Nurse and Physician Barriers to Spiritual Care Provision at the End of Life

Abstract

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.

Spirituality and Health: A Middle Eastern Perspective

“…However, the need for further education for nurses and other healthcare professionals in relation to the best methods of delivering spiritual care is evident (Jafari et al 2014a;Rassool 2000). In both Middle Eastern and Western contexts, factors such as workload, lack of time, lack of knowledge, and insufficient resources, most likely contribute to this issue of spiritual care delivery in practice (Balboni et al 2014;Baldacchino 2008;Cadge et al 2009;O'Brien 2007;Ronaldson et al 2012;Wong and Yau 2010).…”

The Spiritual Care Team: Enabling the Practice of Whole Person Medicine

“…The following are 10 barriers that stand in the way of spiritual care. These barriers are based on research by the Harvard oncology group at the Dana Farber Institute [32]. They asked oncologists and oncology nurses why they did not routinely assess and address the spiritual needs of patients.…”

Using Nurse Ratings of Physician Communication in the ICU To Identify Potential Targets for Interventions To Improve End-of-Life Care

“…For example, prior research has shown that patients and families value discussions of spiritual care in the ICU, 41 but that physicians in particular are reluctant to spontaneously raise this topic. [42][43][44] Focusing end-of-life conversations on spiritual concerns could improve quality of dying. Potential interventions to improve the quality of end-of-life care could include teaching physicians and nurses to discuss these topics during end-of-life discussions.…”