This article is more than 5 years old. Information may no longer be current.
Spirituality plays key role in patients’ cancer care
Click Here to Manage Email Alerts
When I was doing my medical training, I couldn’t help but notice a tension in everyday caregiving to sick patients.
The frequent role of spirituality in patients’ experiences of illness was completely divorced from any recognition within medical care — an omission that seemed odd, particularly in caring for patients with serious illnesses such as advanced cancer.
This tension prompted me to spend an elective month with chaplaincy during my internship — an experience that was eye-opening to the importance of spiritual care within patient care. I witnessed the role of chaplaincy in supporting a family facing difficult medical decisions as their critically ill loved one lay unconscious and ventilated in the ICU. I saw a chaplain provide prayer and communion to a patient with advanced cancer who had just made the decision to transition from anticancer therapies to home hospice care — care that brought evident comfort in the midst of this difficult decision.
Tracy Balboni
Spiritual care, something entirely foreign and unseen within my medical training, was in these experiences plainly present as a critical part of what it means to face illness and to care for patients as whole persons. Hence, I was spurred to pursue a research career dedicated to uncovering the spiritual aspects of facing serious illness.
Research efforts
The most current research endeavors include examining the role of chaplaincy within the care of patients with advanced cancer, a study supported by a grant from the John Templeton Foundation, a philanthropic catalyst for research related to spirituality and the human experience, and managed by HealthCare Chaplaincy Network, a national health care organization that provides spiritual care for the seriously ill and their caregivers.
On March 31, we presented our preliminary results at HealthCare Chaplaincy Network’s first national conference, Caring for the Human Spirit — Driving the Research Agenda for Spiritual Care in Health Care, held at the New York Academy of Medicine.
Our study focuses on how chaplaincy influences quality of life and medical care for patients with advanced cancer. I have acted as project director, and Angelika Zollfrank — a board-certified chaplain and director of clinical pastoral education at Massachusetts General Hospital in Boston — is the project chaplain. Holly Prigerson, PhD — a professor at Weill Cornell Medical College, former director of psycho-oncology research at Dana-Farber Cancer Institute, and principal investigator of the Coping with Cancer I and II studies — acted as the senior co-principal investigator.
This study builds on work done within the NIH- and Fetzer-funded, multi-institutional Coping with Cancer I study, a prospective study of patients with advanced cancers that examined the effect of psychosocial and spiritual factors on patient end-of-life outcomes, including quality of life and the types of medical care received before death.
As part of the Coping with Cancer I study, we found that patients infrequently are receiving spiritual care from their medical teams. When asked the degree that their spiritual needs were supported by their medical team (including chaplains, doctors and nurses), only 27% of patients with advanced cancer reported they felt well-supported. However, when spiritual care is present, it is prospectively associated with better patient quality of life at the end of life, less aggressive medical interventions in the last week of life — such as dying in an ICU — and greater hospice care.
This current study, performed within the ongoing NIH-funded Coping with Cancer II study, is using both qualitative and quantitative research methods to examine how chaplaincy spiritual care is influencing these outcomes.
Preliminary data from the first 250 enrolled patients indicate that 48% receive chaplaincy visits, but when patients receive those visits, 88% view them as helpful. Patients noted chaplains frequently brought compassion, attended to spiritual concerns, and provided prayer and religious rituals or scriptures. Taken together with the findings from the Coping with Cancer I study, early conclusions are that chaplaincy visits are perceived as helpful by most patients with advanced cancer and are associated with improved patient quality of life. This ongoing research is expected to aid efforts to further understand how chaplaincy spiritual care influences patient outcomes, including quality of life and medical decision-making at the end of life.
A key component of the John Templeton Foundation/HealthCare Chaplaincy-supported research grant is the development of the project chaplain’s research training. With the support of the research team, Zollfrank led a project that examined a clinical pastoral education program for health care providers at Massachusetts General Hospital — a program designed to develop health care providers’ expertise in the basics of spiritual caregiving.
This study demonstrated that clinical pastoral education for health care providers is an effective educational method to help caregivers gain confidence in providing spiritual care to patients. Health care providers also reported greater spiritual caregiving to their patients after receiving spiritual care education. The study showed health care providers can be educated about the basics of spiritual care and that such education results in greater integration of spiritual care within patient care.
Recognition of patients’ needs
In light of this and other research demonstrating the frequent and key role of patient spirituality in the experience of serious illness, spiritual care is included as a key domain of palliative care within national guidelines, most notably the National Consensus Project Guidelines for Quality Palliative Care.
Consequently, cancer centers should be equipped to recognize and address the spiritual needs of their patients. This includes improving the integration of chaplaincy within medical care and educating clinicians about their role within spiritual care, including taking spiritual histories and referring patients to pastoral care.
A commonly used spiritual history tool designed by Christina Pulchalski, MD, founder and director of the George Washington Institute for Spirituality and Health, is the FICA Spiritual History Tool. The FICA acronym represents the domains of spirituality about which clinicians should inquire, ideally as part of a routine social history:
By assessing the role of spirituality in illness, physicians will better recognize the spiritual aspects of their patients and involve professional spiritual caregivers to meet patients’ spiritual needs.
Spirituality frequently plays a key role in patients’ experiences during serious illness. Considerable research work remains, such as defining the role of chaplaincy within medical teams. But the data thus far are clear: Spiritual care no longer can be divorced from the care of patients facing serious illness.
References:
Alcorn SR. J Pall Med. 2010;13:581-588.
Balboni TA. J Clin Oncol. 2007;10:555-560.
Balboni TA. J Clin Oncol. 2010;28:445-452.
Balboni TA. JAMA Intern Med. 2013;173:1109-1117.
Borneman T. J Pain Symptom Manage. 2010;40:163-173.
National Consensus Project for Quality Palliative Care. Clinical practice guidelines for quality palliative care, second edition. 2009. Available at: www.nationalconsensusproject.org/guideline.pdf. Accessed on May 19, 2014.
Phelps AC. JAMA. 2009;301:1140-1147.
Phelps AC. J Clin Oncol. 2012;30:2538-2544.
Zollfrank A. Teaching healthcare providers how to provide spiritual care: A pilot study. Presented at: American Psycho-Oncology Society Annual Conference; Feb. 13-15, 2014; Tampa, Fla.
For more information:
Tracy Balboni, MD, MPH, is an associate professor of radiation oncology at Harvard Medical School and clinical director of the Supportive and Palliative Radiation Oncology Service at the Dana-Farber/Brigham and Women’s Cancer Center. She can be reached at tbalboni@lroc.harvard.edu.
Disclosure: Balboni reports no relevant financial disclosures.