Spiritual needs of patients with cancer in palliative care: an integrative review

Spiritual conversation model for patients and loved ones in palliative care: a validation study

OBJECTIVES

In palliative care, validated tools for professionals that facilitate day-to-day spiritual conversations with patients and loved ones are scarce. The objective of this study was to validate the Diamond spiritual conversation model across different palliative care settings as well as professional and educational levels.

METHODS

An online survey was filled in by 387 professionals providing palliative care for patients in hospice, home care, hospital and nursing home settings. The five polarities of the Diamond model: holding on-letting go, doing-undergoing, remembering-forgetting, me-the other and believing-knowing were operationalised and evaluated on reported occurrence.

RESULTS

In conversations with patients, palliative care professionals reported letting go of loved ones (81.8%), dealing with pain and suffering (88.1%), dealing with issues from the past (67.2%), dealing with own versus loved one's wishes (69.4%) and giving meaning to death (66.7%) as themes occurring regularly to very often. In conversations with loved ones, this was 70.8%, 78.5%, 55.4%, 68,8% and 62%, respectively. Respondents working in hospices reported these themes significantly more than those working in home care settings, nursing homes or hospitals. Nurse assistant respondents reported the themes significantly less than nurses or chaplains.

CONCLUSION

From the perspective of professionals providing palliative care in different palliative care settings, the Diamond model offers a validated framework for addressing relevant spiritual themes for patients and loved ones.

Methylnaltrexone's Effect on Cholestasis in Trauma Patients

Introduction Cholestasis in hospitalized patients receiving opiates has the potential to have devastating outcomes including acalculous cholecystitis, sepsis, or even death. In this study, we evaluate the outcomes of trauma patients treated with methylnaltrexone. Methods We conducted the study at Desert Regional Medical Center, a level 1 trauma center in Palm Springs, California. Our electronic medical record was queried for all trauma patients between January 1, 2018 and January 1, 2024. Patients were excluded if they were under 18 years old or had a documented history of cirrhosis, congestive heart failure, or cardiac arrest during their admission. Those not excluded were divided into a treatment group including those who received at least one dose of methylnaltrexone and those who never received a dose of methylnaltrexone. A control group was created matching by randomly selecting one patient from the non-treatment group for each patient in the treatment group. The control and treatment groups were then analyzed using SPSS (IBM Corp., Armonk, NY). Demographic data was compared using student t-test between the two groups including age, sex, length of stay, ICU length of stay, ventilator days, and mortality. A p-value is reported as a test statistic. The incidence of cholestasis was measured by either laboratory evidence of hyperbilirubinemia, radiologic evidence of cholecystitis, diagnosis code of cholecystitis, or procedural intervention for cholecystitis. The two groups were compared for incidence of cholestasis using student t-test. Results are reported below. Results A total of 9894 patients were evaluated for inclusion in the study. Of those patients, 1292 patients met the exclusion criteria, and 8602 patients were analyzed for administration of the study drug. Fifty-six patients received at least one dose of methylnaltrexone. The remaining 8597 patients did not receive the treatment. Fifty-six patients were selected randomly for the control group. The median age between the treatment and control groups did not show statistically significant differences. Sex was also not statistically different between the two groups with 38 males and 18 females in the treatment group as compared to 39 males and 17 females in the control group with a p-value of 0.86. The median hospital length of stay was longer in the treatment group at 13 days compared to only one day in the control group which was statistically different with a p-value of <.001. ICU length of stay was also found to be statistically different between the treatment and control groups with 4 and 0 days respectively and a p-value of <.001. Mortality between the two groups was also higher in the treatment group with five patients in the treatment group not surviving to discharge as compared to one patient in the control group (p-value = .044). Both groups had one patient who met the criteria for cholestasis representing an overall incidence of 1.8% for each group. Conclusion Our data suggests that patients who received the medication were overall sicker with longer hospital stays, increased mortality, and more likely to have required surgery. We did not show a significant difference in incident of cholestasis or acalculous cholecystitis between the two groups but suggest that a larger study is warranted to study a causal relationship.

Spiritual needs, spiritual well-being, and Buddhist practices of patients with terminal illness, Thailand

OBJECTIVES

The purposes of this study were to describe and compare the spiritual needs and spiritual well-being among terminally ill patients receiving care in different palliative care settings and to investigate the differences in spiritual well-being in relation to the level of Buddhist practices.

METHODS

A cross-sectional multicenter study was carried out that included community/home-based care (Home), a faith-based organization for patients with AIDS (FB_AIDS), a faith-based organization for patients with cancer (FB_CA), and a hospice ward (Hospice). Descriptive statistics were used to analyze the participants' demographics, Buddhist practices, spiritual needs, and spiritual well-being. The analysis was performed using analysis of variance and Kruskal-Wallis tests to compare the spiritual needs and the spiritual well-being in the different settings. The Kruskal-Wallis test was used to investigate the differences in spiritual well-being in relation to the level of Buddhist practices.

RESULTS

A total of 170 patients with a terminal illness (30 Home, 33 FB_AIDS, 64 FB_CA, and 43 Hospice) participated. Patients with a terminal illness receiving care at the FB_CA and Home had significantly higher mean scores for spiritual needs than those in the other settings. Patients with a terminal illness receiving care at the FB_CA had a significantly higher mean score for spiritual well-being than those receiving care in the other settings. Participants having a higher frequency of Buddhist practice had significantly higher mean scores for spiritual well-being.

SIGNIFICANCE OF RESULTS

Spiritual needs and spiritual well-being differed significantly among participants in different palliative care settings. The more the patients engaged in Buddhist practices, the higher their scores were for spiritual well-being. Thus, religious-based strategies should be integrated into palliative care and should be more emphasized.

Clinician's perspectives on gene therapy for Alzheimer's disease: A qualitative study

INTRODUCTION

We aimed to understand clinician views regarding gene therapy as a future treatment for Alzheimer's disease (AD) and potential barriers and facilitators to its use.

METHODS

We interviewed ten clinicians who treat patients with AD. Clinicians helped design a semi-structured interview including the following domains: establishing understanding, cost/access, quality of life, and religion/spirituality. Transcripts were analyzed by a coding team using descriptive content analysis with inductive approach.

RESULTS

Clinicians identified three main areas of concern: 1) potential clinician and patient understanding of gene therapy and Alzheimer's disease 2) consideration of inequity (i.e., care access, disease awareness along with education level, family support, trust in care systems); and 3) considerations in decision-making (i.e., religious/spiritual beliefs and method of treatment delivery as a decision-making tools).

DISCUSSION AND CONCLUSION

Findings highlight areas for knowledge-building for patients and clinicians alike. Clinicians must be aware of patient/family educational needs and gaps in their own clinical knowledge before engaging patients/families with new technology. Allowing time for questions is crucial to building rapport and trust.

A Comparative Analysis of Spiritual Care Needs Among Cancer Patients Receiving Home Care and Their Caregivers in Turkey

This study was conducted to determine and compare the spiritual care needs of cancer patients and their caregivers. A comparative descriptive, cross-sectional design was employed in this study. The study comprised 102 patients who were registered in the hospital's home care unit, as well as their caregivers (total number = 204). The data were collected using a personal information form and the Spiritual Care Needs Inventory. The cancer patients had a mean age of 69.5 years, while their caregivers' mean age was 53.1 years. According to the results, the cancer patients needed more spiritual care than their caregivers (p < 0.01). Patients' spiritual care needs differed significantly by employment status (p  < 0.05). However, gender, educational level, and marital status did not have a significant difference in the spiritual care needs of the patients and their caregivers (p > 0.05). Moderately positive and significant (p < 0.05) correlations between patients and their caregivers were found for the total Spiritual Care Needs Inventory scores (r = 0.449), the meaning and hope subscale (r = 0.378), and the caring and respect subscale (r = 0.546). It is important to evaluate the spiritual needs of patients with cancer and their caregivers. In this evaluation, it is essential to elicit the perspectives of cancer patients and their caregivers concerning spiritual needs and religion. Effective spiritual care for patients and their caregivers can only be provided if their beliefs and priorities are taken into consideration.

Exploring the spiritual needs of patients with advanced cancer in China: a qualitative study

This qualitative study aimed to gain a deep understanding of the spiritual needs of patients with advanced cancer. A qualitative study using semi-structured interviews was conducted. The interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Two researchers coded the interviews independently in NVivo 12 plus and developed major themes and subthemes by inductive and constant comparison. This study was conducted in the inpatient ward of a tertiary cancer hospital in Hunan Province, Chinese Mainland. Eligible participants with advanced cancer were recruited using the purposive sampling method. The sample size was determined by data saturation. All interviews were conducted face-to-face individually from May 2021 to July 2021. A total of 13 patients with advanced cancer patients were interviewed. Six themes were identified, namely being treated as normal and independent individuals, receiving and giving love, seeking inner peace, connecting with spiritual sources, finding meaning and purpose, and preparing for death. Different categories of spiritual needs of patients with advanced cancer were identified in this study. Healthcare professionals need to develop interventions that aim to meet patients' spiritual needs.

Australian Patient Preferences for Discussing Spiritual Issues in the Hospital Setting: An Exploratory Mixed Methods Study

While there is high patient acceptance for clinical staff discussing issues regarding spirituality with hospital inpatients, it is not clear which staff member patients prefer for these discussions. This unique exploratory study investigated inpatient preferences regarding which staff member should raise the topic of spirituality. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). Pastoral care staff (32.9%) were the preferred staff members with whom to discuss spiritual issues, followed by doctors (22.4%). Qualitative findings indicated that individual characteristics of the staff member are more important than their role.

No effects were found in favor of Hatha or Iyengar yoga exercises for improving cancer-related fatigue, depression symptoms, or quality of life: a systematic review with meta-analysis and metaregression

OBJECTIVE

To summarize the evidence on the effectiveness of Hatha or Iyengar yoga exercises on cancer-related fatigue, depression symptoms, and the overall quality of life in adults with cancer.

METHODS

A systematic review with meta-analysis was conducted. The CINAHL (via EBSCOhost), Embase, PubMed, and SPORTDiscus (via EBSCOhost) databases were searched from inception to 7th November 2022. Clinical trials evaluating cancer-related fatigue, depression symptoms, and the overall quality of life were included. The risk of bias was assessed using the Cochrane Risk of Bias tool 2. The Template for Intervention Description and Replication (TIDieR) checklist was used to check if the interventions reviewed were described in detail to be implemented in the clinical setting. The Grading of Recommendations, Assessment, Development, and Evaluations approach was used to rate the certainty of evidence. Meta-regressions, sensitivity analyses, and subgroup meta-analyses were conducted to explore sources of heterogeneity.

RESULTS

Eleven studies were included (N = 777 participants). Overall, Hatha, Iyengar, and the combination of both yoga styles did not improve any of the outcomes of interest. In addition, five studies had a high risk of bias, and six studies had some concerns about biases. Weaknesses in reporting modifications during the development of the study were observed (TIDieR item 10). The certainty of evidence ranged from low to very low across the outcomes.

CONCLUSIONS

We could not make sound clinical recommendations with the current quality of the findings.

Spiritual Well-Being and Psychological Well-Being Among Hemodialysis Patients in Turkey: A Descriptive and Correlational Study

This study aimed to determine the psychological and spiritual well-being of hemodialysis patients in Turkey. This descriptive and correlational study included 86 hemodialysis patients. Data were collected using the Spiritual Well-Being Scale and Psychological Well-Being Scale. There was a positive correlation between spiritual and psychological well-being (r = 0.315, p = 0.003). Psychological well-being and age explained 39% of total variance (F = 7.593, p = 0.001). In conclusion, there should be provided individualized spiritual care and counseling to improve the psychological well-being of hemodialysis patients.

Spirituality in Australian Health Professional Practice: A Scoping Review and Qualitative Synthesis of Findings

This study explores how spirituality is integrated into practice across the different Australian health professions. Utilising the Joanna Briggs Institute's (JBI) protocol, six databases were searched, and sixty-seven articles were finally included. To present the findings, a qualitative synthesis was used. 'Meaning' and 'purpose in life' were found to be key to many spirituality definitions. The most frequently reported approach for Australian health professionals (HPs) in asking about client spirituality was using one or two questions within a comprehensive assessment. Major facilitators included a holistic care approach and prior training, whereas a key barrier was a lack of time.

A Hermeneutic Phenomenological Study of Aesthetics in Nursing Practice Among Hospitalized Cancer Patients in Nepal

Background: Aesthetics is the art of nursing that is expressive, subjective, and visible in the act of caring in nursing practice. Aesthetics in nursing practice satisfies holistic needs and achieves the quality of whole-person care. Purpose: The aim of this study is to describe the meanings of the lived experiences of cancer patients in terms of receiving care from the perspective of aesthetics in nursing practice. Methods: The hermeneutic phenomenological approach grounded on Gadamerian philosophy guided this study. Eleven Nepalese cancer patients who met the inclusion criteria shared their experiences through graphic illustrations (drawings) and interviews. Data were analyzed and interpreted following van Manen's phenomenological approach reflective of the four life worlds. The trustworthiness of findings was established following the criteria by Lincoln and Guba. Results: Thematic categories of the lived experience of cancer patients were revealed, reflecting the four life worlds: lived relation expressed as being nurtured as a family; lived space as appreciating the healing space; lived time as being hopeful; and lived body as receiving a new life. This experience was described as experiencing self and other while appreciating the healing space, being hopeful and nurtured as family and having a new life Implications for Practice: Aesthetics in nursing practice values on politely nurturing cancer patients as nurses' family members in a pleasant healing environment. Further, cancer patients experience having a new life.

Assessment of spiritual needs in cancer patients: A cross-sectional study

Introduction

Addressing the spiritual needs of patients is an essential component of holistic care in nursing. Acknowledging the spiritual needs of cancer patients enhances the performance of clinical caregivers in providing quality services to such patients. Therefore, caregivers successfully fulfill or decrease the patients' needs and thus increase their adaptation to crises.

Methods

The present cross-sectional study was conducted to determine the spiritual needs of cancer patients. In this study, 96 cancer patients were selected from Ayatollah Khansari Hospital in Arak, Iran. The required data were collected through a demographic information form and the Persian version of the Spiritual Needs Questionnaire.

Ethical Considerations

Participants' verbal consent to participate in the study was obtained, and they were assured of anonymity and confidentiality.

Results

In the present study, the mean age of the participants was 47.82 ± 14.34 years. The frequency distribution of respondents by gender was 36 males (37.5%) and 60 females (62.5%). The mean scores of spiritual needs in the domains of religious needs, need for inner peace, existential needs, and need for giving/generativity were 12.03 ± 3.18, 7.26 ± 3.26, 4.61 ± 2.96, and 4.06 ± 2.32, respectively. The highest and lowest mean values were associated with religious needs and need for giving/generativity, respectively. Religious needs showed a significantly positive relationship with gender, occupation, and the type of treatment (P < 0.05). Moreover, a significant relationship was observed between the need for peace and level of education (P < 0.05).

Conclusion

The recognition of the spiritual needs of cancer patients is the first step in prioritizing and planning to provide spiritual care to these patients and supporting them in adapting to and coping with the disease. Therefore, nurses need to acquire the fundamental knowledge and skills required to identify these needs.

Meaning and purpose in life, happiness, and life satisfaction in cancer: Systematic review with meta-analysis

OBJECTIVE

To summarize current evidence on the potential cross-sectional and longitudinal association between meaning or purpose in life and subjective happiness or life satisfaction among cancer patients.

METHODS

A systematic review with meta-analysis and meta-regression was conducted. CINAHL (via EBSCOhost), Embase, PubMed, and PsycINFO (via ProQuest) were searched from inception to 31 December 2022. In addition, manual searches were performed. The risk of bias in cross-sectional and longitudinal studies was assessed using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and the Quality in Prognosis Studies tool, respectively. Certainty in the evidence was judged using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Meta-regressions and sensitivity analyses were performed to explore potential sources of heterogeneity.

RESULTS

We included 13 cross-sectional studies, comprising 12 different samples, and a longitudinal study. A total of 4968 individuals with cancer were interviewed across included studies. Certainty in the evidence was judged as very low for all outcomes, which was associated to serious concerns on risk of bias and imprecision of the results, and very serious concerns on indirectness of evidence. The assessed studies showed a marked heterogeneity in terms of participants' clinical (i.e., disease stage) and sociodemographic factors. A lack of reporting of these clinical and sociodemographic aspects were also evident among included studies.

CONCLUSIONS

The wide number of methodological flaws detected in this systematic review preclude to make any clinical recommendation. More rigorous high-quality observational studies should guide future research on this topic.

Enhancing the integration of chaplains within the healthcare team A qualitative analysis of a survey study among healthcare chaplains

Background

Spiritual well-being is considered an important component of health and is increasingly integrated at all levels of healthcare. Delivering good integrated spiritual care requires coordination between different colleagues in which interprofessional collaboration is crucial. However, this interprofessional collaboration is not always self-evident. What spiritual care entails, is often poorly understood by their healthcare colleagues. Developing a shared professional identity is a crucial component of the shift towards professionalisation in chaplaincy.

Objectives

We aim to answer the following research question: how do healthcare chaplains in the Netherlands describe their work and their professional identity in relation to other healthcare professionals?

Design and subjects

Analysis of open-ended questions of a survey among healthcare chaplains regarding professional self-understanding in the Netherlands.

Results

107 Dutch chaplains working in a healthcare setting completed the five open-ended questions in the survey. The field of healthcare chaplaincy is changing from an exclusive focus at patients, towards more activities at staff and organisational level such as educating other healthcare professionals and, being involved in ethics and policy making.

Conclusions

Our research shows that the professional self-understanding of chaplains entails many leads to foster interprofessional collaboration. At the same time, there are concerns about the professional identity of the chaplain which is not always clear to every healthcare professional. Healthcare teams can benefit from an extensive integration of chaplains in the healthcare team, by including the non-patient-related activities of chaplains, such as staff training, moral deliberation and policy advice.

Cost-Utility of the eHealth Application ‘Oncokompas’, Supporting Incurably Ill Cancer Patients to Self-Manage Their Cancer-Related Symptoms: Results of a Randomized Controlled Trial

Evidence on the cost-effectiveness of eHealth in palliative care is scarce. Oncokompas, a fully automated behavioral intervention technology, aims to support self-management in cancer patients. This study aimed to assess the cost-utility of the eHealth application Oncokompas among incurably ill cancer patients, compared to care as usual. In this randomized controlled trial, patients were randomized into the intervention group (access to Oncokompas) or the waiting-list control group (access after three months). Healthcare costs, productivity losses, and health status were measured at baseline and three months. Intervention costs were also taken into account. Non-parametric bootstrapping with 5000 replications was used to obtain 95% confidence intervals around the incremental costs and quality-adjusted life years (QALYs). A probabilistic approach was used because of the skewness of cost data. Altogether, 138 patients completed the baseline questionnaire and were randomly assigned to the intervention group (69) or the control group (69). In the base case analysis, mean total costs and mean total effects were non-significantly lower in the intervention group (−€806 and −0.01 QALYs). The probability that the intervention was more effective and less costly was 4%, whereas the probability of being less effective and less costly was 74%. Among patients with incurable cancer, Oncokompas does not impact incremental costs and seems slightly less effective in terms of QALYs, compared to care as usual. Future research on the costs of eHealth in palliative cancer care is warranted to assess the generalizability of the findings of this study.

Spiritual Care Needs of Patients in Oncology Units and Nursing Practices in Turkey: A Qualitative Study

This descriptive qualitative study was planned to determine the spiritual care needs of patients hospitalized in the oncology department and nursing care practices. Twenty-five patients and 15 nurses were interviewed. Concerning the spiritual care practices expected from nurses, the following themes were determined: Interest-Compassion, Smiling Face, Confidence, Being Informative, Morale, and Understanding. The themes for spiritual nursing practices were Chatting-Suggesting, Smiling Face, Giving Opportunities for Religious Practice, Love and Belonging, Giving Hope-Precedent Examples, and Giving Information. Patients expected nurses to ask about their spiritual needs. However, nurses did not ask about spiritual issues because they were afraid of affecting patients adversely.

Spiritual Needs of Lung Cancer Patients and Their Relation to Psychological Distress and Quality of Life

Background

This study aimed to investigate the spiritual needs of patients suffering from lung cancer in relation to their mental health and quality of life.

Methodology

A cross-sectional quantitative study design was employed to investigate 110 lung cancer patients receiving chemotherapy. A four-part self-assessment instrument was used to gather the data comprising a sheet containing demographic and clinical information, Spiritual Needs Questionnaire, The Depression, Anxiety, and Stress Scale-21 Items, and the 12-item Health Survey. Descriptive inferential statistics were applied.

Results

Of the 110 patients, 71.8% were men, the mean age was 64.25 (±9.3) years, and 71.8% were married. In total, 40.9% of the patients were retired, and 92.7% had a public insurance company. Regarding education, 30% were primary school graduates and 31.8% were high school graduates. Regarding the clinical features of the sample, 23.6% of the patients had small-cell carcinoma, 71.9% had non-small-cell carcinoma, and 4.5% had large-cell carcinoma. Spiritual needs have a negative effect on the mental health component of quality of life (p < 0.001) and can increase psychological distress in lung cancer patients.

Conclusions

In contrast to the findings of other international studies, spiritual needs appeared to be lower; however, similar to other studies, spiritual needs increased in those suffering from depression and anxiety. Moreover, the subtype of lung cancer also appeared to play a role.

Need for additional professional psychosocial and spiritual support in patients with advanced diseases in the course of specialist palliative care - a longitudinal observational study

BACKGROUND

We investigated the need for additional professional support and associated factors in patients (pts) at initiation and in the course of in- and outpatient specialist palliative care (I-SPC/O-SPC).

METHODS

Pts entering an urban SPC network consecutively completed questionnaires on psychosocial/spiritual problems and support needs within 72 h (T0) as well as within the first 6 weeks (T1) of SPC. Hierarchical linear regression analysis was used to investigate the impact of sociodemographic / disease-related variables, psychological / physical burden, social support, and SPC setting on the extent of support needs.

RESULTS

Four hundred twenty-five pts (70 years, 48% female, 91% cancer, 67% O-SPC) answered at T0, and 167 at T1. At T0, main problems related to transportation, usual activities, and dependency (83-89%). At T1, most prevalent problems also related to transportation and usual activities and additionally to light housework (82-86%). At T0, support needs were highest for transportation, light housework, and usual activities (35-41%). Cross-sectional comparisons of SPC settings revealed higher problem scores in O-SPC compared to I-SPC at T0 (p = .039), but not at T1. Support need scores were higher in O-SPC at T0 (p < .001), but lower at T1 (p = .039). Longitudinal analyses showed a decrease of support need scores over time, independent from the SPC setting. At T0, higher distress (p = .047), anxiety/depression (p < .001), physical symptom burden (p < .001) and I-SPC (p < .001) were associated with higher support need scores (at T1: only higher distress, p = .037).

CONCLUSION

Need for additional professional psychosocial/spiritual support was identified in up to 40% of pts. with higher need at the beginning of O-SPC than of I-SPC. During SPC, this need decreased in both settings, but got lower in O-SPC than in I-SPC over time. Support need scores were not only associated with psychological, but also physical burden.

Spiritual Care Assessment and Intervention (SCAI) for Adult Outpatients With Advanced Cancer and Caregivers: A Pilot Trial to Assess Feasibility, Acceptability, and Preliminary Effects

BACKGROUND

Although religion and spirituality are important to adults with cancer and their family caregivers, few studies have tested spiritual care interventions in the outpatient setting.

AIM

To determine the feasibility, acceptability, and preliminary effects of chaplain-delivered, semi-structured spiritual care to adult outpatients with advanced cancer and their caregivers.

DESIGN

In this pre/post pilot intervention study, board-certified chaplains utilized the Spiritual Care Assessment and Intervention (SCAI) framework during 4 individual sessions. Surveys at baseline and at 1, 6, and 12 weeks post-intervention assessed spiritual well-being, quality of life, depression, anxiety, and religious coping.

SETTING/PARTICIPANTS

We enrolled U.S. adult outpatients with or without an eligible family caregiver. Eligible patients were at least 18 years old and at least 2 weeks post-diagnosis of incurable and advanced-stage lung or gastrointestinal (GI) cancer.

RESULTS

Of 82 eligible patients, 24 enrolled (29.3%); of 22 eligible caregivers, 18 enrolled (81.8%). Four planned chaplain visits were completed by 87.5% of patients and 77.8% of caregivers. All enrolled participants completed baseline surveys, and more than 75% completed follow-up surveys at 2 of 3 time points. More than 80% of patients and caregivers reported they would recommend the sessions to a friend or family member. Patients' spiritual well-being improved significantly at all timepoints compared to baseline: 1-week post (p < .006), 6-weeks post (p < .001), and 12-weeks post (p < .004).

CONCLUSIONS

Spiritual care through SCAI is feasible, acceptable, and shows promise in improving spiritual well-being and other important outcomes in advanced-stage cancer patients and family caregivers. Further investigation is warranted.

Spiritual needs among Koreans and Americans with advanced chronic illnesses: A cultural comparison

AIMS AND OBJECTIVES

This study aimed to measure the frequency of spiritual needs, identify the factors associated with these needs among Korean and American persons living with an advance chronic illness and compare them from a cross-cultural perspective.

BACKGROUND

Persons with serious or life-limiting illnesses often have spiritual needs. Unmet spiritual needs are associated with poor well-being and threaten psychological health. Little is known about how specific spiritual needs vary across cultures.

DESIGN

A quantitative, cross-sectional, observational cross-cultural comparison was undertaken.

METHODS

The study has been prepared in accordance with the STROBE guidelines. Convenience sampling was used to recruit participants from outpatient clinics in South Korea and Southern California (N = 202). Spiritual needs were measured using the Spiritual Interests Related to Illness Tool (SpIRIT); demographic and illness-related variables were also assessed using paper-and-pencil questionnaires. Data were analysed using various parametric statistical tests, including multiple regression analysis.

RESULTS

The findings quantify the intensity and types of spiritual needs that persons living with an advanced chronic illness experience. Furthermore, they show how the spiritual needs of religiously diverse samples of South Koreans and Americans differ. The findings also indicate that self-reported spirituality and religiosity independently explain a substantial amount of the variance in spiritual needs.

CONCLUSIONS

In both the samples, spiritual needs were reported and associated with spirituality and religiosity. Although all the eight domains of spiritual needs assessed by the SpIRIT were pertinent to the Korean and American samples, they were prioritised differently.

RELEVANCE TO CLINICAL PRACTICE

Screening patients to ascertain how important spirituality or religiosity is to them may help clinicians focus their in-depth assessments on those who report high levels of spirituality or religiosity because these patients may experience the strongest spiritual needs. The SpIRIT shows promise as a measure of diverse spiritual needs.

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.

Toward a socio-spiritual approach? A mixed-methods systematic review on the social and spiritual needs of patients in the palliative phase of their illness

BACKGROUND

Patients express a variety of needs, some of which are labeled social and spiritual. Without an in-depth exploration of patients' expressions of these needs, it is difficult to differentiate between them and allocate appropriate healthcare interventions.

AIM

To gain insight into the social and spiritual needs of patients with a life-limiting illness and the distinction between these needs, as found in the research literature.

DESIGN

A mixed-methods systematic review and meta-aggregation were conducted following the Joanna Briggs Institute (JBI) approach to qualitative synthesis and the PALETTE framework and were reported according to the PRISMA statement. This review was registered in PROSPERO (CRD42019133571).

DATA SOURCES

The search was conducted in PubMed, EMBASE, CINAHL, Scopus, and PsycInfo. Eligible studies reported social and spiritual needs from the patients' perspective and were published between January 1st 2008 and October 2020. The quality of evidence was assessed using JBI Critical Appraisal Tools.

RESULTS

Thirty-four studies (19 qualitative, 1 mixed-methods, and 14 quantitative) were included. The five synthesized findings encompassing social and spiritual needs were: being autonomous, being connected, finding and having meaning, having a positive outlook, and dealing with dying and death.

CONCLUSION

What literature labels as social and spiritual needs shows great similarities and overlap. Instead of distinguishing social from spiritual needs based on patients' linguistic expressions, needs should always be explored in-depth. We propose a socio-spiritual approach that honors and preserves the multidimensionality of patients' needs and enables interdisciplinary teamwork to allocate patient-tailored care.

Quality of Life for Older Cancer Patients: Relation of Psychospiritual Distress to Meaning-Making During Dignity Therapy

BACKGROUND

Nearly 500,000 older Americans die a cancer-related death annually. Best practices for seriously ill patients include palliative care that aids in promoting personal dignity. Dignity Therapy is an internationally recognized therapeutic intervention designed to enhance dignity for the seriously ill. Theoretically, Dignity Therapy provides opportunity for patients to make meaning by contextualizing their illness within their larger life story. The extent to which Dignity Therapy actually elicits meaning-making from patients, however, has not been tested.

AIM

The current study examines (i) extent of patient meaning-making during Dignity Therapy, and (ii) whether baseline psychospiritual distress relates to subsequent meaning-making during Dignity Therapy.

DESIGN

Participants completed baseline self-report measures of psychospiritual distress (i.e., dignity-related distress, spiritual distress, quality of life), before participating in Dignity Therapy. Narrative analysis identified the extent of meaning-making during Dignity Therapy sessions.

PARTICIPANTS

Twenty-five outpatients (M age = 63, SD = 5.72) with late-stage cancer and moderate cancer-related symptoms were recruited.

RESULTS

Narrative analysis revealed all patients made meaning during Dignity Therapy but there was wide variation (i.e., 1-12 occurrences). Patients who made greater meaning were those who, at baseline, reported significantly higher psychospiritual distress, including greater dignity-related distress (r = .46), greater spiritual distress (r = .44), and lower quality of life (r = -.56).

CONCLUSION

Meaning-making was found to be a central component of Dignity Therapy. Particularly, patients experiencing greater distress in facing their illness use the Dignity Therapy session to express how they have made meaning in their lives.

Cross-cultural Validation of the Spiritual Interests Related to Illness Tool-Korean Version

Living with a terminal illness, whether as a patient or as the family member of a patient, often involves spiritual challenges. The ability to ascertain and meet the spiritual needs of terminally ill patients and their loved ones is an essential part of providing compassionate and competent whole person care. This study aimed to adapt the original Spiritual Interests Related to Illness Tool (SpIRIT) for use in Korea (SpIRIT-K) and to assess its reliability and validity as a tool to determine the spiritual needs of terminally ill Korean patients and their caregivers. After translation-back-translation and content validity indexing, SpIRIT-K was administered to 106 terminally ill patients and 105 family caregivers in 20 sites across South Korea. SPSS and AMOS were used for evaluating validity and reliability. The 37-item SpIRIT-K consisted of 8 factors (subscales), with each subscale consisting of between 3 and 8 items. Evidence for structural and convergent validity was observed. Internal reliability of the overall scale was 0.95. The findings showed patients and family caregivers reported no significant difference in 7 of the 8 subscales, demonstrating known-groups validity. The rigorous process of establishing cross-cultural validity for this scale provided evidence supporting its validity and reliability. The findings suggest that SpIRIT-K is suitable for research and for clinical purposes in palliative care settings in South Korea. This development also allows for comparisons between Korean and North American cultures in terms of spiritual needs among terminally ill patients and their caregivers.

Spiritual Needs of Older Adults during Hospitalization: An Integrative Review

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

Spiritual care interventions in nursing: an integrative literature review

As an important part of the holistic care, spiritual care is considered an indicator of care quality. This study aims to identify and characterize nursing spiritual care interventions. In order to identify and select resources, an integrative review was done. The search was conducted in national and international databases such as Google Scholar, Scopus, INML, Iran Medex, Iran Doc, Web of Science, Wiley, SID, ProQuest, Ovid, Science Direct, PubMed, ebrary, Sage, CINAHL, and Magiran from 1994 to 2018. As a result, 1625 articles were detected, 59 of which were included in synthesis. Data extraction and analysis presented eight categories of spiritual care interventions in the field of nursing including (1) the exploration of spiritual perspective, (2) healing presence, (3) the therapeutic use of self, (4) intuitive sense, (5) patient-centeredness, (6) meaning-centered therapeutic interventions, (7) the creation of a spiritually nurturing environment, and (8) the documentation and evaluation of spiritual care.

The Relationship Between Spiritual Health and Quality of Life of Heart Transplant Candidates

The heart transplantation is a stressful event, and its waiting time is often associated with worsening of clinical conditions and deterioration of the patient's quality of life. Spirituality plays an important role in mental health, so the present study was conducted to investigate the relationship between spiritual health and quality of life of patients undergoing cardiac transplantation. The present descriptive study was performed on 48 patients undergoing cardiac transplantation at the Shahid Rajaee Cardiovascular Center in Tehran during the first half of 2016. The data were collected by Ellisan-Palutzian Spiritual Well-Being Scale, Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Iranian Heart Failure Quality of Life Questionnaire (IHF-QOL). We used the SPSS v.20 software to analyze the data via descriptive statistics, parametric and non-parametric correlation and regression tests. The majority of patients (60.4%) had high spiritual health with a median score of 105, and its religious dimension was reported better (P < 0.001 and r = 0.591). With a mean of 63.23 ± 23.25, the quality of life of the majority of patients (75%) was at a poor level based on the Minnesota questionnaire. According to the IHF-QOL, the median total score was 39.50. There was a significant relationship between spiritual health score and quality of life in both questionnaires (MLHFQ: P = 0.006 and r = - 394; IHF-QOL: P = 0.022 and r = 0.329). Considering the positive relationship between spiritual health and quality of life of patients in this study, it is recommended to implement spiritual care and provide fulfillment for various needs of patients along with other medical care services.

Identifying End-of-Life Preferences Among Chinese Patients With Cancer Using the Heart to Heart Card Game

Background:

Understanding the preferences for end-of-life (EOL) care is imperative in providing quality care to patients with life-threatening illness. However, it is difficult for patients, families, and health-care providers to initiate EOL conversations in China. An easy-to-use tool that could help health-care providers initiate EOL discussions is the Heart to Heart Card Game (HHCG), originally designed for Chinese Americans.

Objective:

To evaluate the EOL preferences among Chinese patients with cancer using the HHCG.

Methods:

We conducted a descriptive study to assess EOL preferences using HHCG among patients at the oncology chemoradiotherapy department of a Chinese tertiary hospital.

Results:

We recruited 58 patients in total of which 40 (69%) patients completed HHCG. The most frequently selected card was “I want my family to get along,” followed by “I don’t want to be a burden to my family,” and “I want to maintain my dignity.” Among the 3 cards selected, social needs were rated as the most important (36.7%), followed by spiritual needs (35.8%), physical needs (20.0%), and financial needs (7.5%). The evaluation of the HHCG revealed that more than 70% of the participants highly valued HHCG.

Conclusion:

The HHCG can be used as a communication tool to encourage EOL discussions between cancer patients and health-care providers in China. Moreover, Chinese patients with cancer attach significant importance to their family and maintaining dignity at the EOL.

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.

Spiritual care by nurses in curative oncology: a mixed-method study on patients' perspectives and experiences

AIMS

Spirituality can be important in adjusting to the experience of cancer and its medical treatment. Since nurses have frequent contact with patients, they seem to have a unique role in providing spiritual care. Nurses consider spiritual care important; however, little is known about how patients in a curative setting experience and value spiritual care. Therefore, this study aimed to give insight into patients' experiences with and opinions about spiritual care as provided by nurses in curative cancer care.

METHODS

This is a national, multicentre mixed-methods study, combining a quantitative approach using questionnaires (n = 62) and a qualitative analysis of semi-structured interviews (n = 61). Nonparametric tests were used for quantitative data, and qualitative data were analysed inductively.

FINDINGS

Most patients rarely received spiritual care by nurses. If spiritual care was provided, it mainly consisted of noticing problems and referring to other professionals. This appeared to be dependent on certain 'triggers', such as age. Structural discussions on spirituality with a nurse were experienced rarely. This was explained by, among other factors, the hospital setting. Yet, the majority (79%) of patients found the attention to spirituality sufficient or very good. Furthermore, a majority (58%) viewed spiritual care as a nursing task: nurses should notice spiritual problems and refer to other professionals, though extensively discussing patients' spirituality was neither considered nurses' task nor capability.

CONCLUSIONS

Attention to spiritual care in a curative setting, though not so much desired by most patients, should be pursued, because of its importance in performing person-centred nursing care and its positive impact on patients' health. By training nurses in offering spiritual care in proactive and 'nonactive' (accepting) ways, spiritual care could be structurally offered in clinical practice in personalised forms. Since younger and less spiritual patients are not much satisfied with spiritual care by nurses, they need special attention.

Spiritual care at the end of life in the primary care setting: experiences from spiritual caregivers - a mixed methods study

Background

Spiritual care is an important aspect of palliative care. In the Netherlands, general practitioners and district nurses play a leading role in palliative care in the primary care setting. When they are unable to provide adequate spiritual care to their patient, they can refer to spiritual caregivers. This study aimed to provide an overview of the practice of spiritual caregivers in the primary care setting, and to investigate, from their own perspective, the reasons why spiritual caregivers are infrequently involved in palliative care and what is needed to improve this.

Method

Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 31 spiritual caregivers, followed by an online focus group with 9 spiritual caregivers, analysed through open coding.

Results

Spiritual caregivers provide care for existential, relational and religious issues, and the emotions related to these issues. Aspects of spiritual care in practice include helping patients find meaning, acceptance or reconciliation, paying attention to the spiritual issues of relatives of the patient, and helping them all to say farewell. Besides spiritual issues, spiritual caregivers also discuss topics related to medical care with patients and relatives, such as treatment wishes and options. Spiritual caregivers also mentioned barriers and facilitators for the provision of spiritual care, such as communication with other healthcare providers, having a relationship of trust and structural funding.. In the online focus group, local multidisciplinary meetings were suggested as ideal opportunities to familiarize other healthcare providers with spirituality and promote spiritual caregivers’ services. Also, structural funding for spiritual caregivers in the primary care setting should be organized.

Conclusion

Spiritual caregivers provide broad spiritual care at the end of life, and discuss many different topics beside spiritual issues with patients in the palliative phase, supporting them when making medical end-of-life decisions. Spiritual care in the primary care setting may be improved by better cooperation between spiritual caregiver and other healthcare providers, through improved education in spiritual care and better promotion of spiritual caregivers’ services.

Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

Distress is defined in the NCCN Guidelines for Distress Management as a multifactorial, unpleasant experience of a psychologic (ie, cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. Early evaluation and screening for distress leads to early and timely management of psychologic distress, which in turn improves medical management. The panel for the Distress Management Guidelines recently added a new principles section including guidance on implementation of standards of psychosocial care for patients with cancer.

Pain and Suffering

OBJECTIVE

To review literature on the relationship of pain, spirituality, and suffering as it relates to the patient with cancer who is experiencing pain.

DATA SOURCES

Peer-reviewed articles, textbooks, internet.

CONCLUSION

Pain and suffering are distinct and yet closely related in patients with cancer. Oncology nurses are important in assessing a patient's pain, including dimensions of spirituality and suffering.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses are the front line of pain management for patients. This includes recognizing existential distress and suffering and responding to suffering.

Thai medical students' attitudes regarding what constitutes a "good death": a multi-center study

BACKGROUND

Few studies exist regarding the perception of medical students toward older adults' wishes during their end-of-life period. Better understanding of students' perceptions regarding this topic could help improve palliative education. The purposes of this study were to examine the perceptions of medical students regarding what constitutes a "good death" and to demonstrate the factors associated with the necessary care decisions in older patients.

METHODS

This is a cross-sectional study. A questionnaire was developed and given to all of the medical students at two medical schools in Thailand (Siriraj and Srinagarind Hospital) from September 2017 to February 2018. They were asked to response to the questions by imagining how older people would think, and their preferences regarding care at the end-of-life period. The anonymous questionnaires were collected and analyzed.

RESULTS

A total of 1029 out of 2990 surveys were returned (34.4%). A minority of the sixth-year medical students rated themselves as being knowledgeable about palliative care (11.3%). According to the survey, desire to have spiritual needs met and have their loved ones present were the most important conditions that contributed to a "good death". Factors associated with reluctance to receive prolonged treatment were female sex (adjusted odds ratio (AOR 1.39), being in the clinical years of training (AOR 1.92), self-rated good health (AOR 1.45), and prior experience of watching someone dying (AOR 1.61). Enrollment in Srinagarind medical school (AOR 2.05), being a clinical student (AOR1.91), and being dissatisfied with life (AOR 1.78) were independent factors related to preference for home death.

CONCLUSIONS

Most medical students signified understanding of concepts of geriatric palliative care but felt that they had insufficient knowledge in this area. Multiple factors related to decision regarding the care that was required were identified. Medical schools should consider this information to improve geriatric palliative medical education in undergraduate training.

Spiritual Experiences of Adults With Advanced Cancer in Outpatient Clinical Settings

CONTEXT

Adults who have advanced cancer experience distress, and many use religion and spirituality to cope. Research on the spiritual experiences of patients with advanced cancer will help guide the provision of high-quality spiritual care.

OBJECTIVES

To qualitatively describe advanced cancer patients' spiritual experiences of illness.

METHODS

We conducted semistructured qualitative interviews at a single cancer center with 21 patients with stage IV solid malignancies who had a prognosis of less than 12 months, as estimated by each patient's medical oncologist. Five investigators conducted a thematic analysis of the transcribed interviews.

RESULTS

We found 31 patients who were eligible for enrollment, and 21 (67.7%) participated in interviews to thematic saturation. Using a thematic-analysis approach, five major themes emerged. Relationships with family and friends was the most important theme among all 21 patients irrespective of their religious or spiritual identity. Relationship with God and faith community was frequently identified by those who considered themselves spiritually religious. Cancer often led to reflection about the meaning of life and the nature of existential suffering. Patients addressed the extent to which identity was changed or maintained through the cancer experience, and some expressed acceptance as a way of coping with illness.

CONCLUSIONS

Spiritual care for dying cancer patients should always include the exploration of relationships with family and friends, as well as God and faith community for some patients. Relationships with family, friends, and God can be a source of strength for many. Making meaning, addressing identity concerns, supporting acceptance as a resource for coping with illness, and acknowledging existential suffering will often arise for these patients.

Relationship Between Coping Strategies, Religious Attitude, and Optimism of Mothers of Children With Cancer

INTRODUCTION

The purpose of this study was to examine the relationship between coping strategies, religious attitude, and optimism of mothers of children with cancer.

METHOD

The sample was 97 mothers of children with cancer. To collect data, the Coping Strategy Questionnaire, Religious Attitude Scale, and Life Orientation were used.

RESULTS

There were positive correlations between the total score of Coping Strategy Questionnaire and emotional scores of Religious Attitude Scale ( r = 0.170, p = .04). The correlation relationship between mothers' coping, religious tendencies, and optimism tendencies was not significant ( p > .05). There were also positive correlations between Coping Strategy Questionnaire Social Support Seeking subscale and the total scores of Religious Attitude Scale ( r = 0.189, p = .03) and Life Orientation Test ( r = 0.183, p = .03).

DISCUSSION

Mothers with a higher religious attitude had bettter social support and were more optimistic. These results will contribute to understanding the influence of religion in different cultures.