Responding to the Spiritual Needs of Palliative Care Patients: A Randomized Controlled Trial to Test the Effectiveness of the Kibo Therapeutic Interview

Abstract

Context: The WHO recognizes the need to attend to patients' spiritual needs as being fundamental to comprehensive and high-quality end-of-life care. Spiritual needs must be attended to since the resolution of biological and psychosocial issues is insufficient to reduce patients' suffering. Associations have been found between spiritual needs and other variables of importance for patients in palliative care. Despite the consensus that exists regarding the importance of assessing and attending to spiritual needs, professionals encounter many difficulties in attempting to do so. Objectives: Our study aims to demonstrate the benefits that the Kibo therapeutic interview in palliative care patients can have for spirituality, demoralization, and resilience. Methods: A parallel randomized controlled trial of two groups was undertaken. Information on 60 palliative care patients during pre-and post-intervention time points was gathered. Results: ANOVAs showed a statistically significant effect of the intervention on the dimension of transpersonal spirituality. The ANCOVA for the effect of the intervention on resilience also pointed to its effectiveness. When the means of demoralization were examined, a higher decrease in the levels of demoralization for patients in the intervention group was observed, when compared to patients in the control group. Conclusion: Our findings point to this interview as an effective means to attend to the spiritual needs of palliative patients, reducing demoralization and increasing resilience. Future research could focus on a broader sample and on the effects of this interview on family caregivers, mourners, and health care professionals.

Systematic Review of Interventions for Demoralization in Patients With Cancer

“…The 14 included studies were conducted in the United States (Agin-Liebes et al, 2020; Nelson et al, 2019; Ross et al, 2016, 2021), Germany (Fraguell-Hernando et al, 2020; Mehnert et al, 2020), China (Li et al, 2020; Sun et al, 2021), Spain (Soto-Rubio et al, 2020), Ireland (Sarizadeh et al, 2021), Italy (Iani et al, 2020), Portugal (Juliao et al, 2017), Australia (Kissane et al, 2019), and Canada (Rodin et al, 2018). Nine studies were RCTs (Agin-Liebes et al, 2020; Iani et al, 2020; Juliao et al, 2017; Mehnert et al, 2020; Rodin et al, 2018; Ross et al, 2016, 2021; Sarizadeh et al, 2021; Soto-Rubio et al, 2020), four studies were pilot studies (Fraguell-Hernando et al, 2020; Kissane et al, 2019; Nelson et al, 2019; Sun et al, 2021), and one study was quasi-experimental study (Li et al, 2020). The sample size of each study ranged from 11 to 305 participants, with a total sample size of 1049 patients with cancer.…”

“…Based on the content of the interventions, we briefly classified the included interventions into five types, namely, psilocybin-assisted psychotherapy, meaning-related psychotherapy, CALM therapy, DT, and other interventions (Cancer and Aging: Reflections for Elders [CARE]—psychotherapy, Acceptance and Commitment Therapy [ACT], and Kibo Therapeutic Interview). Six studies indicated that one of the aims of the study was to improve demoralization among patients with cancer (Iani et al, 2020; Juliao et al, 2017; Li et al, 2020; Sarizadeh et al, 2021; Soto-Rubio et al, 2020; Sun et al, 2021). In addition, demoralization was a secondary outcome indicator in other studies.…”

“…Kibo therapy's main aim is to improve the patient's spirituality level. The Kibo intervention is more novel than other interventions, but there is a lack of evidence to support it (Soto-Rubio et al, 2020). Cancer and Aging: Reflections for Elders (CARE) is a psychological intervention specifically for older patients with cancer.…”

“…The content of psychological interventions to improve demoralization in other studies varied widely, and the studies assessing these individualized interventions were relatively single and the sample sizes in the studies were small; thus, the significant effects of these interventions on improving demoralization should be considered with caution (Sarizadeh et al, 2021; Soto-Rubio et al, 2020). ACT is a third-generation cognitive and behavioral therapy (Ducasse and Fond, 2015).…”

“…Kibo therapeutic interviewing to facilitate discussion of spirituality in a natural way seeks to explore the three core dimensions of spirituality (intrapersonal, interpersonal, and transpersonal). Given that the level of spirituality is closely linked to the patient's mental health, Kibo therapy can indirectly improve demoralization (Soto-Rubio et al, 2020).…”