Screening for religious/spiritual struggle in blood and marrow transplant patients

Testing items to screen for religious or spiritual distress in adult outpatient cancer care

PURPOSE

The experience of cancer diagnosis and treatment is associated with significant stress. While religion and spirituality (R/S) can provide crucial support, many patients also experience R/S distress. Screening for distress has gained recognition, with tools evolving to address spiritual needs; however, existing screening measures have limitations. This study aims to validate screening items for R/S distress among cancer patients undergoing treatment, using a standardized chaplain assessment as a reference standard.

METHODS

The study involved adult cancer patients undergoing outpatient treatment at Rush Cancer Center. Procedures included researcher-administered screening questions and the ONC-5 spiritual assessment interview with a board-certified chaplain. Data included demographics, illness variables, and R/S measures. Eight single-item and two multi-item screening measures were evaluated against the ONC-5. Analysis entailed descriptive statistics and sensitivity/specificity determination.

RESULTS

Study participants (N = 71) were predominantly female (53.5%) with common cancers (breast, colon/rectum, and lung). R/S distress was evident in 19.7%. Single-item screeners exhibited sensitivities from 14 to 71% and specificities from 72 to 98%. The King 2-question combination showed 71% sensitivity and 63% specificity. The Rush protocol demonstrated 36% sensitivity and 88% specificity. Post hoc analyses of two-item combinations did not enhance sensitivity.

CONCLUSION

This study evaluated R/S distress screening items among outpatient cancer patients. The single-item screener asking whether participants' R/S provided all the strength and comfort needed now performed best with a sensitivity and specificity of 71% and 83%, respectively. Despite limitations, our findings underscore the importance of refining R/S distress screening tools in oncology care.

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.

Wellbeing at Work before and during the SARS-COV-2 Pandemic: A Brazilian Nationwide Study among Dietitians

This study aimed to evaluate the perceptions of dietitians' wellbeing at work before and during the SARS-COV-2 pandemic in Brazil. This cross-sectional study was performed using a previously validated instrument to investigate the wellbeing of dietitians at work in Brazil. The questionnaire on the wellbeing of dietitians was composed of 25 items (with a 5-point scale), characteristics, and questions about the SARS-COV-2 period. The application was carried out with GoogleForms® tool from 26 May to 7 June 2020. The weblink to access the research was sent via email, messaging apps, and social networks. Volunteers were recruited nationwide with the help of the Brazilian Dietitians Councils, support groups, as well as media outreach to reach as many dietitians as possible. Volunteers received, along with the research link, the invitation to participate, as well as the consent form. A representative sample of 1359 dietitians from all the Brazilian regions answered the questionnaire-mostly female (92.5%), Catholic (52.9%), from 25 to 39 years old (58.4%), with a partner (63.8%), and with no children (58%). Most of the participants continue working during the pandemic period (83.8%), but they did not have SARS-COV-2 (96%), nor did their family members (80.7%). The wellbeing at work before SARS-COV-2 was 3.88 ± 0.71, statistically different (p < 0.05) from during the pandemic, with the wellbeing of 3.71 ± 0.78. Wellbeing at work was higher before the pandemic for all the analyzed variables. Analyzing variables separately before and during the pandemic, dietitians with partners, children and a Ph.D. presented higher scores for wellbeing at work. Professionals receiving more than five times the minimum wage have higher scores. During the pandemic, better wellbeing was observed for dietitians working remotely.

The Role of Spirituality in Patients Undergoing Hematopoietic Stem Cell Transplantation: a Systematic Mixed Studies Review

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) has become the standard treatment for many diseases, but it is an intense and distinctive experience for patients. HSCT-related mortality is present throughout the whole process of transplantation, from pretransplantation to recovery. Long-term rehabilitation and the uncertain risk of death evoke feelings of vulnerability, helplessness, and intense fear. Zimmermann et al. proposed that spiritual well-being is an important dimension of quality of life and that patients at the end stage of life require spiritual support in addition to physical care, psychological care, and social support. Therefore, the purpose of this review is to examine the role of spirituality in the process of HSCT.

METHOD

A systematic mixed studies review (SMSR) was based on Pluye and Hong's framework to understand the role of spirituality in patients' experiences while undergoing HSCT. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement to report the results of integration.

RESULTS

Fifteen original qualitative studies, 19 quantitative studies, and one mixed method study were included in the systematic mixed studies review. The evidence from the review revealed the following three themes: the spiritual experiences of HSCT patients, the spiritual coping styles of HSCT patients, and the spiritual need changes brought about by HSCT.

DISCUSSION

Few medical institutions currently offer spiritual healing, although HSCT patients with different cultural backgrounds may have different spiritual experiences and spiritual coping styles. Psychotherapists or nurses should be considered to provide spiritual care for patients undergoing HSCT, to help patients cope with disease pressures, promote HSCT patients' comfort, and improve their quality of life.

Mapping the Healthcare Chaplaincy Literature: An Analytical Review of Publications Authored by Chaplains and Theologians Between 2000 and 2018

The body of theoretical and empirical research led by chaplains and theologians between 2000 and 2018 is developing into a rich, diverse, and methodologically rigorous healthcare chaplaincy literature, which this review proposes to map. Online keyword and bibliographical searches and specialist recommendations yielded 199 relevant publications, which we analyzed in terms of methodology, topic, and results. On this basis, this article identifies and describes five key areas of the literature: chaplains' practices, spirituality, research, impact, and healthcare professionals' practices of spiritual care. The discussion further highlights that publications would benefit from greater conceptual clarity, common research standards, and more critical research designs.

Factors Associated with Surrogate Self-Efficacy in Decision-Making for Patients with End-Stage Renal Disease

AIM

The aim of the study is to assess which factors are associated with self-efficacy for making these decisions in surrogates of end-stage kidney disease patients.

MATERIALS AND METHODS

Cross-sectional study conducted in the hemodialysis clinic of a private hospital in Mexico City. A total of 124 surrogates of patients in hemodialysis were included in the study. Self-efficacy for decision-making was assessed with the Family Decision-Making Self-Efficacy Scale. As factors related to decision-making self-efficacy, sociodemographic data, health information, and professional help received for dealing with end-of-life issues were assessed in both patients and surrogates. Functional status and advanced directives of the patient as well as prior experience in decision-making of the surrogates were also included. Logistic regression models were used to establish the associations.

RESULTS

The mean age of participants was 49.4 years (standard deviation: 14). Factors associated to decision-making self-efficacy were awareness of the surrogate about the terminal disease of the patient (P < 0.001), prior conversation between the surrogate and the patient about end-of-life preferences (P = 0.037), time between the patient was told dialysis was required and accepting it inferior to 1 month (P = 0.016), and visual impairment of the patient (0.040).

CONCLUSIONS

This study provides information of which factors are associated with self-effectiveness in surrogates of terminally ill renal patients so that strategies based on these considerations might be implemented in the future.

Role of Early Palliative Care Interventions in Hematological Malignancies and Bone Marrow Transplant Patients: Barriers and Potential Solutions

INTRODUCTION

Despite advances in palliative care management of physical, psychological, and emotional symptoms along the spectrum of chronic conditions, early palliative care interventions are not used frequently and comprehensively in bone marrow transplant units.

METHODS

The literature review of PubMed articles in English published until December 2017.

RESULTS

Patients with hematologic malignancies and bone marrow transplant interventions are a heterogeneous group. The majority experience symptoms associated with induction or condition regimens. Curative intent of treatment is the norm. Pain, mucositis, nausea and vomiting, diarrhea, psychological, spiritual, and emotional concerns may not be properly and comprehensively tackled by primary oncology and bone marrow transplant teams. Quality of life may be decreased due to the presence of these symptoms. Obstacles to early palliative care interventions include overestimation of survival, focus on curative intent with underestimation of palliative care needs, lack of a comprehensive understanding of hematologic malignancies and bone marrow transplant process on the side of palliative care providers, and logistical restrictions. Potential interventions include education of oncologists, palliative care providers, patients, integration of models of care pre- and posttreatment and bone marrow transplantation, development of guidelines, institutional commitment and leadership in creating new initiatives, clinical research activities to measure outcomes, and community-based participatory research.

CONCLUSIONS

Early palliative care interventions are beneficial for patients with hematologic malignancies and bone marrow transplant processes. Better understanding of barriers to its implementation and development of creative initiatives is of paramount importance. New research endeavors should focus on providers' attitudes toward patients and communities.

The Relationship of Religious Comfort and Struggle with Anxiety and Satisfaction with Life in Roman Catholic Polish Men: The Moderating Effect of Sexual Orientation

The aim of the research was to analyze the relationships of religious comfort and struggle with state anxiety and satisfaction with life in homosexual and heterosexual samples of men. A hundred and eight men aged between 18 and 43 participated in the research in total, 54 declared themselves as homosexual and 54 as heterosexual. The Religious Comfort and Strain Scale, the State-Trait Anxiety Inventory and the Satisfaction with Life Scale were applied to the research. The results of hierarchical multiple regression analyses revealed that sexual orientation moderated the relationships of religious comfort and struggle with state anxiety and satisfaction with life. The highest state anxiety was observed in homosexual participants with high negative social interactions surrounding religion scores. Negative religious social interactions with fellow congregants and religious leaders, including disapproval and criticism, create anxiety among homosexual people. It seems that homosexual participants are engaged in a trade-off between valued and necessary religious engagement and the harassment and persecution they may be forced to endure in order to access that engagement.

Do Journal Clubs Work? The Effectiveness of Journal Clubs in a Clinical Pastoral Education Residency Program

Journal clubs are an established means of ongoing learning in medicine. Beginning with physicians in the nineteenth century, journal clubs have gradually become established in nursing and other allied health professions. However, their use in Clinical Pastoral Education (CPE) is relatively new. We describe the creation of a journal club for CPE residents and discuss the lessons learned from this effort. Over two years, a journal club was conducted with two different cohorts of residents. Residents were surveyed regarding the perceived strengths and weaknesses of the journal club and their recommendations for improvement. A small group of six to eight residents appears to be most effective. Focusing on a specific topic is preferable to broad-based readings. Residents preferred greater discussion about the applicability of the research findings to their clinical activity. Finally, the pros and cons of residents selecting articles and use of the Rush Research Summary Worksheet are discussed.

Recent Progress in Chaplaincy-Related Research

In light of the continued growth of chaplaincy-related research this paper presents an overview of important findings. The review summarizes research in six broad areas: what chaplains do; the importance of religion and spiritual care to patients and families; the impact of chaplains' spiritual care on the patient experience; the impact of chaplain care on other patient outcomes; spiritual needs and chaplain care in palliative and end of life care; and chaplain care for staff colleagues. It concludes with a description of several innovative and important new studies of chaplain care and notes areas for future investigation.

Screening for Spiritual Struggle in an Adolescent Transgender Clinic: Feasibility and Acceptability

Spiritual struggles are associated with poorer health outcomes, including depression, which has higher prevalence among transgender individuals than the general population. This study's objective was to improve the quality of care in an outpatient transgender clinic by screening patients and caregivers for spiritual struggle and future intervention. The quality improvement questions addressed were whether screening for spiritual struggle was feasible and acceptable; and whether the sensitivity and specificity of the Rush Protocol were acceptable. Revision of the screening was based on cognitive interviews with the 115 adolescents and caregivers who were screened. Prevalence of spiritual struggle was 38-47%. Compared to the Negative R-COPE, the Rush Protocol screener had sensitivities of 44-80% and specificities of 60-74%. The Rush Protocol was acceptable to adolescents seen in a transgender clinic, caregivers, and clinic staff; was feasible to deliver during outpatient clinic visits, and offers a straightforward means of identifying transgender persons and caregivers experiencing spiritual struggle.

Spiritual Well-Being in Hispanic and Non-Hispanic Survivors of Allogeneic Hematopoietic Stem Cell Transplantation

Research suggests that spiritual well-being positively contributes to quality of life during and following cancer treatment. This relationship has not been well-described in ethnically diverse survivors of allogeneic transplantation.  This study compares spiritual well-being and quality of life of Hispanic (n = 69) and non-Hispanic (n = 102) survivors. Hispanic participants were significantly younger and reported significantly greater spiritual well-being than non-Hispanic survivors. Survivors with higher spiritual well-being had significantly better quality of life. Meaning and Peace significantly predicted quality of life. Although Hispanic survivors report greater spiritual well-being, Meaning and Peace, irrespective of ethnicity, have a salutary effect on quality of life.

Patient and healthcare perspectives on the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic: a qualitative study

OBJECTIVES

The purpose of this study was to use a qualitative approach to better understand the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic from the perspectives of patients and healthcare providers.

SETTING

Participants were recruited from the bone marrow transplant clinic of a large urban outpatient cancer care centre in western Canada.

PARTICIPANTS

Focus groups were conducted with patients (n=7) and healthcare providers (n=9) to explore the importance of addressing spiritual issues across the treatment trajectory and to identify factors associated with effectively addressing these needs.

RESULTS

Data were analysed using the qualitative approach of latent content analysis. Addressing spiritual issues was understood by patients and healthcare providers, as a core, yet under addressed, component of comprehensive care. Both sets of participants felt that addressing basic spiritual issues was the responsibility of all members of the interdisciplinary team, while recognising the need for specialised and embedded support from a spiritual care professional. While healthcare providers felt that the impact of the illness and treatment had a negative effect on patients' spiritual well-being, patients felt the opposite. Skills, challenges, key time points and clinical indicators associated with addressing spiritual issues were identified.

CONCLUSIONS

Despite a number of conceptual and clinical challenges associated with addressing spiritual issues patients and their healthcare providers emphasised the importance of an integrated approach whereby basic spiritual issues are addressed by members of the interdisciplinary team and by an embedded spiritual care professional, who in addition also provides specialised support. The identification of clinical issues associated with addressing spiritual needs provides healthcare providers with clinical guidance on how to better integrate this aspect of care into their clinical practice, while also identifying acute incidences when a more targeted and specialised approach may be of benefit.

The role of religion and spirituality in mental health

PURPOSE OF REVIEW

There has been increased interest in the relationship between religion and spirituality and mental health in recent years. This article reviews recent research into the capacity of religion and spirituality to benefit or harm the mental health of believers. We also examine the implications this may have for assessment and treatment in psychiatric settings.

RECENT FINDINGS

Studies indicate that religion and spirituality can promote mental health through positive religious coping, community and support, and positive beliefs. Research also shows that religion and spirituality can be damaging to mental health by means of negative religious coping, misunderstanding and miscommunication, and negative beliefs. Tools for the assessment of patients' spiritual needs have been studied, and incorporation of spiritual themes into treatment has shown some promise.

SUMMARY

Religion and spirituality have the ability to promote or damage mental health. This potential demands an increased awareness of religious matters by practitioners in the mental health field as well as ongoing attention in psychiatric research.

Identifying religious and/or spiritual perspectives of adolescents and young adults receiving blood and marrow transplants: a prospective qualitative study

The potential benefits (or detriments) of religious beliefs in adolescent and young adults (AYA) are poorly understood. Moreover, the literature gives little guidance to health care teams or to chaplains about assessing and addressing the spiritual needs of AYA receiving hematopoietic stem cell transplants (HSCT). We used an institutional review board-approved, prospective, longitudinal study to explore the use of religion and/or spirituality (R/S) in AYA HSCT recipients and to assess changes in belief during the transplantation experience. We used the qualitative methodology, grounded theory, to gather and analyze data. Twelve AYA recipients were interviewed within 100 days of receiving HSCT and 6 participants were interviewed 1 year after HSCT; the other 6 participants died. Results from the first set of interviews identified 5 major themes: using R/S to address questions of "why me?" and "what will happen to me;" believing God has a reason; using faith practices; and benefitting from spiritual support people. The second set of interviews resulted in 4 major themes: believing God chose me; affirming that my life has a purpose; receiving spiritual encouragement; and experiencing strengthened faith. We learned that AYA patients were utilizing R/S far more than we suspected and that rather than losing faith in the process of HSCT, they reported using R/S to cope with illness and HSCT and to understand their lives as having special purpose. Our data, supported by findings of adult R/S studies, suggest that professionally prepared chaplains should be proactive in asking AYA patients about their understanding and use of faith, and the data can actively help members of the treatment team understand how AYA are using R/S to make meaning, address fear, and inform medical decisions.

Spiritual coping and adjustment in adolescents with chronic illness: a 2-year prospective study

OBJECTIVE

Examine longitudinal relationships between spiritual coping and psychological adjustment among adolescents with chronic illness.

METHODS

Adolescents (N = 128; M = 14.7 years) with cystic fibrosis or diabetes completed measures of spiritual coping and adjustment at 2 time points ∼2 years apart; parents also reported on adolescent adjustment. Prospective relationships between spiritual coping and adjustment were evaluated with an autoregressive cross-lagged path model.

RESULTS

Positive spiritual coping predicted fewer symptoms of depression and less negative spiritual coping over time, whereas negative spiritual coping predicted more positive spiritual coping. Depressive symptoms predicted higher levels of negative spiritual coping and conduct problems over time. The results did not vary by disease.

CONCLUSIONS

Positive spiritual coping may buffer adolescent patients from developing depression and maladaptive coping strategies. Results also highlight the harmful role of depression in subsequent behavior difficulties and maladaptive coping. Addressing spiritual beliefs and depressive symptoms in pediatric medical care is warranted.

Struggle with the divine in Swiss patients visited by chaplains: prevalence and correlates

A body of evidence is developing that describes harmful effects of religious struggle that includes struggle with the divine (e.g. feeling abandoned or punished by God). We examined the prevalence and correlates of divine struggle among 540 Swiss hospital patients. Some divine struggle was reported by 46 percent of the sample. Unexpected hospital admission and scores on a measure of faith were associated with a greater likelihood of reporting any divine struggle. Higher levels of anxiety and depression were also associated with divine struggle. Screening for divine struggle or other forms of religious struggle will permit, where indicated, appropriate religious assessment and care to mitigate the harmful effects that may accompany religious struggle.

Testing the Validity of a Protocol to Screen for Spiritual Struggle among Parents of Children with Cystic Fibrosis

Spirituality is important to many Americans and is used to cope with adverse events. Some forms of spiritual coping are maladaptive or troubling, and are known as negative spiritual coping or spiritual struggle. These forms of spirituality are often associated with poorer physical and mental health outcomes. Thus, in clinical contexts there is a need to identify persons who may be experiencing spiritual struggle and, if indicated, offer spiritual care that may address that struggle. Twenty-two parents of children with cystic fibrosis (CF) completed semi-structured interviews and questionnaires exploring spirituality's role in their child's illness. Interviews included oral administration of a protocol to screen for spiritual struggle. The parents also completed the negative religious coping subscale of the Brief RCOPE, a commonly used measure of spiritual struggle. Descriptive statistics were obtained. The screening protocol identified 18% of the parents as potentially having spiritual struggle. Thirty-two percent had negative religious coping scores suggestive of spiritual struggle. Comparison of results with both measures found the screening protocol had good specificity (87%) but relatively low sensitivity (29%). Using either measure, indications of spiritual struggle were associated with higher levels of depressive symptoms. The screener's administration was acceptable and feasible. The low sensitivity may be due in part to differences between the focus of the screener and that of the negative religious coping subscale, which focuses on struggle with the Divine. Further work is needed to establish the best approach to screening for spiritual struggle.