Depression and Spiritual Distress in Adult Palliative Patients: A Cross-Sectional Study

Spiritual Distress, Hopelessness, and Depression in Palliative Care: Simultaneous Concept Analysis

Spiritual distress, hopelessness, and depression are concepts that are often used in palliative care. A simultaneous concept analysis (SCA) of these concepts is needed to clarify the terminology used in palliative care. Therefore, the aim of this study is to conduct a SCA of spiritual distress, hopelessness, and depression in palliative care. A SCA was performed using the methodology of Haase's model. A literature search was conducted in March 2020 and updated in April 2022 and April 2024. The search was performed on the following online databases: CINAHL with Full-Text, MEDLINE with Full-Text, MedicLatina, LILACS, SciELO, and PubMed. The search was achieved without restrictions on the date of publication. A total of 84 articles were included in this study. The results highlight that the three concepts are different but also share some overlapping points. Spiritual distress is embedded in the rupture of their spiritual/religious belief systems, a lack of meaning in life, and existential issues. Hopelessness is a sense of giving up and an inability to control and fix the patient's situation. Finally, depression is a state of sadness with a multi-impaired situation. In conclusion, refining the three concepts in palliative care is essential since it promotes clarification and enhances knowledge development towards intervention.

Nursing students' perceptions of spiritual needs at the end of life. A qualitative study

Spirituality is defined as the meaning of life, being the very essence of life made up of all of the aspects inherent to it. During end-of-life processes, this need is shown to be particularly altered in patients and yet it is an aspect that the health professionals accompanying patients in this situation report being least equipped to address, alongside therapies that could help to meet these needs, such as art therapy. An exploratory qualitative study was conducted, adheres to the guidelines of COREQ (41). The study population were final year students undertaking a nursing degree at the University of Huelva, Spain. The sample was selected via intentional sampling using snowball recruitment from the study population. Stratification according to gender was performed due to the feminised nature of the population. Sample size was determined progressively during the research, with recruitment ceasing at 13 informants once information saturation was achieved. Inclusion criteria required that participants were to be final year students enrolled on a nursing degree who had provided consent to participate voluntarily in the research. The analysis Realized was interpretive phenomenological (IPA) as described by Smith (43-45). The present study revealed that students perceive their training on spiritual care to be deficient. Despite them reporting that they possess the skills and tools to provide end-of-life care, this is not enough to provide effective accompaniment, given that this moment brings them into touch with their own insecurities. Students verbalized the need to learn strategies to address this shortcoming regarding final accompaniment, for instance, through art, with creativity being one of the skills with the potential to uncover the meaning of life.

Pain and Spiritual Distress at End of Life: A Correlational Study

Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ² (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ² (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ² (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ² (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.

Preferences for healthcare chaplaincy services among U.S. adults: differences by inpatient and outpatient settings

We examined preferences around spiritual support services delivered by chaplains among U.S. adults in outpatient and inpatient healthcare settings using a cross-sectional national survey of U.S. adults (n = 1,020). For outpatient settings, 5% reported interest in chaplain services, whereas 16% reported interest in inpatient settings. In both settings, a higher perceived value of chaplain services (p < 01) and previous experience with a chaplain (p < .01) were associated with a greater interest in a chaplain consult when adjusting for demographic factors. In both settings, the most desired services were to explore what was most important in the event of a serious illness or injury (46-47%), values related to treatment decisions (43-46%), and connecting to resources for personal strength and resilience (36-39%), whereas exploring more religious concerns was less desirable. There is a need to identify the role of chaplains within the context of healthcare to meet patients' desire for specific services.

Validation of the Nurse Spiritual Care Therapeutics Scale in Portuguese palliative care settings: a methodological study

BACKGROUND

Spirituality is a critical dimension in palliative care, but difficulties have been described in literature concerning the effective implementation and measuring of spiritual care.

AIM

To translate, adapt and validate the Nurse Spiritual Care Therapeutics Scale (NSCTS) in Portuguese palliative care settings.

METHODS

A methodological study was conducted. A final version of the questionnaire included the scale and was submitted to full psychometric testing using nurses working in Portuguese palliative care settings.

FINDINGS

A total of 88 nurses participated. The average age of the sample was 36.1 ± 8.93 years (range 23-60 years), and 92.0% were women. A Cronbach alpha value of 0.88; Kaiser-Meyer-Olkin measure of sampling adequacy 0.80; and Bartlett's Test of Sphericity were adequate. An exploratory factor analysis was conducted using principal axis factoring with an oblimin rotation that resulted in a three-factors solution.

CONCLUSION

The European Portuguese NSCTS questionnaire is a valid and reliable tool to assess the frequency of nurses' activities concerning spirituality in palliative care.

Spirituality in Patients at the End of Life-Is It Necessary? A Qualitative Approach to the Protagonists

Spirituality is the most unknown aspect of palliative care despite being the need that is most altered in the last moments of life. Objective. To identify on the one hand the spiritual needs of patients who are at the end of life and on the other hand, the way in which nursing professionals can work to provide effective accompaniment in this process. Method. A qualitative study was conducted which applied different data collection techniques. This was done to describe the phenomenon from a holistic perspective in relation to experts’ perceptions of the competencies required by health professionals and palliative patients’ spiritual needs. Semi-structured interviews were conducted within both populations. In order to analyze the qualitative data collected through interviews, discourse was analyzed according to the Taylor–Bodgan model and processed using Atlas.ti software. Results. Three well-differentiated lines of argument are extracted from the discourse in each of the groups, on the one hand in the group of patients they define the concept of spirituality, system of values and beliefs, and the Factors that influence the spirituality of patients at the end of life (differentiating palliative care areas/other areas) and on the other, the professionals agree with the patients in the line of argument of concept of spirituality although they define more metaphysical categories and the other two lines of argument that result are the spiritual attention in this process and the need for formation in spirituality. Conclusions. The provision of spiritual care gives meaning to the actions of nursing professionals when it comes to providing end-of-life care, achieving holistic care, humanizing death, and promoting a dignified end.

Association Between Self-reported Importance of Religious or Spiritual Beliefs and End-of-Life Care Preferences Among People Receiving Dialysis

IMPORTANCE

Although people receiving maintenance dialysis have limited life expectancy and a high burden of comorbidity, relatively few studies have examined spirituality and religious beliefs among members of this population.

OBJECTIVE

To examine whether there is an association between the importance of religious or spiritual beliefs and care preferences and palliative care needs in people who receive dialysis.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional survey study was conducted among adults who were undergoing maintenance dialysis at 31 facilities in Seattle, Washington, and Nashville, Tennessee, between April 22, 2015, and October 2, 2018. The survey included a series of questions assessing patients' knowledge, preferences, values, and expectations related to end-of-life care. Data were analyzed from February 12, 2020, to April 21, 2021.

EXPOSURES

The importance of religious or spiritual beliefs was ascertained by asking participants to respond to this statement: "My religious or spiritual beliefs are what really lie behind my whole approach to life." Response options were definitely true, tends to be true, tends not to be true, or definitely not true.

MAIN OUTCOMES AND MEASUREMENTS

Outcome measures were based on self-reported engagement in advance care planning, resuscitation preferences, values regarding life prolongation, preferred place of death, decision-making preference, thoughts or discussion about hospice or stopping dialysis, prognostic expectations, and palliative care needs.

RESULTS

A total of 937 participants were included in the cohort, of whom the mean (SD) age was 62.8 (13.8) years and 524 (55.9%) were men. Overall, 435 (46.4%) participants rated the statement about religious or spiritual beliefs as definitely true, 230 (24.6%) rated it as tends to be true, 137 (14.6%) rated it as tends not to be true, and 135 (14.4%) rated it as definitely not true. Participants for whom these beliefs were more important were more likely to prefer cardiopulmonary resuscitation (estimated probability for definitely true: 69.8% [95% CI, 66.5%-73.2%]; tends to be true: 60.8% [95% CI, 53.4%-68.3%]; tends not to be true: 61.6% [95% CI, 53.6%-69.6%]; and definitely not true: 60.6% [95% CI, 52.5%-68.6%]; P for trend = .003) and mechanical ventilation (estimated probability for definitely true: 42.6% [95% CI, 38.1%-47.0%]; tends to be true: 33.5% [95% CI, 25.9%-41.2%]; tends not to be true: 35.1% [95% CI, 27.2%-42.9%]; and definitely not true: 27.9% [95% CI, 19.6%-36.1%]; P for trend = .002) and to prefer a shared role in decision-making (estimated probability for definitely true: 41.6% [95% CI, 37.7%-45.5%]; tends to be true: 35.4% [95% CI, 29.0%-41.8%]; tends not to be true: 36.0% [95% CI, 26.7%-45.2%]; and definitely not true: 23.8% [95% CI, 17.3%-30.3%]; P for trend = .001) and were less likely to have thought or spoken about stopping dialysis. These participants were no less likely to have engaged in advance care planning, to value relief of pain and discomfort, to prefer to die at home, to have ever thought or spoken about hospice, and to have unmet palliative care needs and had similar prognostic expectations.

CONCLUSIONS AND RELEVANCE

The finding that religious or spiritual beliefs were important to most study participants suggests the value of an integrative approach that addresses these beliefs in caring for people who receive dialysis.

Life's hard and then you die: the end-of-life priorities of people experiencing homelessness in the UK

BACKGROUND

People experiencing homelessness often die young and without adequate support. In the UK, they fail to access palliative care services and their end-of-life priorities remain poorly understood.

AIMS

To explore the end-of-life concerns, fears, preferences and priorities of a sample of people experiencing homelessness in the UK.

METHODS

This is an interpretive phenomenology. Data collected through semi-structured, audio-recorded, face-to-face interviews with 21 homeless participants in the UK were analysed iteratively using thematic analysis. Findings have been interpreted through the lens of Merleau-Ponty's philosophy.

RESULTS

Eight themes are reported: spiritual concerns; practical concerns; fear of needing care; fear of being forgotten; preference for dying suddenly; preference for being somewhere comfortable where people know me; prioritising autonomy and self-determination; and prioritising authenticity.

CONCLUSION

A strengths-based, trauma-informed, person-centred, collaborative 'compassionate community' approach to care is recommended for people experiencing homelessness at end of life.

A spiritual care intervention for chaplains in home-based palliative care: design of a mixed-methods study investigating effects on patients' spiritual wellbeing

Recently, the call for chaplains to become 'research literate' has been recognized by various scholars as well as by practitioners in the field. However, papers that present and discuss the study design and provide guidance on the methodology of chaplaincy research are scarce. The aim of this study is to present the design of a mixed-methods study that investigates the impact of a spiritual care intervention on patients' spiritual wellbeing in palliative, home-based care. It reports on the steps needed to conduct such a study in chaplaincy care, and describes and discusses the study's research design, intervention, participants, sampling strategy, patient and public involvement, procedure, ethical considerations, data collection, and analysis. Presenting and discussing such a design is not only useful for researchers before conducting their study, in order to create transparency, but also for chaplains to improve their knowledge on research methodology and research literacy.

Spirituality and Health in Pandemic Times: Lessons from the Ancient Wisdom

The goal of this paper is to analyze how the historical episode of the so-called Plague of Athens between the years 430 and 426 BC seems to have been the first phenomenon classified as an epidemic by Hippocrates, and the historian Thucydides described its cultural, social, political and religious consequences. However, such a crisis generated the need for a new culture, and consequently a new theological mentality, as a cultural driver that made it possible to transform the Asclepiad Sanctuary of Kos into the first hospital in the West to integrate spirituality and science as ways to promote the healing of culture in order to achieve the ideal of health. The adopted method was a semantic analysis of the classic texts that help contextualize the Hippocratic view of the epidemic, spirituality, and health, and how these questions were received by Christianity at the time. The reception of this experience by Christianity, despite suffering some tension, also expands this Greek ideal and constitutes a true heritage of ancient wisdom that can be revisited in the time of the new pandemic, COVID-19. The perspective assumed here is interdisciplinary, putting in dialogue Theology and Health Sciences.

Religious/spiritual coping and spiritual distress in people with cancer

ABSTRACT Objective: To investigate the relation between the presence of spiritual distress and use of RSC and sociodemographic, clinical and religious/spiritual variables in people with cancer. Method: Cross-sectional study conducted in an association for support to people with cancer. The data obtained with the tools were analyzed using the Spearman‘s correlation coefficient and the Mann-Whitney Test. Results: 129 volunteers participated in the study, of which 57% showed moderate spiritual distress, 96% used medium and high positive religious/spiritual coping. Spiritual distress showed positive correlation with negative religious/spiritual coping (P<0.001) and inverse correlation with age (p 0.002). The use of positive religious coping was statistically significant in people who have religious practices (p 0.001). Conclusão: Spiritual distress is a phenomenon that is present in the lives of people with cancer and has significant relation with the use, in a negative manner, of religion/spirituality as a way of coping with the disease.

Validation of the Spiritual Distress Scale in Portuguese Cancer Patients Undergoing Chemotherapy: A Methodological Study

Spiritual distress may ascend from unmet spiritual needs. The use of instruments to measure spiritual distress seems to facilitate the approach to spirituality, such as the Spiritual Distress Scale (SDS) that has been used worldwide. No instrument to assess spiritual distress in cancer patients is currently available in Portugal. This study aims to conduct the translation, adaptation and validation of the SDS in Portuguese cancer patients undergoing chemotherapy. Methodological study based on Sousa and Rojjanasrirat (2011), a seven-step approach, started with the linguistic translation to the psychometric tests. The main participants (55.4%) were older than 60 years; about 64.7% were females, married (68.0%), and 86.7% were Catholic. Moderate spiritual distress was experienced by 49.3% of the participants. Linguistic and conceptual equivalences were obtained. The SDS European Portuguese version has an overall Cronbach’s alpha of 0.91, and the subscales were as follows: “relationship with self” (0.92), “relationship with others” (0.63), “relationship with God” (0.64) and “facing death” (0.85). Four factors emerged after Varimax rotation. Overall, these results indicate that the SDS European Portuguese version has good psychometric characteristics and can used in assessing spiritual distress in cancer patients.