Do spiritual patients want spiritual interventions?: A qualitative exploration of underserved cancer patients' perspectives on religion and spirituality

AbstractObjective:This study examines religion and spirituality among advanced cancer patients from an underserved, ethnically-diverse population by exploring patient conceptualizations of religion and spirituality, the role of religion and spirituality in coping with cancer, and patient interest in spiritual support.Method:Qualitative semi-structured interviews were conducted with patients who had participated in a study of a “mind-body” support group for patients with all cancer types. Analysis based on grounded theory was utilized to identify themes and theoretical constructs.Results:With regard to patient conceptualizations of religion and spirituality, three categories emerged: (1) Spirituality is intertwined with organized religion; (2) Religion is one manifestation of the broader construct of spirituality; (3) Religion and spirituality are completely independent, with spirituality being desirable and religion not. Religion and spirituality played a central role in patients' coping with cancer, providing comfort, hope, and meaning. Patients diverged when it came to spiritual support, with some enthusiastic about interventions incorporating their spiritual values and others stating that they already get this support through religious communities.Significance of results:Spirituality plays a central role in the cancer experience of this underserved ethnically-diverse population. While spirituality seems to be a universal concern in advanced cancer patients, the meaning of spirituality differs across individuals, with some equating it with organized religion and others taking a more individualized approach. It is important that psychosocial interventions are developed to address this concern. Future research is needed to further explore the different ways that patients conceptualize spirituality and to develop spiritually-based treatments that are not “one size fits all.”

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Religiousness and Spiritual Support Among Advanced Cancer Patients and Associations With End-of-Life Treatment Preferences and Quality of Life

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.9046 ◽

2007 ◽

Vol 25 (5) ◽

pp. 555-560 ◽

Cited By ~ 528

Author(s):

Tracy A. Balboni ◽

Lauren C. Vanderwerker ◽

Susan D. Block ◽

M. Elizabeth Paulk ◽

Christopher S. Lathan ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Medical System ◽

Religious Communities ◽

Treatment Preferences ◽

Spiritual Needs ◽

Spiritual Support ◽

Advanced Cancer Patients ◽

Advance Care

Purpose Religion and spirituality play a role in coping with illness for many cancer patients. This study examined religiousness and spiritual support in advanced cancer patients of diverse racial/ethnic backgrounds and associations with quality of life (QOL), treatment preferences, and advance care planning. Methods The Coping With Cancer study is a federally funded, multi-institutional investigation examining factors associated with advanced cancer patient and caregiver well-being. Patients with an advanced cancer diagnosis and failure of first-line chemotherapy were interviewed at baseline regarding religiousness, spiritual support, QOL, treatment preferences, and advance care planning. Results Most (88%) of the study population (N = 230) considered religion to be at least somewhat important. Nearly half (47%) reported that their spiritual needs were minimally or not at all supported by a religious community, and 72% reported that their spiritual needs were supported minimally or not at all by the medical system. Spiritual support by religious communities or the medical system was significantly associated with patient QOL (P = .0003). Religiousness was significantly associated with wanting all measures to extend life (odds ratio, 1.96; 95% CI, 1.08 to 3.57). Conclusion Many advanced cancer patients’ spiritual needs are not supported by religious communities or the medical system, and spiritual support is associated with better QOL. Religious individuals more frequently want aggressive measures to extend life.

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Psychosocial interventions for advanced cancer patients: A systematic review

Psycho-Oncology ◽

10.1002/pon.5103 ◽

2019 ◽

Vol 28 (7) ◽

pp. 1394-1407 ◽

Cited By ~ 15

Author(s):

Irene Teo ◽

Anirudh Krishnan ◽

Geok Ling Lee

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Advanced Cancer ◽

Psychosocial Interventions ◽

Advanced Cancer Patients

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Coping with cancer: Associations between coping methods and use of intensive life-prolonging care near death

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9575 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9575-9575 ◽

Cited By ~ 2

Author(s):

A. C. Phelps ◽

P. K. Maciejewski ◽

M. Nilsson ◽

T. A. Balboni ◽

A. A. Wright ◽

...

Keyword(s):

Religious Coping ◽

Cancer Patients ◽

Advanced Cancer ◽

Coping Mechanisms ◽

Advanced Cancer Patients ◽

Brief Cope ◽

Coping With Cancer ◽

Behavioral Disengagement ◽

Prospective Longitudinal ◽

Positive Religious Coping

9575 Background: Cancer patients cope with advanced illness in a variety of ways, including relying on their religious beliefs. Religious coping has been associated with preference for aggressive care near death, yet little is known about how religious and other coping mechanisms effect the use of intensive life-prolonging care at the end-of-life (EOL). We sought to determine how patient coping mechanisms affect the use of intensive life-prolonging EOL care among advanced cancer patients. Methods: The Coping with Cancer Study is a US multi-site, prospective, longitudinal cohort of 345 advanced cancer patients enrolled January, 2003 -August, 2007. The Brief COPE assessed active coping (e.g., problem solving), emotional-support based coping (e.g., getting comfort from others), and behavioral disengagement (e.g., giving up the attempt to cope). The Brief RCOPE assessed positive religious coping (e.g., seeking a strength and guidance from God) and negative religious coping (e.g., believing illness is God's punishment). Patients were followed until death, a median of 122 days after baseline assessment. The main outcome was receipt of intensive life-prolonging care, defined as receipt of ventilation or resuscitation in the last week of life. Results: Greater use of positive religious coping prospectively predicted receipt of intensive life-prolonging care (AOR, 5.43; p<0.001), ventilation (AOR, 4.40; p<0.01), resuscitation (AOR, 5.19; p<0.05), and death in the intensive care unit (AOR, 2.76; p<0.05) in the last week of life, controlling for confounding factors and other examined coping styles. In analyses that adjusted for significant confounding influences, behavioral disengagement was associated with DNR order completion (AOR, 2.80; p<0.01), and prospectively predicted lower rates of intensive life-prolonging care (AOR, 0.20; p<0.05), and ventilation (AOR 0.13, p<0.05). Conclusions: The manner in which patients cope with advanced cancer predicts receipt of intensive life-prolonging care at the EOL. Specifically, positive religious coping predicts the receipt of aggressive medical care near death. No significant financial relationships to disclose.

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Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses

Palliative & Supportive Care ◽

10.1017/s147895151800055x ◽

2018 ◽

Vol 17 (03) ◽

pp. 345-352 ◽

Cited By ~ 8

Author(s):

Gil Bar-Sela ◽

Michael J. Schultz ◽

Karima Elshamy ◽

Maryam Rassouli ◽

Eran Ben-Arye ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Spiritual Care ◽

Cultural Context ◽

Multivariable Analysis ◽

Perceived Barriers ◽

Care Provision ◽

Religion And Spirituality ◽

Advanced Cancer Patients ◽

Key Factor

AbstractObjectiveWhen patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with “unrealized potential” for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it.MethodWe distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p< 0.001) and not having received training (p= 0.02; only 22% received training). How “developed” a country is negatively predicted spiritual care provision (p< 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

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Creating communicative opportunity: The supportive benefits of legacy building for families of advanced cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.230 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 230-230

Author(s):

Jennifer Kim Bernat ◽

Paul R. Helft ◽

Laura R. Wilhelm ◽

Karen Schmidt ◽

Shelley A. Johns

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Family Members ◽

Terminally Ill ◽

Future Generations ◽

Future Research ◽

Advanced Cancer Patients ◽

Great Loss ◽

The Family ◽

New Knowledge

230 Background: Being diagnosed with advanced cancer is a painful reality that impacts entire families. Families face the challenge of great loss and can regret conversations left unspoken. Dignity therapy (DT) is an empirically supported intervention that gives families communicative opportunity. During DT, terminally ill patients engage in legacy building and create a written project containing their meaningful memories and values. This project is given to the family, succeeding the person in death and providing continuity to those who are left behind. We developed a narrative intervention based on DT that used a novel web portal for project dissemination. This study qualitatively explores the family’s reactions to legacy building to learn about its potential for future bereavement support. Methods: Semi-structured phone interviews (20-30 minutes) with family members (n=7) of terminally ill cancer patients were completed approximately one week after receiving the legacy project. Recipients were spouses (n=4), siblings (n=2), or an adult child (n=1). Interviews were coded using conventional content analysis and an open-coding strategy. Themes were recorded as they emerged. Results: Three communication themes emerged from the data. Legacy building: (1) facilitates conversation; (2) creates new knowledge and understanding; and (3) leaves lasting communication for future generations. The family members felt overall communication improved before the patient died, and they were able to discuss the terminal nature of their loved one’s illness. New knowledge was communicated in the project, which sometimes led to further understanding of personal life events. Also, the project was viewed as a family heirloom to be bequeathed to future generations. All family members stated they would recommend legacy building to others. Conclusions: This study adds the unique impact of communication to the literature on the supportive benefit of DT for families of advanced cancer patients. Future research should investigate and quantitatively assess bereavement outcomes for families over time, as well as the direct impact these outcomes have on family members’ quality of life.

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Correction to: Psychosocial Interventions for Pain Management in Advanced Cancer Patients: a Systematic Review and Meta-analysis

Current Oncology Reports ◽

10.1007/s11912-021-01063-5 ◽

2021 ◽

Vol 23 (6) ◽

Author(s):

Marco Warth ◽

Joshua Zöller ◽

Friederike Köhler ◽

Corina Aguilar-Raab ◽

Jens Kessler ◽

...

Keyword(s):

Systematic Review ◽

Pain Management ◽

Cancer Patients ◽

Advanced Cancer ◽

Meta Analysis ◽

Psychosocial Interventions ◽

Advanced Cancer Patients ◽

Link Type

A Correction to this paper has been published: 10.1007/s11912-021-01063-5

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One Thousand Lives

Managing Cancer and Living Meaningfully ◽

10.1093/med/9780190236427.003.0004 ◽

2021 ◽

pp. 31-44

Author(s):

Gary Rodin ◽

Sarah Hales

Keyword(s):

Palliative Care ◽

End Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Psychosocial Interventions ◽

Psychosocial Oncology ◽

Advanced Cancer Patients ◽

Will To Live

This chapter provides an overview of the foundational contributions of early leaders in psychosocial oncology and palliative care that informed the development of the Managing Cancer and Living Meaningfully (CALM) intervention. This includes the collective works of such pioneers as Kübler-Ross, Glaser and Strauss, and Pattison, which were instrumental in the development of psychosocial interventions such as CALM. The research conducted by our team with advanced cancer patients and their families over two decades is also described, highlighting the longitudinal Will to Live Study. In that study over 700 patients with advanced cancer were assessed at baseline and over 400 were followed longitudinally until the end of life, deepening our understanding of their experience over the trajectory of this disease. The findings of this research confirmed the need for an intervention such as CALM and helped to shape its nature and form.

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Psychotherapy and Behavioral Interventions in Palliative Care

Psychosocial Palliative Care ◽

10.1093/med/9780199917402.003.0009 ◽

2014 ◽

pp. 91-102

Author(s):

William S. Breitbart

Keyword(s):

Palliative Care ◽

Depressive Symptoms ◽

Cancer Patients ◽

Advanced Cancer ◽

Behavioral Interventions ◽

Psychosocial Interventions ◽

Advanced Cancer Patients ◽

Behavioural Interventions ◽

Life Threatening Illness ◽

Life Threatening

A range of psychotherapeutic and behavioural interventions have been demonstrated to be effective and useful for patients struggling with advanced life-threatening illness. Despite lack of evidence for prolonged survival, psychosocial interventions have been shown to be effective in decreasing depressive symptoms and suffering in advanced cancer patients. This chapter provides an overview of the commonly used, effective individual, group, and family psychotherapy modalities among advanced cancer patients and their families.

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

Quality of Life Research ◽

10.1007/s11136-020-02633-z ◽

2020 ◽

Author(s):

Dwi Gayatri ◽

Ljupcho Efremov ◽

Eva Johanna Kantelhardt ◽

Rafael Mikolajczyk

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Palliative Care ◽

Developing Countries ◽

Cancer Patients ◽

Advanced Cancer ◽

Experimental Studies ◽

Spiritual Support ◽

Advanced Cancer Patients

Abstract Purpose This systematic review aims to summarize factors that influence the quality of life (QOL) of advanced cancer patients in palliative care (PC) in developing countries. Understanding this context in developing countries milieu is necessary; however, this outcome is rarely reported. Methods Following the PRISMA guidelines, the electronic databases MEDLINE, Embase, CINAHL, and Web of Science were systematically searched using the search terms: QOL, cancer, PC, and names of all developing countries. Studies with less than ten subjects, qualitative or pilot studies, reviews, conference abstracts, and that reported validation of QOL questionnaires were excluded. Results Fifty-five studies from 15 developing countries in the African (n = 5), Latin America and the Caribbean (n = 10), and Asian (n = 40) region were included in the narrative synthesis. 65.4% were cross-sectional, 27.3% were cohort studies, 7.3% were RCTs or quasi-experimental studies. Around 30 QOL factors were studied with 20 different types of QOL instruments. Advanced cancer patients who were older, married/ever married, participated in additional care within PC, used complementary and alternative medicine (CAM), and practiced spirituality/religiosity showed higher QOL score. Low educational level and high depression were associated with a lower QOL. Conclusion Various factors affect QOL among cancer patients in PC. Patients valued the use of CAMs; however, the quality and safety aspects should be properly addressed. Important factors that influenced the QOL score were social and spiritual support. While there is a general need to develop PC strategies further, recognizing patients’ needs should be prioritized in national cancer programs.

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