Distress of inpatients with terminal cancer in Japanese palliative care units: from the viewpoint of spirituality

Abstract

A qualitative study was conducted in an attempt to improve our understanding of the spiritual distress of terminally ill cancer patients in Japan. The subjects were inpatients at four approved palliative care units in Japan. The patients were interviewed and they expressed their own experiences in which spirituality was considered to be identifiable. Literal records of the interviews were analyzed using constant comparative analyses as proposed in relation to the grounded theory approach. The analysis included 11 inpatients and a variety of expressions of distress were obtained. After the conditions of the subjects were evaluated in order to search for common factors related to distress, consciousness of the gap between the patient's aspirations and the present situation were found to cause gap-induced distress. Distress was classified into three categories: distress due to the gap between the present situation and how the individual wanted to live, how the individual wished to die, and the individual's wish to maintain relations with others. The aspirations causing the gap were then interpreted from the viewpoint of spirituality as "anchors in life" for Japanese patients with terminal cancer. It was also revealed that in patients who possessed pictures of how they wished to die as their "anchors in life" and who were in a severe physical condition, distress increased and they became confused after their physical symptoms were relieved following admission to PCU.

Spiritual distress: the search for new evidence

“…either spontaneously or by means of interrogation, is a feature existent in other studies, 9,19 which reinforces the importance of attention that the health care professional must provide to the spiritual dimension of the patient. Although for Villagomeza 20 the investigation of spiritual distress does not need to necessarily involve direct questioning to the patient, it has recently been proven, 15 after comparing with other methods, that this is an effective means to assist in identifying the presence or absence of this phenomenon.…”

“…The studies investigated in this review presented the following ways to identify spiritual distress: careful observation, 20 active listening, 9,[19][20] investigation of the defining characteristics of the nursing diagnosis for spiritual distress 15 and the application of psychometric assessment instruments. 15,[17][18]20 According to scholar, 20 …”

“…[25][26] But it is a personal, complex reaction, difficult to define and to articulate, 25,27-28 that harms or threatens the spiritual integrity of the person 20,[29][30] and may contribute to the loss of the meaning of life. 20,26,29,31 Through the studies analyzed, it was also possible to highlight the relationship between the cancer experience and the presence of spiritual distress, since of the nine articles included in this review, four (44,4%) 9,17,19,20 highlighted this situation as a key condition for the occurrence of spiritual distress. It is emphasized that one of the reasons why this may happen is due to the fact that the diagnosis of cancer by itself produces a strong impact on the lives of individuals, as well as its treatment is fraught with stressful events.…”

“…8 The most favorable time to experience this phenomenon is when an individual experiences a moment of pain and, in most reports, this happens after the discovery of the diagnosis of an illness, especially a chronic disease like cancer, which can be life threatening. 9 Identifying the phenomenon of spiritual distress is not an easy task, but it can be noticeable by the attitude of people, in interpersonal relationships and with the environment, as well as through verbal and non-verbal language. 8 The …”

“…32 Furthermore, chronic terminal illness can trigger spiritual distress, since it influences directly on spirituality, which was observed in study 17. We also observed that is considered a total aspect of pain, which is called in a special way spiritual pain. 9 Identifying and having reliable means of evaluating the presence of a diagnosis of spiritual distress, especially in patients affected by chronic illness such as cancer, can prevent the physical and emotional symptoms of the disease from getting worse, and also contributes to the patient's ability to face this process in a positive way.…”