Abstract PA-15: Consensus Project and Pilot Demonstration Projects to Improve the Quality of Spiritual Care in Palliative Care

Palliative care has an interdisciplinary tradition and Canada is a leader in its research and practice. Yet even in Canada, a full interdisciplinary complement is often lacking, with psychosocial presence ranging from 0–67.4% depending on the discipline and region. We sought to examine the most notable gaps in care from the perspective of Canadian palliative professionals. Canadian directors of palliative care programs were surveyed with respect to interdisciplinary integration. Participants responded in writing or by phone interview. We operationalized reports of interdisciplinary professions as either “present” or “under/not-represented”. The Vaismoradi, Turunen, and Bondas’ procedure was used for content analysis. Our 14 participants consisted of physicians (85.7%), nurses (14.3%), and a social worker (7.1%) from Ontario (35.7%), British Columbia (14.3%), Alberta (14.3%), Quebec (14.3%), Nova Scotia (14.3%), and New Brunswick (7.1%). Psychology and social work were equally and most frequently reported as “under/not represented” (5/14, each). All participants reported the presence of medical professionals (physicians and nurses) and these groups were not reported as under/not represented. Spiritual care and others (e.g., rehabilitation and volunteers) were infrequently reported as “under/not represented”. Qualitative themes included Commonly Represented Disciplines, Quality of Multidisciplinary Collaboration, Commonly Under-Represented Disciplines, and Special Concern: Psychosocial Care. Similar to previous reports, we found that (1) psychology was under-represented yet highly valued and (2) despite social work’s relative high presence in care, our participants reported a higher need for more. These finding highlight those psychosocial gaps in care are most frequently noted by palliative care professionals, especially psychology and social work. We speculate on barriers and enablers to addressing this need.

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What information do patients need about their disease or treatments and what they want for end of life?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20656 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20656-e20656

Author(s):

Gaston Martin Reinas ◽

Ernesto Gil Deza ◽

Eduardo L. Morgenfeld ◽

Daniela Gercovich ◽

Flavio Tognelli ◽

...

Keyword(s):

High School ◽

Palliative Care ◽

End Of Life ◽

Spiritual Care ◽

Educational Level ◽

Clinical Investigation ◽

Psychological Support ◽

Chi Square ◽

Stage Of Disease

e20656 Background: As it is very important for Doctors, Patients (Pt) and Family to know everything related to end of life we thought it was unavoidable to develop a survey for that purpose. Methods: Between Oct 15th and Nov 15th, 2012, 1003 Pt out of 3795 Pt that were assisted at the IOHM were given the option to participate in an anonymous survey about diagnosis, prognosis, efficacy and toxicity of treatments, as well as interest in palliative care (PC), clinical investigation (CI), psychological support (PS), spiritual care (SC) for an eventual situation of coping with the end of life dilemma. Results: A total of 845 out of 1,003 (84%) Pt elected to participate. Population: Sex: fem: 332, male: 207, left blank (LB): 306. Mean age 58y (range 18 – 94). Married: 355, unmarried: 211, LB: 279. Children Yes 460 No/LB: 385. Highest educational level achieved: primary Studies:186, high School: 348, universitary:216. LB: 98. Employed:382, retired: 240, unemployed: 112, LB 111. Disclosed diagnostic and stage of disease: 470 (56%). The following results are expressed as a percentage of 845 pt: Are aware of the diagnostic (82%); Pt interested in knowing everythingabout their prognosis (85%) or their treatment’s efficacy (67%) or toxicity (52%). Pt interested in: PC (85%), CI (80%), PS (74%), SC (58%). If they were to choose a place for dying: 40% chose to die in the hospital, 30% at home, 29% did not answer and 1% was indifferent. It was possible to detect a marked increase in the amount of answers with regards to last wishes as the stage of the disease worsened (Chi square= 0.011). Pt were asked to rate the survey: 95% considered it good or very Good, 56% found it useful, 36% thought it necessary, while 23% would recommend it. Conclusions: 1) Most of the pt know their diagnosis, would like to know their prognosis and need to know everything about efficacy and toxicity of treatments. 2) 40% of the pt would prefer to die in the hospital, but analyzing this choice at earlier stages of disease may be inappropriate. 3) PC and CI are of interest to both sexes but women are more likely to request PS and SC. 4) Although the survey was considered good by 95% of pt and more than 50% found it useful, only 23% would recommend it, which speaks about the sensitive quality of these topics.

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Effect of a spiritual care training program on patient quality of life and spiritual well-being.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.235 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 235-235

Author(s):

Grace Meijuan Yang ◽

Yung Ying Tan ◽

Yin Bun Cheung ◽

Dennis Dignadice ◽

Amy Lim ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Training Program ◽

Spiritual Care ◽

Training Session ◽

Palliative Care Service ◽

Well Being ◽

Spiritual Assessment ◽

Spiritual Well Being

235 Background: Spiritual care (SC) is a vital part of palliative care (PC) but its provision is still not routine. We studied the effect of a SC training program for staff on patient quality of life (QOL) and spiritual wellbeing (SPS), as measured by the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being (FACIT-Sp). Methods: This study was conducted at two sites: a PC consultative service in an acute hospital and a home PC service. The program comprised a 30 min training session for nurses and doctors on using the FICA tool for spiritual assessment and subsequent referral to a medical social worker (MSW) if needed, and a 60min training session with the MSWs on how to manage spiritual problems. A prospective cluster-controlled trial was done across 7 clusters. FACIT-Sp comprises 27 items for QOL (FACT-G) in the 4 domains and 12 items for SPS. This was administered at T1: upon referral to the palliative care service and T2: after 3 clinical visits by the PC team (doctor, nurse or MSW visits). Results: QOL data from 142 participants (69 intervention and 73 control) were analyzed. There appeared to be some benefit of the program on all domains of QOL as well as SPS, although only the FACT-G score achieved statistical significance. After further statistical adjustment for scores at T1 (to account for any regression to the mean), FACT-G score remained practically significant (p value 0.076). Conclusions: A brief SC training program for staff (30 min for nurses and doctors, 60 min for MSWs) appeared to result in some improved QOL and SPS for patients. However, a larger sample size will be needed to estimate the degree of benefit more accurately. [Table: see text]

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Global Palliative Care: Improving the Quality of Spiritual Care in Global Palliative Care (SA525)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2017.12.348 ◽

2018 ◽

Vol 55 (2) ◽

pp. 652

Author(s):

Christina Puchalski ◽

Betty Ferrell ◽

Kathleen Foley ◽

Katherine Pettus ◽

Anke Flohr

Keyword(s):

Palliative Care ◽

Spiritual Care

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Effect of a spiritual care training program for staff on patient outcomes

Palliative & Supportive Care ◽

10.1017/s1478951516000894 ◽

2016 ◽

Vol 15 (4) ◽

pp. 434-443 ◽

Cited By ~ 12

Author(s):

Grace Meijuan Yang ◽

Yung Ying Tan ◽

Yin Bun Cheung ◽

Weng Kit Lye ◽

Sock Hui Amy Lim ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Training Program ◽

Spiritual Care ◽

Intervention Group ◽

Well Being ◽

Control Group ◽

Spiritual Well Being ◽

Care Training

ABSTRACTObjective:Physicians and nurses do not assess spirituality routinely, even though spiritual care is a vital part of palliative care for patients with an advanced serious illness. The aim of our study was to determine whether a training program for healthcare professionals on spirituality and the taking of a spiritual history would result in improved patient quality of life (QoL) and spiritual well-being.Method:This was a cluster-controlled trial of a spiritual care training program for palliative care doctors and nurses. Three of seven clinical teams (clusters) received the intervention, while the other four served as controls. Included patients were newly referred to the palliative care service, had an estimated survival of more than one month, and were aware of their diagnosis and prognosis. The primary outcome measure was the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT–Sp) patient-reported questionnaire, which patients completed at two timepoints. Total FACIT–Sp score includes the Functional Assessment of Cancer Therapy–General (FACT–G) questionnaire, which measures overall quality of life, as well as a spiritual well-being score.Results:Some 144 patients completed the FACIT–Sp at both timepoints—74 in the control group and 70 in the intervention group. The change in overall quality of life, measured by change in FACT–G scores, was 3.89 points (95% confidence interval [CI95%] = –0.42 to 8.19, p = 0.076) higher in the intervention group than in the control group. The difference between the intervention and control groups in terms of change in spiritual well-being was 0.32 (CI95% = –2.23 to 2.88, p = 0.804).Significance of results:A brief spiritual care training program can possibly help bring about enhanced improvement of global patient QoL, but the effect on patients' spiritual well-being was not as evident in our participants. Further study with larger sample sizes is needed to allow for more definite conclusions to be drawn.

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Comprometimento da qualidade de vida de pacientes em quimioterapia paliativa e cuidados paliativos: Scoping Review / Life quality assessment of patients in palliative chemotherapy and palliative care: Scoping Review

Ciência Cuidado e Saúde ◽

10.4025/cienccuidsaude.v18i1.43078 ◽

2019 ◽

Vol 18 (1) ◽

Author(s):

Bruna Eloise Lenhani ◽

Dabna Hellen Tomim ◽

Leonel Dos Santos Silva ◽

Luciana De Alcantara Nogueira ◽

Luciana Puchalski Kalinke

Keyword(s):

Palliative Care ◽

Scoping Review ◽

Spiritual Care ◽

Social Care ◽

Palliative Chemotherapy ◽

Life Quality ◽

Care Quality ◽

Comfort Care ◽

Physical Care

Objetivo: avaliar os domínios que comprometem a qualidade de vida de pacientes com câncer avançado em tratamento quimioterápico paliativo e cuidado paliativo. Método: Trata-se de uma scoping review realizada de março a maio de 2018, nas bases de dados CINAHL, LILACS, PubMed, Cuiden e na literatura cinzenta (Google Scholar e referências encontradas nos artigos analisados), utilizando os descritores “palliative care”,“quality of life”,“emotionalcare”, “functional care”,“sexual care”, “physical care”,“social care”,“comfort care”,“spiritual care”,“palliative chemotherapy” e “cancer advanced”. Foi realizada avaliação da qualidade metodológica por meio do instrumento STROBE para estudos observacionais e o CONSORT para os ensaios clínicos. Resultados: Os nove artigos encontrados e analisados são internacionais, publicados entre 2012 e 2016, com boa qualidade metodológica. Os domínios identificados foram os físicos, sociais e emocionais; o internamento hospitalar e local de óbito são fatores que também comprometeram a qualidade de vida. Conclusão: os pacientes em quimioterapia paliativa possuem baixa qualidade de vida. Porém, a presença de familiar e o acompanhamento concomitante com o serviço de cuidados paliativos melhoram essa situação. A avaliação dos pacientes, com enfoque nestes domínios, permite à Enfermagem adotar estratégias para melhoraria da qualidade de vida.

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Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference

Journal of Palliative Medicine ◽

10.1089/jpm.2009.0142 ◽

2009 ◽

Vol 12 (10) ◽

pp. 885-904 ◽

Cited By ~ 643

Author(s):

Christina Puchalski ◽

Betty Ferrell ◽

Rose Virani ◽

Shirley Otis-Green ◽

Pamela Baird ◽

...

Keyword(s):

Palliative Care ◽

Spiritual Care ◽

Consensus Conference

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Research Literature on the Intersection of Dementia, Spirituality, and Palliative Care: A Scoping Review

Innovation in Aging ◽

10.1093/geroni/igaa057.3187 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 864-864

Author(s):

Jennifer Palmer ◽

Alyssa Smith ◽

Sara Paasche-Orlow ◽

George Fitchett

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Scoping Review ◽

Spiritual Care ◽

Randomized Clinical Trials ◽

A Priori ◽

Research Literature ◽

Care Needs ◽

Term Care

Abstract Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care. Thus, we conducted the first scoping review examining the nature and breadth of peer-reviewed studies across these three topics. The scoping review followed methods from The Joanna Briggs Institute Reviewers’ Manual (2015). We developed a priori a scoping review protocol outlining the Population, Concept and Context for study, data sources, search strategy, inclusion/exclusion criteria, and procedure for screening, extracting, and analyzing data. The final sample consisted of 19 studies with the following themes: Characterizing Spiritual Needs, Preferences, and Resources; Characterizing Palliative or Spiritual Care; Predicting Provision of Spiritual Care; and Assessing Spiritual Care Interventions. Eighteen studies were published in the past decade, and eleven were based in Europe. The majority of studies focused on long-term care settings, grouped stages of dementia or did not specify dementia stage, and investigated interventions indirectly related to spiritual palliation. Many studies were limited in sample size and in generalizability / transferability and used less sophisticated research designs. Accordingly, research across dementia, spirituality, and palliative care needs to examine distinct stages of dementia; hospital-, home- and community-based settings; and formal spiritual care interventions (e.g., administered by chaplains) and needs to utilize rigorous study designs (e.g., randomized clinical trials). Such research could advance practice and policy that enhance quality of life for tens of millions of persons with dementia and their family members worldwide.

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