A B S T R A C T PurposeTo determine factors contributing to the infrequent provision of spiritual care (SC) by nurses and physicians caring for patients at the end of life (EOL). Patients and MethodsThis is a survey-based, multisite study conducted from March 2006 through January 2009. All eligible patients with advanced cancer receiving palliative radiation therapy and oncology physician and nurses at four Boston academic centers were approached for study participation; 75 patients (response rate ϭ 73%) and 339 nurses and physicians (response rate ϭ 63%) participated. The survey assessed practical and operational dimensions of SC, including eight SC examples. Outcomes assessed five factors hypothesized to contribute to SC infrequency. ResultsMost patients with advanced cancer had never received any form of spiritual care from their oncology nurses or physicians (87% and 94%, respectively; P for difference ϭ .043). Majorities of patients indicated that SC is an important component of cancer care from nurses and physicians (86% and 87%, respectively; P ϭ .1). Most nurses and physicians thought that SC should at least occasionally be provided (87% and 80%, respectively; P ϭ .16). Majorities of patients, nurses, and physicians endorsed the appropriateness of eight examples of SC (averages, 78%, 93%, and 87%, respectively; P ϭ .01). In adjusted analyses, the strongest predictor of SC provision by nurses and physicians was reception of SC training (odds ratio [OR] ϭ 11.20, 95% CI, 1.24 to 101; and OR ϭ 7.22, 95% CI, 1.91 to 27.30, respectively). Most nurses and physicians had not received SC training (88% and 86%, respectively; P ϭ .83). ConclusionPatients, nurses, and physicians view SC as an important, appropriate, and beneficial component of EOL care. SC infrequency may be primarily due to lack of training, suggesting that SC training is critical to meeting national EOL care guidelines.

Context Spiritual care (SC) from medical practitioners is infrequent at the end of life (EOL) despite national standards. Objectives The study aimed to describe nurses' and physicians' desire to provide SC to terminally ill patients and assess 11 potential SC barriers. Methods This was a survey-based, multisite study conducted from October 2008 through January 2009. All eligible oncology nurses and physicians at four Boston academic centers were approached for study participation; 339 nurses and physicians participated (response rate = 63%). Results Most nurses and physicians desire to provide SC within the setting of terminal illness (74% vs. 60%, respectively; P = 0.002); however, 40% of nurses/physicians provide SC less often than they desire. The most highly endorsed barriers were “lack of private space” for nurses and “lack of time” for physicians, but neither was associated with actual SC provision. Barriers that predicted less frequent SC for all medical professionals included inadequate training (nurses: odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.12–0.73, P = 0.01; physicians: OR = 0.49, 95% CI = 0.25–0.95, P = 0.04), “not my professional role” (nurses: OR = 0.21, 95% CI = 0.07–0.61, P = 0.004; physicians: OR = 0.35, 95% CI = 0.17–0.72, P = 0.004), and “power inequity with patient” (nurses: OR = 0.33, 95% CI = 0.12–0.87, P = 0.03; physicians: OR = 0.41, 95% CI = 0.21–0.78, P = 0.007). A minority of nurses and physicians (21% and 49%, P = 0.003, respectively) did not desire SC training. Those less likely to desire SC training reported lower self-ratings of spirituality (nurses: OR = 5.00, 95% CI = 1.82–12.50, P = 0.002; physicians: OR = 3.33, 95% CI = 1.82–5.88, P < 0.001) and male gender (physicians: OR = 3.03, 95% CI = 1.67–5.56, P < 0.001). Conclusion SC training is suggested to be critical to the provision of SC in accordance with national care quality standards.

Spiritual care (SC) is important to the care of seriously ill patients. Few studies have examined types of SC provided and their perceived impact. This study surveyed patients with advanced cancer (N = 75, response rate [RR] = 73%) and oncology nurses and physicians (N = 339, RR = 63%). Frequency and perceived impact of 8 SC types were assessed. Spiritual care is infrequently provided, with encouraging or affirming beliefs the most common type (20%). Spiritual history taking and chaplaincy referrals comprised 10% and 16%, respectively. Most patients viewed each SC type positively, and SC training predicted provision of many SC types. In conclusion, SC is infrequent, and core elements of SC—spiritual history taking and chaplaincy referrals—represent a minority of SC. Spiritual care training predicts provision of SC, indicting its importance to advancing SC in the clinical setting.

Purpose We surveyed how radiation oncologists think about and incorporate a palliative cancer patient’s life expectancy (LE) into their treatment recommendations. Methods and Materials A 41-item survey was e-mailed to 113 radiation oncology attending physicians and residents at radiation oncology centers within the Boston area. Physicians estimated how frequently they assessed the LE of their palliative cancer patients and rated the importance of 18 factors in formulating LE estimates. For 3 common palliative case scenarios, physicians estimated LE and reported whether they had an LE threshold below which they would modify their treatment recommendation. LE estimates were considered accurate when within the 95% confidence interval of median survival estimates from an established prognostic model. Results Among 92 respondents (81%), the majority were male (62%), from an academic practice (75%), and an attending physician (70%). Physicians reported assessing LE in 91% of their evaluations and most frequently rated performance status (92%), overall metastatic burden (90%), presence of central nervous system metastases (75%), and primary cancer site (73%) as “very important” in assessing LE. Across the 3 cases, most (88%–97%) had LE thresholds that would alter treatment recommendations. Overall, physicians’ LE estimates were 22% accurate with 67% over the range predicted by the prognostic model. Conclusions Physicians often incorporate LE estimates into palliative cancer care and identify important prognostic factors. Most have LE thresholds that guide their treatment recommendations. However, physicians overestimated patient survival times in most cases. Future studies focused on improving LE assessment are needed.