their social networks. Patients demonstrated prognostic understanding when they reported close relationships and open communication with their network members. Case examples revealed some ways that patients sought information and had better sense of their prognosis when they had supportive social networks. CONCLUSION Findings illustrate how understanding social networks may provide information on how older adults with cancer seek, share, and process prognostic information.
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Affiliation(s)
- Veronica Yu
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Sule Yilmaz
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jorie Freitag
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Lee Kehoe
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY, USA
| | - Grace Digiovanni
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jessica Bauer
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Chandrika Sanapala
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Ronald M Epstein
- Department of Family Medicine Research, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya Mohile
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
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11
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Cannon ST, Gabbard J, Walsh RC, Statler TM, Browne JD, Marterre B. Concordant palliative care delivery in advanced head and neck cancer. Am J Otolaryngol 2023; 44:103675. [PMID: 36302326 PMCID: PMC9743959 DOI: 10.1016/j.amjoto.2022.103675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the palliative care consultation practices in an academic head and neck surgery practice. METHODS This is a retrospective review of a palliative care database and the health record for all palliative care consultations of patients suffering from advanced stage head and neck cancer within a 21-month period. RESULTS Ten head and neck cancer patients received palliative care consults while on the otolaryngology service. One consultation occurred preoperatively; nine occurred postoperatively, on a median of hospital day 9. At the time of referral, seven patients were in the ICU and three were on a surgical floor. Code status de-escalation occurred in six patients and psycho-socio-spiritual suffering was supported in all consultations. Nine patients died within six months, with a median post-consultation survival of 35 days. Of these, two died in an ICU, five were discharged to hospice, one to a SNF, and one to a LTACH. CONCLUSION Palliative care consultation in this advanced head and neck cancer cohort was commonly late, however, significant suffering was mitigated following most consults. Palliative care specialists are experts at eliciting patient values, determining acceptable tradeoffs and suffering limitations by employing a shared decision-making process that ends with a patient-centered value-congruent treatment recommendation. Oftentimes, this embraces curative-intent or palliative surgery, along with contingency plans for unacceptable value-incongruent postoperative outcomes. Enhanced awareness of the benefits of embracing concordant palliative care in advanced head and neck cancer patients may help overcome the significant barriers to involving palliative care experts earlier.
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Affiliation(s)
- Sydney T. Cannon
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Palliative Care, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
| | - Rebecca C. Walsh
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
| | - Tiffany M. Statler
- Department of Internal Medicine, Section on Palliative Care, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
| | - J. Dale Browne
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America,Corresponding author at: 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. (J.D. Browne)
| | - Buddy Marterre
- Department of Internal Medicine, Section on Palliative Care, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America,Department of General Surgery, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
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12
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Leidl BF, Fox-Davis D, Walker FO, Gabbard J, Marterre B. Layers of Loss: A Scoping Review and Taxonomy of HD Caregivers' Spiritual Suffering, Grief/Loss and Coping Strategies. J Pain Symptom Manage 2023; 65:e29-e50. [PMID: 36198334 PMCID: PMC9790041 DOI: 10.1016/j.jpainsymman.2022.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Huntington's disease (HD), an incurable, multi-generational, autosomal dominant disorder, creating unique challenges and a myriad of spiritually-related stressors in those affected and their familial caregivers. Spiritual suffering, experiences of grief/loss, and coping strategies have not been systematically studied in HD caregivers. OBJECTIVES To comprehensively define spiritual suffering, grief/loss, and coping strategies used by HD caregivers. METHODS A PRISMA-ScR scoping literature review was conducted. Data from included research articles were organized thematically using induction and open coding. A grounded, deductive approach was used to delineate a demarcated taxonomy of themes, which encompasses all three over-arching domains. Four reviewers, employing a modified Delphi approach, ascertained which themes were demonstrated by research participants in each study. RESULTS 36 of 583 articles met the review criteria; none were published in the palliative care literature. Investigations primarily focused on intrapersonal (self-image) distress and existential angst; only rarely looking deeper into divine/transpersonal suffering, disrupted religious relationships, or meaning distress. HD caregivers experience profound grief/loss, expressed as disenfranchised grief that is associated with the ambiguous loss of their loved one, loss of family structure, social connectedness, and personal losses. Half of the studies reported maladaptive HD caregiver coping strategies-characterized by dysfunctional escape schemes; in contrast, transcendent/creative strategies were often unexplored. CONCLUSION HD caregivers experience prolonged grief and other forms of spiritual suffering as they progressively lose their loved ones and disruption to their own lives. With an improved assessment tool, teams with spiritual and palliative care experts will better be able to support HD family caregivers.
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Affiliation(s)
- Bethany Faith Leidl
- Wake Forest University School of Medicine, (B.F.L., B.M.) Winston-Salem, North Carolina
| | | | - Francis O Walker
- Department of Neurology, Emeritus, Winston-Salem, (F.O.W.) North Carolina, USA
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatrics (Palliative Care), (J.G., B.M.) Winston-Salem, North Carolina
| | - Buddy Marterre
- Wake Forest University School of Medicine, (B.F.L., B.M.) Winston-Salem, North Carolina; Department of Internal Medicine, Section on Gerontology and Geriatrics (Palliative Care), (J.G., B.M.) Winston-Salem, North Carolina; Department of General Surgery, (B.M.) Winston-Salem, North Carolina.
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Hanna JR, McConnell T, Harrison C, Patynowska KA, Finucane AM, Hudson B, Paradine S, McCullagh A, Reid J. 'There's something about admitting that you are lonely' - prevalence, impact and solutions to loneliness in terminal illness: An explanatory sequential multi-methods study. Palliat Med 2022; 36:1483-1492. [PMID: 36081273 PMCID: PMC9749015 DOI: 10.1177/02692163221122269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Loneliness is a prevalent societal issue and can impact on a person's physical and mental health. It is unclear how loneliness impacts on end of life experiences or how such feelings can be alleviated. AIM To explore the perceived prevalence, impact and possible solutions to loneliness among people who are terminally ill and their carers in Northern Ireland through the lens of health and social care professionals. DESIGN An explanatory multi-method study. SETTING/PARTICIPANTS An online survey (n = 68, response rate 30%) followed by three online focus groups with palliative and end of life care health and social care professionals (n = 14). Data were analysed using descriptive statistics and thematic analysis. RESULTS Loneliness was perceived by professionals as highly prevalent for people with a terminal illness (92.6%) and their carers (86.8%). Loneliness was considered a taboo subject and impacts on symptoms including pain and breathlessness and overall wellbeing at end of life. Social support was viewed as central towards alleviating feelings of loneliness and promoting connectedness at end of life. Four themes were identified: (1) the stigma of loneliness, (2) COVID-19: The loneliness pandemic (3) impact of loneliness across physical and mental health domains and (4) the power of social networks. CONCLUSION There is a need for greater investment for social support initiatives to tackle experiences of loneliness at end of life. These services must be co-produced with people impacted by terminal illness to ensure they meet the needs of this population.
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Oliveira GMMD, Almeida MCCD, Marques-Santos C, Costa MENC, Carvalho RCMD, Freire CMV, Magalhães LBNC, Hajjar LA, Rivera MAM, Castro MLD, Avila WS, Lucena AJGD, Brandão AA, Macedo AVS, Lantieri CJB, Polanczyk CA, Albuquerque CJDM, Born D, Falcheto EB, Bragança ÉOV, Braga FGM, Colombo FMC, Jatene IB, Costa IBSDS, Rivera IR, Scholz JR, Melo Filho JXD, Santos MAD, Izar MCDO, Azevedo MF, Moura MS, Campos MDSB, Souza OFD, Medeiros OOD, Silva SCTFD, Rizk SI, Rodrigues TDCV, Salim TR, Lemke VDMG. Position Statement on Women's Cardiovascular Health - 2022. Arq Bras Cardiol 2022; 119:815-882. [PMID: 36453774 PMCID: PMC10473826 DOI: 10.36660/abc.20220734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Daniel Born
- Escola Paulista de Medicina , São Paulo SP - Brasil
| | | | | | | | | | | | | | - Ivan Romero Rivera
- Hospital Universitário Professor Alberto Antunes / Universidade Federal de Alagoas , Maceió AL - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Stéphanie Itala Rizk
- Instituto do Coração (Incor) do Hospital das Clínicas FMUSP , São Paulo SP - Brasil
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15
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Gargiulo MT, Hernán Vázquez S. Incommensurability: an obstacle to the integration of psychotherapy and spirituality. the desert fathers as an overcoming epistemological paradigm. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:341-350. [PMID: 36404247 DOI: 10.1016/j.rcpeng.2020.12.005] [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: 12/31/2018] [Accepted: 12/28/2020] [Indexed: 06/16/2023]
Abstract
In recent years, the body of literature that deals with trying different ways of integrating spirituality into psychotherapeutic practice has grown exponentially. Probably the interest in this topic has arisen with regard to the inclusion in the DSM-IV of the new category "Religious or Spiritual Problem" (Code V62.89). Until then, religious or spiritual issues had been viewed in the clinical practice as symptoms of some mental illnesses like, for example, the delusions with religious content typical of schizophrenics. But with the fourth edition of the aforementioned manual, there began to be an interest in the study of spirituality as it expresses a fundamental aspect of personality. In this vein, various models of integration of spirituality and psychotherapy have been formulated. Our intention is to study the problem of incommensurability as one of the epistemological and methodological problems that supposes a project of this type. We present the writings of the Desert Fathers as an explanatory model that guarantees an epistemologically legitimate integration of spiritual traditions with psychotherapeutic practice. And for that reason, we argue that their writings could constitute a way to overcome the relationship of mutual incommensurability that apparently exists between scientific rationality and spirituality.
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16
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Men VY, Emery CR, Lam TC, Yip PSF. Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis. Psychol Med 2022; 52:2342-2351. [PMID: 33226318 DOI: 10.1017/s0033291720004250] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors. METHODS Patients aged 10 or above who received their first cancer-related hospital admission (2002-2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender. RESULTS In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender. CONCLUSIONS Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.
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Affiliation(s)
- Vera Yu Men
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Clifton Robert Emery
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Tai-Chung Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR
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17
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Robinson KL, Connelly CD, Georges JM. Pain and Spiritual Distress at End of Life: A Correlational Study. J Palliat Care 2022; 37:526-534. [PMID: 35535413 DOI: 10.1177/08258597221090482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.
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Affiliation(s)
| | | | - Jane M Georges
- Hahn School of Nursing and Health Science, University of San Diego, USA
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18
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Abstract
BACKGROUND Existential distress is a widely used concept used in describing cancer patients. However, this concept is vague and has failed to achieve a consensus. The lack of a recognized conceptual framework could hinder future research on existential distress. OBJECTIVE The aim of this study was to clarify and analyze the concept of existential distress in cancer patients. METHODS The Walker and Avant concept analysis approach was applied. RESULTS For cancer patients, the concept of existential distress included 5 core attributes: (a) lack of meaning; (b) loss of autonomy; (c) loss of dignity; (d) hopelessness; and (e) death anxiety. Existential distress is a key factor causing poor quality of life, a poor emotional state, demoralization, and even suicide. It is often underpinned by uncontrolled physical pain, serious psychological morbidity, and a perceived sense of being a burden on others. CONCLUSION The concept analysis provides a theoretical framework for healthcare providers to better understand existential distress in cancer patients, to improve patient well-being. IMPLICATIONS FOR PRACTICE On the basis of the antecedents of this concept, cancer patients experiencing uncontrolled physical pain, severe psychological morbidity, and a perceived sense of being a burden on others are at a high risk of existential distress. These factors should be eliminated in a timely manner to prevent cancer patients from being caught in a state of existential distress. The 5 defining attributes and empirical referents of this concept could be used to develop tools to screen for existential distress in cancer patients and distinguish it from similar concepts.
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Gielen J, Kashyap K, Singh SP, Bhatnagar S, Chaturvedi SK. Psychometric Assessment of SpiDiscI: Spiritual Distress Scale for Palliative Care Patients in India. Indian J Palliat Care 2022; 28:13-20. [PMID: 35673385 PMCID: PMC9165459 DOI: 10.25259/ijpc_50_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/09/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: Spirituality has an impact on the quality of life of palliative care patients and it influences the way in which they experience their disease. Spiritual distress is a common issue among palliative care patients in India that is best assessed through a tool specifically designed for them. This study presents the findings of a psychometric assessment of SpiDiscI: a 16-item spiritual distress scale for Hindi speaking palliative care patients in India. Materials and Methods: This study used a non-experimental cross-sectional sample survey design. 400 cancer patients undergoing pain treatment at the pain and palliative care unit of a tertiary cancer hospital in New Delhi enrolled in the study and completed the study’s questionnaire. The questionnaire contained a section on demographic information, a numerical rating scale (NRS) for pain, SpiDiscI, FACIT-Sp-12, and WHOQOL-BREF. A subset of 50 patients with stable pain completed SpiDiscI a 2nd time 2 weeks after the first administration of the scale to assess test-retest reliability. Results: The scale’s internal consistency is very good (Cronbach’s Alpha 0.85). Spiritual distress scores ranged from 0 to 93.8 (mean 37.1, SD 23.6). Significant negative correlations between SpiDiScI and both FACIT-Sp-12 (R = –0.16, P = 0.001) and WHOQOL-BREF (R = –0.27, P < 0.001) confirmed convergent validity. There was no significant association with NRS pain scores (R = 0.06, P = 0.224). The highly significant association (R = 0.75, P < 0.001) of the scores on assessments 2 weeks apart confirmed test-retest reliability. Conclusion: SpiDiScI is a reliable and valid measure to assess spiritual distress in research among Hindi speaking palliative care patients in India.
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Affiliation(s)
- Joris Gielen
- Center for Global Health Ethics, Duquesne University, Pitsburgh, PA, United States,
| | - Komal Kashyap
- Department of Onco-anesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - Suraj Pal Singh
- Department of Onco-anesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - Sushma Bhatnagar
- Department of Onco-anesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - Santosh K. Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India,
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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: 2] [Impact Index Per Article: 1.0] [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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21
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Voetmann SS, Hvidt NC, Viftrup DT. Verbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices. BMC Palliat Care 2022; 21:3. [PMID: 34980085 PMCID: PMC8725243 DOI: 10.1186/s12904-021-00886-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Denmark is considered one of the World's most secular societies, and spiritual matters are rarely verbalized in public. Patients report that their spiritual needs are not cared for sufficiently. For studying spiritual care and communication, twelve patients admitted to two Danish hospices were interviewed. Verbal and non-verbal communication between patients and healthcare professionals were identified and analysed. Methodically, the Interpretative Phenomenological Analysis was used, and the findings were discussed through the lenses of existential psychology as well as philosophy and theory of caring sciences. Three themes were identified: 1. When death becomes present, 2. Direction of the initiative, and 3. Bodily presence and non-verbal communication. The encounter between patient and healthcare professional is greatly influenced by sensing, decoding, and interpretation. A perceived connection between the patient and the healthcare professional is of great importance as to how the patient experiences the relationship with the healthcare professional.The patient's perception and the patient's bodily experience of the healthcare professional are crucial to whether the patient opens up to the healthcare professional about thoughts and needs of a spiritual nature and initiates a conversation hereabout. In this way we found three dynamically connected movements toward spiritual care: 1. From secular to spiritual aspects of care 2. From bodily, sensory to verbal aspects of spiritual care and 3. From biomedical to spiritual communication and care. Thus, the non-verbal dimension becomes a prerequisite for the verbal dimension of spiritual communication to develop and unfold. The behaviour of the healthcare professionals, characterised by the way they move physically and the way they touch the patient, was found to be just as important as verbal conversation when it comes to spiritual care. The healthcare professional can create a connection to the patient through bodily and relational presence. Furthermore, the healthcare professionals should let their sensing and impressions guide them when meeting the patient in dialog about matters of a spiritual nature. Their perception of the patient and non-verbal communication are a prerequisite for being able to meet patient's spiritual needs with care and verbal communication.
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Affiliation(s)
- Sara Stage Voetmann
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Toudal Viftrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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22
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Palmer PK, Wehrmeyer K, Florian MP, Raison C, Idler E, Mascaro JS. The prevalence, grouping, and distribution of stressors and their association with anxiety among hospitalized patients. PLoS One 2021; 16:e0260921. [PMID: 34871325 PMCID: PMC8648119 DOI: 10.1371/journal.pone.0260921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Anxiety is prevalent among hospital inpatients and it has harmful effects on patient well-being and clinical outcomes. We aimed to characterize the sources of hospital distress and their relationship to anxiety. We conducted a cross-sectional study of inpatients (n = 271) throughout two Southeastern U.S. metropolitan hospitals. Participants completed a survey to identify which of 38 stressors they were experiencing. They also completed the State Trait Anxiety Inventory six-item scale. We evaluated the prevalence of stressors, their distribution, and crude association with anxiety. We then used multivariate logistic regression to estimate the association between stressors and clinically relevant anxiety, with and without adjusting for demographic variables. We used factor analysis to describe the interrelationships among stressors and to examine whether groups of stressors tend to be endorsed together. The following stressors were highly endorsed across all unit types: pain, being unable to sleep, feelings of frustration, being overwhelmed, and fear of the unknown. Stressors relating to isolation/meaninglessness and fear/frustration tend to be endorsed together. Stressors were more frequently endorsed by younger, female, and uninsured or Medicaid-insured patients and being female and uninsured was associated with anxiety in bivariate analysis. After controlling for the sources of distress in multivariate linear analysis, gender and insurance status no longer predicted anxiety. Feelings of isolation, lack of meaning, frustration, fear, or a loss of control were predictive. Study results suggest that multiple stressors are prevalent among hospital inpatients and relatively consistent across hospital unit and disease type. Interventions for anxiety or emotional/spiritual burden may be best targeted to stressors that are frequently endorsed or associated with anxiety, especially among young and female patients.
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Affiliation(s)
- Patricia K. Palmer
- Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, United States of America
- * E-mail:
| | - Kathryn Wehrmeyer
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Marianne P. Florian
- Graduate Division of Religion, Emory University, Atlanta, Georgia, United States of America
| | - Charles Raison
- Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, United States of America
- School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ellen Idler
- Department of Sociology and Rollins School of Public Health, Emory University; Atlanta, Georgia, United States of America
| | - Jennifer S. Mascaro
- Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, United States of America
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Park Y, Suh SY, Kim SH, Park J, Yoon SJ, Kim YJ, Kang B, Kwon JH, Park K, Hui D, Kim HJ, Lee S, Ahn HY. Development of a One-item Screening Question to Assess Spiritual Well-Being for Advanced Cancer Inpatients in Korea. J Pain Symptom Manage 2021; 62:910-917. [PMID: 34000335 DOI: 10.1016/j.jpainsymman.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Spiritual well-being (SWB) is significant for patients with life-limiting illnesses. Thus, shortened versions of questions would be helpful in approaching SWB. OBJECTIVES Our goal was to develop a one-item screening question to assess the SWB of advanced cancer inpatients. METHODS This was a cross-sectional, multicenter study involving adult advanced cancer inpatients from seven palliative care units in South Korea. The candidate one-item questions were three questions scored using numeric rating scales from 0 to 10: feeling at peace (Are you at peace?), self-rated spirituality (Do you think of yourself as a spiritual person?), and self-rated religiosity (Do you think of yourself as a religious person?). The Functional Assessment of Chronic Illness Therapy-Spirituality 12 (FACIT-Sp-12) comprised of two subscales Meaning/Peace and Faith was used to assess SWB. Pearson's correlation test was conducted to determine the relationship between the three questions, the total FACIT-Sp-12 score, and its subscales. RESULTS A total of 202 patients were enrolled. A strong correlation was observed between self-rated spirituality (r = 0.732 and 0.790; P < 0.001 and < 0.001 respectively) and religiosity (r = 0.708 and 0.758; P < 0.001 and < 0.001 respectively) with the total FACIT-Sp-12 scores and faith subscale scores. Feeling at peace showed a moderate correlation with the total of FACIT-Sp-12 scores (r = 0.505, P < 0.01). All three questions had a moderate correlation with the meaning/peace subscale. CONCLUSION Self-rated spirituality and religiosity showed better convergence validity than feeling at peace. Therefore, we recommend self-rated spirituality or religiosity as a one-item question for screening SWB in inpatients with advanced cancer.
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Affiliation(s)
- Youngmin Park
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Sang-Yeon Suh
- Hospice & Palliative Care Center, Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea; Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea.
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Jeanno Park
- Hospice & Palliative Care Center, Bobath Memorial Hospital, Seongnam, South Korea
| | - Seok Joon Yoon
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Beodeul Kang
- Department of Internal Medicine, Division of Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Kwonoh Park
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hyeon Jeong Kim
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Sanghee Lee
- Department of Cancer Control and Population Health, National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
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Viftrup DT, Nissen R, Søndergaard J, Hvidt NC. Four aspects of spiritual care: a phenomenological action research study on practicing and improving spiritual care at two Danish hospices. Palliat Care Soc Pract 2021; 15:26323524211050646. [PMID: 34708208 PMCID: PMC8543636 DOI: 10.1177/26323524211050646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Denmark and internationally, there has been an increased focus on strengthening palliative care by enhancing spiritual care. Dying patients, however, do not experience their spiritual needs being adequately met. METHODS Through an action research study design with four consecutive stages, namely, observation in practice, reflection-on-praxis, action-in-praxis, and evaluation of the action research process involving patients and hospice staff from two hospices in Denmark, two research questions were explored: (1) How do patients and staff perceive, feel, live, practice, and understand spiritual care at hospice? and (2) How can spiritual care be improved in hospice practice? The data material presented comprised 12 individual interviews with patients and nine focus group interviews with the staff. RESULTS We found four aspects of spiritual care through which patients and staff seemed to perceive, feel, live, practice, and understand spiritual care at hospice, and from where spiritual care may be improved in hospice practice. These aspects constituted four themes: (1) relational, (2) individualistic, (3) embodied, and (4) verbal aspects of spiritual care. CONCLUSION Staff realized immanent limitations of individual aspects of spiritual care but learned to trust that their relational abilities could improve spiritual care. Embodied aspects seemed to open for verbal aspects of spiritual care, but staff were reluctant to initiative verbal dialogue. They would bodily sense values about preserving patients' boundaries in ways that seemed to hinder verbal aspects of spiritual care. During action-in-praxis, however, staff realized that they might have to initiate spiritual conversation in order to care for patients' spiritual needs.
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Affiliation(s)
- Dorte Toudal Viftrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark
| | - Ricko Nissen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Ripamonti C, Leporati R, De Feo G, Di Pede P, Toffolatti L, Guglielmo M, La Carpia D, Miccinesi G, Chiesi F. Italian version of the Edmonton Symptom Assessment System (ESAS)-Total Care (TC): development and psychometric validation in patients undergoing cancer treatment or follow-up. Support Care Cancer 2021; 30:1923-1933. [PMID: 34623487 DOI: 10.1007/s00520-021-06594-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The routine use of patient-reported outcomes (PROs) in clinical practice improves quality of care, it helps in reducing the access to emergency services and unscheduled visits, and it can improve cancer patients' time survival. The Edmonton Symptom Assessment System (ESAS) is a PRO largely used in different care settings to monitor physical and psychological symptoms. Nonetheless, along with these symptoms, literature also highlighted the presence and effect of spiritual pain, financial distress, and social isolation on quality of care, treatment effectiveness, and survival. AIM The aims of the current study were (a) to complete the Italian version of the ESAS validation process by adding the missing symptom "insomnia" and (b) to develop and validate the ESAS-Total Care (ESAS-TC) that is intended to evaluate and screen not only physical and psychological symptoms but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS A sample of Italian native outpatients, who referred to the dedicated Supportive Care Unit of the Fondazione IRCCS, Istituto Nazionale deiTumori (INT), Milano, were asked to fill the ESAS-TC to assess item properties, factorial structure, internal consistency, test-retest reliability (patients were asked to retake the scale after 2-6 weeks), and external validity. Concerning the latter, other self-administered scales were employed to assess perceived stress (Perceived Stress Scale), unmet needs (using theNeed Evaluation Questionnaire that describes informative, assistance/care, relational, needs for psycho-emotional support, material needs), and perceived social support (administering the Multidimensional Scale of Perceived Social Support that evaluates perceived support of family, friends, and significant others in the wider social field). RESULTS The scales were administered to 243 patients with solid (90%) and hematologic (10%) cancers, mean age 62.6, female 76.5%. Analysis suggested that a single factor better represents the structure of the ESAS scales, their internal consistency and test-retest reliability were good, and evidence of construct and criterion validity were provided. Additionally, incremental validity of the ESAS-TC was proved showing that the added items offer a unique contribution in predicting the patient's stress. Finally, known groups validity was confirmed testing the differences in the ESAS scores due to the Karnofsky Performance Status. CONCLUSIONS The current study allowed to complete the validation of the Italian version of the ESAS and to develop a psychometrically sound scale, the ESAS-Total Care, that potentially helps in moving cancer research toward personalized total cancer care.
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Affiliation(s)
- Carla Ripamonti
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy.
| | - Rita Leporati
- Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Giulia De Feo
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Patricia Di Pede
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Luisa Toffolatti
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Mauro Guglielmo
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Domenico La Carpia
- Azienda USL Toscana Centro, UDS Cure Palliative Prato Pistoia, Firenze, Italy
| | - Guido Miccinesi
- Epidemiologia Clinica e Di Supporto Al Governo Clinico, Istituto Per lo Studio, la Prevenzione e la Rete Oncologica-ISPRO, Firenze, Italy
| | - Francesca Chiesi
- Department of Neuroscience and Child's Health (NEUROFARBA), University of Florence, Florence, Italy
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Earlix K, Shive N, Coats H. Unpacking characteristics of spirituality through the lens of persons of colour living with serious illness: The need for nurse-based education to increase understanding of the spiritual dimension in healthcare. J Clin Nurs 2021; 31:2354-2364. [PMID: 34601788 PMCID: PMC8976857 DOI: 10.1111/jocn.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the characteristics of spirituality as expressed by persons of colour living with serious illness. BACKGROUND Spiritual, Religious and Existential Care, as specified in the National Consensus Project (NCP) Guidelines, is a core domain of palliative nursing. DESIGN OF THE STUDY A constructionist approach to narrative analysis was used for this study and reported in accordance with the COREQ guideline. METHODS In-depth narrative interviews were conducted with 20 participants. These participants included persons of colour living with serious illness who were admitted to an acute-care hospital. Through a deductive coding approach, a codebook was created based on a broad definition of spirituality including: religion, self, family, community, nature and art/music/literature. RESULTS The major themes expressed were religion, self and family. Subthemes of religion included increased faith, support of the church community and God's intervention in patients' lives. Subthemes of self included increased self-worth, self-awareness of one's place in the world and individualised transition to new meaning in life. Subthemes of family included family adding meaning and purpose to their lives, family as an important source of strength and support, wanting to regain their health to go back to caring for their families, and believing that their illness had brought their family closer together. CONCLUSION The thematic analysis revealed a broader existential aspect of what brought value, meaning and purpose into their lives, despite their progressive physical illness. More research is needed to understand spiritual, religious or existential needs of persons of colour living with serious illness and how nurses can best support these needs. By understanding the components of spirituality, nurses can learn to recognise the signs of spiritual distress. This awareness also helps to know when a spiritual specialist is needed-either the patient's own spiritual guide(s) or the hospital chaplain. Nurses can also use spiritual assessment tools when performing a general assessment on the patient. RELEVANCE TO CLINICAL PRACTICE By understanding the components of spirituality, nurses can learn to recognise the signs of spiritual distress. This awareness also helps to know when a spiritual specialist is needed-either the patient's own spiritual guide(s) or the hospital chaplain. Nurses can also use spiritual assessment tools when performing a general assessment on the patient.
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Affiliation(s)
- Kerith Earlix
- College of Nursing, Anschutz Medical Campus, University of Colorado, Denver, Colorado, USA
| | - Nadia Shive
- College of Nursing, Anschutz Medical Campus, University of Colorado, Denver, Colorado, USA
| | - Heather Coats
- College of Nursing, Anschutz Medical Campus, University of Colorado, Denver, Colorado, USA
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Developing an Educational Course in Spiritual Care: An Action Research Study at Two Danish Hospices. RELIGIONS 2021. [DOI: 10.3390/rel12100827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Further improvement of spiritual care in palliative care is warranted. Particularly reducing barriers and enhancing spiritual care competencies among the healthcare professionals is needed. The aim was to develop a training course in spiritual care in close collaboration with patients and staff from two Danish hospices. We applied an action research design to ensure that the training course was rooted in everyday practice of patients and staff. The methodology applied was based on philosophical hermeneutics and existential phenomenology. The action research process enabled the division into three topics on how a training course can reduce barriers towards spiritual care among the healthcare professionals. These three topics functioned as a theoretical framework for educating staff at a hospice in spiritual care. The three topics were: (1) the vulnerable encounter; (2) self-reflection concerning spiritual needs, thoughts, beliefs, and values; and (3) shared professional language for spiritual care. We operationalized the three topics into a flexible course design that could be adaptable to the practical possibilities and limitations of the individual hospice. The curriculum includes theoretical teaching, reflection exercises, and an improvisation theater workshop with professional actors. Educating staff led to the improvement of spiritual care at the hospices involved in the study.
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Nobre F, Esporcatte R, Brandão AA, Avezum Á, Feitosa ADM, Amodeo C, Barbosa ECD, Moriguchi EH, Lucchese FA, Griz HB, Nicolau JC, Magalhães LBNC, Mota-Gomes MA, Borba MHED, Pontes MRN, Jardim PCBV, Spineti PPDM, Mourilhe-Rocha R, Miranda RD, Couceiro SLM, Barroso WKS. Position Statement on Hypertension and Spirituality - 2021. Arq Bras Cardiol 2021; 117:599-613. [PMID: 34550245 PMCID: PMC8462965 DOI: 10.36660/abc.20210723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Fernando Nobre
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil.,Hospital São Francisco, Ribeirão Preto, SP - Brasil
| | - Roberto Esporcatte
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil.,Hospital Pró-Cradíaco, Rio de Janeiro, RJ - Brasil
| | | | - Álvaro Avezum
- Hospital Alemão Oswaldo Cruz, São Paulo, SP - Brasil
| | - Audes Diógenes Magalhães Feitosa
- Universidade Federal de Pernambuco, Recife, PE - Brasil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
| | - Celso Amodeo
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | | | | | | | - José Carlos Nicolau
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Weimar Kunz Sebba Barroso
- Liga de Hipertensão Arterial, Goiânia, GO - Brasil.,Universidade Federal de Goiás, Goiânia, GO - Brasil
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Mercadante S, Adile C, Ricci M, Maltoni M, Bonanno G, Casuccio A. The Role of Religiosity in Symptom Expression of Advanced Cancer Patients. Am J Hosp Palliat Care 2021; 39:705-709. [PMID: 34493072 DOI: 10.1177/10499091211041349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM The aim of this study was to assess the religious pattern and its impact on symptom expression in patients with advanced cancer. METHODS A consecutive sample of advanced cancer patients screened at admission to palliative care. Standard epidemiological data were recorded. Patients were asked about their religious beliefs, the degree of social relationship to existing religions, the role of religion in their life, and the frequency of their prayer. The Edmonton Symptom Assessment Scale (ESAS) and Hospital Anxiety Depression scale (HADS) were assessed. RESULTS Two-hundred-eighty-three patients were screened. Age and gender were found to be independently correlated with religious belief (p = 0.042 and p = 0.016, respectively). Gender (females, p = 0.026), age (p = 0.003), lower Karnofsky performance status (KPS) (p = 0.022), and higher values of HADS-A (p = 0.003) were independently correlated with the degree of social relationship to existing religions. Gender (females, p = 0.002), lower KPS (p = 0.005), and higher values of HADS-A (p = 0.04) were independently correlated with a more relevant role of religiosity. Gender (females, p < 0.0005), lower KPS (p = 0.001), and drowsiness (p = 0.05) were independently correlated with frequency of prayer. CONCLUSION The more the patients have demanding religious issues, the greater the state of anxiety, particularly in older and female patients with a lower KPS. The religious pattern did not have relevant role in the expression of other symptoms included in the ESAS.
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Affiliation(s)
| | - Claudio Adile
- Private Hospital La Maddalena Palermo, Sicilia, Italy
| | - Marianna Ricci
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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30
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Damen A, Exline J, Pargament K, Yao Y, Chochinov H, Emanuel L, Handzo G, Wilkie DJ, Fitchett G. Prevalence, Predictors and Correlates of Religious and Spiritual Struggles in Palliative Cancer Patients. J Pain Symptom Manage 2021; 62:e139-e147. [PMID: 33984462 PMCID: PMC8419029 DOI: 10.1016/j.jpainsymman.2021.04.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
CONTEXT Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. This concise measure allows for the assessment of multiple types of r/s struggles for people from different religious backgrounds or none. OBJECTIVES The aim of the present study was to examine the prevalence, predictors and correlates of r/s struggles as measured by the RSS-14 and its subdomains in a cancer population receiving palliative care. METHODS Data were collected from six outpatient palliative care services across the US. Inclusion criteria for patients were age 55 or older with a cancer diagnosis. In addition to demographic and r/s characteristics, study measures included the Edmonton Symptom Assessment Scale (ESAS), the Patient Dignity Inventory (PDI) and the Quality of Life at the End of Life (QUAL-E). RESULTS The study included 331 participants. Some r/s struggle was reported by 66%, moderate to high struggle for at least one item was reported by 20% of the patients. In bivariate analyses, r/s struggle was associated with greater symptom burden, greater dignity-related problems and poorer quality of life; in multivariable analyses, dignity-related problems remained a predictor of total r/s struggle. CONCLUSION R/S struggles may compromise well-being for cancer patients receiving palliative care. Clinicians should consider periodic screening for r/s struggles and referrals for spiritual care if indicated.
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Affiliation(s)
- Annelieke Damen
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands.
| | - Julie Exline
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Kenneth Pargament
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio
| | - Yingwei Yao
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, Florida
| | - Harvey Chochinov
- Research Institute of Oncology and Hematology, Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Emanuel
- Buehler Center on Aging, Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - George Handzo
- Health Services Research & Quality, HealthCare Chaplaincy Network, Caring for the Human Spirit TM, New York, New York
| | - Diana J Wilkie
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, Florida
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois
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Thompson M, Rabusch S, Radomski MV, Marquardt V, Kath K, Kreiger R, Squires K. Grace Notes: feasibility of a manualized intervention to advance spiritual well-being for clients with acquired brain injury. J Health Care Chaplain 2021; 28:497-509. [PMID: 34024265 DOI: 10.1080/08854726.2021.1929764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Spiritual well-being appears to contribute to mental health and adaptation in adults with acquired brain injury (ABI). ABI-related interventions, including those associated with spirituality, must be specifically designed with learning-related impairments in mind. We conducted a feasibility study of a manualized intervention to support spiritual well-being after ABI called Grace Notes. The goal is to provide clients with time tested, easily accessible spiritual practices that help them experience deeper feelings of being in relationship with their Higher Power as they understand it. Findings suggest that Grace Notes can be implemented by both its developer with the context of an interdisciplinary outpatient rehabilitation program and a rehabilitation clinician as a stand-alone group. People with ABI appear to be interested in a spiritually intervention that draws from a variety of spiritual practices and traditions. Further study related to the efficacy of spiritual well-being intervention after ABI is warranted.
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Affiliation(s)
- Margaret Thompson
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
| | - Stacey Rabusch
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| | | | - Valerie Marquardt
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
| | - Kristina Kath
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| | - Robert Kreiger
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| | - Kelsey Squires
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
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Lim MA, Ang BT, Lam CL, Loh EC, Zainuddin SI, Capelle DP, Ng CG, Lim PK, Khor PY, Lim JY, Huang SY, Low GQJ, Gan XY, Tan SB. The effect of 5-min mindfulness of love on suffering and spiritual quality of life of palliative care patients: A randomized controlled study. Eur J Cancer Care (Engl) 2021; 30:e13456. [PMID: 33913192 DOI: 10.1111/ecc.13456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/15/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Suffering is a common experience in palliative care. In our study, we aimed to determine the effect of 5-min mindfulness of love on suffering and the spiritual quality of life of palliative care patients. METHODS We conducted a parallel-group, blinded, randomized controlled study at the University of Malaya Medical Centre (UMMC), Malaysia from February 2019 to April 2019. Sixty adult palliative care patients with an overall suffering score of 4/10 or above based on the Suffering Pictogram were recruited and randomly assigned to either the 5-min mindfulness of love group (N = 30) or the 5-min supportive listening group (N = 30). RESULTS There were statistically significant improvements in the overall suffering score (mean difference = -2.9, CI = -3.7 to -2.1, t = -7.268, p = 0.000) and the total FACIT-Sp-12 score (mean difference = 2.9, CI = 1.5 to 4.3, t = 4.124, p = 0.000) in the intervention group compared to the control group. CONCLUSION The results provided evidence that 5-min mindfulness of love could affect the actual state of suffering and the spiritual quality of life of palliative care patients.
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Affiliation(s)
- Min Ai Lim
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bin Ting Ang
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Loong Lam
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Chin Loh
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Chong Guan Ng
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Poh Khuen Lim
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pei Yi Khor
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia Yu Lim
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - See Yong Huang
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Xhi Yan Gan
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seng Beng Tan
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Delgado-Guay MO, Palma A, Duarte E, Grez M, Tupper L, Liu DD, Bruera E. Association between Spirituality, Religiosity, Spiritual Pain, Symptom Distress, and Quality of Life among Latin American Patients with Advanced Cancer: A Multicenter Study. J Palliat Med 2021; 24:1606-1615. [PMID: 33844951 DOI: 10.1089/jpm.2020.0776] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives: The purpose of this multicenter study was to characterize the association between spirituality, religiosity, spiritual pain, symptom distress, coping, and quality of life (QOL) among Latin American advanced cancer patients. Methods: Three hundred twenty-five advanced cancer patients from palliative care clinics in Chile, Guatemala, and the United States completed validated assessments: Faith, Importance and Influence, Community, and Address (FICA) (spirituality/religiosity), Edmonton Symptom Assessment Scale-Financial/Spiritual (ESAS-FS), including spiritual pain, Penn State Worry Questionnaire-Abbreviated (PSWQ-A), Center for Epidemiologic Studies Depression Scale (CES-D), Brief-coping strategies (COPE) and Brief religious coping (RCOPE) and RCOPE, respectively, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Expanded version (FACIT-Sp-Ex). Results: Median age: 58 years (range: 19-85); 60% female; and 62% Catholic and 30% Christian, but not Catholic. Three hundred fifteen patients (97%) considered themselves spiritual and 89% religious, with median intensities of 7 (interquartile range [IQR]: 5-10) and 7 (5-9), respectively (0-10 scale, 10 = "very much"). Median importance of spirituality/religiosity was 10 (IQR: 8-10). The frequency and associations between spirituality/religiosity and various items were as follows: helps to cope with illness (98%; r = 0.66303; p < 0.0001), positive effect on physical symptoms (81%; r = 0.42067; p < 0.0001), and emotional symptoms (84%; r = 0.16577; p < 0.0001). One hundred ninety-five patients (60%) reported that their spiritual/religious needs had not been supported by the medical team. Spiritual pain was reported in 162/311 patients (52%), with median intensity of 6 (IQR: 5-8). Spiritual pain was associated with pain (p = 0.0225), depression (p < 0.0001), anxiety (p < 0.0001), worry (p < 0.001), behavioral disengagement (p = 0.0148), FACIT-Sp-Ex score (p = 0.0002), and negative RCOPE (p < 0.0001). Significance of Results: Spirituality and religiosity are frequent, intense, and rarely addressed among Latin American patients. Spirituality/religiosity was associated with positive COPE and higher QOL. Spiritual pain was also frequent and associated with physical and psychosocial distress. These patients need increased spiritual/religious support.
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Affiliation(s)
- Marvin O Delgado-Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alejandra Palma
- Seccion de Cuidados Continuos y Paliativos, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eva Duarte
- Departamento de Cuidados Paliativos, Instituto Nacional de Cancerología de Guatemala, Guatemala City, Guatemala
| | - Mónica Grez
- Seccion de Cuidados Continuos y Paliativos, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Laura Tupper
- Seccion de Cuidados Continuos y Paliativos, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Gargiulo MT, Vázquez SH. Incommensurability: An Obstacle to the Integration of Psychotherapy and Spirituality. The Desert Fathers as an Overcoming Epistemological Paradigm. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(21)00027-5. [PMID: 33771362 DOI: 10.1016/j.rcp.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/27/2019] [Accepted: 12/28/2020] [Indexed: 10/21/2022]
Abstract
In recent years, the body of literature that deals with trying different ways of integrating spirituality into psychotherapeutic practice has grown exponentially. Probably the interest in this topic has arisen with regard to the inclusion in the DSM-IV of the new category "Religious or Spiritual Problem" (Code V62.89). Until then, religious or spiritual issues had been viewed in the clinical practice as symptoms of some mental illnesses like, for example, the delusions with religious content typical of schizophrenics. But with the fourth edition of the aforementioned manual, there began to be an interest in the study of spirituality as it expresses a fundamental aspect of personality. In this vein, various models of integration of spirituality and psychotherapy have been formulated. Our intention is to study the problem of incommensurability as one of the epistemological and methodological problems that supposes a project of this type. We present the writings of the Desert Fathers as an explanatory model that guarantees an epistemologically legitimate integration of spiritual traditions with psychotherapeutic practice. And for that reason, we argue that their writings could constitute a way to overcome the relationship of mutual incommensurability that apparently exists between scientific rationality and spirituality.
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Hvidt NC, Nielsen KT, Kørup AK, Prinds C, Hansen DG, Viftrup DT, Assing Hvidt E, Hammer ER, Falkø E, Locher F, Boelsbjerg HB, Wallin JA, Thomsen KF, Schrøder K, Moestrup L, Nissen RD, Stewart-Ferrer S, Stripp TK, Steenfeldt VØ, Søndergaard J, Wæhrens EE. What is spiritual care? Professional perspectives on the concept of spiritual care identified through group concept mapping. BMJ Open 2020; 10:e042142. [PMID: 33372078 PMCID: PMC7772306 DOI: 10.1136/bmjopen-2020-042142] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The overall study aim was to synthesise understandings and experiences regarding the concept of spiritual care (SC). More specifically, to identify, organise and prioritise experiences with the way SC is conceived and practised by professionals in research and the clinic. DESIGN Group concept mapping (GCM). SETTING The study was conducted within a university setting in Denmark. PARTICIPANTS Researchers, students and clinicians working with SC on a daily basis in the clinic and/or through research participated in brainstorming (n=15), sorting (n=15), rating and validation (n=13). RESULTS Applying GCM, ideas were identified, organised and prioritised online. A total of 192 unique ideas of SC were identified and organised into six clusters. The results were discussed and interpreted at a validation meeting. Based on input from the validation meeting a conceptual model was developed. The model highlights three overall themes: (1) 'SC as an integral but overlooked aspect of healthcare' containing the two clusters SC as a part of healthcare and perceived significance; (2) 'delivering SC' containing the three clusters quality in attitude and action, relationship and help and support, and finally (3) 'the role of spirituality' containing a single cluster. CONCLUSION Because spirituality is predominantly seen as a fundamental aspect of each individual human being, particularly important during suffering, SC should be an integral aspect of healthcare, although it is challenging to handle. SC involves paying attention to patients' values and beliefs, requires adequate skills and is realised in a relationship between healthcare professional and patient founded on trust and confidence.
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Affiliation(s)
- Niels Christian Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Kristina Tomra Nielsen
- Department of Occupational Therapy, University College of Northern Denmark (UCN), Aalborg, Denmark
- The ADL Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Alex K Kørup
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Mental Health Service Kolding-Vejle, Region of Southern Denmark, Vejle, Denmark
| | - Christina Prinds
- Clinical Institute, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
- Research, University College South - Campus Haderslev, Haderslev, Denmark
| | - Dorte Gilså Hansen
- IRS, Center for Shared Decision Making, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Dorte Toudal Viftrup
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Erik Falkø
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Flemming Locher
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, JELLING, Denmark
| | - Hanne Bess Boelsbjerg
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Midtjylland, Denmark
| | - Johan Albert Wallin
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karsten Flemming Thomsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Katja Schrøder
- Department of Public Health, Syddansk Universitet, Odense, Denmark
| | - Lene Moestrup
- Health Science Research Center, University College Lillebaelt - Campus Odense, Odense, Denmark
| | - Ricko Damberg Nissen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sif Stewart-Ferrer
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tobias Kvist Stripp
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Eva Ejlersen Wæhrens
- The Research Initiative for Activity studies and Occupational Therapy, Research Unit of User Perspectives, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- The ADL unit, Frederiksberg Hospital Parker Institute, Frederiksberg, Hovedstaden, Denmark
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The accuracy of measures in screening adults for spiritual suffering in health care settings: A systematic review. Palliat Support Care 2020; 18:89-102. [PMID: 31387655 DOI: 10.1017/s1478951519000506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Guidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence of the accuracy of measures used to screen adults for spiritual suffering. METHODS A systematic review of the literature. We searched five scientific databases to identify relevant articles. Two independent reviewers screened, extracted data, and assessed study methodological quality. RESULTS We identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the two-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82-87%), and the revised Rush protocol had the highest specificity (81-90%). The methodological quality of all included studies was low. SIGNIFICANCE OF RESULTS While most of the identified spiritual screening measures are brief (comprised 1 to 12 items), few had sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.
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Yik LL, Ling LM, Ai LM, Ting AB, Capelle DP, Zainuddin SI, Beng TS, Chin LE, Loong LC. The Effect of 5-Minute Mindfulness of Peace on Suffering and Spiritual Well-Being Among Palliative Care Patients: A Randomized Controlled Study. Am J Hosp Palliat Care 2020; 38:1083-1090. [PMID: 33078627 DOI: 10.1177/1049909120965944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mindfulness practices may have a role in reducing suffering and improving spiritual well-being among patients with serious illness. The efficacy, feasibility and acceptability of such interventions warrant further exploration in the palliative care population. OBJECTIVE To investigate the effect of a brief mindfulness practice, the 5-minute mindfulness of peace intervention, on suffering and spiritual well-being among palliative care patients. METHODS A randomized controlled study was conducted on adult palliative care patients with moderate to severe levels of suffering. Participants in the intervention arm were guided through a 5-minute mindfulness of peace exercise while participants in the control arm received 5 minutes of active listening. Pre- and post-intervention suffering and spiritual well-being were measured using the Suffering Pictogram and the FACIT-Sp-12 questionnaire, respectively. RESULTS 40 participants completed the study. 5-minute mindfulness of peace significantly reduced suffering (median = -3.00, IQR = 2.00) more than 5 minutes of active listening (median = -1.00, IQR = 1.75), U = 73.50, z = -3.48, p = 0.001, η2 = 0.31. FACIT-Sp-12 score also significantly improved in the intervention arm (median = +5.00, IQR = 2.75) compared with the control arm after 5 minutes (median = +1.00, IQR = 3.00), U = 95.50, z = -2.85, p = 0.004, η2 = 0.21. CONCLUSIONS A brief 5-minute mindfulness of peace exercise is effective in providing immediate relief of suffering and improving spiritual well-being. It is a useful and feasible intervention among patients receiving palliative care for rapidly and momentarily reducing spiritual suffering.
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Affiliation(s)
- Lim Liang Yik
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Look Mei Ling
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Lim Min Ai
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Ang Bin Ting
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Sheriza Izwa Zainuddin
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Tan Seng Beng
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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Piderman KM, Radecki Breitkopf C, Jenkins SM, Ingram C, Sytsma TT, Lapid MI, Tata BS, Chatterjee K, Egginton JS, Jatoi A. Hearing and Heeding the Voices of those With Advanced Illnesses. J Palliat Care 2020; 35:248-255. [PMID: 32466734 DOI: 10.1177/0825859720928623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the feasibility of a chaplain-led spiritually focused life review interview and the development of a spiritual legacy document (SLD) for patients with advanced diseases and to describe changes in spiritual well-being (SWB), spiritual coping strategies (SC), and quality of life (QOL) after receiving the SLD. PATIENTS AND METHODS In all, 130 patients and support person (SP) pairs were recruited from July 2012 to January 2019. Following enrollment, demographic information was gathered and baseline questionnaires were administered. Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) and a linear analog scale assessment (LASA) measured SWB. LASAs also measured QOL and emotional well-being (EWB). Positive Religious Coping Scale (RCOPE) measured SC. After completion of baseline forms, participants were interviewed (individually) by a chaplain. Interviews were digitally recorded, transcribed, and verified. Transcripts were edited and participants were given the opportunity to make adaptations. The participant-approved draft was then developed into a professionally printed SLD. Follow-up questionnaires were administered to assess change. RESULTS Significant improvements from baseline to post-SLD follow-up were found for patients on the LASAs: SWB (average 7.7-8.3, P = .01), QOL (average 6.7-7.3, P = .03), EWB (average 6.9-7.5, P = .01), and on the positive RCOPE (average 1.8-2.0, P = .007). Effect sizes were approximately 0.25. Considering any improvement, 61.0% improved their positive RCOPE score, 46.6% improved EWB, and 39.7% improved SWB. No significant changes were found on the FACIT-Sp-12. No significant changes were found for SPs. CONCLUSION The results suggest that the primary participants who completed the study benefited by significantly increasing their QOL, SWB, EWB, and SC.
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Affiliation(s)
- Katherine M Piderman
- Department of Chaplain Services, 4352Mayo Clinic, Rochester, MN, USA.,Department of Psychiatry and Psychology, 4352Mayo Clinic, Rochester, MN, USA
| | | | - Sarah M Jenkins
- Statistician III, Division of Biostatistics and Informatics, 4352Mayo Clinic, Rochester, MN, USA
| | - Cory Ingram
- Department of Family Medicine, 4352Mayo Clinic, Rochester, MN, USA
| | - Terin T Sytsma
- Community Internal Medicine, Instructor in Medicine, 4352Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, 4352Mayo Clinic, Rochester, MN, USA
| | - Beba S Tata
- Department of Chaplain Services, 4352Mayo Clinic, Rochester, MN, USA
| | | | - Jason S Egginton
- Center for Science of Health Care Delivery, 4352Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- Department of Medical Oncology, 4352Mayo Clinic, Rochester, MN, USA
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Bingo SAM, Maree JE, Jansen van Rensburg JJM. Living with cancer of the head and neck: A qualitative inquiry into the experiences of South African patients. Eur J Cancer Care (Engl) 2019; 29:e13205. [PMID: 31829489 DOI: 10.1111/ecc.13205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/09/2019] [Accepted: 11/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the experiences of South African patients living with head and neck cancer. METHODS We used a qualitative descriptive design and conducted unstructured interviews with 18 (n = 18) purposive selected participants. Data saturation determined the sample size. Qualitative content analysis was used to analyse the data. RESULTS The majority of the sample were Black males; on average, 50.8 years (SD ± 13.6) old. Two themes and eight subthemes arose from the data. The themes were living with the consequences of the illness and treatment, and coping with a changed life. The lives the participants knew before becoming sick changed and became a living hell; pain was a major problem as was eating and for some, communicating. The participants were stigmatised, ridiculed and rejected which added to their suffering. Receiving support from family and friends and their faith in God assisted them to cope with their changed lives. CONCLUSION Our study poses various challenges to clinical practice. Pain management is of the utmost importance; the nutritional status of these patients should be monitored and best practices in terms of management applied. Raising awareness of cancer and its complications could improve knowledge and decrease blame, stigmatisation and rejection and improve patient outcomes.
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Affiliation(s)
- Samuel Alloss Mbale Bingo
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna Elizabeth Maree
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kamijo Y, Miyamura T. Spirituality and associated factors among cancer patients undergoing chemotherapy. Jpn J Nurs Sci 2019; 17:e12276. [DOI: 10.1111/jjns.12276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 04/01/2019] [Accepted: 05/28/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Yuko Kamijo
- Faculty of Nursing Yokohama Soei University Yokohama Japan
| | - Toshihiro Miyamura
- Department of Health Science and Community‐Based Nursing, Division of Nursing Science, Faculty of Medicine Graduate Faculty of Interdisciplinary Research, University of Yamanashi Kofu Japan
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Marterre B, Clayville K. Navigating the Murky Waters of Hope, Fear, and Spiritual Suffering: An Expert Co-Captain's Guide. Surg Clin North Am 2019; 99:991-1018. [PMID: 31446923 DOI: 10.1016/j.suc.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
How can surgeons deliver compassionate, holistic care to patients who are beyond cure? Interacting emotionally and understanding hope, fear, and spiritual suffering is key. Responsibly reframing hope to underlying meanings, and away from specific outcomes, is critical. Facilitating moves from cure to comfort to a peaceful dying process requires some retooling of the surgical toolbox. Surgeons possess a unique set of skills, including imagination and an undying sense of hope. Surgeons who have the courage to delve into their emotions and sustain realistic hope for their patients, all the way to the end, will reap deep personal and professional rewards.
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Affiliation(s)
- Buddy Marterre
- Surgical Palliative Care, Department of General Surgery, Wake Forest Baptist Health, 5th Floor, Watlington Hall, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Kristel Clayville
- Zygon Center for Religion and Science, MacLean Center for Clinical Medical Ethics, 1100 East 55th Street, Chicago, IL 60615, USA
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Tarbi EC, Meghani SH. A concept analysis of the existential experience of adults with advanced cancer. Nurs Outlook 2019; 67:540-557. [PMID: 31040052 PMCID: PMC6764914 DOI: 10.1016/j.outlook.2019.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/04/2019] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attention to the existential dimension of an individual's experience during serious illness is important. However, existential concerns continue to be poorly defined in literature, leading to neglect in the clinical realm. PURPOSE This concept analysis seeks to clarify the concept of the existential experience within the context of adults with advanced cancer. METHODS Rodgers' evolutionary method of concept analysis was used. DISCUSSION Existential experience in adults with advanced cancer is a dynamic state, preceded by confronting mortality, defined by diverse reactions to shared existential challenges related to the parameters of existence (body, time, others, and death), resulting in a dialectical movement between existential suffering and existential health, with capacity for personal growth. Personal factors and the ability to cope appear to influence this experience. CONCLUSION These findings can drive future research and enhance clinician ability to attend to the existential domain, thereby improving patient experience at end-of-life.
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Affiliation(s)
- Elise C Tarbi
- University of Pennsylvania School of Nursing, Philadelphia, PA.
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Mathew-Geevarughese SE, Corzo O, Figuracion E. Cultural, Religious, and Spiritual Issues in Palliative Care. Prim Care 2019; 46:399-413. [PMID: 31375189 DOI: 10.1016/j.pop.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary care physicians are at the frontlines, often the first point of contact for many people with the medical system. They have to manage chronically ill patients with life-limiting diagnoses who also have ongoing psychosocial needs. This article discusses why cultural, spiritual, and religious interplay with medical decision making is important and provide some strategies for addressing these aspects of care.
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Affiliation(s)
- Sally E Mathew-Geevarughese
- Palliative Care Department, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway Suite 3D, Jamaica, NY 11418, USA.
| | - Oscar Corzo
- Palliative Care Department, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway Suite 3D, Jamaica, NY 11418, USA
| | - Elizabeth Figuracion
- Palliative Care Department, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway Suite 3D, Jamaica, NY 11418, USA
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Gillespie E. A Qualitative Pilot Study of Spirituality in Long-term Recovery in Acquired Brain Injury. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2019; 73:96-105. [PMID: 31189453 DOI: 10.1177/1542305019853588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Increased spirituality occurring after acquired brain injury is a part of post traumatic growth (PTG). Participants were asked about their spirituality, and their responses were analyzed. Eighty-one percent exhibited a moderate spiritual impact on their recovery. Studies suggest that patients' spiritual needs are not being met, and chaplains are being underutilized. Trust and a sense of presence are essential to encouraging PTG, and, by fully utilizing the skills of our chaplain colleagues, could improve PTG.
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Affiliation(s)
- Elena Gillespie
- College of Integrative Medical Sciences, Saybrook University, Oakland, USA
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Kittelson S, Scarton L, Barker P, Hauser J, O'Mahony S, Rabow M, Delgado Guay M, Quest TE, Emanuel L, Fitchett G, Handzo G, Yao Y, Chochinov HM, Wilkie D. Dignity Therapy Led by Nurses or Chaplains for Elderly Cancer Palliative Care Outpatients: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12213. [PMID: 30994466 PMCID: PMC6492061 DOI: 10.2196/12213] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity therapy (DT) has clear feasibility but inconsistent efficacy. DT could be led by nurses or chaplains, the 2 disciplines within palliative care that may be most available to provide this intervention; however, it remains unclear how best it can work in real-life settings. OBJECTIVE We propose a randomized clinical trial whose aims are to (1) compare groups receiving usual palliative care for elderly patients with cancer or usual palliative care with DT for effects on (a) patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness); and (b) processes of delivering palliative spiritual care services (satisfaction and unmet spiritual needs); and (2) explore the influence of physical symptoms and spiritual distress on the outcome effects (dignity impact and existential tasks) of usual palliative care and nurse- or chaplain-led DT. We hypothesize that, controlling for pretest scores, each of the DT groups will have higher scores on the dignity impact and existential task measures than the usual care group; each of the DT groups will have better peaceful awareness and treatment preference more consistent with their cancer prognosis than the usual care group. We also hypothesize that physical symptoms and spiritual distress will significantly affect intervention effects. METHODS We are conducting a 3-arm, pre- and posttest, randomized, controlled 4-step, stepped-wedge design to compare the effects of usual outpatient palliative care and usual outpatient palliative care along with either nurse- or chaplain-led DT on patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness). We will include 560 elderly patients with cancer from 6 outpatient palliative care services across the United States. Using multilevel analysis with site, provider (nurse, chaplain), and time (step) included in the model, we will compare usual care and DT groups for effects on patient outcomes and spiritual care processes and determine the moderating effects of physical symptoms and spiritual distress. RESULTS The funding was obtained in 2016, with participant enrollment starting in 2017. Results are expected in 2021. CONCLUSIONS This rigorous trial of DT will constitute a landmark step in palliative care and spiritual health services research for elderly cancer patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03209440; https://clinicaltrials.gov/ct2/show/NCT03209440. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12213.
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Affiliation(s)
- Sheri Kittelson
- Center for Palliative Care Research and Education, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Lisa Scarton
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Paige Barker
- Center for Palliative Care Research and Education, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Joshua Hauser
- Buehler Center on Aging, Health and Society, Palliative Care, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Sean O'Mahony
- Palliative Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Michael Rabow
- Helen Diller Family Comprehensive Cancer Center, Center for Educaiton in Palliative Care, University of California, San Francisco, San Francisco, CA, United States
| | - Marvin Delgado Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, University of Texas, MD Anderson, Houson, TX, United States
| | - Tammie E Quest
- Buehler Center on Aging, Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Linda Emanuel
- Buehler Center on Aging, Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, United States
| | - George Handzo
- Health Services Research & Quality, HealthCare Chaplaincy Network, Caring for the Human Spirit TM, New York, NY, United States
| | - Yingewi Yao
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Harvey Max Chochinov
- Research Institute of Oncology and Hematology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Diana Wilkie
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, United States
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Pérez-Cruz PE, Langer P, Carrasco C, Bonati P, Batic B, Tupper Satt L, Gonzalez Otaiza M. Spiritual Pain Is Associated with Decreased Quality of Life in Advanced Cancer Patients in Palliative Care: An Exploratory Study. J Palliat Med 2019; 22:663-669. [PMID: 30649985 DOI: 10.1089/jpm.2018.0340] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Improving quality of life (QOL) is important in cancer palliative care (PC) patients. "Spiritual pain" (SP) is common in this population, but it is unknown how it affects QOL. Objective: To study the associations between SP and QOL in cancer patients in PC. Design: Cross-sectional. Settings/Subjects: Cancer patients assessed at a PC clinic in Puente Alto, Chile, were enrolled in a longitudinal study to characterize patients' end of life. Inclusion criteria included age ≥18, a primary caregiver, not having delirium, and a Karnofsky performance status (KPS) ≤80. Measurements: After consenting patients completed baseline surveys that included demographics, single-item questions to assess SP (0-10), financial distress, spirituality-related variables and questionnaires to assess QOL (0-100), and physical (Global distress score-physical) and psychological distress (Hospital Anxiety and Depression Scale), baseline data analyses to explore associations between SP and QOL were adjusted for potential confounders. Results: Two hundred and eight patients were enrolled: mean age was 64, 50% were female, and 67% had SP. In univariate analysis, SP was significantly associated with lower QOL (coefficient [95% confidence interval]: -1.88 [-2.93 to -0.84], p < 0.001). Lower QOL was also associated with being younger, lower KPS, higher physical distress, having anxiety or depression, and decreased religiosity and religious coping. In the multivariate analysis, QOL remained independently associated with SP (-1.25 [-2.35; to -0.15], p < 0.026), religious coping (11.74 [1.09 to 22.38], p < 0.031), and physical distress (-0.52 [-0.89 to -0.16], p < 0.005). Conclusions: SP is associated with QOL in cancer patients in PC. SP should be regularly assessed to plan for interventions that could impact QOL. More research is needed.
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Affiliation(s)
- Pedro E Pérez-Cruz
- 1 Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,2 Núcleo Milenio para el Estudio del Curso de Vida y la Vulnerabilidad, Santiago, Chile.,3 Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paola Langer
- 4 Instituto de Sociología, Facultad de Ciencias Sociales, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Carrasco
- 3 Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pilar Bonati
- 3 Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bogomila Batic
- 3 Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Laura Tupper Satt
- 5 Unidad Cuidados Paliativos, Complejo Asistencial Dr. Sótero del Río, Servicio de Salud Metropolitano Sur Oriente, Puente Alto, Chile
| | - Marcela Gonzalez Otaiza
- 5 Unidad Cuidados Paliativos, Complejo Asistencial Dr. Sótero del Río, Servicio de Salud Metropolitano Sur Oriente, Puente Alto, Chile
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García-Alandete J, Hernández Jiménez MJ. El sufrimiento existencial en el paciente oncológico en estadio avanzado: dimensiones y ejes vertebradores para la intervención psicológica. PERSONA Y BIOÉTICA 2018. [DOI: 10.5294/pebi.2018.22.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
El alivio del sufrimiento existencial en los pacientes oncológicos en estadio avanzado es un objetivo terapéutico de primer orden. En el presente trabajo se sugieren una serie de ejes sobre los cuales podría pivotar la intervención psicoterapéutica, con el fin de propiciar: 1) la experiencia de que a pesar del “ya” de la situación límite, la vida “todavía” tiene sentido; 2) experiencias emocionales positivas que promuevan el bienestar y la calidad de vida; 3) el afrontamiento de la experiencia de enfermedad grave y de muerte esperada más o menos inminente, mediante el desarrollo de una actitud serena, reconciliada con la vida e integradora con uno mismo y con los demás, a la par que abierta a la trascendencia.
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Yoon SJ, Suh SY, Kim SH, Park J, Kim YJ, Kang B, Park Y, Kwon JH, Park K, Shin DW, Kim HJ, Ahn HY, Hui D. Spiritual Well-being Among Palliative Care Patients With Different Religious Affiliations: A Multicenter Korean Study. J Pain Symptom Manage 2018; 56:893-901. [PMID: 30201487 DOI: 10.1016/j.jpainsymman.2018.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT Spiritual well-being (SWB) is very important in palliative care patients. OBJECTIVES The aim of this study was to investigate the SWB among palliative care patients in Korea with different religious affiliations and to identify the correlates of SWB. METHODS This study is a cross-sectional, multicenter study involving hospitalized patients seen by palliative care teams. We collected data on basic clinicodemographic characteristics, factors related to religion (meaningful religious events, religious activities such as attending worship, individual spiritual activities such as prayer), overall quality of life, and SWB. SWB was measured using Functional Assessment of Chronic Illness Therapy-Spirituality 12. We examined the differences in SWB among patients who reported themselves as Protestants, Catholics, Buddhists, and having no religious affiliations. RESULTS Among the 202 patients enrolled, 69 (34.2%), 48 (23.8%), 43 (21.3%), and 42 (20.8%) persons were Protestants, were Catholics, were Buddhists, and had no religious affiliation, respectively. The Functional Assessment of Chronic Illness Therapy-Spirituality 12 was highest among Protestants, followed by Catholics, Buddhists, and those without religious affiliation (29.8 vs. 27.0 vs. 23.2 vs. 16.3, P < 0.001). The faith subscale (12.4 vs. 10.4 vs. 7.7 vs. 2.5, P < 0.001) showed similar distributions. Christians reported higher SWB in the meaning and the peace subscale than patients without a religious affiliation. In the multivariate analysis, religious affiliation (P < 0.001), individual spiritual activities (P < 0.001), and quality of life (P < 0.001) were significantly related to a greater SWB. Age was inversely associated with the meaning subscale (P = 0.002). CONCLUSION Although faith practices may be particularly helpful to improve spiritual well-being among Christians, further research is needed to determine what individual spiritual activities can support non-Christians.
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Affiliation(s)
- Seok Joon Yoon
- Department of Family Medicine, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea; Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea.
| | - Sun Hyun Kim
- Department of Family Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Jeanno Park
- Department of Internal Medicine, Bobath Hospital, Seongnam, South Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Youngmin Park
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, South Korea
| | - Kwonoh Park
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Seoul, South Korea
| | - Hyeon Jeong Kim
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - David Hui
- Division of Cancer Medicine, Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
The death of a child is a heart-wrenching experience that can have a significant impact on parents, siblings, and families while also often having ripple effects throughout the child's community. Pediatric loss has an impact on family structure and dynamics, individual identity formation, and conceptualization as well as professional practice. This article explores bereavement after a child's death through the lens of the family, the parent, the sibling, the forgotten grievers, and the provider.
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Affiliation(s)
- Danielle Jonas
- Division of Comfort and Palliative Care, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Caitlin Scanlon
- Integrated Care Management, Palliative Care Team, Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA
| | - Rachel Rusch
- Division of Comfort and Palliative Care, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Janie Ito
- Spiritual Care and Clinical Pastoral Education, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Marsha Joselow
- Pediatric Advance Care Team, Boston Children's Hospital, Dana Farber Cancer Institute, Boston, MA, USA
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50
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Roze des Ordons AL, Sinuff T, Stelfox HT, Kondejewski J, Sinclair S. Spiritual Distress Within Inpatient Settings-A Scoping Review of Patients' and Families' Experiences. J Pain Symptom Manage 2018; 56:122-145. [PMID: 29548894 DOI: 10.1016/j.jpainsymman.2018.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
CONTEXT Spiritual distress contributes to patients' and families' experiences of care. OBJECTIVES To map the literature on how seriously ill patients and their family members experience spiritual distress within inpatient settings. METHODS Our scoping review included four databases using search terms "existential" or "spiritual" combined with "angst," "anxiety," "distress," "stress," or "anguish." We included original research describing experiences of spiritual distress among adult patients or family members within inpatient settings and instrument validation studies. Each study was screened in duplicate for inclusion, and the data from included articles were extracted. Themes were identified, and data were synthesized. RESULTS Within the 37 articles meeting inclusion criteria, we identified six themes: conceptualizing spiritual distress (n = 2), diagnosis and prevalence (n = 7), assessment instrument development (n = 5), experiences (n = 12), associated variables (n = 12), and barriers and facilitators to clinical support (n = 5). The majority of studies focused on patients; two studies focused on family caregivers. The most common clinical settings were oncology (n = 19) and advanced disease (n = 19). Terminology to describe spiritual distress varied among studies. The prevalence of at least moderate spiritual distress in patients was 10%-63%. Spiritual distress was experienced in relation to self and others. Associated variables included demographic, physical, cognitive, and psychological factors. Barriers and facilitators were described. CONCLUSION Patients' and families' experiences of spiritual distress in the inpatient setting are multifaceted. Important gaps in the literature include a narrow spectrum of populations, limited consideration of family caregivers, and inconsistent terminology. Research addressing these gaps may improve conceptual clarity and help clinicians better identify spiritual distress.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jane Kondejewski
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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