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Ashcraft R, Jimenez MG, Taylor H, Delzell E, Kirklin K, Edwards L, Yuen HK. The Use of a Prayer Tree to Support the Emotional and Spiritual Needs of Visitors to Critical Care Units in the Deep South Region of the United States. Am J Hosp Palliat Care 2025:10499091251330618. [PMID: 40130910 DOI: 10.1177/10499091251330618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2025] Open
Abstract
ObjectivesThis study aims to understand specific spiritual expressions by visitors of patients in intensive care units (ICUs) made through an inclusive art installation called a Prayer Tree.MethodsThe Prayer Tree was a two-dimensional plastic or painted tree affixed to a window in the ICU waiting area. Waiting areas of the neuroscience ICU and the trauma-burn ICU at a tertiary care hospital had a Prayer Tree. Visitors wrote a prayer, a hope, or a wish on a piece of paper for their relatives and friends who were patients in an ICU and hung it on a Prayer Tree. These notes were collected between the beginning of 2018 to mid-July 2023. All notes (N = 3673) were compiled and subjected to qualitative analysis.ResultsNotes were categorized into seven themes: Healing, Faith, Love, Thankfulness, Encouragement, Grief, and Prayer of Acknowledgement. The predominant spiritual expressions in the notes were prayers requesting healing by a higher power, faith, love, and thankfulness.ConclusionThe large number of notes left on the Prayer Tree indicates that many visitors chose to engage with the Prayer Tree. Themes of prayers identified in this study align with similar prayer themes in related studies. Findings from this study support that an art-based art environmental intervention in the form of a Prayer Tree to ICU waiting areas provides a needed outlet for visitors' emotional and spiritual expression. By identifying commonly expressed themes among ICU visitors, this study has enhanced understanding of their spiritual needs and expressions.
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Affiliation(s)
- Rachel Ashcraft
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria G Jimenez
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | - Emily Delzell
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | | | - Hon K Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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Osei EA, Aquah AA, Appiah S, Nasreen L, Oware J, Sarpong C, Asuboni Z, Omoze HO. Enhancing end-of-life care in Ghana: nurse strategies and practices in addressing patient needs. BMC Palliat Care 2025; 24:70. [PMID: 40087751 PMCID: PMC11907864 DOI: 10.1186/s12904-025-01706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 03/03/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND Globally, end-of-life care is vital for individuals in their final months or years, emphasizing comfort and dignity. However, the provision of palliative care in low-resource countries, such as Ghana, remains inadequately documented and poorly understood. This study aimed to identify the specific end-of-life care needs of patients and families and explore strategies to enhance end of life care practices among nurses in selected settings in Accra, Ghana. METHODOLOGY This qualitative research utilized in-depth, one-on-one interviews using semi-structured interviews in a sample of N = 32 nurses working in two selected hospitals in Ghana. Thematic content analysis was used to analyze the data. Participants were purposively selected, with the sample size determined by data saturation. RESULTS The analysis identified three main themes and eleven subthemes. The main themes were: providing dignity and comfort care, respecting ethical values, and perceptions of end-of-life care. The subthemes included: showing presence, demonstrating compassion, addressing challenges in end-of-life conversations, fostering autonomy and respect, managing gratitude and discontent, helping patients accept their condition, seeking additional training, building emotional connections, involving families, and respecting patients' cultural, social, and religious beliefs. The participants had cared for or were currently caring for patients aged 50-75 years with cancer, organ failures, Advanced Heart diseases and cognitive disorders. Participants described their efforts to make the last days of their patients and families memorable as possible. CONCLUSIONS Nurses in Ghana provide compassionate care, addressing pain relief, ethical concerns, and patient expressions of gratitude and discontent, with their efforts influenced by religious and cultural factors. To enhance end of life care quality, policymakers should implement structured end-of-life care training for nurses and develop culturally aligned palliative care guidelines to meet the needs of patients receiving end of life care.
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Affiliation(s)
- Evans Appiah Osei
- Department of Nursing/Gerontology, Purdue University, 425 South River Road, West Lafayette, Indiana, USA.
| | | | - Stella Appiah
- Department of Nursing, Valley View University, Accra, Ghana
| | - Lalani Nasreen
- Department of Nursing/Gerontology, Purdue University, 425 South River Road, West Lafayette, Indiana, USA
| | - Jenifer Oware
- Niagara College, Palliative Care- Multidiscipline, Welland, Canada
| | - Collins Sarpong
- Korlebu Teaching Hospital, Ghana Health Service, Accra, Ghana
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Bolt S, Metselaar S, Versteeg T, Kröger C. Addressing spirituality-related moral challenges in palliative care: perspectives of spiritual counselors. J Health Care Chaplain 2025:1-21. [PMID: 40029334 DOI: 10.1080/08854726.2025.2471740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
Spiritual beliefs are increasingly important toward the end-of-life as they shape perspectives on good care, life, and death. However, in pluralistic societies, the spiritual beliefs of patients and care providers may differ. Care providers can find it difficult to be responsive to spiritual diversity and to how different belief systems of patients and their families may influence perspectives on care and dying. This can lead to moral challenges. Dialogical clinical ethics support (CES) helps care providers to jointly reflect on and deal with moral challenges. However, while spirituality shapes perspectives on good care, it is rarely addressed explicitly in CES sessions. We interviewed ten spiritual counselors of different denominations in The Netherlands to explore spirituality-related moral challenges in the delivery of palliative care, and to gain insight into their perspectives on what is needed to make both dialogues with patients and family and dialogical CES more responsive to spiritual diversity.
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Affiliation(s)
- Shanti Bolt
- Center for Ethics and Health, Netherlands Ministry of Health, Welfare and Sport, The Hague, Netherlands
| | - Suzanne Metselaar
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Tonke Versteeg
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charlotte Kröger
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Faculty of Military Sciences, Netherlands Defence Academy, Netherlands Ministry of Defense, Breda, Netherlands
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Ferrell BR, Borneman T, Koczywas M, Galchutt P. Research Synthesis Related to Oncology Family Caregiver Spirituality in Palliative Care. J Palliat Med 2025; 28:77-85. [PMID: 39429141 DOI: 10.1089/jpm.2024.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2024] Open
Abstract
Background: Family caregivers are central to the delivery of serious illness care and also have needs related to their role and experience. One aspect of the family caregiver quality of life (QOL) that has received less attention is caregiver spirituality. Objectives: The research objectives for this analysis were (1) Describe spirituality in oncology family caregivers. (2) Determine the impact of palliative care interventions on spirituality and related variables in oncology family caregivers. (3) Describe findings from the research literature related to spirituality in family caregivers. The authors include two nurse researchers (BF, TB) and a physician (MK) who conducted these studies and a board-certified chaplain (PG) who contributed his expertise in chaplaincy. Design: This study synthesized data from seven earlier studies by the investigators from their research in family caregiving and also compared findings to the literature. Setting/Subjects: Subjects were family caregivers (n = 1039) of patients with cancer from studies conducted primarily in the Western United States. Measurements: The key spirituality instruments used were the Functional Assessment of Chronic Illness Therapy tool and the City of Hope QOL tool. Results: Spirituality was identified as important to family caregivers and most caregivers reported a religious affiliation. Living with uncertainty was consistently reported as the worst aspect of QOL/spirituality. Having a sense of purpose and meaning was the highest rated area. Conclusions: The authors' research synthesis and the literature support the importance of additional research and clinical focus in family caregiver spirituality in serious illness care.
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Affiliation(s)
- Betty R Ferrell
- Division of Nursing Research and Education, City of Hope Medical Center, Duarte, California, USA
| | - Tami Borneman
- Division of Nursing Research and Education, City of Hope Medical Center, Duarte, California, USA
| | - Marianna Koczywas
- Division of Nursing Research and Education, City of Hope Medical Center, Duarte, California, USA
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5
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Uzun U, Başar S, Saritaş A. Spiritual needs of family caregivers in palliative care. BMC Palliat Care 2024; 23:256. [PMID: 39511622 PMCID: PMC11542245 DOI: 10.1186/s12904-024-01589-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 10/29/2024] [Indexed: 11/15/2024] Open
Abstract
OBJECTIVE The primary aim of this study is to elucidate the spiritual needs encountered by family members who intricately engage in the progression of illness within the palliative care framework, thus assuming the paramount responsibility of caregiving. METHODS This study was approved by the Institutional Review Board and Ethics Committee of the University of Health Sciences İzmir Tepecik Training and Research Hospital (17/01/2022-2022/01-16). The research was designed as a prospective study. It was conducted through face-to-face, interactive interviews with family caregivers of patients admitted to the palliative care unit at Tepecik Training and Research Hospital between April 2022 and December 2022. The interviews were performed using a phenomenological approach and structured in a question-and-answer format. Data from twenty family caregivers were analyzed using thematic analysis. The questions were specifically designed to explore the psychological processes, spirituality, conceptions of God, meaning-making, and coping strategies of the family caregivers. RESULTS Caregivers experienced various psychological and emotional states progressing through stages of denial, anger, and acceptance. Spirituality emerged as a critical coping mechanism providing strength and meaning amidst caregiving challenges. Caregivers' perceptions of God varied from loving to punitive, influencing their interpretations of suffering and caregiving roles. CONCLUSION This study underscores the importance of integrating spiritual support into palliative care practices. Recognizing and addressing caregivers' spiritual needs is crucial for enhancing their well-being and improving the quality of palliative care delivery. Training healthcare professionals in spiritual care and implementing targeted interventions can effectively support family caregivers in their caregiving journey.
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Affiliation(s)
- Uğur Uzun
- Department of Anesthesiology and Reanimation, Health Sciences University Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Serpil Başar
- Provincial Mufti Office, Presidency of Religious Affairs, İzmir, Türkiye
| | - Aykut Saritaş
- Department of Anesthesiology and Reanimation, Health Sciences University Tepecik Training and Research Hospital, İzmir, Türkiye.
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Chan WCH, Yu CTK, Kwok DKS, Wan JKM. Prevalence of and factors associated with demoralization among family caregivers of palliative care patients in Hong Kong. Palliat Support Care 2024; 22:1125-1135. [PMID: 37409593 DOI: 10.1017/s1478951523000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVES This study aims to examine (1) the prevalence of demoralization among family caregivers of palliative care patients (PCP) in Hong Kong, (2) the percentage of caregivers who are demoralized but not depressed, (3) the factors associated with demoralization, and (4) the differences in caregivers' support needs between high and low levels of demoralization groups. METHODS Ninety-four family caregivers were recruited and completed a questionnaire that included measures of demoralization, depression and caregiving strain, caregivers' support needs, and demographic information. RESULTS The prevalence of demoralization among family caregivers of PCP was found to be 12.8% (cutoff score = 50) and 51.1% (cutoff score = 30). Although 27.7% of caregivers met the criteria of depression and demoralization, 12.8% of demoralized caregivers were not depressed. Depression and caregiving strain were identified as the predictors of demoralization. Caregivers with a poorer subjective physical status and a lower education level are more prone to demoralization. The three major caregivers' needs for support reported were (1) knowing what to expect in the future (77.7%); (2) knowing who to contact (74.5%); and (3) understanding your relative's illness (73.4%). Those who experienced a high level of demoralization often reported more need for support in end-of-life caregiving. SIGNIFICANCE OF RESULTS This is the first study that focused on the demoralization of family caregivers of PCP in the East Asian context. Demoralization is prevalent among these caregivers. We recommend that early assessment of demoralization among family caregivers of PCP be considered, especially for those who are more depressed and have a higher level of caregiving stress.
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Affiliation(s)
- Wallace Chi Ho Chan
- Department of Social Work, Education, Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - Clare Tsz Kiu Yu
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Denis Ka-Shaw Kwok
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jamie Kit Ming Wan
- Medical Social Work Department, Bradbury Hospice, Hospital Authority, Shatin, Hong Kong
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Chan WCH, Yu CTK, Kwok DKS, Wan JKM. Prevalence and factors associated with demoralization in palliative care patients: A cross-sectional study from Hong Kong. Palliat Support Care 2024; 22:709-717. [PMID: 36052852 DOI: 10.1017/s1478951522001171] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Although demoralization is common among palliative care patients, it has not yet been examined empirically in the Hong Kong Chinese context. This study aims to examine (1) the prevalence of demoralization among community-dwelling palliative care patients in Hong Kong; (2) the percentage of palliative care patients who are demoralized but not depressed and vice versa; and (3) the association of socio-demographic factors, particularly family support, with demoralization. METHOD A cross-sectional study targeting community-living palliative care patients in Hong Kong was conducted. A total of 54 patients were recruited by a local hospice and interviewed for completing a questionnaire which included measures of demoralization, depression, perceived family support, and demographic information. RESULTS The prevalence of demoralization was 64.8%. Although there was overlap between demoralization and depression (52.8% meeting the criteria of both), 7.5% of depressed patients were not demoralized, and 13.2% of demoralized patients were not depressed. Participants who were not single and had more depressive symptoms and less family support had a significantly higher demoralization level. SIGNIFICANCE OF RESULTS This is the first study which reports the prevalence of demoralization in Hong Kong. Demoralization was found common in community-living palliative care patients receiving medical social work services in Hong Kong. This study provides evidence of the importance of differentiating the constructs between demoralization and depression. It also provides an implication that those who are married, more depressed, and have the least family support could be the most vulnerable group at risk of demoralization. We recommend that early assessment of demoralization among palliative care patients be considered.
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Affiliation(s)
- Wallace Chi Ho Chan
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clare Tsz Kiu Yu
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Denis Ka Shaw Kwok
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
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Young S, Walter S, Wang K, Piamjariyakul U, Lewis F. The influence of spirituality on caregiver burden and quality of life in older adult informal caregivers. Geriatr Nurs 2024; 58:127-134. [PMID: 38797023 DOI: 10.1016/j.gerinurse.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Caregiver burden (CB) reduces quality of life (QOL) and causes poor health outcomes. Spirituality impacts this relationship. AIMS To determine prevalence of CB and investigate relationships among CB, spirituality, and QOL in older U.S. adult informal caregivers (n = 754). METHODS This was a cross-sectional, descriptive secondary analysis of data from the 2020 Health and Retirement Study using GLM and SEM. RESULTS Caregiver mean age was 65.93 (SD=8.37). Caregivers were primarily female (n = 456, 54.0%), White (n = 500, 79.5%), and married (n = 469, 65.3%). Most caregivers had moderate CB (n = 369, 49.8%). Black caregivers who were spiritual (p=.031) and caregivers with a high school diploma/GED who were spiritual (p=.021) had lower CB. Lower CB was correlated with higher QOL (p=< 0.001). SEM depicting an influencing effect of spirituality revealed good model fit (NFI=0.988; IFI=0.993; TLI=0.983; PCFI=0.397, RMSEA=0.043; χ2=9.577, p=.048, DF=4) CONCLUSIONS: Fostering spirituality in older adult caregivers could reduce CB and improve QOL.
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Affiliation(s)
- Stephanie Young
- West Virginia University, School of Nursing, 64 Medical Center Dr., Morgantown, WV 26506, USA.
| | - Suzy Walter
- West Virginia University, School of Nursing, 64 Medical Center Dr., Morgantown, WV 26506, USA
| | - Kesheng Wang
- West Virginia University, School of Nursing, 64 Medical Center Dr., Morgantown, WV 26506, USA
| | - Ubolrat Piamjariyakul
- West Virginia University, School of Nursing, 64 Medical Center Dr., Morgantown, WV 26506, USA
| | - Feylyn Lewis
- Vanderbilt University, School of Nursing, 461 21st St Ave South, Nashville, TN 37240, USA
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La IS, Johantgen M, Storr CL, Zhu S, Cagle JG, Ross A. Spirituality moderates the relationship between cancer caregiver burden and depression. Palliat Support Care 2024; 22:470-481. [PMID: 38131143 DOI: 10.1017/s1478951523001785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Cancer has become a chronic disease that requires a considerable amount of informal caregiving, often quite burdensome to family caregivers. However, the influence of spirituality on the caregivers' burden and mental health outcomes has been understudied. This study was to examine how caregiver burden, spirituality, and depression change during cancer treatment and investigate the moderating role of spirituality in the relationship between caregiver burden and depression for a sample of caregivers of persons with cancer. METHODS This secondary analysis used a longitudinal design employing 3 waves of data collection (at baseline, 3 months, and 6 months). Family caregivers completed the Caregiver Reaction Assessment, Spiritual Perspective Scale, and the PROMIS® depression measure. Linear mixed model analyses were used, controlling for pertinent covariates. RESULTS Spirituality, total caregiver burden, and depression remained stable over 6 months. More than 30% of the caregivers had mild to severe depressive symptoms at 3 time points. There was evidence of overall burden influencing depression. Of note was a protective effect of caregivers' spirituality on the relationship between depression and caregiver burden over time (b = -1.35, p = .015). The lower the spirituality, the stronger the relationship between depression and burden, especially regarding subscales of schedule burden, financial burden, and lack of family support. SIGNIFICANCE OF RESULTS Spirituality was a significant resource for coping with caregiving challenges. This study suggests that comprehensive screening and spiritual care for cancer caregivers may improve their cancer caregiving experience and possibly influence the care recipients' health.
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Affiliation(s)
- In Seo La
- College of Nursing Science, Kyung Hee University, Seoul, South Korea
| | - Meg Johantgen
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Carla L Storr
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - John G Cagle
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Alyson Ross
- Wisdom of the Whole Coaching Academy, Asheville, NC, USA
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King JJ, Badger TA, Segrin C, Thomson CA. Loneliness, Spirituality, and Health-Related Quality of Life in Hispanic English-Speaking Cancer Caregivers: A Qualitative Approach. JOURNAL OF RELIGION AND HEALTH 2024; 63:1433-1456. [PMID: 37665415 PMCID: PMC10965732 DOI: 10.1007/s10943-023-01880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 09/05/2023]
Abstract
Hispanic caregivers experiencing higher caregiving burden than their non-Hispanic cohorts, due in part to contextual factors, such as barriers to accessing health care, challenging employment environments, low education and income, immigration issues, and minority stress. Spirituality may serve as a coping strategy for Hispanic caregivers that influences health-related quality of life (HRQoL), possibly by modifying loneliness associated with caregiving. We explored these concepts using semi-structured interviews (N = 10 Hispanic caregivers). Participants shared perceptions of loneliness, spirituality, and how these factors related to HRQoL. Five themes emerged: caregiver experience, coping strategies, loneliness, religion and spirituality to gain strength. Findings suggested that spirituality and religion improved HRQoL partially by reducing loneliness. Future programs to improve HRQoL in Hispanic English-speaking cancer caregivers should address spirituality.
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Affiliation(s)
- Jennifer J King
- University of Arizona Cancer Center, University of Arizona, 1295 N. Martin Ave., Drachman Hall, A260, PO Box 245209, Tucson, AZ, 85719, USA.
| | - Terry A Badger
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Chris Segrin
- College of Social and Behavioral Sciences, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, The University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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Kurtgöz A, Edis EK. Spiritual care from the perspective of family caregivers and nurses in palliative care: a qualitative study. BMC Palliat Care 2023; 22:161. [PMID: 37884938 PMCID: PMC10601296 DOI: 10.1186/s12904-023-01286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The palliative care period not only affects patients but also family caregivers in many ways. Palliative care units are places where the spiritual needs of family caregivers become important. According to a holistic care approach, palliative care nurses should determine the spiritual needs of family caregivers and help meet these needs. OBJECTIVE This study aims at exploring nurses' and family caregivers' experiences of spiritual care. METHODS A phenomenological study was designed in this qualitative research. A total of 10 nurses working in palliative care and 11 family caregivers participated in the study. Nurses' experiences of delivering spiritual care and family caregivers' experiences of receiving spiritual care were examined through the in-depth interviewing method on a one-to-one basis. The data were examined using thematic analysis. RESULTS Four main themes were obtained by the data analysis: (I) Impacts of being in a palliative care unit; (II) Coping methods; (III) Importance of spirituality and spiritual care; (IV) Spiritual care. The results were presented according to the COREQ criteria. CONCLUSION Although spiritual care is very necessary for family caregivers, it is not offered sufficiently due to nurse-and institution-related reasons. Palliative care nurses should determine the spiritual needs of family caregivers in line with the holistic care approach. Nurse managers should determine factors preventing nurses from offering spiritual care and create solutions for these factors. The lack of nurses' knowledge about spiritual care should be resolved by providing continuous training and therefore, nurses' competencies in spiritual care should be improved.
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Affiliation(s)
- Aslı Kurtgöz
- Department of Therapy and Rehabilitation, Sabuncuoglu Serefeddin Health Services Vocational School, Amasya University, Amasya, 05100, Türkiye.
| | - Elif Keten Edis
- Department of Nursing, Health Science Faculty, Amasya University, Amasya, Türkiye
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García-Navarro EB, Navarro SG, Sousa L, José H, Caceres-Titos MJ, Ortega-Galán Á. Nursing students' perceptions of spiritual needs at the end of life. A qualitative study. Front Psychiatry 2023; 14:1132581. [PMID: 37520236 PMCID: PMC10375720 DOI: 10.3389/fpsyt.2023.1132581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Spirituality is defined as the meaning of life, being the very essence of life made up of all of the aspects inherent to it. During end-of-life processes, this need is shown to be particularly altered in patients and yet it is an aspect that the health professionals accompanying patients in this situation report being least equipped to address, alongside therapies that could help to meet these needs, such as art therapy. An exploratory qualitative study was conducted, adheres to the guidelines of COREQ (41). The study population were final year students undertaking a nursing degree at the University of Huelva, Spain. The sample was selected via intentional sampling using snowball recruitment from the study population. Stratification according to gender was performed due to the feminised nature of the population. Sample size was determined progressively during the research, with recruitment ceasing at 13 informants once information saturation was achieved. Inclusion criteria required that participants were to be final year students enrolled on a nursing degree who had provided consent to participate voluntarily in the research. The analysis Realized was interpretive phenomenological (IPA) as described by Smith (43-45). The present study revealed that students perceive their training on spiritual care to be deficient. Despite them reporting that they possess the skills and tools to provide end-of-life care, this is not enough to provide effective accompaniment, given that this moment brings them into touch with their own insecurities. Students verbalized the need to learn strategies to address this shortcoming regarding final accompaniment, for instance, through art, with creativity being one of the skills with the potential to uncover the meaning of life.
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Affiliation(s)
- E. Begoña García-Navarro
- Social Studies and Social Intervention Research Center & COIDESO, University of Huelva, Huelva, Spain
- Department of Nursing, University of Huelva, Huelva, Spain
| | | | - Luis Sousa
- Escola Superior de Saúde Atlântica, Barcarena, Portugal
| | - Helena José
- Escola Superior de Saúde Atlântica, Barcarena, Portugal
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Reblin M, Iacob E, Tay DL, Li H, Hebdon MCT, Beck A, Donaldson G, Cloyes KG, Ellington L. Family Caregiver Reports of Their Own and Patient Symptoms in Cancer Home Hospice Approaching End-of-Life. Am J Hosp Palliat Care 2023; 40:508-516. [PMID: 35689339 PMCID: PMC9734284 DOI: 10.1177/10499091221108119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context: Family caregivers assume the primary responsibility of assessing and managing hospice cancer patient symptoms while simultaneously managing their own wellbeing and symptoms. Objectives: Describe caregivers' assessment of hospice cancer patient and their own symptoms during the last 60 days of patient life, and assess the relationship between patient and caregiver symptoms over time. Methods: Caregiver symptom report of self and cancer home hospice patient symptom data were collected via telephone in the final 60 days of patient life. Descriptive data on symptom severity and prevalence were summarized. Exploratory Factor Analysis was used to group individual symptoms. Factors representing patient symptoms, caregiver symptoms, and caregiver outlook were analyzed using mixed-effects analysis to determine relationships between factors and change in relationship between factors over time. Results: Data from 61 patient-caregiver dyads are presented. At least 1 day of moderate-to-severe symptoms were reported in the majority of dyads. Significant auto-regressive associations were found, namely previous factor scores for an individual positively predicted the next factor scores for that individual. Previous caregiver report of patient symptoms was also positively associated with the next report of caregiver symptoms; previous caregiver report of their own symptoms were negatively associated with their next report of patient symptoms. Patient and caregiver symptoms and caregiver outlook worsened over time and the relationship between patient and caregiver symptoms strengthened closer to death. Conclusion: Our findings may guide hospice care team responses to caregiver and patient symptoms to promote individual level and unit level functioning.
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Affiliation(s)
- Maija Reblin
- School of Medicine, University of Vermont, Burlington, VT, USA
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Djin L. Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Hui Li
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Anna Beck
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Gary Donaldson
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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14
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Young S, Smith M, Shafique S, Piamjariyakul U. You're Not Who You Used to Be: A Case Report of a Family Living with Heart Failure and Vascular Dementia. Home Healthc Now 2023; 41:140-148. [PMID: 37144929 PMCID: PMC11168254 DOI: 10.1097/nhh.0000000000001165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Heart failure and vascular dementia have similar underlying pathologies, so it is not uncommon for one condition to exist in the presence of the other. In-home management of each condition is challenging for patients and their family caregivers, but when both conditions are present, those challenges are amplified. The purpose of this case report is to describe one family's experience managing heart failure and vascular dementia at home. A mixed method of semistructured interviews and short surveys was used to examine the health status and well-being of the patient and family caregiver. Data were derived from individual interviews and standardized measures. Survey results revealed the patient had worsening dementia, poor heart failure-related quality of life, poor spiritual well-being, depression, and diminished self-care. The caregiver reported poor physical and mental health. Interview data revealed frustration dealing with worsening symptoms, inadequate information about disease progression, and fear of an unknown future. Additionally, the patient suggested strategies to deal with challenges. Families managing heart failure and vascular dementia need easy-to-understand education from healthcare providers, on-going assessments, and early referrals to support services including those provided by social workers and chaplains.
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Lv T, Li L, Wang H, Zhao H, Chen F, He X, Zhang H. Relationship between Death Coping and Death Cognition and Meaning in Life among Nurses: A Cross-Sectional Study. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231158911. [PMID: 36803151 DOI: 10.1177/00302228231158911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
To explore nurses' ability to cope with death and its relationship with death cognition and meaning in life in the context of Chinese traditional culture. 1146 nurses from six tertiary hospitals were recruited. Participants completed the Coping with Death Scale, the Meaning in Life Questionnaire, and the self-made Death Cognition Questionnaire. Multiple regression analysis revealed that the search for meaning, the understanding of "good death", receiving education related to life-and-death, cultural aspect, the presence of meaning, and the number of patient deaths experienced in career explained 20.3% of the variance in the ability to cope with death. Lacking a correct understanding of death, nurses are not sufficiently prepared to deal with death and their ability to cope with death is influenced by the unique cognition of death and the sense of the meaning in life in the context of Chinese traditional culture.
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Affiliation(s)
- Tingting Lv
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Lezhi Li
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Huiping Wang
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hong Zhao
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Fengzhi Chen
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiachan He
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Huilin Zhang
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
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Hayden L, Byrne E, Deegan A, Dunne S, Gallagher P. A qualitative meta-synthesis examining spirituality as experienced by individuals living with terminal cancer. Health Psychol Open 2022; 9:20551029221121526. [PMID: 36105766 PMCID: PMC9465615 DOI: 10.1177/20551029221121526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This review aimed to examine and synthesise literature on spirituality as experienced by individuals living with terminal cancer. Six databases were systematically searched for studies with qualitative findings relevant to spirituality and terminal cancer. Thirty-seven studies were included and thematic synthesis was used to identify themes. Analytical themes included: making sense of dying; living with dying; feeling connected; and being reflective. This review highlights how the experience of spirituality can positively impact the lives of terminal cancer patients. Further, these findings suggest that spirituality can be a transformative experience that allows individuals to experience peace at end of life.
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Affiliation(s)
- Lucy Hayden
- School of Psychology, Dublin City University, Ireland
| | - Emma Byrne
- School of Psychology, Dublin City University, Ireland
| | - Avril Deegan
- School of Psychology, Dublin City University, Ireland
| | - Simon Dunne
- School of Psychology, Dublin City University, Ireland
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17
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Reina-Gamba NC, Medellin-Olaya J, Burbano-Rivera DV, Miranda-Rojas HM, Vargas-Escobar LM, Colmenares-Tovar C. Health-Related Quality of Life in Primary Caregivers of People Receiving Palliative Home Care. J Hosp Palliat Nurs 2022; 24:E41-E47. [PMID: 35019891 DOI: 10.1097/njh.0000000000000832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary caregivers face constant challenges because of changes in the clinical situation of the person receiving palliative home care. These changes can alter the health-related quality of life and all its dimensions. This study aimed to describe the health-related quality of life of 137 primary caregivers of people enrolled in a palliative home care program in Bogotá, Colombia, applying a quantitative, descriptive, and cross-sectional research design. The Caregiver's Quality of Life Instrument, initially developed by Ferrell, and the sociodemographic characteristics form for caregivers of people with chronic disease, both previously validated in the Colombian population, were used. The results showed that the primary caregivers have a good and adequate overall health-related quality of life; however, they presented some alterations in the physical, psychological, and social dimensions. Therefore, nursing and interdisciplinary palliative care teams should aim their interventions not only at patients but also at primary caregivers during palliative home care.
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18
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Benites AC, Arantes de Oliveira-Cardoso É, Dos Santos MA. Spirituality in Brazilian family caregivers of patients with cancer from the end-of-life care to bereavement. DEATH STUDIES 2022; 47:249-258. [PMID: 35300583 DOI: 10.1080/07481187.2022.2051095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although spirituality can be a source of support during end-of-life and engage a transformative experience after loss, few studies report family members' spiritual and existential needs considering their experiences over time. We conducted a longitudinal interpretative phenomenological analysis from audio-recorded interviews of 10 family caregivers while providing end-of-life care for cancer patients and during bereavement. Participants' spirituality experiences were presented in three superordinate themes: connectedness with religious beliefs and the deceased; re-signifying relationships, life, and loss; suffering and the family caregiver's needs. Finding connection through relationships, greater existential and spiritual suffering post-loss were important issues involved in expressing their spirituality.
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Affiliation(s)
- Andrea Carolina Benites
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Ribeirao Preto, Brazil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Érika Arantes de Oliveira-Cardoso
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Ribeirao Preto, Brazil
| | - Manoel Antônio Dos Santos
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Ribeirao Preto, Brazil
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Validation of the Brief RCOPE in Portuguese Family Caregivers of Adults with Health Conditions. RELIGIONS 2022. [DOI: 10.3390/rel13020144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Coping is a multifactorial and individual process related to responding to stressful situations, such as being a caregiver of a relative with health conditions. Spiritual/religious coping is an important internal resource used by individuals enduring stressful situations. The 14-item Brief RCOPE is a widely used instrument but not available in European Portuguese. Objective: To translate, adapt and validate the 14-item Brief RCOPE in Portuguese caregivers of an adult relative with a health condition. Method: The methodological guideline provided by Sousa and Rojjanasrirat was used to examine the psychometric properties of the Brief RCOPE. Results: The linguistic and conceptual equivalence of the scale was determined. The internal consistency was acceptable (Cronbach’s α = 0.86). The Principal Axis Factor (PAF) analysis with varimax rotation identified two factors made up of 13 items, and one item was excluded from the scale. Conclusion: The European Portuguese version of the Brief RCOPE is a reliable and valid measure for assessing religious coping of family caregivers of adults with health conditions.
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"You begin to give more value in life, in minutes, in seconds": spiritual and existential experiences of family caregivers of patients with advanced cancer receiving end-of-life care in Brazil. Support Care Cancer 2021; 30:2631-2638. [PMID: 34817692 PMCID: PMC8611251 DOI: 10.1007/s00520-021-06712-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022]
Abstract
Purpose Facing the end of life may trigger significant distress in family caregivers of patients with advanced cancer. However, few studies have addressed the spiritual and existential concerns of these family caregivers in their end-of-life care journey. This study aimed to understand the spiritual and existential experience of family caregivers of patients with advanced cancer facing the end of life in Brazil. Methods A purposive sample of 16 family caregivers of hospitalized terminally ill cancer patients in Brazil participated in in-depth interviews. Data collection and analysis were based on interpretative phenomenological analysis. Results Three superordinate themes in their spiritual and existential experience were identified: (i) connectedness through caregiving, personal relationships, and spiritual beliefs; (ii) shifting hope: from death as a possibility to preparation for impending death; (iii) reframing suffering and meaning. For these caregivers, the relationship with the patient and with others, their spiritual beliefs, and hope were significant sources of meaning. Hope was sustained by death avoidance, oscillating with death acceptance and hope that it would occur with comfort. Family caregivers also experienced existential and spiritual suffering in the form of guilt, suppressed emotions, and loneliness. Conclusion Health care providers should address and support caregivers’ spiritual needs and their relationships with the patient and others during end-of-life care and facilitate reflection regarding existential concerns, meaning, and preparation for impending death.
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21
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Koljack CE, Miyasaki J, Prizer LP, Katz M, Galifianakis N, Sillau SH, Kluger BM. Predictors of Spiritual Well-Being in Family Caregivers for Individuals with Parkinson's Disease. J Palliat Med 2021; 25:606-613. [PMID: 34818097 DOI: 10.1089/jpm.2020.0797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Parkinson's disease (PD) is a common neurodegenerative illness that causes disability through both motor and nonmotor symptoms. Family caregivers provide substantial care to persons living with PD, often at great personal cost. While spiritual well-being and spirituality have been suggested to promote resiliency in caregivers of persons living with cancer and dementia, this issue has not been explored in PD. Objective: The aim of this study was to identify predictors of spiritual well-being in PD patients' caregivers. Design: A cross-sectional analysis was performed. Our primary outcome measure, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), was measured in caregivers alongside measures of patient quality of life, symptom burden, global function, grief, and spiritual well-being and caregiver mood, burden, and perceptions of patient quality of life. Univariate correlation and multiple regression were used to determine associations between predictor variables and caregiver FACIT-Sp. Setting/Subjects: PD patient/caregiver dyads were recruited through three academic medical centers in the United States and Canada and regional community support groups. Results: We recruited 183 dyads. Patient faith, symptom burden, health-related quality of life, depression, motor function, and grief were significant predictors of caregiver spiritual well-being. Predictive caregiver factors included caregiver depression and anxiety. These factors remained significant in combined models, suggesting that both patient and caregiver factors make independent contributions to caregiver spiritual well-being. Conclusions: The present study suggests that both patient and caregiver factors are associated with spiritual well-being in PD. Further study is needed to understand the causal relationship of these factors and whether interventions to support caregiver spiritual well-being improve outcomes for caregivers or patients. Clinicaltrials.gov registration NCT02533921.
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Affiliation(s)
- Claire E Koljack
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Janis Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Maya Katz
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Nick Galifianakis
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Benzi M Kluger
- Department of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
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22
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Huang LT, Tai CY, Longcoy J, McMillan SC. The Mutual Effects of Perceived Spiritual Needs on Quality of Life in Patients With Advanced Cancer and Family Caregivers. J Hosp Palliat Nurs 2021; 23:323-330. [PMID: 34185726 PMCID: PMC8243389 DOI: 10.1097/njh.0000000000000758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Perceived spiritual needs may increase when patients with advanced cancer and their family caregivers are confronted with the challenges of physical and psychological distress. Given the intertwined relationships between patients and family caregivers, their interdependence should be considered to understand how perceived spiritual needs affect the quality of life of their own and of their partner. This study used the Actor-Partner Interdependence Model as the conceptual model to investigate the mutual effects of perceived spiritual needs on the quality of life in patients with advanced cancer and their family caregivers after being admitted to hospice. This cross-sectional study used the baseline data of a large clinical trial and identified that patients with cancer and their family caregivers perceived similar spiritual needs associated with the community and outlook needs and had fewer unmet spiritual needs. After controlling for partner effects, perceived outlook needs shown in patients significantly predicted their own functional well-being and social/spiritual well-being. Outlook and community needs perceived by family caregivers also significantly predicted their own mental health. Although partner effects were not shown as expected, the findings provide insight into the mutuality of spirituality and demonstrate the necessity of providing timely and ongoing spiritual assessment and care.
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Affiliation(s)
- Li-Ting Huang
- College of Nursing, University of Illinois at Chicago
| | - Chun-Yi Tai
- School of Nursing, National Taipei University of Nursing and Health Sciences
| | - Joshua Longcoy
- Center for Community Health Equity, Rush University Medical Center
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Lalani N, Drolet JL, McDonald-Harker C, Brown MRG, Brett-MacLean P, Agyapong VI, Greenshaw AJ, Silverstone PH. Nurturing Spiritual Resilience to Promote Post-disaster Community Recovery: The 2016 Alberta Wildfire in Canada. Front Public Health 2021; 9:682558. [PMID: 34368055 PMCID: PMC8342851 DOI: 10.3389/fpubh.2021.682558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/18/2021] [Indexed: 12/04/2022] Open
Abstract
The 2016 Alberta wildfire, the largest insured natural disaster in Canada, led to a mass evacuation of residents of Fort McMurray, a small city in northern Alberta. The wildfire resulted in significant damages to housing and community infrastructure. The entire community was displaced for several weeks. Post-disaster, community members experienced individual and collective trauma, and other negative mental health impacts in response to the significant losses and grief they endured. Spirituality has been found to be a major protective factor in facilitating resiliency and recovery following the experience of disaster. Nonetheless, little focus has been directed toward how spirituality can strengthen and empower community capacity and growth during post-disaster recovery. Our study explored various meanings and concerns, along with tools and strategies that helped to nurture spiritual resilience and well-being among residents of Fort McMurray following the Alberta wildfire. Data were collected through interviews and focus group discussions with community influencers working to support long-term recovery efforts in the city. Participants identified a number of spiritual resources such as a strong sense of belonging, a shared positive outlook, faith and hope, compassion, and sense of gratitude, which contributed to increased resilience and positive health and well-being and helped them to support families and communities in the post disaster recovery period. Our findings indicate that spiritual values and beliefs can play a significant role in building resilience and promoting individual and communal healing and recovery post-disaster. These findings have important implications for post-disaster recovery strategies, as they highlight the need to ensure supports for interventions and initiatives that strengthen a collective sense of identity and social cohesion, informed by communal norms and beliefs, including programs and resources which support opportunities for reflexivity to foster shared healing and ongoing recovery processes.
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Affiliation(s)
- Nasreen Lalani
- School of Nursing, Purdue University, West Lafayette, IN, United States
| | - Julie L. Drolet
- Faculty of Social Work, University of Calgary, Edmonton, AB, Canada
| | | | - Matthew R. G. Brown
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Pamela Brett-MacLean
- Department of Psychiatry & Director, Arts & Humanities in Health & Medicine MD Program, and Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent I.O. Agyapong
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andrew J. Greenshaw
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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How does spirituality manifest in family caregivers of terminally ill cancer patients? A qualitative secondary analysis. Palliat Support Care 2021; 20:45-54. [PMID: 33781355 DOI: 10.1017/s1478951521000353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Considering the risk of spiritual distress among terminally ill patients, experts long agree that spiritual care has to be an integral component of palliative care. Despite this consensus, the role of spirituality among family caregivers remains largely unexplored. We aimed to describe how spirituality manifests in the lived experience of family caregivers (FCs) in a palliative care context. METHOD As part of a secondary analysis, data derived from two qualitative primary studies on FCs' burdens and needs in the context of caring for a patient with a diagnosis of incurable cancer. Previously transcribed interviews were examined by means of a thematic analysis, transcending the focus of the primary studies to examine how spirituality arises and/or persists in the life of FCs from the time of diagnosis of incurable cancer up until bereavement. RESULTS Twenty-nine narratives were explored and all included spirituality as a relevant theme. Analysis revealed four aspects associated with the presence of spirituality among FCs' experiences: "Connectedness," "Religious Faith," "Transcendence," "Hope," and a fifth overarching aspect which we named "Ongoing integration of spiritual experience." Spirituality appeared as a multilayered phenomenon and was shaped individually among FCs' narratives. SIGNIFICANCE OF RESULTS In view of the results, exploring and discussing spirituality and underlying experiences in the situation as an FC seems likely to widen the perspective on FCs' problems and needs. Further research on spiritual needs among FCs of patients with incurable life-limiting cancer is deemed necessary.
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25
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Benites AC, Rodin G, Leite ACAB, Nascimento LC, Dos Santos MA. 'The experience of spirituality in family caregivers of adult and elderly cancer patients receiving palliative care: A meta-synthesis'. Eur J Cancer Care (Engl) 2021; 30:e13424. [PMID: 33547680 DOI: 10.1111/ecc.13424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Spirituality is a multidimensional aspect of human experience. In the context of palliative care, it is an individual resource that can be used to cope with illness and to assign new meanings to suffering. Qualitative studies that aim to investigate the experience of spirituality and the needs of family caregivers in this context are rare. OBJECTIVE This meta-synthesis aimed to synthesise qualitative studies on the experience of spirituality in family caregivers of adult and elderly cancer patients receiving palliative care. METHODS A systematic review was performed in six databases, and 14 studies were included in this meta-synthesis. RESULTS The results are presented as a thematic synthesis divided into two analytical themes: (1) The interweaving of spirituality with end-of-life care and (2) The dimensions of suffering and spirituality in the dying process of the loved one. Each analytical theme is explained by two descriptive themes. The results showed that family caregivers express their spirituality in a multidimensional way, giving meaning to the care provided and reassessing the meanings of their lives and their suffering. CONCLUSION Investigating the suffering and spiritual needs of family members in this context may be of value to inform comprehensive and multi-professional psychosocial care.
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Affiliation(s)
- Andrea Carolina Benites
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ana Carolina Andrade Biaggi Leite
- Escola de Enfermagem de Ribeirão Preto, WHO Collaborating Centre for Nursing Research Development, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucila Castanheira Nascimento
- Escola de Enfermagem de Ribeirão Preto, WHO Collaborating Centre for Nursing Research Development, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Manoel Antônio Dos Santos
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Kang KA, Mamier I, Chun J, Taylor EJ. Cross-cultural Validation of the Spiritual Interests Related to Illness Tool-Korean Version. J Hosp Palliat Nurs 2021; 23:98-108. [PMID: 33252424 DOI: 10.1097/njh.0000000000000718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Living with a terminal illness, whether as a patient or as the family member of a patient, often involves spiritual challenges. The ability to ascertain and meet the spiritual needs of terminally ill patients and their loved ones is an essential part of providing compassionate and competent whole person care. This study aimed to adapt the original Spiritual Interests Related to Illness Tool (SpIRIT) for use in Korea (SpIRIT-K) and to assess its reliability and validity as a tool to determine the spiritual needs of terminally ill Korean patients and their caregivers. After translation-back-translation and content validity indexing, SpIRIT-K was administered to 106 terminally ill patients and 105 family caregivers in 20 sites across South Korea. SPSS and AMOS were used for evaluating validity and reliability. The 37-item SpIRIT-K consisted of 8 factors (subscales), with each subscale consisting of between 3 and 8 items. Evidence for structural and convergent validity was observed. Internal reliability of the overall scale was 0.95. The findings showed patients and family caregivers reported no significant difference in 7 of the 8 subscales, demonstrating known-groups validity. The rigorous process of establishing cross-cultural validity for this scale provided evidence supporting its validity and reliability. The findings suggest that SpIRIT-K is suitable for research and for clinical purposes in palliative care settings in South Korea. This development also allows for comparisons between Korean and North American cultures in terms of spiritual needs among terminally ill patients and their caregivers.
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Gutierrez‐Baena B, Romero‐Grimaldi C. Development and psychometric testing of the Spanish version of the Caregiver Preparedness Scale. Nurs Open 2020; 8:1183-1193. [PMID: 33340272 PMCID: PMC8046102 DOI: 10.1002/nop2.732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/09/2020] [Indexed: 01/10/2023] Open
Abstract
AIM To psychometrically test the Spanish version of the Caregiver Preparedness Scale (CPS) and document the preparedness level of caregivers. DESIGN A descriptive and validation study. METHOD Purposive sampling method was used to select 171 family caregivers Spain. The scale was cross-culturally adapted through a process that included translation, comparison with versions in other languages and back-translation, review, pre-testing and validity, and reliability tests. RESULTS The Spanish family caregivers are mainly female (79%) and married (75%). The Spanish version of the CPS presents changes with respect to the original. Confirmatory factor analysis supported the single-factor model. Analysis of internal consistency yielded a Cronbach's α of 0.89. Significant correlations (p < .01) with other scales supported convergent validity. A descriptive analysis of the validated scale showed average levels of preparation (2.16 out of 4). Caregivers felt better prepared to attend to the patient's physical needs than emotional or spiritual needs.
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Affiliation(s)
- Belen Gutierrez‐Baena
- Vocational training center “María de Madariaga”CádizSpain
- Hospital “Viamed Bahía de Cádiz,” Chiclana de la FronteraCádizSpain
| | - Carmen Romero‐Grimaldi
- Nursing Faculty “Salus Infirmorum”University of CadizCádizSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III.MadridSpain
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Lalani N, Ali G. Methodological and ethical challenges while conducting qualitative research on spirituality and end of life in a Muslim context: a guide to novice researchers. Int J Palliat Nurs 2020; 26:362-370. [PMID: 33108928 DOI: 10.12968/ijpn.2020.26.7.362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract Spirituality could be understood as a personal belief, a relation with sacred, divine experience, a sense of purpose and meaning towards life, authenticity and connectedness. It is a continually evolving, highly complex, contextual, subjective, and sensitive construct. A continuous development is seen around understanding about spirituality and spiritual concepts, such as spiritual experiences, spiritual pain and spiritual distress, especially among patients and families at the end of life. The concepts, values, attitudes, and beliefs around spirituality, spiritual needs and expressions vary among different individuals, cultures, and religions. There is a dearth of literature around spirituality, especially among Muslim patients and families at the end of life. The complexities around the concept of spirituality in the literature raise several ethical and methodological concerns for a novice researcher while planning and conducting a study on spirituality during end-of-life care in a hospice setting, especially among a Muslim population. This paper aims to share some of the methodological and ethical challenges that can be faced by qualitative researchers while conducting research around spirituality and end-of-life care in an Islamic/Muslim context. Major challenges include defining the term spirituality, spirituality and culture, communication, power relations, language and translation, recruitment and selection of the participants, emotional distress, and reflexivity and reciprocity. Having an in-depth understanding of these challenges can guide researchers to address these issues adequately in their spirituality research in a Muslim context.
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Affiliation(s)
- Nasreen Lalani
- Assistant Professor, Purdue University, West Lafayette, Indiana, USA
| | - Gulnar Ali
- Consultant in Spirituality and Existential Care, New School of Psychotherapy and Counselling, London, UK
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29
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Abstract
Numerous spirituality models and tools have been developed in health education and research, but a gap still exists around the conceptual clarity and articulation of spirituality among nurses and healthcare providers. Nurses and healthcare providers still find it difficult to interpret and apply the concepts of spirituality in their practice settings. This paper provides a concept analysis of spirituality using the Walker and Avant method of conceptual analysis. Several databases including conceptual and empirical literature from various disciplines have been used. The defining attributes of spirituality included spirituality and religion as a separable or mutual construct, spirituality as a personal construct, wholeness and integration, meaning making and purpose, sense of connectedness and relationship, transcendence, inner source of power, energy, and strength. Major antecedents of spirituality found were faith, personal values, and belief systems, and life adversities. Consequences of spirituality included personal/spiritual growth and wellbeing, resilience, and religiousness. Spirituality is a unique and personal human experience, an individualised journey characterised by multiple experiential accounts such as meaning making, purpose, connectedness, wholeness and integration, energy, and transcendence. Spiritual experiences are often difficult to examine and measure using scientific tools and empirical language. Healthcare providers need to fully understand and apply spirituality and spiritual care aspects to provide holistic person-centred care.
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Vachon M. "It Made Me More Human": Existential Journeys of Family Caregivers from Prognosis Notification Until after the Death of a Loved One. J Palliat Med 2020; 23:1613-1618. [PMID: 32343649 DOI: 10.1089/jpm.2019.0689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: An essential component of palliative care (PC) is providing psychological and existential support to the family caregivers. However, there is scant research on the existential journeys of family caregivers throughout the disease trajectory and beyond. Objective: This study aimed to obtain a deep understanding of the existential journeys of family caregivers from prognosis notification until after the death. Setting/Participants: A purposive sample of 22 caregivers of terminally ill family members who had died was recruited at a PC bereavement program in Canada and participated to qualitative phenomenological interviews. Data Collection: Interpretative phenomenological analysis was used to analyze the data derived from in-depth interviews. Results: The participants' existential journeys can be described by three dynamic dimensions: (1) from avoidance to integration of death, (2) from meaninglessness to meaningfulness, and (3) from transformation to transmission. The findings highlight the importance to family caregivers of having opportunities to share their experiences as a way to progress on the existential journey. Conclusions: PC should extend beyond the death of the loved one and expand to include existential aspects of the caregiving experience.
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Affiliation(s)
- Mélanie Vachon
- Psychology Department, Université du Québec à Montréal, Montréal, Québec, Canada.,Center for Research and Intervention on Suicide, Ethical Issues, and End-of-Life Practices, Montreal, Québec, Canada
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Cai S, Guo Q, Luo Y, Zhou Y, Abbas A, Zhou X, Peng X. Spiritual needs and communicating about death in nonreligious theistic families in pediatric palliative care: A qualitative study. Palliat Med 2020; 34:533-540. [PMID: 31971068 DOI: 10.1177/0269216319896747] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spiritual support should be offered to all patients and their families regardless of their affiliated status with an organized religion. AIM To understand nonreligious theistic parents' spirituality and to explore how parents discuss death with their terminally ill children in mainland China. DESIGN Qualitative study. SETTING/PARTICIPANTS This study was conducted in the hematology oncology center at Beijing Children's Hospital. Participants in this study included 16 bereaved parents. RESULTS Participants described themselves as nonreligious but showed a tendency toward a particular religion. Parents sought religious support in the face of the life-threatening conditions that affected their child and regarded the religious belief as an important way to get psychological and spiritual comfort after experiencing the death of their child. Religious support could partially address parents' spiritual needs. Parents' spiritual needs still require other supports such as bereavement services, death education, and family support groups. Some parents stated that it was difficult to find a way to discuss death with their children. For patients who come from nonreligious theistic families, their understanding of death was more complex and may be related to atheism. CONCLUSION Religious support could be an element of spiritual support for nonreligious theistic parents of terminally ill children. Multiple strategies including religious supports and nonreligious supports should be rationally integrated into spiritual support of nonreligious theistic family. Patient's personal belief in death should be assessed before discussing death with them.
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Affiliation(s)
- Siyu Cai
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qiaohong Guo
- School of Nursing, Capital Medical University, Beijing, China
| | - Yanhui Luo
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuchen Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ali Abbas
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuan Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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O'Callaghan C, Brooker J, de Silva W, Glenister D, Melia Cert A, Symons X, Kissane D, Michael N. Patients' and Caregivers' Contested Perspectives on Spiritual Care for Those Affected by Advanced Illnesses: A Qualitative Descriptive Study. J Pain Symptom Manage 2019; 58:977-988. [PMID: 31404641 DOI: 10.1016/j.jpainsymman.2019.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Spiritual care refers to practices and rituals addressing spiritual/religious concerns. It supports coping with loss and finding hope, meaning, and peace. Although integral to palliative care, its implementation is challenging. OBJECTIVE To understand an Australian cohort of patients' and caregivers' perspectives about experiencing and optimizing spiritual care in the context of advanced illness. METHODS Patients and caregivers of patients with ≤12 month prognosis were recruited from a broader spiritual study via criterion sampling and agreed to opt-in interviews. Participants from an Australian, metropolitan health service received a spiritual care definition and were interviewed. Transcripts were analyzed using qualitative description. RESULTS 30 patients (17 male; mean age 70 years) and 10 caregivers (six male; mean age 58.9 years) participated. 27 identified as Christian, and 10 had no religion. Participants described multifaceted and contested beliefs about spirituality. Many queried the tangibility of spirituality, but all valued respectful staff who affirmed personhood, that is, each individual's worth, especially when care exceeded expectations. They also resonated with positive organizational and environmental tones that improved holistic well-being. Participants stressed the importance of the hospital's welcoming context and skilled care, which comforted and reassured. CONCLUSION Although many patients and caregivers did not resonate with the term "spiritual care," all described how the hospital's hospitality could affirm their values and strengthen coping. The phrase "spiritual care and hospitality" may optimally articulate and guide care in similar, pluralist inpatient palliative care contexts, recognizing that such care encompasses an interplay of generalist and specialist pastoral care staff and organizational and environmental qualities.
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Affiliation(s)
- Clare O'Callaghan
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia; Institute for Ethics & Society, The University of Notre Dame Australia, New South Wales, Australia; Departments of Psychosocial Cancer Care and Medicine, St. Vincent's Hospital Fitzroy, The University of Melbourne, Victoria, Australia.
| | - Joanne Brooker
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - William de Silva
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - David Glenister
- Centre for Clinical Pastoral Education, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Adelaide Melia Cert
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia
| | - Xavier Symons
- Institute for Ethics & Society, The University of Notre Dame Australia, New South Wales, Australia
| | - David Kissane
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia; Szalmuk Family Psycho-oncology Research Unit, Cabrini Health, Malvern, Melbourne, Victoria, Australia; School of Medicine, The University of Notre Dame Australia, New South Wales, Australia
| | - Natasha Michael
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; School of Medicine, The University of Notre Dame Australia, New South Wales, Australia
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