Tag Archives: terminal care

Increased spiritual support may be linked to higher quality of life in cancer patients

This headline is likely not news to most of the readers of this blog — or likely to most people. We all seem to know intuitively that terminal diagnoses cause people to begin to think about spiritaul and eternal issues. HealthDay reports, “Addressing the spiritual needs of someone with advanced cancer could be just as important as taking care of their medical needs.” This is based upon a study appearing in the Journal of Clinical Oncology.

The study of 670 patients showed that 60 percent “said that their spiritual needs either hadn’t been met or were minimally supported,” even though patients ranked “pain control and being at peace with God” as the two most important factors “at the end of their lives.”

Patients who received “greater spiritual support from their medical team” said they had “a higher quality of life as they neared death.” Addressing the spiritual needs of someone with advanced cancer could be just as important as taking care of their medical needs, a new study suggests.

The take home for us healthcare professionals is that we all need to do a better job of taking a spiritual history on our cancer patients. In fact, the Joint Commission requires a spiritual history or assessment for all patients admitted to long-term care, home care, behavioral care, and hospital admission.

What should the assessment include? The Joint Commission says that it “should, at a minimum, determine the patient’s denomination, beliefs, and what spiritual practices are important to them.”

Why? They say, “This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed.”

The take home for the rest of us is to be sure that our family and friends who receive the diagnosis of cancer have the spiritual support upon which their health and well-being may depend.

The famous Johns Hopkins medical professor, Sir William Osler, writing in an editorial, titled “The Faith that Heals,” printed in the first edition of the British Medical Journal (BMJ 1910;1:470-2), wrote, “Nothing in life is more wonderful than faith … the one great moving force which we can neither weigh in the balance nor test in the crucible …” He wrote that faith is”… mysterious, indefinable, known only by its effects, faith pours out an unfailing stream of energy while abating neither jot nor tittle of its potence …”

Psychotherapist Arthur Kornhaber said, in a 1992 interview published in Newsweek magazine, “To exclude God from a medical consultation is a form of malpractice … spirituality is wonder, joy and shouldn’t be left in the clinical closet.”

I was the chief author of a systematic review (Annals of Behavioral Medicine 2002;24(1):69-73) that concluded, “The current evidence would encourage physicians, health-care providers and systems to learn to assess their patients’ spiritual health and to provide indicated and desired spiritual intervention. Clinicians should not, without compelling data to the contrary, deprive their patients of the spiritual support and comfort upon which their hope, health, and well being may hinge.”

“This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed.

Here’s the HealthDay report:

When asked what was important to them at the end of their lives, people dying of cancer ranked two factors highest: pain control and being at peace with God, the study found.

“Medicine tends to focus on the more scientific aspects of the person, and we’ve made wonderful strides in improving patient care, but there’s another important component of patient health: spirituality,” explained Dr. Tracy Anne Balboni, a radiation oncologist at the Dana-Farber Cancer Institute in Boston and the study’s lead author. “This is clearly an area where some important advancements can be made.”

The researchers discovered that people with advanced cancer were far more likely to choose hospice care when their spiritual needs had been addressed. And among those who were very religious, meeting spiritual needs increased the odds that a terminal patient would choose to forgo aggressive, yet often unsuccessful, medical treatments, the study found.

However, at least six of 10 people with advanced cancer reported that their spiritual needs were only minimally or not at all supported.

The new study involved 670 people with advanced cancer from seven treatment centers in the Northeast and Texas. The final analysis included information from 343 people who later died and whose caregivers completed a post-death interview. The average time between the start of the study and the person’s death was 116 days.

For purposes of the study, spiritual care was defined as patient-perceived support of their spiritual needs by their medical team and the receipt of pastoral care services.

Most people (60 percent) said that their spiritual needs either hadn’t been met or were minimally supported at the start of the study, and 54 percent had not received pastoral care visits. In the final week of life, 73 percent of the participants received hospice care, and 17 percent received aggressive care.

Those who had greater spiritual support from their medical team, including doctors, nurses, chaplains and more, reported a higher quality of life as they neared death than did those who felt unsupported spiritually.

People who felt they were getting better spiritual support were 3½ times more likely to receive hospice care. And among highly religious people, those whose spiritual needs were supported were five times more likely to receive hospice care and five times less likely to receive aggressive medical care, the study reported.

“We found that patients whose spiritual needs were well-supported seemed to transition to hospice more frequently and had a marked reduction in the use of aggressive care,” Balboni said.

Yet despite the findings, said Dr. Harold G. Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center, “few people are getting their spiritual needs met by the medical system.”

“Many doctors are uncomfortable discussing spirituality and haven’t been trained to do so,” he said. “And churches have a role, too. Although it’s not a popular topic, churches need to talk about the end of life in the pulpit. People don’t know theologically what they’re supposed to do.”

Religious people, Koenig said, are often left to think they should always have hope and should always “give God a chance to provide a miracle.” Hospice care, though, can often provide spiritual guidance and help people prepare for death, he said.

Doctors don’t need to actually provide spiritual care, Koenig said, but it’s important for physicians to acknowledge their patients’ spiritual needs and make sure they’re addressed by pastoral care or hospice. “The doctor does have to be the one to orchestrate this,” he said.

But if someone’s spiritual needs are not being met, Koenig and Balboni agreed that the person — or a friend or family member — needs to speak up. And if the patient’s doctor doesn’t feel qualified to discuss end-of-life spiritual issues, the doctor should be able to refer you to someone who can.

Ironically, the most devout are the most likely to utilize death-to-the-end treatment

The New York Times reports, “Terminally ill cancer patients who drew comfort from religion were far more likely to seek aggressive, life-prolonging care in the week before they died than were less religious patients.” What does this story mean?

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