Spiritual Well-being May Reduce the Negative Impacts of Cancer Symptoms on the Quality of Life and the Desire for Hastened Death in Terminally Ill Cancer Patients

The Mediating Role of Resilience in the Relationship Between Hope and Spiritual Well-being in Cancer Patients: A Study From Turkey

BACKGROUND

Cancer is a significant public health concern in the healthcare landscape. Amidst this challenging journey, the levels of hope, spiritual well-being, and resilience in patients with cancer have emerged as pivotal factors influencing the healing process.

OBJECTIVE

This study aimed to evaluate the relationship between hope and spiritual well-being in cancer patients and the mediating role of resilience in the relationship between hope and spiritual well-being levels.

METHODS

This study is a descriptive, cross-sectional, correlational study. The study included 152 cancer patients undergoing treatment. A patient information form, the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-SP-12) Scale, the Dispositional Hope Scale, and the Brief Resilience Scale were used to collect study data.

RESULTS

Positive and meaningful correlations were observed between the Dispositional Hope Scale and FACIT-SP-12, Brief Resilience Scale, and FACIT-SP-12 (r = 0.390, P < .05; r = 0.246, P < .05). Mediation analysis indicated that Brief Resilience Scale scores partially mediated the relationship between the Dispositional Hope Scale and FACIT-SP-12 Scale scores; the indirect effect of hope on spiritual well-being through resilience was 0.351 (P < .05).

CONCLUSION

The study has indicated a direct relationship between hope and spiritual well-being, and resilience partially mediated the relationship between hope and spiritual well-being.

IMPLICATIONS FOR PRACTICE

It is significant to provide psychosocial care to cancer patients to increase their resilience levels and to support their hope and spiritual well-being.

Do Spiritual Well-Being and Pain Intensity Predict Physical or Mental Components of Health-Related Quality-of-Life Scale in Patients With Multiple Myeloma?

BACKGROUND

Multiple myeloma is a complex disease and supportive care is important for improving quality of life. Management of disease treatment symptoms, bone disease, renal dysfunction, infection, anemia, pain, and coagulation disorder are specific issues. Spirituality, or spiritual well-being, is one of the most fundamental and essential concepts for coping with the difficulties and stress caused by cancer.

AIMS

This study explores whether spiritual well-being, pain, and other demographic factors predict the physical and mental components of quality of life in MM subjects.

METHODS

This cross-sectional descriptive study was conducted with 92 multiple myeloma patients registered with the Cancer Warriors Association in Turkey. The data were collected using the Personal Information Form, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12, the Numeric Rating Scale for Pain, and the Short Form-12 Health-Related Quality of Life Scale.

RESULTS

The mean age of the patients was 54.4 ± 10.7 years. It was found that the mean total pain score in the previous week was 3.9 ± 2.6, while the mean total The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 score was 28.1 ± 9.8. Their mean Short Form-12 total physical component score was 39.1 ± 25.4; whereas the Short Form-12 total mental component score was 45.5 ± 24.8. According to this model, 56.7% of the physical component score was explained by vertebroplasty, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 total score and subscale of peace and the pain intensity experienced in the previous week. According to multiple linear regression analysis, bone-sparing therapy and FACIT-Sp-12-Total and subscale peace significantly predicted the Mental component score (p < .05).

CONCLUSIONS

Cancer pain remains undertreated, and patients with myeloma are no exception. Pain and spiritual well-being scores were significant predictors of physical and mental component scores of quality of life in this group of patients. According to this result, pain-reducing practices should be implemented to improve the quality of life in MM patients and the spiritual needs of the patients should be met.

Desire for hastened death in advanced cancer: cross-sectional study in China

OBJECTIVE

To evaluate the incidence of desire for hastened death (DHD) among patients with advanced cancer and to identify factors associated with DHD.

METHODS

This was a cross-sectional study of 227 patients with advanced cancer in Hunan Cancer Hospital. The patients were assessed using Chinese version of the Schedule of Attitudes toward Hastened Death, Karnofsky Performance Scale, Quality of Life (QOL), MD Anderson Symptom Inventory and Patient Health Questionnaire Depression Module-9.

RESULTS

The number of patients with or without DHD were 71 (31.3%) and 156 (68.7%), respectively. Follow-up visits and average and high QOL were protective factors for DHD; severely disturbed sleep, symptoms that severely interfered with mood, and symptoms that severely interfered with relations with other people were risk factors for DHD.

CONCLUSIONS

The incidence of the DHD in patients with advanced cancer at home is high. Those who have low QOL, severely disturbed sleep, symptoms that severely interfered with mood, or symptoms that severely interfered with relations with other people should be paid attention to. These data provide a theoretical basis for the early detection and diagnosis of the desire to accelerate death of patients with advanced cancer.

Effects of Music Therapy on Spiritual Well-Being among Patients with Advanced Cancer in Palliative Care: A Meta-Analysis of Randomized Controlled Trials

PURPOSE

Patients with advanced cancer in palliative care often experience physical and psychological symptoms that negatively impact their quality of life (QoL) and spiritual well-being. Music therapy can be used for symptom management in these patients. However, the effectiveness is uncertain. To determine the effectiveness of music therapy on spiritual well-being, QoL, pain, and psychological distress using randomized controlled trials (RCTs).

DATA SOURCE

A systematic search was conducted in EMBASE, PubMed, Cochrane Library, CINAHL, Web of Science, and the ClinicalTrial.gov registry up to September 2022.

CONCLUSION

The meta-analysis included seven RCTs with a total of 747 advanced cancer patients. Music therapy was found to significantly improve spiritual well-being with a mean difference of 0.43 (95% CI: 0.25 to 0.61, P < .001) in the intervention group compared to the control group. However, no significant group differences were found between the intervention and control groups for QoL (SMD: 0.53, 95% CI: -0.12 to 1.13, P = .11), pain (MD: -0.81, 95% CI: -2.06 to 0.44, P = .20), and psychological distress (SMD: -0.05, 95% CI: -0.41 to 0.32, P = .81). Music therapy can effectively improve the spiritual well-being of palliative care patients. However, its beneficial effects on QoL, pain, and psychological distress were minimal.

IMPLICATIONS FOR NURSING PRACTICE

Music therapy interventions can be introduced to help patients deal with spiritual/existential needs. Future studies should identify optimal characteristics of music therapy interventions to aid in enhancing the quality of palliative care for patients with advanced cancer.

Psychometric Properties of the Turkish Version of the Nurse Spiritual Therapeutic Scale for Oncology Patients and Caregivers

This study evaluated the Turkish version of the Nurse Spiritual Therapeutic Scale for assessing oncology patients' and caregivers' needs. It involved 200 participants from July 2022 to May 2023. The scale demonstrated high validity (content validity index = 0.97) and good internal consistency (Cronbach's alpha = 0.879). Factor analysis revealed a 20-item single-factor structure with satisfactory representation (factor loadings: 0.29-0.89). Item-total score correlations indicated moderate to strong relationships (0.236-0.761). The model showed a good fit (goodness-of-fit indices > 0.90). The Turkish version of the scale is valid and reliable for assessing oncology patients' and caregivers' spiritual care needs.

The Meaning of Occupation for Adults With Advanced Cancer: A Scoping Review

IMPORTANCE

In this scoping review, we explore the meaning of occupation for people with advanced cancer to develop and improve occupation-based services in oncology.

OBJECTIVE

To identify the meaning(s) of occupation for adults with advanced cancer through relevant peer-reviewed literature.

DATA SOURCES

Scopus, CINAHL, Medline, and PubMed were used to identify peer-reviewed articles published between 2011 and 2021.

STUDY SELECTION AND DATA COLLECTION

Inclusion criteria comprised research studies in English and on meaningful occupations as well as participants age 19 yr or older and diagnosed with advanced cancer. Exclusion criteria comprised non-English publications, studies with participants in an early stage of cancer, and gray literature or nonreviewed articles.

FINDINGS

Thirteen articles matched the inclusion criteria: 9 qualitative studies, 1 mixed-methods study, 1 case study, 1 pilot study (pretest-posttest design), and 1 retrospective study (review of clinical data). Four themes emerged from the thematic analysis: occupation benefits important relationships and connections with others, occupation as a source of physical or psychological comfort, managing one's identity through occupation, and occupation as a religious expression.

CONCLUSIONS AND RELEVANCE

This scoping review highlights the value of participating in an occupation for people with advanced cancer. It also shows the importance of meaningful occupations to the quality of life and well-being of adults with advanced cancer. What This Article Adds: This scoping review identifies meanings of occupation linked to the health and well-being of adults with advanced cancer to develop and improve occupation-based services in oncology.

The concept of spirituality in the context of Chinese patients with cancer: A scoping review

AIM

To elucidate how the concept of spirituality has been addressed in studies with Chinese people with cancer.

DESIGN

A scoping review.

METHODS

Patterns in conceptual definitions of spirituality and indicators for measuring spirituality were analysed.

DATA SOURCES (INCLUDE SEARCH DATES)

Literature published from inception to August 2022 was searched in five electronic databases (CINAHL, PubMed, Web of Science, PsycINFO and a Chinese database).

RESULTS

Using data from 10 qualitative studies, a new taxonomy of concepts of spirituality among Chinese people with cancer was derived, consisting of four categories: Creation of meaning, Connection, Transcendence and Existence. A total of 12 instruments developed outside of Chinese contexts and used to measure dimensions of spirituality across 27 quantitative studies were compared to the taxonomy developed in this review, and patterns were identified according to the dimensions of spirituality. Several instruments required modifications or additional explanations in questions regarding God/Higher Power and religion.

CONCLUSION

The four categories of spirituality classified in the current review are considered universal across all cultural contexts. Spirituality is multidimensional and functional concept, and the components of the instruments differed depending on which dimension of spirituality was being measured.

IMPACT

The findings of this study suggest that for measuring spirituality in research and clinical settings with Chinese people with cancer, it is important to use culturally appropriate scales that are consistent with the dimensions of spirituality being measured.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Even instruments developed outside of the Chinese context could be used for Chinese people with cancer if appropriately selected for their intended use.

REPORTING METHOD

This paper adheres to the EQUATOR guidelines and has no direct patient or public contribution.

The effect of physical and psychological symptoms on spiritual well-being and emotional distress in inpatient cancer patients

PURPOSE

This study was conducted to examine the effects of physical and psychological symptoms seen in inpatient cancer patients on spiritual well-being and emotional distress.

METHOD

This descriptive and cross-sectional study was conducted with 98 cancer patients treated in oncology, haematology, and stem cell services at a university hospital between April and June 2022. Socio-demographic characteristic form, Karnofsky performance scale, Nightingale Symptom Assessment Scale, Hospital Anxiety and Depression Scale, distress thermometer and spiritual well-being scale were used to collect data. Statistical analyses were made by taking the descriptive features of the data.

RESULTS

It was determined that 55.1% of the patients were diagnosed with cancer for more than one year, 53.1% receiving treatment for more than one year, 61.2% were diagnosed with haematological cancer, and 62.2% were treated only with chemotherapy. Cancer type (p<0.01), treatment (p<0.05) and Karnofsky scores (p<0.01) had an effect on the spiritual well-being and distress scores. It was determined that 39.8% of the patients were in the yellow zone of the distress thermometer, could not manage their stress well and needed psychological support. As the psychological symptoms of the patients increased, their spiritual well-being declined (r=-0.447, p<0.01), and as their physical (r=0.222, p<0.05) and psychological (r=0.311, p<0.01) symptoms increased, their distress scores increased.

CONCLUSION

It is anticipated that identifying the problems that patients have and making interventions to solve those problems by oncology nurses would significantly contribute to the patient's spiritual well-being and emotional distress.

Mediating role of spirituality on the relationships between posttraumatic stress and posttraumatic growth among patients with cancer: A cross-sectional study

Objective

This study explores the impact of posttraumatic stress (PTS) on posttraumatic growth (PTG) and verifies the mediating effect of spirituality among patients with cancer.

Methods

This study used a cross-sectional correlational design. This study surveyed 141 hospitalized patients over 20 years of age diagnosed with cancer. Participants were recruited by convenience sampling from a regional hospital in Taiwan. Data were collected from January to April 2021. Measurements included sociodemographic and disease-related information and data from the following self-report questionnaires: Posttraumatic Stress Reaction Index-Short Form, Posttraumatic Growth Inventory, and Spiritual Health Scale-Short Form. Structural equation modeling and bootstrapping were used to analyze the mediating effect of spiritual health on PTS and PTG.

Results

PTS and spirituality were negatively correlated, spirituality, and PTG were positively correlated, and PTS had no correlation with PTG. Spirituality fully presented a mediating role between PTS and PTG.

Conclusions

Patients' spirituality should be regarded as an important variable that can impact stress appraisal and improve the patient's PTG when a diagnosis of cancer is received. Assessing spiritual health at regular intervals and integrating spiritual care with clinical care could decrease PTS and improve PTG for patients with cancer.

Eutanasia y Psicología. Algunas claves para la intervención en Procesos Adelantados de Muerte

Los países que han optado por regular los Procesos Adelantados de Muerte (PAM) van en aumento en los últimos años. Este tipo de legislaciones implican directamente a los equipos sanitarios.Los psicólogos incluidos en estos equipos están en contacto con estos procesos, por lo que se torna imprescindible dilucidar, mediante la escasa literatura existente, si los PAM presentan variables diferenciales con otros procesos de muerte, que sean necesarias tener en cuenta durante la asistencia psicológica. Esta recopilación de literatura pretende plantear las diferencias que en la actualidad están contrastadas y plantear qué opciones de intervención psicológica están a nuestra disposición para realizar el acompañamiento a estas personas, sus cuidadores y los equipos sanitarios que los asisten.

Barriers and facilitators to multidimensional symptom management in palliative care: A focus group study among patient representatives and clinicians

OBJECTIVES

It is widely acknowledged that co-occurring symptoms in patients with a psychosocial and spiritual aspects should also be considered. However, this multidimensional approach is difficult to integrate into daily practice, especially for generalist clinicians not specialized in palliative care. We aimed to identify the barriers and facilitators to multidimensional symptom management.

METHODS

Focus group meetings were conducted with the following stakeholders: (1) patient representatives, (2) generalist community nurses, (3) generalist hospital nurses, (4) general practitioners, (5) generalist hospital physicians, and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analyzed.

RESULTS

Fifty-one participants (6-12 per group) reported barriers and facilitators with 3 main themes: multidimensional symptom assessment, initiating management of nonphysical problems, and multidisciplinary collaboration. As barriers, generalist clinicians and palliative care specialists reported that generalist clinicians often lack the communication skills to address nonphysical problems and are unaware of available resources for multidimensional symptom management. Palliative care specialists felt that generalist clinicians may be unaware that assessing nonphysical problems is important and focus on pharmacological interventions. Generalist nurses and palliative care specialists indicated that hierarchical difficulties between them and generalist physicians are barriers to multidisciplinary collaboration. Reported facilitators included using symptom assessment scales and standardized questions on nonphysical problems.

SIGNIFICANCE OF RESULTS

Generalist clinicians can be supported by improving their communication skills, increasing their awareness of available resources for multidimensional symptom management, and by using a standardized approach to assess all 4 dimensions of palliative care.

The effect of spiritual well-being on symptom experience in patients with cancer

PURPOSE

To explore the effect of spiritual well-being on the symptom experience of patients with cancer.

METHODS

This is a cross-sectional survey that enrolled 459 patients with cancer from three large hospitals in Jordan in 2018. Participants completed questionnaires related to demographic data, spiritual well-being, and symptom experience. Additional information was obtained from the medical record review. We then conducted multiple regression to evaluate if spiritual well-being predicts the patients' reported symptom distress.

RESULTS

Patients reported thirty-six symptoms. Of which 15 have a prevalence of more than 30%. Fatigue was the most prevalent symptom (n = 282, 61.4%), followed by pain (n = 243, 52.9%) and anxiety (n = 230, 50.1%). Spiritual well-being predicted 7.1% of the total variance in patients' symptom distress (F, 19.650; p < 0.0001). Additional predictors were gender, education level, having a problem covering the treatment cost, family cancer history, and whether taking a complementary treatment or not.

CONCLUSIONS

Patients with cancer experience multiple symptoms related to the disease and its treatment. Improving patients' spiritual well-being through an increased sense of meaning and peace can improve cancer symptom experience by decreasing symptom distress. In general, hospitals in Jordan focus on direct symptom management and do not look after patients' spiritual needs. Raising awareness about the importance of patients' spiritual well-being and providing appropriate spiritual assessment and interventions to patients with spiritual distress can improve patients' symptom experience.

Spiritual Well-Being and Associated Factors in Dutch Patients With Advanced Cancer

CONTEXT

Palliative care aims to support patients' spiritual needs with the intention of promoting their spiritual well-being (SWB), an important dimension of quality of life. SWB is one of the less-studied dimensions of QoL, particularly in a secular country such as the Netherlands.

OBJECTIVES

In this study we aimed to get a better understanding of SWB in Dutch patients with advanced cancer. We therefore examined its prominence and associated factors.

METHODS

We used the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), which included 1,103 patients with advanced cancer. In addition to sociodemographic and religious/spiritual characteristics, study measures comprised the SWB subscales Meaning, Peace, and Faith of the revised FACIT-Sp-12, spiritual problems and needs (PNPCsv), quality of life (EORTC-QLQ-C30) and satisfaction with healthcare professionals' interpersonal skills (INPATSAT-32).

RESULTS

On average, patients experienced quite a bit of Meaning (8.9, SD 2.3), a little bit to somewhat Peace (6.8, SD 2.7), and very low levels of Faith (2.9, SD 3.7). Two-thirds (71%) of patients reported one or more spiritual problems, for which the majority (54%) wanted to receive attention. In the final multivariable models, only a few factors were associated with SWB, such as greater spiritual needs with lower levels of Meaning and Peace.

CONCLUSION

Dutch patients with advanced cancer experience medium to low levels of Meaning, Peace, and Faith. More attention for their SWB is warranted.

The relationship between spiritual well-being, hope and depression in gynecologic oncology patients

The authors' aim in this study was to determine the relationship between spiritual well-being, hope and depression in gynecologic oncology patients. This is a descriptive and correlational study. The patients received a total of 41.59 ± 12.11 points from the Spiritual Well-Being Scale, 5.57 ± 4.19 points from the Beck Hopelessness Scale, and 14.92 ± 11.61 points from the Beck Depression Scale. Gynecologic oncology patients had high spiritual well-being levels and low hopelessness and depression levels, and their hopelessness and depression levels decreased and hope levels increased as their spiritual well-being levels increased.

Impact of spiritual care on the spiritual and mental health and quality of life of patients with advanced cancer

BACKGROUND

Cancer is a growing threat to human health. Due to the double torment of cancer and cancer treatment, patients with advanced cancer generally have a low quality of life. At present, there is a lack of systematic spiritual care plans for patients with advanced cancer as well as systematic guidance plans on the specific clinical application of spiritual care for advanced cancer patients. We hypothesized that our care plan would be effective in improving the spiritual and mental health and quality of life of patients with advanced cancer.

AIM

To construct a spiritual care plan suitable for Chinese patients with advanced cancer through literature analysis.

METHODS

From February to December 2018, through purpose sampling, we selected 100 advanced cancer patients from the Oncology Department and Hospice Ward of a tertiary hospital in Liaoning Province who met the study standards. Patients were randomly divided into experimental and control groups, with 50 cases in each group. The control group received the current routine care, while the experimental group received the advanced cancer spiritual care intervention in addition to routine care.

RESULTS

After the intervention, the overall spiritual health score for the experimental group was higher than that of the control group (4.68 ± 1.36 vs 3.63 ± 1.71). The difference between the groups was statistically significant (P < 0.05). The proportion of anxiety-free patients in the experimental group was 95.45%, which was significantly higher than the 60.98% in the control group. Moreover, the proportion of non-depressed patients in the experimental group was 97.73%, which was significantly higher than the 85.37% in the control group (P < 0.05). The overall quality of life score for the experimental group was significantly higher than that of the control group (5.36 ± 1.16 vs 4.39 ± 1.36, P < 0.05).

CONCLUSION

Our spiritual care plan for patients with advanced cancer could improve their spiritual health and quality of life and reduce negative mental health symptoms.

Nursing care based on the Support-Based Spiritual Care Model increases hope among women with breast cancer in Iran

PURPOSE

Taking care of cancer patients and treating them are among major challenges in the field of health. Several studies have shown that promotion of hope is an efficient strategy for effectively treating this group of patients, reducing their symptoms, and improving the quality of their life. It seems that spiritual care can boost hope in these patients. This study aims to determine the effects of nursing care based on the Support-Based Spiritual Care Model on boosting hope among women with breast cancer.

METHODS

In this controlled clinical trial, 72 patients with breast cancer were selected through consecutive sampling and randomly assigned to two control and intervention groups (n = 36 in each group) based on four randomized blocks. The intervention was carried out based on the Support-Based Spiritual Care Model for the patients and their main caregivers in six sessions. Besides, the Snyder's hope scale was completed before and 1 month after the intervention by the participants in the intervention and control groups.

RESULTS

The results of the independent samples t-test showed no significant difference in the mean scores of hope between the intervention and control groups before the intervention (P > 0.05). However, after the intervention, the mean scores of hope for the intervention and control groups were 46.71 ± 4.61 and 40.40 ± 5.42, respectively, showing a significant intergroup difference as verified by the independent samples t-test (P < 0.05).

CONCLUSION

According to the results of this study, providing nursing care based on the Support-Based Spiritual Care Model can raise hope in patients with breast cancer.

CLINICAL IMPLICATIONS

Healthcare professionals can boost hope in cancer patients through proper planning and adequate support in providing nursing care based on the proposed model.

The role of spirituality in symptom experiences among adults with cancer

PURPOSE

Adults with cancer experience symptoms such as pain, fatigue, depression, and sleep disturbance, which can impede quality of life. Research suggests that addressing spirituality may be one route to support holistic symptom management. The purpose of this study is to explore how spirituality relates to common cancer-related symptoms (including severity, distress, and interference) among a sample of adults with cancer.

METHODS

This is a secondary analysis of data from N = 200 solid tumor cancer patients undergoing chemotherapy. Symptom experiences were assessed with a modified version of the Memorial Symptom Assessment Scale and the M. D. Anderson Symptom Inventory-Interference Subscale. Spirituality was assessed using a subset of items from the Fox Simple Quality of Life Scale. A series of ordinal and linear regressions were used to examine the relationship between spirituality and symptom severity, symptom-related distress, and symptom interference across four cancer-related symptoms (pain, fatigue, depression, and sleep disturbance).

RESULTS

Higher spirituality trended toward an association with lower pain severity, although results were not significant (p < .058). Higher spirituality was significantly associated with lower severity of fatigue (p < .003), depression (p < .006), and sleep disturbance (p < .004). Spirituality was not significantly associated with any of the four symptom-related distress outcomes. Higher spirituality was significantly associated with lower overall symptom interference (p < .004).

DISCUSSION

This study highlights the role of spirituality in the experience of cancer-related symptoms. Additional research is needed among more diverse samples of people with cancer. This foundational work could lead to the development of symptom management interventions that incorporate aspects of spirituality.

Longitudinal changes in spiritual well-being and associations with emotional distress, pain, and optimism-pessimism: a prospective observational study of terminal cancer patients admitted to a palliative care unit

PURPOSE

Although spiritual well-being (SWB) is gaining increasing attention within the international palliative care (PC) guidelines, a lack of insight exists into the correlates and course of SWB among cancer patients. We therefore conducted a prospective observational study to capture trend of SWB and to identify their predictors in Chinese inpatients with terminal cancer receiving short-term PC.

METHODS

A prospective observational study was conducted of terminal cancer inpatients in the hospice ward, Shengjing Hospital of China Medical University. A total of 108 patients completed self-report questionnaires on Functional Assessment of Chronic Illness Therapy-Spiritual Well-being, Hospital Anxiety and Depression Scale, Numerical Rating Scales, and Life Orientation Scale-Revised anonymously at baseline; SWB, depression, anxiety, and pain were subsequently assessed at 1-week interval. Multilevel regression was used to analyze the temporal course and predictors of SWB.

RESULTS

Patients' existential well-being (B =  - 0.99, p = 0.008; 95%CI =  - 1.72 to - 0.26) and meaning dimension (B =  - 0.87, p < 0.001; 95% CI =  - 1.29 to - 0.43) significantly decreased after admission to the PC unit, but peace and faith did not change over time. Increases in depression and pain were related to lower existential well-being, particularly in the meaning dimension. Optimism-pessimism moderated the linear trend of existential well-being and meaning domain, such that those with higher optimism and lower pessimism paired with a decrease in outcomes.

CONCLUSIONS

Terminal cancer patients experienced worsening existential well-being, particularly in the meaning facet while hospitalized, indicating that PC should include content that targets the existential concerns of spirituality in China. These findings also supported the need for an integrated PC to address personality traits and emotional and physical distress in this population.

Palliative Care in the Greater China Region: A Systematic Review of Needs, Models, and Outcomes

CONTEXT

There is rapidly increasing need for palliative care in Greater China because of rapidly aging populations.

OBJECTIVES

This study aimed to systematically review and appraise evidence for palliative care needs, models of care, interventions, and outcomes in Greater China.

METHODS

Four databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) were searched, with hand searching of local journals and databases. Narrative synthesis was applied to the qualitative and quantitative evidence.

RESULTS

Nineteen qualitative studies and 47 quantitative studies were retained. With respect to care needs, nine themes were synthesized: pain control, reduced aggressive end-of-life care, truth telling, physical, emotional, and spiritual supports, and achieving preferred place of care/death. Informal caregivers expressed their needs for education and burden reduction. Health care professionals called for training and national policy support. Twenty-four studies evaluated interventions, mostly among patients with advanced cancer. Positive effects were suggested for improvements in quality of life, pain, anxiety and depression, readmission rate, and costs. Models of care evaluated were mostly specialist palliative care delivered in various settings (hospitals, residential care, and home). Outcome measures used were grouped into six categories of construct: quality of life, pain, physical assessment, psychospiritual assessment, quality of care, and implementation assessment. Limited rigorous randomized controlled trials are available to document intervention outcomes, and some problems (such as high attrition rates) reduced the strength of the evidence.

CONCLUSION

Palliative care services within Greater China should pay more attention to management of nonmalignant disease and to integration into primary services. Policy support is key to establishing culturally appropriate person-centered services.

Pain and Spirituality Outcomes Among Women With Advanced Breast Cancer Participating in a Foot Reflexology Trial

OBJECTIVES

To examine pain and spirituality, demographic and clinical factors associated with pain and spirituality, the contribution of spirituality to experiences of pain over time, and how pain and spirituality relate to engagement with a caregiver-delivered intervention.

SAMPLE & SETTING

Women with advanced breast cancer (N = 256) enrolled in a home-based randomized controlled trial of foot reflexology.

METHODS & VARIABLES

Secondary analyses were conducted with baseline and postintervention data. Stepwise model building, linear mixed-effects modeling, and negative binomial regression were used.

RESULTS

Participants who were younger, not married or partnered, not employed, or receiving hormonal therapy had increased odds of higher pain levels. Those who were older, non-White, or Christian had increased odds of higher spirituality. Spirituality's contribution to pain was not significant over time.

IMPLICATIONS FOR NURSING

Women in this sample experienced moderate pain, on average, at baseline. Women with specific demographic and clinical characteristics may require additional support with pain management and spiritual care.

Predictive factors associated with death depression in women with breast cancer

A cross-sectional study with a convenience sample of 241 patients with breast cancer was conducted to investigate death depression and its explanatory factors in Iranian women who were diagnosed and undergoing treatment for breast cancer. Patients with significantly higher death depression were those who were housewives (β = 0.6, p = 0.016), unskilled workers (β = 15.8, p = 0.002), and retired (β = 13.1, p = 0.002) as compared with those who were professionally employed with higher socio-economic status (β = 17.4, p = 0.002); and those receiving combination therapy as compared to surgery only (β = 6.3, p = 0.02). For patients with higher spiritual health scores, death depression was significantly lower (β = -0.2, p < 0.001).

Quality of life of cancer patients at palliative care units in developing countries: systematic review of the published literature

Purpose

This systematic review aims to summarize factors that influence the quality of life (QOL) of advanced cancer patients in palliative care (PC) in developing countries. Understanding this context in developing countries milieu is necessary; however, this outcome is rarely reported.

Methods

Following the PRISMA guidelines, the electronic databases MEDLINE, Embase, CINAHL, and Web of Science were systematically searched using the search terms: QOL, cancer, PC, and names of all developing countries. Studies with less than ten subjects, qualitative or pilot studies, reviews, conference abstracts, and that reported validation of QOL questionnaires were excluded.

Results

Fifty-five studies from 15 developing countries in the African (n = 5), Latin America and the Caribbean (n = 10), and Asian (n = 40) region were included in the narrative synthesis. 65.4% were cross-sectional, 27.3% were cohort studies, 7.3% were RCTs or quasi-experimental studies. Around 30 QOL factors were studied with 20 different types of QOL instruments. Advanced cancer patients who were older, married/ever married, participated in additional care within PC, used complementary and alternative medicine (CAM), and practiced spirituality/religiosity showed higher QOL score. Low educational level and high depression were associated with a lower QOL.

Conclusion

Various factors affect QOL among cancer patients in PC. Patients valued the use of CAMs; however, the quality and safety aspects should be properly addressed. Important factors that influenced the QOL score were social and spiritual support. While there is a general need to develop PC strategies further, recognizing patients’ needs should be prioritized in national cancer programs.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02633-z) contains supplementary material, which is available to authorized users.

Impact of Islam-Based Caring Intervention on Spiritual Well-Being in Muslim Women with Breast Cancer Undergoing Chemotherapy

This research emphasizes the nurse’s role in incorporating Islamic teaching through the care practices provided in order to promote spiritual well-being in Muslim women with breast cancer undergoing chemotherapy. In addition, religion and spirituality have been recognized as the primary resources for coping. The aim of the study, therefore, was to explore the impact of an Islam-based caring intervention on the spiritual well-being of Muslim women with cancer. Furthermore, data were collected using a questionnaire and, also, the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp) on baseline (Time 1), days 3 (Time 2), 23 (Time 3), and 44 (Time 4). The results showed the significant impact of an Islam-based caring intervention on the participants’ level of spiritual well-being. In addition, the mean scores varied between the intervention and control group over time. Based on the reflection, participants stipulated feeling peace of mind, closer to God, spirit for further life, and healthier.

Health-related quality of life in patients with advanced cancer who express a wish to hasten death: A comparative study

BACKGROUND

Some evidence suggests the wish to hasten death is related to poor health-related quality of life. Deficits in perceived dignity and self-efficacy are risk factors for wish to hasten death that also impact health-related quality of life.

AIM

To compare perceived health-related quality of life, dignity and self-efficacy in patients with advanced cancer who either do (case group) or do not (control group) express a wish to hasten death. Cases and controls were matched on sociodemographic and functional characteristics.

DESIGN

A comparative cross-sectional study.

PARTICIPANTS

A total of 153 adult patients with advanced cancer were assessed for wish to hasten death using the Desire for Death Rating Scale. Scores ⩾1 indicate some degree of wish to hasten death (case group, n = 51), and score = 0 implies no wish to hasten death (control group, n = 102). Assessments included health-related quality of life using the European Organization for Research and Treatment of Cancer Quality-of-Life Core 15-Item Palliative Questionnaire, perceived loss of dignity using the Patient Dignity Inventory and self-efficacy using the General Self-Efficacy Scale.

RESULTS

Patients with a wish to hasten death had worse emotional functioning (p < 0.001), greater perceived loss of dignity (p < 0.001) and lower self-efficacy (p = 0.001). There was no difference in most physical symptoms. Perceived overall health-related quality of life was significantly worse for those with a clinically relevant wish to hasten death (p = 0.023) and marginally worse for the case group than the control group (p = 0.052).

CONCLUSION

Patients with wish to hasten death showed lower perceived dignity, self-efficacy and emotional quality of life than patients without wish to hasten death without necessarily perceiving worse physical symptoms.

Preferences for end-of-life care: a study protocol for a cross-sectional survey of Chinese frail elderly home residents in Hong Kong

INTRODUCTION

Existing literature on attitudes toward end-of-life care (EoLC) covers the general public but has little information on the frail elderly population. The aim of the current study is to investigate the preferences of Chinese frail elderly home residents with respect to EoLC by conducting cross-sectional surveys.

METHODS AND ANALYSIS

Surveys, including resident and family versions, were developed based on the existing literature and our pilot interviews. The targeted participants were 400 frail elderly home residents (aged ≥65 years old) and 200 family caregivers. Purposive sampling will be used as each elderly home will help to recruit five to 15 elderly participants for the study. Descriptive analysis and modelling will be used to examine preferences on EoLC and related factors, as well as to compare the responses of elderly home residents with those of their family caregivers.

ETHICS AND DISSEMINATION

The cross-sectional survey has obtained approval from the Institutional Review Board. Confidentiality and safety issues will be carefully observed. The results of the study will be disseminated through international conferences, peer-reviewed academic journal publications, and a report in plain language to be shared with elderly residential homes.

The assessment of spiritual well-being in cancer patients with advanced disease: which are its meaningful dimensions?

BACKGROUND

Spirituality is particularly important for patients suffering from life-threatening illness. Despite research showing the benefits of spiritual assessment and care for terminally ill patients, their spiritual needs are rarely addressed in clinical practice. This study examined the factor structure and reliability of the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) in patients with advanced cancer. It also examined the clinical meaning and reference intervals of FACIT-Sp scores in cancer patients subgroups through a literature review.

METHODS

A forward-backward translation procedure was adopted to develop the Italian version of the FACIT-Sp, which was administered to 150 terminally ill cancer patients. Exploratory factor analysis was used for construct validity, while Cronbach's α was used to assess the reliability of the scale.

RESULTS

This study replicates previous findings indicating that the FACIT-Sp distinguish well between features of meaning, peace, and faith. In addition, the internal consistency of the FACIT-Sp was acceptable. The literature review also showed that terminal cancer patients have the lowest scores on the Faith and Meaning subscales, whereas cancer survivors have the highest scores on Faith.

CONCLUSIONS

The Italian version of the FACIT-Sp has good construct validity and acceptable reliability. Therefore, it can be used as a tool to assess spiritual well-being in Italian terminally ill cancer patients. This study provides reference intervals of FACIT-Sp scores in newly diagnosed cancer patients, cancer survivors, and terminally ill cancer patients and further highlights the clinical meaning of such detailed assessment.

Hope in Hospitalized Patients with Terminal Cancer

Hope is of great importance for patients diagnosed with cancer, especially those that are terminally ill. The diagnosis often puts an end to the realization of personal, social, and professional goals. The aim of this study was to characterize the hope of hospitalized patients diagnosed with cancer in the terminal phase of the disease. The research tool used in the study was Block’s hope test (NCN-36; NCN- Nadzieja Chorych Nowotworowych—Hope of Cancer Patients), designed for patients with life-threatening diseases. The results showed that the patients were characterized by a moderate level of global hope. The highest levels of hope were noted in the spiritual-religious area and the lowest levels of hope concerned curing the disease. Patients exhibited varied levels of hope and varied internal structures of hope. They presented four different types of hope: optimistic, moderate, religious, and weak. Optimistic hope was found most frequently in patients diagnosed with a terminal phase of cancer, while weak hope was represented by the smallest group of these patients.

The Effects of Holy Name Meditation on Spiritual Well-being, Depression, and Anxiety of Patients With Cancer

This study was conducted to evaluate the effects of the Holy Name Meditation on cancer patients' spiritual well-being, anxiety, depression, and pain. Twenty-eight patients were enrolled in the control group, and 18 patients were selected for the experimental group. Only the patients in the experimental group completed 5 weeks of the Holy Name Meditation Program. All participants were surveyed to assess spiritual well-being (Spiritual Well-Being Scale), anxiety and depression (Symptom Checklist 90-R), and pain (numeric pain rating scale). There were no significant differences between the two groups' general characteristics, but the baseline survey revealed that anxiety and depression levels were higher in the experimental group. Analyzing the results after controlling the baseline scores of anxiety and depression showed that spiritual well-being was increased (F = 4.80, P = .034), whereas anxiety (F = 4.98, P = .031) and depression (F = 7.28, P = .010) were decreased after the intervention. No difference in pain was found between the two groups. The Holy Name Meditation Program was thus effective in enhancing cancer patients' spiritual well-being and decreasing their anxiety and depression. Therefore, it is recommended that Holy Name Meditation be provided in clinical settings to reduce the psychosocial and spiritual suffering of cancer patients.

Hope and perspective on death in patients with cancer

This study was conducted to determine the relationship between various attitudes and hope levels of cancer patients. The study was conducted in an observational and cross-sectional design with 106 cancer patients who were followed in the oncology clinic of a hospital. In the study, it was found that women had lower hope levels than men, and as age decreased, hope levels increased and as educational level increased, hope levels increased. It was found that the patients who said "I have fear/worry/anxiety and think about my family as they will be left behind" had lower total scores and subscale scores of hope. The results of the study showed that individuals with cancer had relatively higher hope levels. It was determined that the patients' thoughts about death affected their hope both directly and indirectly.

Spirituality and Quality of Life in Black Patients With Cancer Pain

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.

Predictors and Moderators of Quality of Life in Alzheimer's Disease Patients

BACKGROUND

Alzheimer's disease (AD) is a chronic degenerative disease leading to global cognitive and functional decline. Quality of Life (QOL) is an important variable in the effectiveness of intervention programs in dementia.

OBJECTIVE

This study analyzed the relationships between gender, psychological variables and QOL, the predictors of QOL, and the role of spirituality as a moderator between functionality and QOL.

METHOD

A cross-sectional study was conducted with 128 patients with mild AD.

RESULTS

Being a male, good social support, and high functionality were significant predictors of better QOL. Spirituality was a moderator in the relationship between functionality and QOL.

CONCLUSION

These results reinforce the importance of gender, psychological morbidity, social support, and functionality, with special emphasis on the role of spirituality, regarding intervention programs that promote QOL, in patients with mild AD.

Determining the Expected Competencies for Oncology Nursing: A Needs Assessment Study

Background:

A critical component of cancer care, rarely addressed in the published literature, is an expected competency in oncology nursing education. The present text describes an effort to develop cancer-nursing competencies in Iran and the process of the needs assessment.

Materials and Methods:

A 3-phase, mixed-method approach for needs assessment was used, incorporating modified Delphi technique, literature review, interviews, and an expert panel. Different stakeholders, consisting of nurses, faculty members in fields related to oncology nursing education, and patients and their families, participated in different phases of the study. Data were analyzed using manual content analysis.

Results:

In the present study, totally 123 sub-competencies were identified under holistic physical healthcare for patients, psychological and social care, spiritual care, palliative care, ability to prevent at three levels, teamwork and inter-professional competencies, management and leadership competencies, ability to conduct research and evidence-based nursing, supportive care, communication skills, professionalism, provision of education and counselling to patients and their families, and reasoning, problem solving, and critical thinking skills, respectively.

Conclusions:

An updated and applicable list of competencies was extracted, which can be used to design and develop educational programs, which seek to train qualified oncology nurses for an effective nursing care.

Meaning in Life as a Mediator Between Physical Impairment and the Wish to Hasten Death in Patients With Advanced Cancer

CONTEXT

Meaning in life (MiL) is a key factor for ensuring spiritual well-being and quality of life among patients with life-threatening illnesses. However, the role of MiL in relation to the wish to hasten death (WTHD) and its interaction with other physical and psychological factors in patients with advanced cancer has not yet been studied.

OBJECTIVE

The objective of this study was to analyze the relationship between the WTHD and MiL and to propose a theoretical model of functional relationships among WTHD, performance status, depression, and MiL.

METHODS

This is a cross-sectional study of 101 patients in a palliative care unit, who were assessed in the context of a clinical interview. Outcome measures included performance status, depression, MiL, and the WTHD. Structural equation modeling was used to analyze the functional relationships between these factors.

RESULTS

The WTHD correlated significantly (P < 0.01) with MiL (r = 0.60), performance status (r = 0.548), and depression (r = 0.397). The structural equation modeling analysis showed that although there was no significant direct effect between performance status and the WTHD, there was a significant total effect because of the mediation of depression and MiL. The latter played the most significant role, accounting for 76.5% of the mediation.

CONCLUSION

These results support the proposed model and provide evidence of a mediator effect of MiL and depression on the relationship between physical impairment and the WTHD in advanced patients. Our findings suggest that interventions to enhance MiL could help to address and/or prevent the emergence of a WTHD in this population.

Assessment of the wish to hasten death in patients with advanced disease: A systematic review of measurement instruments

BACKGROUND

Patients with advanced conditions may present a wish to hasten death. Assessing this wish is complex due to the nature of the phenomenon and the difficulty of conceptualising it.

AIM

To identify and analyse existing instruments for assessing the wish to hasten death and to rate their reported psychometric properties.

DESIGN

Systematic review based on PRISMA guidelines. The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of validation studies and the measurement properties of the instrument described.

DATA SOURCES

The CINAHL, PsycINFO, Pubmed and Web of Science databases were searched from inception to November 2015.

RESULTS

A total of 50 articles involving assessment of the wish to hasten death were included. Eight concerned instrument validation and were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments criteria. They reported data for between two and seven measurement properties, with ratings between fair and excellent. Of the seven instruments identified, the Desire for Death Rating Scale or the Schedule of Attitudes toward Hastened Death feature in 48 of the 50 articles. The Schedule of Attitudes toward Hastened Death is the most widely used and is the instrument whose psychometric properties have been most often analysed. Versions of the Schedule of Attitudes toward Hastened Death are available in five languages other than the original English.

CONCLUSION

This systematic review has analysed existing instruments for assessing the wish to hasten death. It has also explored the methodological quality of studies that have examined the measurement properties of these instruments and offers ratings of the reported properties. These results will be useful to clinicians and researchers with an interest in a phenomenon of considerable relevance to advanced patients.

Development of a short form of the Spanish schedule of attitudes toward hastened death in a palliative care population

PURPOSE

The schedule of attitudes toward hastened death (SAHD) is widely used to assess the wish to hasten death (WTHD) among patients with life-threatening conditions. A short form of the SAHD would increase its clinical applicability in this population.

METHOD

Rasch analysis of data from 101 Spanish palliative inpatients. Item reduction involved selecting items with a high discrimination index (point-biserials ≥0.70), removing items with inadequate fit statistics, and assessing unidimensionality and local dependency. We examined the test probability function to establish an empirical risk score for suffering a WTHD and tested convergence between the original and the reduced set of items.

RESULTS

A set of five items met all quality criteria. In this sample, 20.8 % of participants had a higher risk of a WTHD (p > 50 %) at a score of 3. Correlation analysis confirmed convergent validity between the original and reduced forms. Concurrent validity was confirmed by the similar correlations shown by both versions of the SAHD (5 and 20 items) with other measures.

CONCLUSION

This 5-item Spanish form of the SAHD could be a suitable alternative to the full instrument. The cut-off score derived from the Rasch analysis may be able to detect patients at risk of a WTHD.