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von Schwarz ER, Vartanian K, Schwarz AA, de Kiev LC. Is There Such a Thing as Theological Medicine? Linacre Q 2024; 91:134-143. [PMID: 38726311 PMCID: PMC11078134 DOI: 10.1177/00243639231178608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
The idea that science must be understood in existential contradiction to religion and even theology is more of a conviction than a philosophical or experiential necessity. Indeed, we may now propose "Theological Medicine" as a new terminology for a perennial reality: that most physicians, health care providers, patients, and their caretakers experience the reality of illness within a theological framework, at least for those who have some degree of spiritual or religious belief. Developing a curriculum in Theological Medicine could develop a mechanism to offer appropriate training to healthcare providers. Such a course would have to be created and delivered by experienced physicians and nursing staff, spiritual advisors, clergy representatives such as pastors or priests from different churches or faith communities, bioethicists, psychologists, social workers, psychotherapists, patient support group members, members of institutional review boards, researchers, and even legal advisors, if available. Continuing professional education requirements also create an opportunity to introduce and evaluate competency in theological medicine, an emerging discipline that could add significant value to the lived experience of medical practice which remains based on the uniquely rich relationship between physician and patient.
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Affiliation(s)
- Ernst R. von Schwarz
- Cedars Sinai Medical Center, Los Angeles, CA, USA
- University of California Los Angeles (UCLA), Los Angeles, CA, USA
- University of Riverside (UCR), Riverside, CA, USA
- Euclid University, Washington, DC, USA
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2
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Zhang G, Zhang Q, Li F. The impact of spiritual care on the psychological health and quality of life of adults with heart failure: a systematic review of randomized trials. Front Med (Lausanne) 2024; 11:1334920. [PMID: 38695025 PMCID: PMC11062134 DOI: 10.3389/fmed.2024.1334920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/05/2024] [Indexed: 05/04/2024] Open
Abstract
Background Heart failure (HF) brings not only physical pain but also psychological distress. This systematic review investigated the influence of spiritual care on the psychological well-being and quality of life in adults with HF. Methods We conducted a systematic literature review following PRISMA guidelines, searching seven electronic databases for relevant randomized controlled studies without language or temporal restrictions. The studies were assessed for quality using the Cochrane Bias Risk tool. Results A total of 13 studies (882 participants) were reviewed, investigating interventions such as religion, meditation, mental health, cognitive interventions, and spiritual support. Key factors influencing the effectiveness of spiritual care implementation included integration into routine care, respect for diversity, patient engagement, intervention quality, and alignment with patient beliefs. The majority of the studies indicated that spiritual care has a potentially beneficial impact on the mental health and quality of life of patients with HF. Conclusion The findings provide valuable insights for healthcare professionals, highlighting the importance of adopting a spiritual care approach to healthcare for this population.
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Affiliation(s)
- Guangwei Zhang
- School of Nursing, Jilin University, Changchun, China
- The First Hospital of Jilin University, Changchun, China
| | - Qiyu Zhang
- The First Hospital of Jilin University, Changchun, China
| | - Fan Li
- School of Nursing, Jilin University, Changchun, China
- Department of Pathogenobiology, The Key Laboratory of Zoonosis, Chinese, Ministry of Education, College of Basic Medicine, Jilin University, Changchun, China
- The Key Laboratory for Bionics Engineering, Ministry of Education, Jilin University, Changchun, China
- Engineering Research Center for Medical Biomaterials of Jilin Province, Jilin University, Changchun, China
- Key Laboratory for Health Biomedical Materials of Jilin Province, Jilin University, Changchun, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang, China
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3
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McClung JA, Frishman WH, Aronow WS. The Role of Palliative Care in Cardiovascular Disease. Cardiol Rev 2024:00045415-990000000-00182. [PMID: 38169299 DOI: 10.1097/crd.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The American Heart Association has recommended that palliative care be integrated into the care of all patients with advanced cardiac illnesses. Notwithstanding, the number of patients receiving specialist palliative intervention worldwide remains extremely small. This review examines the nature of palliative care and what is known about its delivery to patients with cardiac illness. Most of the published literature on the subject concern advanced heart failure; however, some data also exist regarding patients with heart transplantation, pulmonary hypertension, valvular disease, congenital heart disease, indwelling devices, mechanical circulatory support, and advanced coronary disease. In addition, outcome data, certification requirements, workforce challenges, barriers to implementation, and a potential caveat about palliative care will also be examined. Further work is required regarding appropriate means of implementation, quality control, and timing of intervention.
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Affiliation(s)
- John Arthur McClung
- From the Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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Cilona L, Veronese N, Lalicata D, Tantillo F, Naro L, Dominguez LJ, Barbagallo M. Spirituality and heart failure: a systematic review. Aging Clin Exp Res 2023; 35:2355-2361. [PMID: 37737928 PMCID: PMC10627967 DOI: 10.1007/s40520-023-02557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Heart failure (HF) is a frequent chronic disease with disturbing symptoms and complex treatments, associated with depression and lower quality of life. Some studies have shown that spirituality and religiosity may be relevant in these patients. We aimed to systematically review the medical literature on spirituality and religiosity in patients with HF. METHODS Major databases for studies investigating the effect of spirituality and religiosity in people affected by HF were searched from inception until 26th April 2023. Studies with clear definition of spirituality or religiosity, validated diagnosis of HF, and reporting outcomes of interest (i.e., incidence of mortality, cardiovascular outcomes, and quality of life) were included. RESULTS Among 810 non-duplicate records, we screened the full texts of 25 works. After excluding 18 studies, we included 7 studies (3 observational and 4 interventional) comprising 1234 HF patients followed up over a median of 3 months. Definitions of spirituality and religiosity were heterogeneous among the studies. The intervention studies showed improvements in quality-of-life parameters, some cardiovascular outcomes, or mortality, and the observational studies showed significant associations with these outcomes. CONCLUSIONS Despite the extreme heterogeneity of the populations included, of the definition of spirituality and religiosity, and of the interventions in the few studies that included it, all the studies reported some positive associations with the outcomes examined. Spirituality/religiosity is an aspect not generally taken into account in the usual practice of medicine and can potentially contribute to improving the conditions of patients with HF, a chronic disease with unfavorable prognosis.
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Affiliation(s)
- Laura Cilona
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, Geriatric Unit, "G. D'Alessandro"- PROMISE - University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy
| | - Nicola Veronese
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, Geriatric Unit, "G. D'Alessandro"- PROMISE - University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy.
| | - Diego Lalicata
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, Geriatric Unit, "G. D'Alessandro"- PROMISE - University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy
| | - Francesca Tantillo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, Geriatric Unit, "G. D'Alessandro"- PROMISE - University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy
| | - Liliana Naro
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, Geriatric Unit, "G. D'Alessandro"- PROMISE - University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy
| | - Ligia J Dominguez
- School of Medicine and Surgery, University Kore of Enna, Enna, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, Geriatric Unit, "G. D'Alessandro"- PROMISE - University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy
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Deng LR, Doyon KJ, Masters KS, Steinhauser KE, Langner PR, Siler S, Bekelman DB. How Does Spiritual Well-Being Change Over Time Among US Patients with Heart Failure and What Predicts Change? J Relig Health 2022:10.1007/s10943-022-01712-4. [PMID: 36478542 DOI: 10.1007/s10943-022-01712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Few studies have examined how spiritual well-being changes over time in patients with heart failure. We conducted a secondary analysis of data from the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) trial (N = 314). Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) at baseline and 12-month follow-up. Of the 165 patients with spiritual well-being data at follow-up, 65 (39%) experienced probable clinically meaningful changes (> 0.5 SD) in spiritual well-being (35 improved, 30 declined). Increased pain (p = 0.04), decreased dyspnea (p < 0.01), and increased life completion (p = 0.02) were associated with improvement in overall spiritual well-being. Exploratory analyses found different predictors for FACIT-Sp subscales.
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Affiliation(s)
- Lubin R Deng
- Denver/Seattle Center of Innovation, Department of Veterans Affairs Eastern Colorado Health Care System, 1700 N Wheeling St, P1-151, Aurora, CO, 80045, USA.
- Department of Statistics, Columbia University, New York, NY, USA.
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Katherine J Doyon
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kevin S Masters
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Karen E Steinhauser
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Paula R Langner
- Denver/Seattle Center of Innovation, Department of Veterans Affairs Eastern Colorado Health Care System, 1700 N Wheeling St, P1-151, Aurora, CO, 80045, USA
| | - Shaunna Siler
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - David B Bekelman
- Denver/Seattle Center of Innovation, Department of Veterans Affairs Eastern Colorado Health Care System, 1700 N Wheeling St, P1-151, Aurora, CO, 80045, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Elhag M, Awaisu A, Koenig HG, Mohamed Ibrahim MI. The Association Between Religiosity, Spirituality, and Medication Adherence Among Patients with Cardiovascular Diseases: A Systematic Review of the Literature. J Relig Health 2022; 61:3988-4027. [PMID: 35274225 PMCID: PMC9509306 DOI: 10.1007/s10943-022-01525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
This systematic review aimed to summarize the literature on the relationship between religiosity or spirituality (R/S) and medication adherence among patients with cardiovascular diseases (CVDs) and to describe the nature and extent of the studies evaluating this relationship. Seven electronic databases (PubMed, MEDLINE, EMBASE, Scopus, the Cochrane Central Library, ProQuest Theses and Dissertations, and Google Scholar) were searched with no restriction on the year of publication. The Crowe Critical Appraisal Tool was used to evaluate the methodological quality of the eligible studies. Due to the heterogeneity observed across the included studies, data synthesis was performed using a narrative approach. Nine original studies published between 2006 and 2018 were included in the review. Only a few quantitative studies have examined the relationship between R/S and medication adherence among patients with CVDs. Most studies were conducted in the USA (n = 7) and involved patients with hypertension (n = 6). Five studies showed a significant correlation between R/S (higher organizational religiousness, prayer, spirituality) and medication adherence and revealed that medication adherence improved with high R/S. The other four studies reported a negative or null association between R/S and medication adherence. Some of these studies have found relationships between R/S and medication adherence in hypertension and heart failure patients. This review showed a paucity of literature exploring the relationship between R/S and medication adherence among patients with other CVDs, such as coronary artery diseases, arrhythmia, angina and myocardial infarction. Therefore, the findings suggest that future studies are needed to explore the relationship between R/S and medication adherence among patients with other types of CVDs. Moreover, there is a need to develop interventions to improve patients' medication-taking behaviors that are tailored to their cultural beliefs and R/S.
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Affiliation(s)
- Marwa Elhag
- College of Pharmacy, Omdurman Islamic University, Omdurman, Sudan
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Harold G. Koenig
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Duke University Medical Center, Durham, NC USA
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Kowalczys A, Bohdan M, Wilkowska A, Pawłowska I, Pawłowski L, Janowiak P, Jassem E, Lelonek M, Gruchała M, Sobański P. Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice. Front Cardiovasc Med 2022; 9:895495. [PMID: 36237915 PMCID: PMC9551106 DOI: 10.3389/fcvm.2022.895495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.
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Affiliation(s)
- Anna Kowalczys
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Anna Kowalczys,
| | - Michał Bohdan
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alina Wilkowska
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Leszek Pawłowski
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Piotr Janowiak
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Sobański
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
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Gholamhosseini M, Dehghan M, Azzizadeh Forouzi M, Mangolian Shahrbabaki P, Roy C. Effectiveness of Spiritual Counseling on the Enhancement of Hope in Iranian Muslim Patients with Myocardial Infarction: A Two-Month Follow-Up. J Relig Health 2021. [PMID: 34014472 DOI: 10.1007/s10943-021-01283-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 12/14/2022]
Abstract
Hope is the most important source of coping in patients who have experienced acute cardiac events, and despair is considered an important cause of discontinued treatment and a threat to patients' mental health. This study aimed to determine the effectiveness of spiritual counseling on hope in patients with myocardial infarction over a two-month period. Fifty-six Iranian Muslim patients with myocardial infarction participated; participants were randomly allocated to either the intervention group (n = 28) or the control group (n = 28). The experiment group received three sessions of group spiritual counseling. The patients' hope was measured before intervention and immediately, one month, and two months after the intervention. The results indicated that no significant difference in hope was present between the intervention and control groups at baseline (Z = - 2.56, effect size = 0.75, P = 0.1). Significance between-group differences favoring the intervention group, however, were noted immediately post-intervention (Z = - 2.72, effect size = 0.91, P = 0.007), one month afterward (Z = - 6.22, effect size = 3.14, P < 0.001), and two months afterward (Z = - 6.10, effect size = 2.65, P < 0.001). Hope significantly improved in the intervention group during the study. Utilizing spiritual counseling as an effective non-aggressive form of treatment can improve hope among patients with myocardial infarction.
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Ross L, Miles J. Spirituality in heart failure: a review of the literature from 2014 to 2019 to identify spiritual care needs and spiritual interventions. Curr Opin Support Palliat Care 2020; 14:9-18. [DOI: 10.1097/spc.0000000000000475] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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García Pinilla JM, Díez-Villanueva P, Bover Freire R, Formiga F, Cobo Marcos M, Bonanad C, Crespo Leiro MG, Ruiz García J, Díaz Molina B, Enjuanes Grau C, García L, Rexach L, Esteban A, Martínez-Sellés M. Documento de consenso y recomendaciones sobre cuidados paliativos en insuficiencia cardiaca de las Secciones de Insuficiencia Cardiaca y Cardiología Geriátrica de la Sociedad Española de Cardiología. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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García Pinilla JM, Díez-Villanueva P, Bover Freire R, Formiga F, Cobo Marcos M, Bonanad C, Crespo Leiro MG, Ruiz García J, Díaz Molina B, Enjuanes Grau C, García L, Rexach L, Esteban A, Martínez-Sellés M. Consensus document and recommendations on palliative care in heart failure of the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology. ACTA ACUST UNITED AC 2019; 73:69-77. [PMID: 31761573 DOI: 10.1016/j.rec.2019.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/05/2019] [Indexed: 12/21/2022]
Abstract
Heart failure is a complex entity, with high morbidity and mortality. The clinical course and outcome are uncertain and difficult to predict. This document, instigated by the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology, addresses various aspects related to palliative care, where most cardiovascular disease will eventually converge. The document also establishes a consensus and a series of recommendations with the aim of recognizing and understanding the need to implement and progressively apply palliative care throughout the course of the disease, not only in the advanced stages, thus improving the care provided and quality of life. The purpose is to improve and adapt treatment to the needs and wishes of each patient, who must have adequate information and participate in decision-making.
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Affiliation(s)
- José Manuel García Pinilla
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ramón Bover Freire
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Cobo Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Clara Bonanad
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María G Crespo Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Juan Ruiz García
- Servicio de Cardiología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - Beatriz Díaz Molina
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Cristina Enjuanes Grau
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lluisa García
- Servicio de Cardiología, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | - Lourdes Rexach
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alberto Esteban
- Servicio de Cardiología, Hospital Universitario de Móstoles, Madrid, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Datla S, Verberkt CA, Hoye A, Janssen DJA, Johnson MJ. Multi-disciplinary palliative care is effective in people with symptomatic heart failure: A systematic review and narrative synthesis. Palliat Med 2019; 33:1003-1016. [PMID: 31307276 DOI: 10.1177/0269216319859148] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite recommendations, people with heart failure have poor access to palliative care. AIM To identify the evidence in relation to palliative care for people with symptomatic heart failure. DESIGN Systematic review and narrative synthesis. (PROSPERO CRD42016029911). DATA SOURCES Databases (Medline, Cochrane database, CINAHL, PsycINFO, HMIC, CareSearch Grey Literature), reference lists and citations were searched and experts contacted. Two independent reviewers screened titles and abstracts and retrieved papers against inclusion criteria. Data were extracted from included papers and studies were critically assessed using a risk of bias tool according to design. RESULTS Thirteen interventional and 10 observational studies were included. Studies were heterogeneous in terms of population, intervention, comparator, outcomes and design rendering combination inappropriate. The evaluation phase studies, with lower risk of bias, using a multi-disciplinary specialist palliative care intervention showed statistically significant benefit for patient-reported outcomes (symptom burden, depression, functional status, quality of life), resource use and costs of care. Benefit was not seen in studies with a single component/discipline intervention or with higher risk of bias. Possible contamination in some studies may have caused under-estimation of effect and missing data may have introduced bias. There was no apparent effect on survival. CONCLUSION Overall, the results support the use of multi-disciplinary palliative care in people with advanced heart failure but trials do not identify who would benefit most from specialist palliative referral. There are no sufficiently robust multi-centre evaluation phase trials to provide generalisable findings. Use of common population, intervention and outcomes in future research would allow meta-analysis.
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Affiliation(s)
- Sushma Datla
- 1 University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Angela Hoye
- 3 Department of Academic Cardiology, Hull York Medical School, University of Hull, Hull, UK
| | - Daisy J A Janssen
- 4 Department of Research & Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.,5 Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Miriam J Johnson
- 6 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Sobanski PZ, Alt-Epping B, Currow DC, Goodlin SJ, Grodzicki T, Hogg K, Janssen DJA, Johnson MJ, Krajnik M, Leget C, Martínez-Sellés M, Moroni M, Mueller PS, Ryder M, Simon ST, Stowe E, Larkin PJ. Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement. Cardiovasc Res 2019; 116:12-27. [DOI: 10.1093/cvr/cvz200] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/19/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Abstract
Contrary to common perception, modern palliative care (PC) is applicable to all people with an incurable disease, not only cancer. PC is appropriate at every stage of disease progression, when PC needs emerge. These needs can be of physical, emotional, social, or spiritual nature. This document encourages the use of validated assessment tools to recognize such needs and ascertain efficacy of management. PC interventions should be provided alongside cardiologic management. Treating breathlessness is more effective, when cardiologic management is supported by PC interventions. Treating other symptoms like pain or depression requires predominantly PC interventions. Advance Care Planning aims to ensure that the future treatment and care the person receives is concordant with their personal values and goals, even after losing decision-making capacity. It should include also disease specific aspects, such as modification of implantable device activity at the end of life. The Whole Person Care concept describes the inseparability of the physical, emotional, and spiritual dimensions of the human being. Addressing psychological and spiritual needs, together with medical treatment, maintains personal integrity and promotes emotional healing. Most PC concerns can be addressed by the usual care team, supported by a PC specialist if needed. During dying, the persons’ needs may change dynamically and intensive PC is often required. Following the death of a person, bereavement services benefit loved ones. The authors conclude that the inclusion of PC within the regular clinical framework for people with heart failure results in a substantial improvement in quality of life as well as comfort and dignity whilst dying.
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Affiliation(s)
- Piotr Z Sobanski
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Spital Schwyz, Waldeggstrasse 10, 6430 Schwyz, Switzerland
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Medical Center Göttingen Georg August University, Robertkochstrasse 40, 37075 Göttingen, Germany
| | - David C Currow
- University of Technology Sydney, Broadway, Ultimo, Sydney, 2007 New South Wales, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, Sydney, New South Wales, Australia
| | - Sarah J Goodlin
- Department of Medicine-Geriatrics, Portland Veterans Affairs Medical Center and Patient-cantered Education and Research, 3710 SW US Veterans Rd, Portland, 97239 OR, USA
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-531 Kraków, Śniadeckich 10, Poland
| | | | - Daisy J A Janssen
- Department of Research and Education, CIRO, Hornerheide 1, 6085 NM Horn, The Netherlands
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Allam Medical Building University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Carlo Leget
- University of Humanistic Studies, Chair Care Ethics, Kromme Nieuwegracht 29, Utrecht, The Netherlands
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Matteo Moroni
- S.S.D. Cure Palliative, sede di Ravenna, AUSL Romagna, Via De Gasperi 8, 48121 Ravenna, Italy
| | - Paul S Mueller
- Mayo Clinic Health System, Mayo Clinic Collage of Medicine and Science, 700 West Avennue South, La Crosse, 54601 Wisconsin, USA
| | - Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland St. Vincent’s University Hospital Dublin,Belfield, Dublin 4, Ireland
| | - Steffen T Simon
- Department of Palliative Medicine, Medical Faculty of the Universityof Cologne, Köln, Germany
- Centre for Integrated Oncology Cologne/Bonn (CIO), Medical Faculty ofthe University of Cologne, Kerpener Strasse 62, 50924 Köln, Germany
| | | | - Philip J Larkin
- Service des soins palliatifs Lausanne University Hospital, CHUV, Centre hospitalier univeritaire vaudois, Lausanne Switzerland
- Institut universitaire de formation et de recherche en soins – IUFRS, Faculté de viologie et de medicine – FBM, Lausanne, Switzerland
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14
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Abstract
As patients face serious and chronic illness, they are confronted with the realities of dying. Spiritual and existential issues are particularly prominent near the end of life and can result in significant distress. It is critical that healthcare professionals know how to address patients' and families' spiritual concerns, diagnose spiritual distress and attend to the deep suffering of patients in a way that can result in a better quality of life for patients and families. Tools such as the FICA spiritual history tool help clinicians invite patients and families to share their spiritual or existential concerns as well as sources of hope and meaning which can help them cope better with their illness. This article presents ways to help clinicians listen to the whole story of the patient and support patients in their care.
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Abstract
It is currently estimated that 5.7 million Americans live with heart failure. Of these, less than 3000 will receive a heart transplant this year, according to the US Department of Health and Human Services Organ Procurement and Transplantation Network. With successful transplantation can come significant emotional and physical symptoms that are not always addressed. Although palliative care is an interdisciplinary subspecialty designed to alleviate multiple domains of suffering in serious illness, many mistakenly associate it solely with the end of life. Traditionally associated with cancer, research into the role of palliative care in other chronic illnesses and complex life-changing therapies such as solid organ transplantation remains scarce but is nonetheless developing. Here, we try to investigate a potential role for palliative care for heart transplant recipients. Early research thus far has demonstrated importance of early involvement of palliative care teams and the significant improvement of physical and emotional symptoms in the pre- and post-transplant period. Nevertheless, more research is warranted to determine the ideal timing of palliative care integration, the effects on health care resource utilization, and whether improving quality of life can affect morbidity and mortality. By understanding these critical elements and others we may be able to develop a model for the role of palliative care for heart transplant patients.
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16
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Abstract
Heart failure is a chronic and terminal disease that affects a significant portion of the U.S. population. It is marked by considerable suffering, for which palliative care has been recommended. Palliative care standards require the inclusion of spiritual care, but there is a paucity of literature supporting effective spiritual interventions for the heart failure population. A literature search resulted in 30 articles meeting the criteria for review of spirituality and spiritual coping in the heart failure population. Findings within this body of literature include descriptive evidence of the uniqueness of spirituality in this population, quantitative and qualitative approaches to inquiry, theoretical models of spiritual coping, and proposed interventions. The article concludes with implications for future research and practice.
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Farshadnia E, Memaryan N, Asgharnejad Farid AA, Bolhari J. Who Can Provide Spiritual Counseling? A Qualitative Study from Iran. Indian J Palliat Care 2018; 24:517-525. [PMID: 30410268 PMCID: PMC6199847 DOI: 10.4103/ijpc.ijpc_104_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Aim: Given the increased prevalence of mental illnesses in recent years, many therapists and researchers use spiritual counseling (SC), which is one of the spiritual interventions. However, unfortunately, the use of this intervention by the therapists is nonscientific because the ambiguities of this issue are high in the mental health field of Iran. The aim of this study is to survey the following most important challenges: what groups are qualified to provide SC, what kind of knowledge should be known by suitable individuals, who can train spiritual counselors, what they should teach, and what teaching methods should be used. Methods: The present conventional qualitative content analysis used deep semi-structured interview to collect data from the view of stakeholders. A total of 15 people were selected through purposive sampling. After transcription of the interviews, the data were analyzed based on the Graneheim and Lundman model. Results: Results obtained from data analysis covered five main themes including SC candidates, general conditions, sciences required, SC curriculum, and spiritual counselors' training method. Conclusions: The present study has answered to the most basic questions in SC scope. Since spiritual services are rooted in our culture and religion, native guidelines should be created for them as soon as possible through conducting similar qualitative researches. Furthermore, it is worth considering teaching and training case in this scope to make spiritual service providers concern about solutions to promote these services.
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Affiliation(s)
- Elahe Farshadnia
- Department of Mental Health, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Nadereh Memaryan
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Asgharnejad Farid
- Department of Mental Health, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
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18
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Abstract
Spirituality has been identified as an important dimension of quality-of-life. The objective of this study was to review the literature on quality-of-life and spirituality, their association, and assessment tools. A search was conducted of the keyterms 'quality-of-life' and 'spirituality' in abstract or title in the databases PsycINFO and PubMed/Medline between 1979-2005, complemented by a new search at PUBMED from 2006-2016. Quality-of-life is a new concept, which encompasses and transcends the concept of health, being composed of multiple domains: physical, psychological, environmental, among others. The missing measure in health has been defined as the individual's perception of their position in life in the context of culture and value system in which they live and in relation to their goals, expectations, standards, and concerns. There is consistent evidence of an association between quality-of-life and religiosity/spirituality (R/S), through studies with reasonable methodological rigour, using several variables to assess R/S (e.g. religious affiliation, religious coping, and prayer/spirituality). There are also several valid and reliable instruments to evaluate quality-of-life and spirituality. Further studies are needed, however, especially in Brazil. Such studies will provide empirical data to be used in planning health interventions based on spirituality, seeking a better quality-of-life. In the last 10 years, research is consistently growing about quality-of-life and spirituality in many countries, and also in many areas of health research.
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Affiliation(s)
- Raquel Gehrke Panzini
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Bruno Paz Mosqueiro
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Rogério R Zimpel
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Denise Ruschel Bandeira
- b Department of Psychology , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Neusa S Rocha
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
| | - Marcelo P Fleck
- a Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre-RS , Brazil
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Abstract
There is a growing body of evidence investigating chaplaincy services. The purpose of this scoping review was to examine the empirical literature specific to the role of chaplaincy within health care published since 2009. Electronic searches of four databases were conducted in August 2015. After screening, 48 studies were retained and reviewed. Four themes emerged: experiences and perceptions of the health care chaplain (n = 15), chaplain practice (n = 9), emerging areas of health care chaplaincy (n = 16), and outcome studies (n = 8). Studies were diverse in topics covered, methods, national contexts, and clinical settings. The majority were descriptive in nature. Evidence continues to demonstrate a relationship between chaplains and increased patient satisfaction. Nascent areas of research include chaplain's role with diverse populations, involvement in clinical ethics, and confidence with research and evidence-based practice. Few conclusions can be drawn from the limited evidence on the outcomes of chaplain interventions.
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Affiliation(s)
- Barbara Pesut
- a School of Nursing, Canada Research Chair, Health, Ethics and Diversity , University of British Columbia , Kelowna , British Columbia , Canada
| | - Shane Sinclair
- b Faculty of Nursing, Cancer Care Research Professorship , University of Calgary , Calgary , Alberta , Canada
| | - George Fitchett
- c Department of Religion, Health, and Human Values , Rush University Medical Center , Chicago , Illinois , USA
| | - Madeleine Greig
- d School of Nursing , University of British Columbia Okanagan , Kelowna , British Columbia , Canada
| | - Sarah E Koss
- e Harvard Divinity School , Cambridge , Massachusetts , USA
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20
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Abstract
PURPOSE OF REVIEW Clinical works at the intersection of 'spirituality, religion, theology and medicine' are studied to identify various aspects of what constitutes spirituality, what contributes to spiritual health and how to provide spiritual-healers for our current health-care system. RECENT FINDINGS Spiritual care in the current medical world can be classed grossly into two departments: complementary and alternative medicine, considered as proxy variable for spirituality, and physician-initiated clinical Chaplaincy, informed by theology. The large body of research on 'self' as a therapeutic tool, though, falls into subtle categories: phenomenological studies, empathy, embodied care, and mindfulness-based therapies. Development in the field of 'spiritual medicine' has focused on spirituality-related curricula. SUMMARY As mindfulness-based meditation programs help build deep listening skills needed to stay aware of the 'self', Clinical Pastoral Education trains the chaplain to transcend the 'self' to provide embodied care. Clinical chaplaincy is the destination for health-care professionals as well as theological/religious scholars who have patients' spiritual health as their primary focus. Medical education curricula that train students in chaplain's model of transpersonal-mindfulness/empathy founded on neuro-physiological principles would help them gain skills in embodied care. Such education would seamlessly integrate evidence-based clinical practice and spiritual-theological concepts.
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