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Ogunsanya ME, Kaninjing E, Ellis TN, Morton DJ, McIntosh AG, Zhao J, Dickey SL, Kendzor DE, Dwyer K, Young ME, Odedina FT. Health-related quality of life in ethnically diverse Black prostate cancer survivors: a convergent parallel mixed-methods approach. Qual Life Res 2024:10.1007/s11136-024-03718-9. [PMID: 39008143 DOI: 10.1007/s11136-024-03718-9] [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] [Accepted: 06/13/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE This study examined the health-related quality of life (HRQoL) among ethnically diverse Black men (BM) with prostate cancer (CaP) in the United States. METHODS A convergent parallel mixed-methods design, employing both qualitative and quantitative research, involved recruiting Black CaP survivors through multiple channels. The target population was native-born BM (NBBM), African-born BM (ABBM), and Caribbean-born BM (CBBM). QoL for all men was assessed using The Functional Assessment Cancer Therapy-Prostate (FACT-P) measure, which includes five domains: physical- (PWB), emotional- (EWB), social-(SWB), and functional-wellbeing (FWB), and a CaP subscale (PCS). A subset of men completed qualitative interviews. Demographic and clinical characteristics were also collected. RESULTS Black CaP survivors aged 49-85 participated in the study (n = 108), with a subset (n = 31) completing a qualitative interview. Participants were mainly NBBM (72.2%) and treated with radiotherapy (51.9%). The FACT-P scale total mean score (± SD) was 114 ± 24.1 (theoretical range 0-156), with lower scores reported on the SWB, FWB, and EWB domains. The mixed-methods findings approach included meta-inferences derived from integrating the corresponding quantitative and qualitative data, covering all the domains within the FACT-P. CONCLUSION Black CaP survivors experienced significant burdens that impacted their overall HRQoL. The analysis revealed impacts on physical, social, and emotional well-being, with variations among ethnic groups suggesting the need for culturally tailored interventions. EWB was also profoundly impacted by CaP treatment, with universal emotional burdens emphasized across all groups. Healthcare providers must recognize and address these multifaceted needs to promote better outcomes and HRQoL for Black CaP survivors.
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Affiliation(s)
- Motolani E Ogunsanya
- Department of Pharmacy, Clinical & Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
- iCCaRE for Black Men Consortium, Jacksonville, FL, USA.
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL, USA.
| | - Ernest Kaninjing
- School of Health and Human Performance, Georgia College & State University, Milledgeville, GA, USA
- iCCaRE for Black Men Consortium, Jacksonville, FL, USA
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL, USA
| | - Tanara N Ellis
- Department of Pharmacy, Clinical & Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Daniel J Morton
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Department of Pediatrics, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Andrew G McIntosh
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Department of Urology, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Jian Zhao
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Sabrina L Dickey
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Darla E Kendzor
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Kathleen Dwyer
- Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Mary Ellen Young
- Community Health Collaborative and Minority Health & Health Equity Research Support Services, Mayo Foundation for Medical Education and Research, Jacksonville, FL, USA
- iCCaRE for Black Men Consortium, Jacksonville, FL, USA
| | - Folakemi T Odedina
- iCCaRE for Black Men Consortium, Jacksonville, FL, USA
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL, USA
- Prevention, Symptom Control and Survivorship, and Care Delivery Transformation (CPSD) Program, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville, USA
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Phoon J, Tan YP, Harding R. A Systematic Review and Narrative Synthesis of the Evidence Underpinning Theoretical Perspectives and Cultural Influences on Forgiveness in Palliative Care. J Palliat Med 2022; 25:1282-1308. [PMID: 35723648 DOI: 10.1089/jpm.2021.0657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The process of forgiveness is proposed to reduce patient and family conflict and suffering in the face of life-limiting illness. However, it is unclear which theoretical perspectives underpin the concept of forgiveness in palliative care, and how culture may influence it. Objectives: To identify and synthesize primary evidence that underpins the concept of forgiveness within palliative care, and identify theoretical perspectives, including cultural assumptions. Design: A systematic review of studies on forgiveness in palliative care regardless of design was prospectively registered on PROSPERO. Narrative synthesis was conducted and the modified Seven-Point Checklist and modified Status Assessment Tool applied to appraise study quality (level 1) and contributions to theory building (level 2). Data Sources: Reference chaining and hand-searching were conducted for 10 electronic databases from 1960 to June 30, 2020. Results: Thirty-nine studies were included. Seven provided a definition of forgiveness, and six studies reported a process model. Twelve patient studies scored "high" on quality level 1 and nine scored "high" on level 2. Conceptualization of forgiveness included a conscious decision to abandon negative thoughts, feelings, and behaviors associated with conflicts, to find positive outcomes through processing of negative affect and cognitive reframing of conflicts. The process of forgiveness develops through time paralleled by an attributional movement from an external to an internal locus of control. Theoretical perspectives of systems, exchange and choice, social constructionism, behaviorism, and humanism were identified. Cultural contexts impact forgiveness. Conclusion: The synthesized model is based on primary evidence of mixed quality. Future research needs better theoretical conceptualization utilizing cultural perspectives. Forgiveness interventions with consideration of cultural influences are encouraged.
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Affiliation(s)
- Jacinta Phoon
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - Yee Pin Tan
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
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Bhadelia A, Oldfield LE, Cruz JL, Singh R, Finkelstein EA. Identifying Core Domains to Assess the "Quality of Death": A Scoping Review. J Pain Symptom Manage 2022; 63:e365-e386. [PMID: 34896278 DOI: 10.1016/j.jpainsymman.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. OBJECTIVES Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems. METHODS PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles. RESULTS A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication. CONCLUSION The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
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Affiliation(s)
- Afsan Bhadelia
- Department of Global Health and Population (A.B.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | | | - Jennifer L Cruz
- Department of Social and Behavioral Sciences (J.L.C.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ratna Singh
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
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Rantanen P, Chochinov HM, Emanuel LL, Handzo G, Wilkie DJ, Yao Y, Fitchett G. Existential Quality of Life and Associated Factors in Cancer Patients Receiving Palliative Care. J Pain Symptom Manage 2022; 63:61-70. [PMID: 34332045 PMCID: PMC8766863 DOI: 10.1016/j.jpainsymman.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Enhancing quality of life (QoL) is a goal of palliative care. Existential QoL is an important aspect of this. OBJECTIVES This study sought to advance our understanding of existential QoL at the end of life through examining levels of Preparation and Completion, subscales of the QUAL-E, and their associated factors. METHODS We used data from a multi-site study of 331 older cancer patients receiving palliative care. We examined levels of Preparation and Completion and their association with demographic, religious, and medical factors, and with the Patient Dignity Inventory. RESULTS Preparation and Completion scores were moderately high. In adjusted models, being 10 years older was associated with an increase of 0.77 in Preparation (P = 0.002). Non-white patients had higher Preparation (1.03, P = 0.01) and Completion (1.56, P = 0.02). Single patients reported Completion score 1.75 point lower than those married (P = 0.01). One-point increase in intrinsic religiousness was associated with a 0.86-point increase in Completion (P = 0.03). One-point increase in terminal illness awareness was associated with 0.75-point decrease in Preparation (P = 0.001). A 10-point increase in symptom burden was associated with a decrease of 0.55 in Preparation (P < 0.001) and a decrease of 1.0 in Completion (P < 0.001). The total Patient Dignity Inventory score and all of its subscales were negatively correlated with Preparation (r from -.26 to -.52, all P < 0.001) and Completion (r from -.18 to -.31, all P < 0.001). CONCLUSION While most patients reported moderate to high levels of existential QoL, a subgroup reported low existential QoL. Terminal illness awareness and symptom burden may be associated with lower existential QoL.
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Affiliation(s)
- Petra Rantanen
- University of Rochester School of Medicine and Dentistry (P.R.) Rochester, New York, USA
| | - Harvey Max Chochinov
- Research Institute of Oncology and Hematology (H.M.C.), Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada, USA
| | - Linda L Emanuel
- Buehler Center on Aging (L.L.E.), Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - George Handzo
- Health Services Research & Quality (G.H.), HealthCare Chaplaincy Network, Caring for the Human Spirit TM, New York, New York, USA
| | - Diana J Wilkie
- Center for Palliative Care Research and Education (D.J.W., Y.Y.), College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Center for Palliative Care Research and Education (D.J.W., Y.Y.), College of Nursing, University of Florida, Gainesville, Florida, USA
| | - George Fitchett
- Department of Religion (G.F.), Health and Human Values, Rush University Medical Center, Chicago, Illinois, USA.
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Pahlevan Sharif S, Ong FS. Education Moderates the Relationship Between Spirituality with Quality of Life and Stress Among Malay Muslim Women with Breast Cancer. JOURNAL OF RELIGION AND HEALTH 2019; 58:1060-1071. [PMID: 29511922 DOI: 10.1007/s10943-018-0587-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to investigate the relationship between spirituality with quality of life and stress of Malay Muslim breast cancer patients in Malaysia. In addition, the moderating role of education on this relationship was examined. Participants consisted of 145 conveniently selected Malay breast cancer patients. The results indicated that the more spiritual respondents reported a higher level of quality of life and lower level of stress. Moreover, education weakened the relationship between spirituality with quality of life and stress.
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Affiliation(s)
- Saeed Pahlevan Sharif
- Taylor's Business School, Taylor's University, No. 1, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia.
- Department of Nursing, Aliabad Katoul Branch, Islamic Azad University, Aliabad Katoul, Iran.
| | - Fon Sim Ong
- University of Nottingham Malaysia Campus, Jalan Broga, 43500, Semenyih, Selangor, Malaysia
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The relationship between spiritual well-being and quality of life in cancer survivors. Palliat Support Care 2019; 18:55-62. [DOI: 10.1017/s1478951519000464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo evaluate the relationship between spiritual well-being (SpWB) and quality of life (QoL) in cancer (CA) survivors.MethodsThe current study was conducted in the oncology center at a university hospital in Central Anatolia/Turkey. In this study, a descriptive cross-sectional survey design was used. The data collected included: a questionnaire form, the current study was conducted in the oncology center at a university hospital in Central Anatolia/Turkey. In this study, a descriptive cross-sectional survey design was used. SpWB was assessed by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, version 4 (FACIT-Sp12, v. 4), including Meaning, Peace, and Faith subscales. The QoL was evaluated using the Functional Assessment of Cancer Therapy-General scale (FACT-G, v. 4). The results were analyzed using descriptive statistics, Pearson correlations, independent sample t-test, Kruskal-Wallis, and Mann-Whitney U test.ResultsOne hundred fifty patients participated in this study: 61.30% female, 78% 45 years of age or older, 94.70% married, 46% had finished, and 69% had gastrointestinal tract CA. The mean age was 53.48 (SD = 9.43). The majority of participants (96.7%) endorsed “a force pushing them a will to live” while 59.3% supported “the power of relationships with others.” There was a positive, strong correlation between overall QoL and SpWB (r = 0.619, p < 0.01). The Meaning dimensions of SpWB with Functional Well-Being (FWB) and overall QoL (r = 0.512; 0.595, p < 0.000 respectively), Peace with Emotional Well-Being (EWB) and FWB (r = 0.598; 0.540, p < 0.000 respectively) dimensions of FACT-G and overall QoL (r = 0.609, p < 0.001) were strong correlated. Faith and QoL were not significantly correlated.Significance of resultsThis study demonstrates that SpWB positively contributed to the QoL of CA survivors. SpWB is not necessarily limited to any specific types of beliefs or practices. For some people, faith in self, others and/or God constitutes, in large part, the meaning, purpose, and fulfillment they find in life.
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Bai J, Brubaker A, Meghani SH, Bruner DW, Yeager KA. Spirituality and Quality of Life in Black Patients With Cancer Pain. J Pain Symptom Manage 2018; 56:390-398. [PMID: 29857179 DOI: 10.1016/j.jpainsymman.2018.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The objective of this study was to examine the associations between spirituality and overall quality of life (QOL) and individual QOL domains in black patients with cancer pain. METHODS A secondary data analysis of a parent study exploring pain medication adherence in black patients receiving around-the-clock opioids with cancer pain was performed. All the participating patients completed Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (spirituality), Brief Pain Inventory (pain severity and interference), Edmonton Symptom Assessment Scale (symptoms), and Functional Assessment of Cancer Therapy-General (QOL). Pearson correlation and multiple linear regression analyses were conducted to examine the associations between spirituality and overall QOL and QOL domains and to identify the predictors of overall QOL and QOL domains. RESULTS Black patients treated for cancer pain (n = 102) completed the study. Pearson correlation showed significant positive associations between spirituality and overall QOL (P < 0.001) and individual QOL domains (physical, social, emotional, and functional). Higher spirituality was associated with lower pain severity (P = 0.01), pain interference (P = 0.001), and total symptoms score (P < 0.001). In multiple regression analysis, the best model for the overall QOL explained 67% of the variance (P < 0.001) and included total symptoms score, pain interference, spirituality, and age. Spirituality significantly predicted QOL domains of social (P < 0.0001), emotional (P = 0.002), and functional well-being (P = 0.001) rather than physical well-being. CONCLUSIONS Spirituality is associated with decreased pain and lower symptom burden and may serve as a protective factor against diminished overall QOL, specifically social, emotional, and functional domains in black patients with cancer pain. There is a need to develop spirituality-based interventions along with symptom management interventions to improve QOL for this population.
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Affiliation(s)
- Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
| | - Andrea Brubaker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Salimah H Meghani
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Gaskin-Wasson AL, Walker KL, Shin LJ, Kaslow NJ. Spiritual Well-Being and Psychological Adjustment: Mediated by Interpersonal Needs? JOURNAL OF RELIGION AND HEALTH 2018; 57:1376-1391. [PMID: 27377390 PMCID: PMC9922545 DOI: 10.1007/s10943-016-0275-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Spiritual well-being has been shown to reduce suicidal behavior, depressive symptoms, and hopelessness. Thwarted interpersonal needs have been shown to increase risk of suicidal behavior. This paper aims to explore the interrelationships among spiritual well-being, thwarted interpersonal needs, and negative outcomes including suicidal ideation, hopelessness, and depressive symptoms among African American women. Sixty-six African American women (M = 36.18; SD = 11.70), from a larger study of women who had experienced interpersonal violence within the past year, completed self-report questionnaires. Mediation analyses revealed that thwarted belongingness, but not perceived burdensomeness, significantly mediated the relations between spiritual well-being and the three outcomes. This study provides the first examination of the role of thwarted interpersonal needs on the link between spiritual well-being and negative psychological outcomes. Spiritual well-being serves a protective role against feelings of social isolation, which may reduce one's risk of negative psychological outcomes. Treatments that bolster a sense of spirituality and social connectedness may reduce suicidal ideation, hopelessness, and depressive symptoms.
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Affiliation(s)
| | - Kristin L Walker
- University of California at Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Lilian J Shin
- University of California Riverside, Riverside, CA, USA
| | - Nadine J Kaslow
- Department of Psychiatry and Behavioral Sciences, Grady Hospital, Emory University School of Medicine, 80 Jesse Hill Jr. Drive, Atlanta, GA, 30303, USA.
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Leland BD, Nitu ME, Hancock M, Moody K, Gunderman R, Moser E, Rowan CM. Prospective Evaluation of Physical Contact with Critically Ill Child on Caregiver Spiritual Wellbeing. J Pediatr 2017; 191:250-254.e1. [PMID: 28987753 DOI: 10.1016/j.jpeds.2017.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/08/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate whether a pediatric intensive care unit initiative promoting physical contact between caregiver and patient improves caregiver spiritual wellbeing. The secondary objectives were to evaluate caregiver perceptions of care before and after the initiative and to follow unplanned extubation rate as a marker of safety of the initiative. We hypothesized that caregiver spiritual wellbeing and caregiver perceptions of care would improve with implementation of our physical contact initiative known as Project ROSE (Reach Out, Soothe, and Embrace). STUDY DESIGN Project ROSE was a practice change initiative promoting physical contact between caregiver and hospitalized child in an academic quaternary care pediatric intensive care unit. Caregivers' spiritual wellbeing and perceptions of care were surveyed at days 1 and 4, then compared pre- and postimplementation of the unit-wide initiative. Wilcoxon rank sum tests compared groups (pre- and post-Project ROSE). A total of 331 caregivers returned surveys. RESULTS We analyzed 331 surveys (pre, n = 174/post, n = 157). Caregiver spiritual wellbeing at enrollment (day 1) was no different between groups (P = .47). Caregiver spiritual wellbeing on day 4 was greater in the postintervention group (pre 40.0 [32.0, 44.0] vs post 42.0 [37.5, 45.0] P = .03). Caregiver perceptions of care improved postintervention. There was no change in the unplanned extubation rate between groups. CONCLUSION Project ROSE improved caregiver spiritual wellbeing and perceptions of care, was implemented safely, addresses a need in family-centered care of critically ill pediatric patients, and merits consideration for integration into practice.
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Affiliation(s)
- Brian D Leland
- Department of Pediatrics, Section of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN.
| | - Mara E Nitu
- Department of Pediatrics, Section of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN
| | - Maureen Hancock
- Section of Pediatric Critical Care Medicine, Indiana University Health, Indianapolis, IN
| | - Karen Moody
- Department of Pediatrics, Section of Pediatric Palliative Care, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Gunderman
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
| | - Elizabeth Moser
- Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, IN
| | - Courtney M Rowan
- Department of Pediatrics, Section of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN
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Dredge A, Oates L, Gregory H, King S. Effective change management within an Australian community palliative care service. Br J Community Nurs 2017; 22:536-541. [PMID: 29091501 DOI: 10.12968/bjcn.2017.22.11.536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lyle Oates
- Calvary Health Care Bethlehem, Australia
| | | | - Scott King
- Calvary Health Care Bethlehem, Australia
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Nakazato K, Shiozaki M, Hirai K, Morita T, Tatara R, Ichihara K, Sato S, Simizu M, Tsuneto S, Shima Y, Miyasita M. Verbal communication of families with cancer patients at end of life: A questionnaire survey with bereaved family members. Psychooncology 2017. [DOI: 10.1002/pon.4482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Mariko Shiozaki
- Department of Applied Sociology; Kindai University; Osaka Japan
| | - Kei Hirai
- Department of Complementary and Alternative Medicine; Osaka University Graduate School of Medicine; Osaka Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice; Seirei Mikatahara Hospital; Hamamatsu Japan
| | - Ryuhei Tatara
- Department of Palliative Medicine; Osaka City General Hospital; Osaka Japan
| | - Kaori Ichihara
- Department of Nursing; Kyoto University Hospital; Kyoto Japan
| | - Shinichi Sato
- Department of Clinical Thanatology and Geriatric Behavioral Science; Osaka University Graduate School of Human Sciences; Osaka Japan
| | - Megumi Simizu
- Department of Clinical Research, Innovation, and Education Center; Tohoku University Hospital; Sendai Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine; Kyoto University Hospital; Kyoto Japan
| | - Yasuo Shima
- Department of Palliative Medicine; Tsukuba Medical Center Hospital; Tsukuba Japan
| | - Mitsunori Miyasita
- Department of Palliative Nursing; Tohoku University Graduate School of Medicine; Sendai Japan
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Abstract
Spirituality has been identified as an important dimension of quality-of-life. The objective of this study was to review the literature on quality-of-life and spirituality, their association, and assessment tools. A search was conducted of the keyterms 'quality-of-life' and 'spirituality' in abstract or title in the databases PsycINFO and PubMed/Medline between 1979-2005, complemented by a new search at PUBMED from 2006-2016. Quality-of-life is a new concept, which encompasses and transcends the concept of health, being composed of multiple domains: physical, psychological, environmental, among others. The missing measure in health has been defined as the individual's perception of their position in life in the context of culture and value system in which they live and in relation to their goals, expectations, standards, and concerns. There is consistent evidence of an association between quality-of-life and religiosity/spirituality (R/S), through studies with reasonable methodological rigour, using several variables to assess R/S (e.g. religious affiliation, religious coping, and prayer/spirituality). There are also several valid and reliable instruments to evaluate quality-of-life and spirituality. Further studies are needed, however, especially in Brazil. Such studies will provide empirical data to be used in planning health interventions based on spirituality, seeking a better quality-of-life. In the last 10 years, research is consistently growing about quality-of-life and spirituality in many countries, and also in many areas of health research.
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Affiliation(s)
- Raquel Gehrke Panzini
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Bruno Paz Mosqueiro
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Rogério R Zimpel
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Denise Ruschel Bandeira
- b Department of Psychology , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Neusa S Rocha
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Marcelo P Fleck
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
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Appraisals, perceived dyadic communication, and quality of life over time among couples coping with prostate cancer. Support Care Cancer 2016; 24:3757-65. [PMID: 27039207 DOI: 10.1007/s00520-016-3188-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Little research has examined how prostate cancer patients' and their spouses' appraisals of illness and quality of life (QOL) interact with one another. This study examined the interdependent relationships between their appraisals of illness and QOL and if their perceived dyadic communication mediated these relationships. METHODS We used the Actor-Partner Interdependence Mediation Model (APIMeM) approach to conduct a secondary analysis of longitudinal data from 124 prostate cancer patient-spouse dyads. We examined actor effects (each person's influence on his/her own outcomes) and partner effects (each person's influence on his/her partner's outcomes). Appraisals of illness, perceived dyadic communication, and QOL were measured using Appraisal of Illness Scale, Lewis Mutuality and Interpersonal Sensitivity Scale, and Functional Assessment of Chronic Illness Therapy General Scale, respectively. Analyses controlled for effects of prostate cancer symptoms and demographic factors. RESULTS Among actor effects, spouses with more negative appraisals at baseline perceived worse dyadic communication 4 months later (p < .05) and worse QOL 8 months later (p < .001). Patients and spouses who perceived more dyadic communication at 4 months had better QOL at 8 months (p < .01). Among partner effects, there was only weak evidence for an association between patient perceived dyadic communication at 4 months and better spouse QOL at 8 months of follow-up (p = .05). No mediation effects were found. CONCLUSIONS Patients' and spouses' appraisals of the illness and their dyadic communication were associated with their long-term QOL. Interventions that reduce negative appraisals of illness and promote dyadic communication may improve QOL for both patients with prostate cancer and their spouses.
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Pautex S, Gamondi C, Philippin Y, Gremaud G, Herrmann F, Camartin C, Vayne-Bossert P. Advance directives and end-of-life decisions in Switzerland: role of patients, relatives and health professionals. BMJ Support Palliat Care 2015; 8:475-484. [DOI: 10.1136/bmjspcare-2014-000730] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/22/2015] [Accepted: 08/17/2015] [Indexed: 11/04/2022]
Abstract
BackgroundLittle is known in Europe about end-of-life (EOL) decisions and advance directives (AD), particularly in patients with severe advanced disease. Switzerland is a multicultural and multilingual federal country and has the particularity of being divided into four linguistic and cultural regionsObjectiveTo understand better in different regions of Switzerland which specific patient's characteristics could have an impact on their decision to complete AD or not.Design/setting/participantsProspective study conducted in four palliative care units. Patients with an advanced oncological disease, fluent in French, German or Italian and with a Mini-Mental State Examination >20 were included. Demographic data, symptom burden (Edmonton Symptom Assessment System, ESAS; Hospital Anxiety and Depression Scale, HADS) and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual well-being, FACIT-sp) have been assessed. A structured questionnaire has been completed by patients, their relatives and health professionals.Results143 patients were included (mean age 68.3 years; 62 male). 41 completed ADs. No particular features were associated with the completion of ADs. Most patients were satisfied with the medical information received. A third of them were not worrying about their future, especially those living in the German-speaking part. Should they become unable to communicate, 87 expected their relative to transmit their own wishes, but only 38 had spoken recently with them about what they wanted. 23 of the 69 included relatives would like to play a more active role in decision-making.ConclusionsThese results illustrate the fact that terminally ill patients wish to be active in decision-making, but only seldom transmit their wishes to their relative or complete a written document. The discussion about ACP should be defined according to the particularity of each region and the role of healthcare professionals’ attitudes towards ADs, but we should also be creative and find other ways to promote shared decision-making.
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Park HY, Maitra K, Martinez KM. The Effect of Occupation-based Cognitive Rehabilitation for Traumatic Brain Injury: A Meta-analysis of Randomized Controlled Trials. Occup Ther Int 2015; 22:104-16. [PMID: 25808426 DOI: 10.1002/oti.1389] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 11/07/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability among people younger than 35 years in the United States. Cognitive difficulty is a common consequence of TBI. To address cognitive deficits of patients with TBI, various cognitive rehabilitation approaches have been used for the clinical setting. The purpose of this study was to investigate the overall effect of occupation-based cognitive rehabilitation on patients' improvement in cognitive performance components, activity of daily living (ADL) performance, and values, beliefs and spirituality functions of patients with TBI. The papers used in this study were retrieved from the Cochrane Database, EBSCO (CINAHL), PsycINFO, PubMed and Web of Science published between 1997 and 2014. The keywords for searching were cognitive, rehabilitation, occupation, memory, attention, problem-solving, executive function, ADL, values, beliefs, spirituality, randomized controlled trials and TBI. For the meta-analysis, we examined 60 effect sizes from nine studies that are related to the occupation-based cognitive rehabilitation on persons with TBI. In persons with TBI, overall mental functions, ADL, and values, beliefs and spirituality were significantly improved in the groups that received occupation-based cognitive rehabilitation compared with comparison groups (mean d = 0.19, p < .05). Evidence from the present meta-analytic study suggests that occupation-based cognitive rehabilitation would be beneficial for individuals with TBI for improving daily functioning and positively be able to affect their psychosocial functions. Collecting many outcome measures in studies with relatively few participants and the final data are less reliable than the whole instrument itself. Future research should evaluate the effectiveness of specific occupation-based cognitive rehabilitations programmes in order to improve consistency among rehabilitation providers.
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Affiliation(s)
- Hae Yean Park
- Occupational Therapy, Florida International University, 11200 SW 8th St., AHC 3, 443, Miami, FL, 33199, USA; Occupational Therapy, Yonsei University, 106ho, Backun-kwan, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, 220-710, South Korea
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Bai M, Lazenby M. A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer. J Palliat Med 2015; 18:286-98. [PMID: 25303461 PMCID: PMC4348086 DOI: 10.1089/jpm.2014.0189] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The purpose of this systematic review was to examine the literature for associations between spiritual well-being and quality of life (QOL) among adults diagnosed with cancer. METHODS A systematic literature search was conducted in the PubMed and CINAHL databases on descriptive correlational studies that provided bivariate correlations or multivariate associations between spiritual well-being and QOL. A total of 566 citations were identified; 36 studies were included in the final review. Thirty-two studies were cross-sectional and four longitudinal; 27 were from the United States. Sample size ranged from 44 to 8805 patients. RESULTS A majority of studies reported a positive association (ranges from 0.36 to 0.70) between overall spiritual well-being and QOL, which was not equal among physical, social, emotional, and functional well-being. The 16 studies that examined the Meaning/Peace factor and its association with QOL reported a positive association for overall QOL (ranges from 0.49 to 0.70) and for physical (ranges from 0.25 to 0.28) and mental health (ranges from 0.55 to 0.73), and remained significant after controlling for demographic and clinical variables. The Faith factor was not consistently associated with QOL. CONCLUSIONS This review found consistent independent associations between spiritual well-being and QOL at the scale and factor (Meaning/Peace) levels, lending support for integrating Meaning/Peace constituents into assessment of QOL outcomes among people with cancer; more research is needed to verify our findings. The number of studies conducted on spiritual well-being and the attention to its importance globally emphasizes its importance in enhancing patients' QOL in cancer care.
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Affiliation(s)
- Mei Bai
- School of Nursing, Yale University , Orange, Connecticut
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Freire MEM, Sawada NO, de França ISX, da Costa SFG, Oliveira CDB. [Health-related quality of life among patients with advanced cancer: an integrative review]. Rev Esc Enferm USP 2014; 48:357-67. [PMID: 24918897 DOI: 10.1590/s0080-6234201400002000022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 02/07/2014] [Indexed: 12/25/2022] Open
Abstract
This integrative literature review aimed to characterize scientific articles on health-related quality of life - HRQoL - among patients with advanced cancer from national and international literature, and summarize those factors evidenced in the literature that contributed to the improvement or worsening of HRQoL among patients with advanced cancer. The search for materials was conducted in the following databases: CINAHL, EMBASE, PubMed, SciELO and LILACS. Among the 21 articles in the sample, 13 showed an improvement of HRQoL among patients with advanced cancer related to the development of physical, emotional and spiritual interventions. In eight studies, we identified predictive symptoms of low HRQoL, such as pain, fatigue, sleep disorders, depression, nutritional changes, and others. The results showed that clinical manifestations, which many times were inherent in cancer, such as factors that can lower patients' HRQoL, while physical, psychological and spiritual benefits resulting from therapeutic interventions may promote its improvement.
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Affiliation(s)
| | - Namie Okino Sawada
- Ribeirão Preto School of Nursing, University of Sao Paulo, Ribeirão Preto, SP, Brazil
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Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med 2014; 17:642-56. [PMID: 24842136 DOI: 10.1089/jpm.2014.9427] [Citation(s) in RCA: 380] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Two conferences, Creating More Compassionate Systems of Care (November 2012) and On Improving the Spiritual Dimension of Whole Person Care: The Transformational Role of Compassion, Love and Forgiveness in Health Care (January 2013), were convened with the goals of reaching consensus on approaches to the integration of spirituality into health care structures at all levels and development of strategies to create more compassionate systems of care. The conferences built on the work of a 2009 consensus conference, Improving the Quality of Spiritual Care as a Dimension of Palliative Care. Conference organizers in 2012 and 2013 aimed to identify consensus-derived care standards and recommendations for implementing them by building and expanding on the 2009 conference model of interprofessional spiritual care and its recommendations for palliative care. The 2013 conference built on the 2012 conference to produce a set of standards and recommended strategies for integrating spiritual care across the entire health care continuum, not just palliative care. Deliberations were based on evidence that spiritual care is a fundamental component of high-quality compassionate health care and it is most effective when it is recognized and reflected in the attitudes and actions of both patients and health care providers.
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Affiliation(s)
- Christina M Puchalski
- 1 George Washington Institute for Spirituality and Health, The George Washington University School of Medicine and Health Sciences, The George Washington University , Washington, DC
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Milberg A, Wåhlberg R, Krevers B. Patients' sense of support within the family in the palliative care context: what are the influencing factors? Psychooncology 2014; 23:1340-9. [DOI: 10.1002/pon.3564] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Anna Milberg
- Department of Social and Welfare Studies; Linköping University; Norrköping Sweden
- Palliative Education and Research Centre in the County of Östergötland; Norrköping Sweden
- LAH Öst; Vrinnevi Hospital; Norrköping Sweden
| | | | - Barbro Krevers
- Department of Medical and Health Sciences, Division of Health Care Analysis; Linköping University; Linköping Sweden
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Spirituality in the context of life-threatening illness and life-transforming change. Palliat Support Care 2014; 13:653-60. [DOI: 10.1017/s1478951514000340] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Individuals with life-threatening illness often engage in some form of spirituality to meet increased needs for meaning and purpose. This study aimed to identify the role of spirituality in persons who had reported positive, life-transforming change in relation to life-threatening cancer or cardiac events, and to connect these roles to palliative and supportive care.Method:A purposive sample of 10 cardiac survivors and 9 cancer survivors was recruited. Once the participants had given informed consent and passed screening in relation to life-transforming change and distress, they engaged in a semistructured one-hour qualitative interview on the theme of how their life-transforming change occurred in the context of their life-threatening illness. In the present article, our phenomenological analysis focuses on participants' references to purpose and meaning in their lives, with particular attention to the role and context of participants' spirituality.Results:Participants mentioned spirituality, meaning, and purpose in many contexts, including connecting with family and friends, nature, art, music, and sometimes creating a relationship with God. Participants often accessed spirituality by enhancing connections in their own lives: with a higher power, people, their work, or themselves. These enhanced connections gave participants greater meaning and purpose in their lives, and substantially helped participants to adjust to their life-threatening illnesses.Significance of results:Understanding the roles and contexts of spirituality among patients with a life-threatening illness allows us to develop better palliative and supportive care plans. Spiritually oriented supportive care may include support groups, yoga, meditation, nature, music, prayer, or referral to spiritual or religious counselors. A quantitative scale is needed to help healthcare clinicians assess the spiritual and coping needs of individuals with life-threatening illness.
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Exploring family relationships through associations of comfort, relatedness states, and life closure in hospice patients: A pilot study. Palliat Support Care 2014; 13:305-11. [PMID: 24762260 DOI: 10.1017/s1478951514000133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Research at the end of life tends to focus on the dying patient's symptoms, often overlooking issues associated with family interactions. However, many families struggle just to maintain or initiate these valuable connections. The purpose of our pilot study was to explore family relationships at the end of life and investigate associations among perceived comfort, relatedness states, and life closure. METHOD This descriptive study used a cross-sectional design, and a convenience sample (n = 30; 18 women; mean age = 71 years) was recruited from patients admitted to a large not-for-profit hospice in northeastern Ohio. In-person interviews using the Hospice Comfort Questionnaire, Relatedness States Visual Analog Scales, and the Life-Closure Scale provided data for analyses. RESULTS Family interactions that were not associated with the physical tasks of caregiving were related to life closure (r = 0.36, p = 0.001), and life closure and comfort were highly correlated (r = 0.69, p < 0.001). Participants residing in an inpatient setting had higher levels of involvement (t[18] = -2.07, p = 0.05) and comfort in relationships (t[28] = -2.06, p = 0.05) than those in the home setting. SIGNIFICANCE OF RESULTS This is the first known study investigating the associations among comfort, relatedness, and life closure at the end of life. The majority of participants had high levels of involvement and comfort in their relationships, and they preferred interactions that required minimal effort. Studies that focus on both patients' and family members' perceptions of relationships are needed as well as outcome studies that test simple interventions.
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Ferrell B, Otis-Green S, Baird RP, Garcia A. Nurses' responses to requests for forgiveness at the end of life. J Pain Symptom Manage 2014; 47:631-41. [PMID: 23880586 DOI: 10.1016/j.jpainsymman.2013.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Patients or family members facing serious illness often express regrets over life events or the need for forgiveness. Professionals, including nurses as the prominent discipline at the bedside, witness these expressions of regret or needs for forgiveness but may not be adequately prepared to optimally address patient concerns regarding forgiveness. OBJECTIVES The objectives of this descriptive study were to 1) identify contexts in which nurses have witnessed expressions of regret or the need for forgiveness and 2) describe nurses' responses to these clinical experiences related to forgiveness. METHODS Nurses attending palliative care educational programs shared narratives of their experiences in caring for patients who expressed regret or the need for forgiveness. Study narratives were analyzed qualitatively, using content analysis. Themes were identified. RESULTS Narratives were provided by 339 nurses from courses throughout the U.S. and Belize, India, the Philippines, and Romania. CONCLUSION Nurses provide clinical care for patients with advanced illness who struggle with issues of forgiveness. Nurses would benefit from additional education regarding how best to address these concerns.
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Affiliation(s)
- Betty Ferrell
- Division of Nursing Research & Education, Department of Population Sciences, City of Hope, Duarte, California, USA.
| | - Shirley Otis-Green
- Division of Nursing Research & Education, Department of Population Sciences, City of Hope, Duarte, California, USA
| | | | - Andrea Garcia
- Division of Nursing Research & Education, Department of Population Sciences, City of Hope, Duarte, California, USA
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Tan H, Wutthilert C, O'Connor M. Spirituality and quality of life in older people with chronic illness in Thailand. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x11y.0000000013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Baldacchino D, Torskenaes K, Kalfoss M, Borg J, Tonna A, Debattista C, Decelis N, Mifsud R. Spiritual coping in rehabilitation- a comparative study: part 2. ACTA ACUST UNITED AC 2013; 22:402-8. [PMID: 23588017 DOI: 10.12968/bjon.2013.22.7.402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Spiritual coping, which may or may not contain religiosity, may enhance adaptation of clients with chronic illness. Part 1 of this article (Baldacchino et al, 2013) presented the research methodology of this cross-sectional comparative study, which explored the spiritual coping of clients with chronic illness receiving rehabilitation services in Malta (n=44) (lower limb amputation: n=10, chronic heart disease: n=9, osteoarthritis in an institution: n=10 and in the community: n=15) and Norway (n=16) (post-hip/shoulder surgery: n=5; chronic heart disease: n=5; chronic pain: n=6). Data were collected from seven purposive samples by focus groups. Roy's adaptation model (1984) and Neuman's Systems Model (2010) guided the study. Part2 discusses the findings, which consist of one main spiritual coping theme and three sub-themes: 'adopting religious coping strategies, relationship with God, and time for reflection and counting one's blessings'. Commonalities were found in the findings except in one dimension, which was found only in the Malta group, that is, being supported by others with a similar condition. This difference may be a result of the environment in the rehabilitation centres, cultural, and geographical differences between the two countries. While considering the limitations of this study, recommendations are proposed to the rehabilitation and education sectors and further trans-cultural comparative longitudinal research with mixed method approach on various clients with acute, chronic and life-threatening illness.
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Torskenæs KB, Baldacchino DR, Kalfoss M, Baldacchino T, Borg J, Falzon M, Grima K. Nurses' and caregivers' definition of spirituality from the Christian perspective: a comparative study between Malta and Norway. J Nurs Manag 2013; 23:39-53. [PMID: 23822866 DOI: 10.1111/jonm.12080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 11/30/2022]
Abstract
AIM The aim of this cross-sectional comparative exploratory study was to explore the term spirituality as defined by four groups of nurses and two groups of caregivers from Malta and Norway. BACKGROUND Spirituality is a complex subjective concept which may or may not contain religiosity. Several factors may influence the individual's interpretation with implications to nursing care and nursing management. METHODS Data were collected from six purposive samples using focus group discussions in Malta and Norway. The Taxonomy of Spirituality guided the study. RESULTS Four themes defined the term 'spirituality'. Two differences were found between Malta and Norway. Connectedness with family and nature was emphasized more by the Maltese group while the Norwegian group identified both the positive and the negative energies of spirituality. IMPLICATIONS TO NURSING CARE AND NURSING MANAGEMENT A clinical environment conducive to holistic care is needed. Inclusion of spirituality in the continuous professional development programmes may enhance understanding of spirituality and foster spiritual growth. CONCLUSIONS Irrespective of differences in cultures between Malta and Norway, commonalities were found in the definition and essence of spirituality in nursing care. Trans-cultural longitudinal research is recommended to explore further the definition of spirituality.
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Johannessen-Henry CT, Deltour I, Bidstrup PE, Dalton SO, Johansen C. Associations between faith, distress and mental adjustment--a Danish survivorship study. Acta Oncol 2013; 52:364-71. [PMID: 23215830 DOI: 10.3109/0284186x.2012.744141] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Several studies have suggested that religion and spirituality are important for overcoming psychological distress and adjusting mentally to cancer, but these studies did not differentiate between spiritual well-being and specific aspects of faith. We examined the extent to which spiritual well-being, the faith dimension of spiritual well-being and aspects of performed faith are associated with distress and mental adjustment among cancer patients. METHODS In a cross-sectional design, 1043 survivors of various cancers filled in a questionnaire on spiritual well-being (FACIT-Sp-12), specific aspects of faith ('belief in a god', 'belief in a god with whom I can talk' and 'experiences of god or a higher power'), religious community and church attendance (DUREL), distress (POMS-SF), adjustment to cancer (Mini-MAC) and sociodemographic factors. Linear regression models were used to analyze the associations between exposure (spiritual well-being and specific faith aspects) and outcome (distress and adjustment to cancer) with adjustment for age, gender, cancer diagnosis and physical and social well-being. RESULTS Higher spiritual well-being was associated with less total distress (β = -0.79, CI -0.92; -0.66) and increased adjustment to cancer (fighting spirit, anxious preoccupation, helplessness-hopelessness). Specific aspects of faith were associated with high confusion-bewilderment and tension-anxiety, but also lower score on vigor-activity, and with higher anxious-preoccupation, both higher and lower cognitive avoidance, but also more fighting spirit. CONCLUSIONS As hypothesized, spiritual well-being were associated with less distress and better mental adjustment. However, specific aspects of faith were both positively and negatively associated with distress and mental adjustment. The results illustrate the complexity of associations between spiritual well-being and specific aspects of faith with psychological function among cancer survivors.
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Exline JJ, Prince-Paul M, Root BL, Peereboom KS, Worthington EL. Forgiveness, Depressive Symptoms, and Communication at the End of Life: A Study with Family Members of Hospice Patients. J Palliat Med 2012; 15:1113-9. [DOI: 10.1089/jpm.2012.0138] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julie J. Exline
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Maryjo Prince-Paul
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
- Hospice of the Western Reserve, Inc., Cleveland, Ohio
| | - Briana L. Root
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Karen S. Peereboom
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Kumar SP. Reporting of "quality of life": a systematic review and quantitative analysis of research publications in palliative care journals. Indian J Palliat Care 2012; 18:59-67. [PMID: 22837613 PMCID: PMC3401736 DOI: 10.4103/0973-1075.97475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
CONTEXT Palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. One of the most important goals in clinical palliative care is to improve patients' quality of life (QoL). AIM This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on QoL. SETTINGS AND DESIGN This was a systematic review of palliative care journals. MATERIALS AND METHODS Twelve palliative care journals were searched for articles with "QoL" in the title of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into assessment and treatment, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original article category was further classified according to study designs. STATISTICAL ANALYSIS USED Descriptive analysis using frequencies and percentiles was done using SPSS for Windows, version 11.5. RESULTS The overall reporting rate among all journals was 1.95% (71/3634), and Indian Journal of Palliative Care (IJPC) had the highest reporting rate of 5.08% (3/59), followed by Palliative Medicine (PM) with 3.71% (20/538), and Palliative and Supportive Care (PSC) with 3.64% (9/247) reporting. CONCLUSIONS The overall reporting rate for QoL articles in palliative care journals was 1.95% and there were very few randomized clinical trials and systematic reviews found. The study findings indicate further high-quality research to establish an adequate evidence base for QoL.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Abstract
This descriptive exploratory study explored illness appraisal and spiritual coping of three groups of individuals with life-threatening illness. These were hospice clients with cancer (Ca; n = 10), clients with first myocardial infarction (MI; n = 6), and parents of children with cystic fibrosis (CF; n = 16). Qualitative data were collected by audiotaped face-to-face interviews (parents) and focus groups (MI and Ca). Similarities in illness appraisal and spiritual coping were found across the three groups except appreciation of crafts, which was found only in clients with Ca and causal meaning of parents (CF). Overall, illness was appraised negatively and positively, whereas spiritual coping incorporated existential and religious coping. These findings confirm the psychological theory (Lazarus & Folkman, 1984) and theological theory (Otto, 1950), which guided this study. Recommendations were proposed to integrate spirituality and religiosity in the curricula, clinical practice and to conduct cross-cultural comparative longitudinal research.
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Gray H, Adam J, Brown D, McLaughlin P, Hill V, Wilson L. Visiting all hours: a focus group study on staff's views of open visiting in a hospice. Int J Palliat Nurs 2012; 17:552-60. [PMID: 22240633 DOI: 10.12968/ijpn.2011.17.11.552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
St Columba's Hospice, Edinburgh, is a busy specialist palliative care unit with 30 inpatient beds. A previous publication reported the first strand of a qualitative exploratory study evaluating the impact of open visiting on patients at the hospice. This paper reports on the second strand, which sought to elicit the views of the hospice staff through focus group interviews. The main themes identified were valuing the family and friends as visitors, involving the family as part of the care team, patient powerlessness over visiting, shared rooms and their impact on visitors and patients, and the staff role as advocates or gatekeepers. Several strategies for developing a flexible and 'patient-controlled' visiting policy were identified, including quiet times without visitors, restriction of visitor numbers in shared rooms, and encouraging breaks from visiting. Since the study was completed, the hospice's visiting policy has been modified to ensure that it is patient-centred and meets the needs of patients and families.
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Affiliation(s)
- Helen Gray
- St Columba's Hospice, 15 Boseall Road, Edinburgh, EH5 3RW, Scotland.
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Ipach I, Mittag F, Kopp HG, Kunze B, Wolf P, Kluba T. Clear-cell sarcoma of the soft tissue--a rare diagnosis with a fatal outcome. Eur J Cancer Care (Engl) 2011; 21:412-20. [PMID: 22150806 DOI: 10.1111/j.1365-2354.2011.01318.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clear-cell sarcomas account for less than 1% of all soft tissue tumours. They most often occur in middle-aged adults as a deeply located lesion with predilection to the tendons and aponeuroses. The aim of the present study was to show possible influencing factors on the outcome after surgical treatment in a detailed case series. We reviewed the medical records of 11 patients with the diagnosis of a clear-cell sarcoma of the soft tissue. These cases were analysed with regard to age, gender, localisation, tumour size, recurrence free survival and overall survival. A minimum follow up of 12 months was achieved. The mean age at the point of diagnosis was 47.9 years. Metastases occurred after a mean of 19.2 months. In the cases with a tumour diameter >5 cm, metastases occurred earlier. When treated in a specialist centre, metastases occurred later. Patients died a mean of 18.4 months after developing metastatic disease. Patients with tumour size >5 cm at the point of primary diagnosis died earlier than patients with a tumour size <5 cm. It is important to detect clear-cell sarcomas as soon as possible and the final surgical treatment should be performed in a centre familiar with the treatment of soft tissue tumours not only to prolong overall survival, but also to treat the patient in a multiprofessional team.
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Affiliation(s)
- I Ipach
- Department of Orthopaedic Surgery, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen, Germany
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Samuelson BT, Fromme EK, Thomas CR. Changes in spirituality and quality of life in patients undergoing radiation therapy. Am J Hosp Palliat Care 2011; 29:449-54. [PMID: 22104046 DOI: 10.1177/1049909111428607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Investigations into the role of spirituality in cancer confirm the association of good spiritual well-being with many positive outcomes. This study aimed to evaluate potential changes in spirituality over the course of radiation therapy (RT). PATIENTS AND MATERIALS The Functional Assessment of Chronic Illness Therapy-Spiritual questionnaire measuring spiritual well-being and quality of life (QOL) was administered to adult patients undergoing RT. Scores were compared using student t tests and chi-square analysis. RESULTS Despite statistically significant declines in QOL measures such as physical well-being (P < .001) and overall well-being (P < .001), no significant changes were noted in spirituality for all comers. A significant increase in the Sp-12 spirituality measure (P = .001) was noted in patients with breast cancer, independent of age, gender, and purpose of treatment. Sp-12 scores were positively correlated with overall QOL scores (P < .001).
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Krikorian A, Limonero JT, Maté J. Suffering and distress at the end-of-life. Psychooncology 2011; 21:799-808. [DOI: 10.1002/pon.2087] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 09/09/2011] [Accepted: 09/20/2011] [Indexed: 11/07/2022]
Affiliation(s)
| | - Joaquín T. Limonero
- Research Group on Stress and Health, Faculty of Psychology; Universidad Autónoma de Barcelona; Barcelona; Spain
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Gijsberts MJHE, Echteld MA, van der Steen JT, Muller MT, Otten RHJ, Ribbe MW, Deliens L. Spirituality at the end of life: conceptualization of measurable aspects-a systematic review. J Palliat Med 2011; 14:852-63. [PMID: 21612502 DOI: 10.1089/jpm.2010.0356] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although spiritual caregiving is a key domain of palliative care, it lacks a clear definition, which impedes both caregiving and research in this domain. The aim of this study was to conceptualize spirituality by identifying dimensions, based on instruments measuring spirituality in end-of-life populations. A systematic literature review was conducted. Literature published between 1980 and 2009, focussing on instruments measuring spirituality at the end of life was collected from the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO databases. Inclusion criteria were: (1) the studies provide empirical data collected with an instrument measuring spirituality or aspects of spirituality at the end of life; (2) the data report on a (subgroup) of an end-of-life population, and (3) the instrument is available in the public domain. Content validity was assessed according to a consensus-based method. From the items of the instruments, three investigators independently derived dimensions of spirituality at the end of life. In 36 articles that met the inclusion criteria we identified 24 instruments. Nine instruments with adequate content validity were used to identify dimensions of spirituality. To adequately represent the items of the instruments and to describe the relationships between the dimensions, a model defining spirituality was constructed. The model distinguishes the dimensions of Spiritual Well-being (e.g., peace), Spiritual Cognitive Behavioral Context (Spiritual Beliefs, Spiritual Activities, and Spiritual Relationships), and Spiritual Coping, and also indicates relationships between the dimensions. This model may help researchers to plan studies and to choose appropriate outcomes, and assist caregivers in planning spiritual care.
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Thomsen TG, Hansen SR, Wagner L. How to Be a Patient in a Palliative Life Experience? A Qualitative Study to Enhance Knowledge About Coping Abilities in Advanced Cancer Patients. J Psychosoc Oncol 2011; 29:254-73. [DOI: 10.1080/07347332.2011.563345] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Thora Grothe Thomsen
- a Research Unit, Department of Palliative Medicine , Bispebjerg Hospital , Copenhagen, Denmark
- b Research Unit of Nursing, Institute of Clinical Research , Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
| | - Susan Rydahl Hansen
- c Research Unit of Nursing, Bispebjerg and Frederiksberg Hospital , Copenhagen, Denmark
| | - Lis Wagner
- b Research Unit of Nursing, Institute of Clinical Research , Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
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Hsiao SM, Gau ML, Ingleton C, Ryan T, Shih FJ. An exploration of spiritual needs of Taiwanese patients with advanced cancer during the therapeutic processes. J Clin Nurs 2011; 20:950-9. [PMID: 21044187 DOI: 10.1111/j.1365-2702.2010.03278.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS AND OBJECTIVES This study explores the spiritual needs of patients with advanced cancer during their therapeutic process in Taiwan and analyses the influence of Chinese culture in addressing their spiritual needs. BACKGROUND Many nurse clinicians have concerns about the difficulties of providing spiritual care for ethnic-Chinese cancer clients within their cultural context, possibly as a result of lack of knowledge and training. There has been little research exploring the potential impact of Chinese cultural values on the spiritual needs of patients with advanced cancer. DESIGN Explorative qualitative enquiry was used. METHODS Data were collected through participant observation and in-depth face-to-face interviews. Transcribed interview data were analysed by using qualitative content analysis. The purposive sample (n = 33) was drawn from a leading medical center (n = 19) with 3000 beds in the capital and a community-based rural teaching hospital (n = 14) with 581 beds in Taiwan. RESULTS Four spiritual needs emerged from the analysis: the need to foster hope for survival and obtain a peaceful mindset, to fulfil the meanings of life and preserve one's dignity, to experience more reciprocal human love and finally, to receive assistance in facing death peacefully. CONCLUSION This research has shown that patients with advanced cancer need caregivers, friends and the help of their religion to meet their spiritual needs during the therapeutic processes. RELEVANCE TO CLINICAL PRACTICE The findings of this study could assist health professionals to detect the unmet spiritual needs of ethnic-Chinese patients with cancer in the context of their cultural or religious background as early as possible.
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Affiliation(s)
- Szu-Mei Hsiao
- Department of Nursing National Yang Ming University, Taipei, Taiwan
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Visser A, Garssen B, Vingerhoets A. Spirituality and well-being in cancer patients: a review. Psychooncology 2010; 19:565-72. [PMID: 19916163 DOI: 10.1002/pon.1626] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cancer places many demands on the patient and threatens the person's sense of meaning to life. It has been shown that cancer patients use their spirituality to cope with these experiences. The present literature review summarizes the research findings on the relationship between spirituality and emotional well-being. Special attention is given to the strength of the research findings. METHODS A literature search was performed in Pubmed and Web of Science. Spirituality does not necessarily coincide with religiosity. Therefore, studies were excluded that focused on religiosity. Forty publications met the inclusion criteria: Twenty-seven studies that investigated the relationship between spirituality and well-being, and 13 publications that explored the relationship between meaning in life and well-being. RESULTS The majority of the cross-sectional studies (31 of 36) found a positive association between spirituality and well-being. The four studies with a longitudinal design showed mixed results. The significance of the findings is challenged, because most spirituality questionnaires contain several items that directly refer to emotional well-being. CONCLUSIONS Despite that the majority of the studies concluded that spirituality was associated with higher well-being, no definitive conclusions on this relationship can be drawn due to major methodological shortcomings of these studies. Longitudinal research utilizing spirituality and well-being measures that do not overlap in content is recommended.
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Affiliation(s)
- Anja Visser
- Helen Dowling Institute, Centre for Psycho-Oncology, Ultrecht, The Netherlands.
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Prince-Paul M, Exline JJ. Personal Relationships and Communication Messages at the End of Life. Nurs Clin North Am 2010; 45:449-63. [DOI: 10.1016/j.cnur.2010.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Considine J, Miller K. The dialectics of care: communicative choices at the end of life. HEALTH COMMUNICATION 2010; 25:165-174. [PMID: 20390682 DOI: 10.1080/10410230903544951] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Communication at the end of life poses important challenges for patients, families, and caregivers. Previous research on end-of-life communication has concentrated on areas including the provision of bad news and clinical and personal decision making. In this study, we turn our attention to the processes through which caregivers provide comfort in palliative care. Our ethnographic and interview study of spiritual communication among hospice workers and their patients is guided by a dialectical framework. We find a central dialectic in which hospice workers recognize the tension between "leading" and "following" patients and families in discussions of spirituality at the end of life. Our analysis reveals that though some care providers choose one pole of this dialectic, most workers try to manage the dialectic by shifting between leading and following in different situations or different points in time or by transcending the dialectic and addressing the multiple goals of interaction.
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Relationship quality and burden among caregivers for late-stage cancer patients. Support Care Cancer 2009; 18:1429-36. [DOI: 10.1007/s00520-009-0765-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
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Mularski RA, Puntillo K, Varkey B, Erstad BL, Grap MJ, Gilbert HC, Li D, Medina J, Pasero C, Sessler CN. Pain management within the palliative and end-of-life care experience in the ICU. Chest 2009; 135:1360-1369. [PMID: 19420206 DOI: 10.1378/chest.08-2328] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In the ICU where critically ill patients receive aggressive life-sustaining interventions, suffering is common and death can be expected in up to 20% of patients. High-quality pain management is a part of optimal therapy and requires knowledge and skill in pharmacologic, behavioral, social, and communication strategies grounded in the holistic palliative care approach. This contemporary review article focuses on pain management within comprehensive palliative and end-of-life care. These key points emerge from the transdisciplinary review: (1) all ICU patients experience opportunities for discomfort and suffering regardless of prognosis or goals, thus palliative therapy is a requisite approach for every patient, of which pain management is a principal component; (2) for those dying in the ICU, an explicit shift in management to comfort-oriented care is often warranted and may be the most beneficial treatment the health-care team can offer; (3) communication and cultural sensitivity with the patient-family unit is a principal approach for optimizing palliative and pain management as part of comprehensive ICU care; (4) ethical and legal misconceptions about the escalation of opiates and other palliative therapies should not be barriers to appropriate care, provided the intention of treatment is alleviation of pain and suffering; (5) standardized instruments, performance measurement, and care delivery aids are effective strategies for decreasing variability and improving palliative care in the complex ICU setting; and (6) comprehensive palliative care should addresses family and caregiver stress associated with caring for critically ill patients and anticipated suffering and loss.
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Affiliation(s)
- Richard A Mularski
- Center for Health Research, Kaiser Permanente Northwest and Oregon Health & Science University, Portland, OR.
| | - Kathleen Puntillo
- Critical Care/Trauma Program, Department of Physiological Nursing, University of California, San Francisco, CA
| | - Basil Varkey
- Department of Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI
| | - Brian L Erstad
- Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, Tucson, AZ
| | - Mary Jo Grap
- Adult Health and Nursing Systems Department, School of Nursing, Virginia Commonwealth University, Richmond, VA
| | - Hugh C Gilbert
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Denise Li
- Department of Nursing and Health Sciences, College of Science, California State University, East Bay, Hayward, CA
| | - Justine Medina
- Professional Practice and Programs, American Association of Critical Care Nurses, Aliso Viejo, CA
| | - Chris Pasero
- Pain Management Educator and Clinical Consultant, El Dorado Hills, CA
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Bibliography. PROGRESS IN PALLIATIVE CARE 2008. [DOI: 10.1179/096992608x296987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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