Spiritual Experience in Dementia From the Health Care Provider Perspective: Implications for Intervention

Spiritual care seeks to counter negative outcomes from spiritual distress and is notably needed in dementia. Such care needs disease-appropriate customization. Employing “cognitive apprenticeship” theory’s focus on learning from contrast, we explored spiritual needs salient within dementia as related to other disease states; we aimed to inform future dementia-focused spiritual care design. Accordingly, we conducted semi-structured qualitative interviews with 24 providers who serve older adults inclusive of persons with dementia. We sampled participants purposively by discipline (chaplains, nursing staff, social workers, activities professionals) and religious tradition (for chaplains). Our interview guide inquired about the nature of spiritual needs in dementia and stakeholders’ roles in addressing them. Hybrid inductive/deductive thematic analysis was employed. A thematic structure emerged with two themes: 1) spiritual experience in dementia compared to other medical conditions (sub-themes: the salience of (a) fear; (b) loss of self; (c) dementia’s progressive and incurable nature; (d) dementia’s impact on accessing faith); and 2) the need for spiritual intervention at the mild stage of dementia (sub-themes: (a) awareness in mild dementia and its influence on spiritual distress; (b) a window of opportunity). These findings pointed to possibilities for the “what” of spiritual needs and the “who” and “when” of implementing spiritual care. Implications included the imperative for dementia-specific spiritual assessment tools, interventions targeting fear and loss early in the disease, and stakeholder training. Researchers should study the “how” of dementia-appropriate spiritual care given recipients’ cognitive and linguistic challenges. Conjointly, these efforts could promote the spiritual well-being of persons with dementia worldwide.

The spiritual experience of dementia from the health care provider perspective: Implications for intervention

Background and Objectives Spiritual care aims to counter negative outcomes from spiritual distress and is beneficial to persons living with dementia. Such care needs dementia-appropriate customization. We explored the salient spiritual needs in dementia to inform future intervention development. Health care providers are well-situated to observe the nature of spiritual needs across and within medical conditions. Research Design and Methods We conducted semi-structured qualitative interviews with providers. We sampled purposively by discipline (chaplains, nursing staff, social workers, activities professionals) and religious tradition (for chaplains). Our interview guide inquired about, e.g., the nature of spiritual needs in dementia and stakeholders’ roles in addressing them. Inductive / deductive thematic analysis was employed. Results Twenty-four providers participated. The thematic structure consisted of two themes: 1) spiritual experience in dementia differs from that in other medical conditions (sub-themes: fear, profound loss of self, progressive and incurable nature, and impacted ability to access faith); and 2) the need for spiritual intervention at the mild stage of dementia (sub-themes: awareness in mild dementia and its influence on spiritual distress, and a window of opportunity). Discussion and Implications We learned about the potential “what” of spiritual needs and “who” and “when” of implementing spiritual care. Implications included the imperative for dementia-specific spiritual assessment tools, interventions targeting fear and loss of self early in symptom progression, and stakeholder training. Researchers should study additionally the “how” of dementia-appropriate spiritual care. Conjointly, these efforts could promote spiritual well-being in persons living with dementia worldwide.

Recognizing spiritual injury in cancer: A case study

Background Spiritual distress is a common symptom among patients with cancer. Spiritual injury (SI), a type of spiritual distress, occurs when there is a breakdown in the relationship between the individual and their higher power. Patients who experience spiritual injury may have poor health outcomes. Methods A case report of a woman with stage IV non-small cell lung cancer who had experienced a SI. Results The palliative care team, in collaboration with the palliative care chaplain, was able to recognize that the patient had experienced a SI. They were able to help the patient to process and reflect upon this experience and ultimately treat her suffering. Significance of results All palliative care providers should assess their patients’ spiritual health and monitor for the existence of SI.

Clinical Interprofessional Model of Spiritual Care

To standardize and institutionalize spirituality as a component of whole-patient care, the biopsychosocial-spiritual model must be integrated across the continuum of care for all patients. This chapter explores the clinical interprofessional model of spiritual care. The biopsychosocial-spiritual model recognizes the distinct dimensions—biological, psychological, social, and spiritual—of a person and the fact that no dimension can be left out when caring for the whole person. This chapter describes a consensus- and evidence-based model that enables clinicians to fully attend to the spiritual needs and the spiritual distress that patients and their families may experience. The chapter is rounded out by two case examples.

Spiritual distress: symptoms, quality of life and hospital utilisation in home-based palliative care

ObjectivesThe purpose of this study was to use a spiritual screening question to quantify the prevalence of spiritual distress (SD) in a large cohort of seriously ill patients at admission to home-based palliative care (HBPC) and to examine the associations between SD with symptom burden, quality of life and hospital-based utilisation up to 6 months after admission to HBPC.MethodsData for this cohort study (n=658) were drawn from a pragmatic comparative-effectiveness trial testing two models of HBPC. At admission to HBPC, SD was measured using a global question (0–10-point scale: none=0; mild=1–4; moderate-to-severe=5+); symptoms and quality of life were measured with the Edmonton Symptom Assessment Scale (ESAS) and PROMIS-10. Hospital utilisation was captured using electronic records and claims. Median regression and proportional hazard competing risk models assessed the association between SD with symptoms and quality of life, and hospital utilisation, respectively.ResultsNearly half of the patients/proxies reported some level of SD. Increasing SD was significantly associated with higher symptom burden (increase of 7–14 points on ESAS) and worse mental well-being (decrease of 2.7 to 4.6 points on PROMIS-10-mental) in adjusted models. Compared with patients/proxies who reported no SD, those with at least some level of SD were not at increased risk for hospital-based utilisation over a median follow-up period of 2 months.ConclusionWhile SD is cross-sectionally associated with worse symptoms and mental well-being, it did not predict downstream hospital-based utilisation. Our results highlight the importance of assessing for and managing SD in patients with serious illness.

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.

The Relationship Between Sexual Compulsivity, Emotional and Spiritual Distress of Religious and Non-religious Internet Pornography Users

This study sought to examine the relationship between the sexual compulsivity, emotional and spiritual distress of religious and non-religious adults who sought assessment for pornography addiction on the Internet. Religious (n = 350) and non-religious (n = 114) data were analyzed separately with a one-way between-subjects multivariate analysis of variance. The Kalichman Sexual Compulsivity Scale was used to divide the religious and non-religious into three groups: non-sexually compulsive (NCs); moderately sexually compulsive and sexually compulsive (SCs). All of the dependent variables, except age, were significantly higher for SCs than NCs for the religious. For the non-religious, all of the dependent variables, except age and time spent viewing Internet pornography (IP), were significantly higher for SCs than NCs. The non-religious spent significantly more time viewing IP than the religious. Yet, the religious were significantly more sexually compulsive. Emotional distress and spiritual distress were found to be significantly higher for SCs than the NCs regardless of religiosity. The non-religious were significantly more anxious and stressed than the religious. Specific religious affiliations did not have any significant bearing on the degree of sexual compulsivity. Religious practice, being associated with less viewing of IP, suggests the likelihood that moral reasons may provide some rationale for not viewing IP. At the same time, religious practice might reinforce shame in the addiction cycle thus religious individuals may be more at-risk to developing a compulsive pattern of viewing IP. The implications of the findings and suggestions for future research are presented.