Provision of Spiritual Care to Patients With Advanced Cancer

Associations With Medical Care and Quality of Life Near Death

Bibliographic Data

ID23320206
AuthorsTracy A Balboni (0000-0001-6564-6951, Brigham and Women's Hospital, corresponding author), Mary Elizabeth Paulk (From the Departments of Psycho-Oncology and Palliative Care, Radiation Oncology, and Medical Oncology and Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute; Department of Practical Theology, Boston University; Department of Internal Medicine, Beth Israel Deaconess Medical Center; Harvard Medical School Center for Palliative Care; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; and Department of Internal Medicine, University of...), Michael J Balboni (From the Departments of Psycho-Oncology and Palliative Care, Radiation Oncology, and Medical Oncology and Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute; Department of Practical Theology, Boston University; Department of Internal Medicine, Beth Israel Deaconess Medical Center; Harvard Medical School Center for Palliative Care; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; and Department of Internal Medicine, University of...), Andrea C Phelps (From the Departments of Psycho-Oncology and Palliative Care, Radiation Oncology, and Medical Oncology and Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute; Department of Practical Theology, Boston University; Department of Internal Medicine, Beth Israel Deaconess Medical Center; Harvard Medical School Center for Palliative Care; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; and Department of Internal Medicine, University of...), Elizabeth T Loggers (0000-0003-3432-0443, Brigham and Women's Hospital), Alexi A Wright (0000-0002-9776-7114, From the Departments of Psycho-Oncology and Palliative Care, Radiation Oncology, and Medical Oncology and Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute; Department of Practical Theology, Boston University; Department of Internal Medicine, Beth Israel Deaconess Medical Center; Harvard Medical School Center for Palliative Care; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; and Department of Internal Medicine, University of...), Susan D Block (0000-0003-1146-4831, From the Departments of Psycho-Oncology and Palliative Care, Radiation Oncology, and Medical Oncology and Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute; Department of Practical Theology, Boston University; Department of Internal Medicine, Beth Israel Deaconess Medical Center; Harvard Medical School Center for Palliative Care; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; and Department of Internal Medicine, University of...), Eldrin F Lewis (From the Departments of Psycho-Oncology and Palliative Care, Radiation Oncology, and Medical Oncology and Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute; Department of Practical Theology, Boston University; Department of Internal Medicine, Beth Israel Deaconess Medical Center; Harvard Medical School Center for Palliative Care; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; and Department of Internal Medicine, University of...), John R Peteet (0000-0001-5362-1765, From the Departments of Psycho-Oncology and Palliative Care, Radiation Oncology, and Medical Oncology and Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute; Department of Practical Theology, Boston University; Department of Internal Medicine, Beth Israel Deaconess Medical Center; Harvard Medical School Center for Palliative Care; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; and Department of Internal Medicine, University of...), Holly G Prigerson (0000-0002-7075-4268, Brigham and Women's Hospital)
Year2010
Volume28
Issue3
Pages445-452
Publication date2010-01-20
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueJournal of Clinical Oncology (JOURNAL)
Journal identifiersISSN: 0732-183X • E-ISSN: 1527-7755
PublisherAmerican Society of Clinical Oncology (ASCO) (PUBLISHER)
DOI10.1200/jco.2009.24.8005
PMID20008625
PMCIDPMC2815706
OpenAlexW2160379920
LanguageEN
Citations received57
References cited32

PURPOSE: To determine whether spiritual care from the medical team impacts medical care received and quality of life (QoL) at the end of life (EoL) and to examine these relationships according to patient religious coping. PATIENTS AND METHODS: Prospective, multisite study of patients with advanced cancer from September 2002 through August 2008. We interviewed 343 patients at baseline and observed them (median, 116 days) until death. Spiritual care was defined by patient-rated support of spiritual needs by the medical team and receipt of pastoral care services. The Brief Religious Coping Scale (RCOPE) assessed positive religious coping. EoL outcomes included patient QoL and receipt of hospice and any aggressive care (eg, resuscitation). Analyses were adjusted for potential confounders and repeated according to median-split religious coping. RESULTS: Patients whose spiritual needs were largely or completely supported by the medical team received more hospice care in comparison with those not supported (adjusted odds ratio [AOR] = 3.53; 95% CI, 1.53 to 8.12, P = .003). High religious coping patients whose spiritual needs were largely or completely supported were more likely to receive hospice (AOR = 4.93; 95% CI, 1.64 to 14.80; P = .004) and less likely to receive aggressive care (AOR = 0.18; 95% CI, 0.04 to 0.79; P = .02) in comparison with those not supported. Spiritual support from the medical team and pastoral care visits were associated with higher QOL scores near death (20.0 [95% CI, 18.9 to 21.1] v 17.3 [95% CI, 15.9 to 18.8], P = .007; and 20.4 [95% CI, 19.2 to 21.1] v 17.7 [95% CI, 16.5 to 18.9], P = .003, respectively). CONCLUSION: Support of terminally ill patients' spiritual needs by the medical team is associated with greater hospice utilization and, among high religious copers, less aggressive care at EoL. Spiritual care is associated with better patient QoL near death.

Alternative medicine · Coping (psychology) · End-of-life care · Family medicine · Odds ratio · Palliative care · Receipt · Spiritual care · Spirituality · Clinical Psychology · Internal Medicine · Medicine · Nursing · Palliative Care and End-of-Life Issues · Religion, Society, and Development · Religion, Spirituality, and Psychology

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