Background: This study sought to inductively derive core themes of religion and=or spirituality (R=S) active in patients' experiences of advanced cancer to inform the development of spiritual care interventions in the terminally ill cancer setting. Methods: This is a multisite, cross-sectional, mixed-methods study of randomly-selected patients with advanced cancer (n ¼ 68). Scripted interviews assessed the role of R=S and R=S concerns encountered in the advanced cancer experience. Qualitative and quantitative data were analyzed. Theme extraction was performed with interdisciplinary input (sociology of religion, medicine, theology), utilizing grounded theory. Spearman correlations determined the degree of association between R=S themes. Predictors of R=S concerns were assessed using linear regression and analysis of variance. Results: Most participants (n ¼ 53, 78%) stated that R=S had been important to the cancer experience. In descriptions of how R=S was related to the cancer experience, five primary R=S themes emerged: coping, practices, beliefs, transformation, and community. Most interviews (75%) contained two or more R=S themes, with 45% mentioning three or more R=S themes. Multiple significant subtheme interrelationships were noted between the primary R=S themes. Most participants (85%) identified 1 or more R=S concerns, with types of R=S concerns spanning the five R=S themes. Younger, more religious, and more spiritual patients identified R=S concerns more frequently (b ¼ À0.11, p < 0.001; b ¼ 0.83, p ¼ 0.03; and b ¼ 0.89, p ¼ 0.04, respectively). Conclusions: R=S plays a variety of important and inter-related roles for most advanced cancer patients. Future research is needed to determine how spiritual care can incorporate these five themes and address R=S concerns.
Purpose Attention to patients’ religious and spiritual needs is included in national guidelines for quality end-of-life care, but little data exist to guide spiritual care. Patients and Methods The Religion and Spirituality in Cancer Care Study is a multi-institution, quantitative-qualitative study of 75 patients with advanced cancer and 339 cancer physicians and nurses. Patients underwent semistructured interviews, and care providers completed a Web-based survey exploring their perspectives on the routine provision of spiritual care by physicians and nurses. Theme extraction was performed following triangulated procedures of interdisciplinary analysis. Multivariable ordinal logistic regression models assessed relationships between participants’ characteristics and attitudes toward spiritual care. Results The majority of patients (77.9%), physicians (71.6%), and nurses (85.1%) believed that routine spiritual care would have a positive impact on patients. Only 25% of patients had previously received spiritual care. Among patients, prior spiritual care (adjusted odds ratio [AOR], 14.65; 95% CI, 1.51 to 142.23), increasing education (AOR, 1.26; 95% CI, 1.06 to 1.49), and religious coping (AOR, 4.79; 95% CI, 1.40 to 16.42) were associated with favorable perceptions of spiritual care. Physicians held more negative perceptions of spiritual care than patients (P<.001) and nurses (P=.008). Qualitative analysis identified benefits of spiritual care, including supporting patients’ emotional well-being and strengthening patient-provider relationships. Objections to spiritual care frequently related to professional role conflicts. Participants described ideal spiritual care to be individualized, voluntary, inclusive of chaplains/clergy, and based on assessing and supporting patient spirituality. Conclusion Most patients with advanced cancer, oncologists, and oncology nurses value spiritual care. Themes described provide an empirical basis for engaging spiritual issues within clinical care.
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