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Terminally ill cancer patients are more likely to seek hospice care and less likely to pursue aggressive end-of-life (EOL) treatment if the medical team supports their spiritual needs, according to a multi-institutional study led by Tracy Anne Balboni, MD, MPH, of the Center for Psycho-Oncology and Palliative Care Research at Dana-Farber Cancer Institute, Boston, Massachusetts. Balboni and colleagues also found that spiritual care helps improve quality of life (QOL) for patients near death.
From September 1, 2002, to August 28, 2008, the team interviewed 343 patients with various types of advanced cancer. The patients were observed until death (median, 116 days) at the following facilities: Dana-Farber; Massachusetts General Hospital; New Hampshire Oncology Hematology; Parkland Hospital, Simmons Comprehensive Cancer Center, Dallas; Veterans’ Affairs Connecticut Comprehensive Cancer Clinics; and Yale University Cancer Center.
Patients rated spiritual care from 0 to 4 for both the medical team and clergy visits at baseline and during follow-up visits. Positive and negative religious coping was assessed using the 14-question Pargament’s Brief Religious Coping Scale. The researchers sought to determine whether a relationship existed between spiritual needs, spiritual care received, and the reliance on hospice care or aggressive treatment in the last week of life. Hospice care was defined as receipt of inpatient or outpatient hospice care versus no hospice care in the last week of life. Aggressive EOL care was considered a need for ventilation, resuscitation, or an intensive care unit stay in the last week of life. Following each patient’s death, the researchers interviewed his or her caregivers regarding the patient’s psychological and physical distress and overall QOL just prior to death.
The study found that patients whose spiritual needs were largely or completely supported by the medical team received more hospice care compared with patients who did not receive spiritual support from the medical team (P = .003). Patients who relied heavily on religion for coping and whose spiritual needs were largely or completely supported were more likely to request hospice care (P = .004) and less likely to receive aggressive care (P = .02) compared with those who felt their needs were not supported. Spiritual support from the medical team and pastoral care visits were also associated with higher QOL scores near death (P = .003).
The study is the first to “prospectively evaluate the impact of spiritual care from the medical system on advanced cancer patients’ medical care and quality of life at the end of life,” said Balboni in an interview with Oncology & Biotech News
. “This study demonstrated that spiritual support from the medical team is significantly associated with greater adoption of hospice care, and among high religious coping patients, less aggressive care at the end of life. Additionally, spiritual care was prospectively associated with better patient quality of life near death.”
Balboni said the findings highlight the relevance of incorporating existing national spiritual care guidelines, such as those provided by the National Consensus Project for Quality Palliative Care. Balboni noted that spiritual care is not frequently provided in the medical setting, and the study’s findings “underscore the importance of training medical practitioners, particularly those caring for those facing life-threatening illness, in recognizing the frequent role of spirituality in illness, such as in taking spiritual histories and in assessing for spiritual needs.” She also recommended integrating pastoral care into multidisciplinary medical teams. The article was published online ahead of print at the Journal of Clinical Oncology
Balboni TA, Paulk ME, Balboni MJ, et al. Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol
. [E-pub ahead of print.]