August 11, 2021

Abstract

Association Between Spirituality and Pain Linguistic Bias in Medical Records Dementia and Medicare Experiences at EOL Effect of Home Hospice on Survival Barriers to ACP for Pediatric Patients The Power of Clinician Empathy Opioid Use Behaviors Rave Reviews Association Between Spirituality, Religiosity, Spiritual Pain, Symptom Distress, and Quality of Life Among Latin American Patients with Advanced Cancer: A Multicenter Study Background: Spirituality and religiosity can be used as integrative therapy to promote general well-being and health.1–4 What is the association between spirituality, religiosity, spiritual pain, symptom distress, coping, and quality of life among Latin American patients with advanced cancer? Design and Participants: This study determined the frequency and intensity of spirituality and religiosity and their association with physical and psychological symptoms, spiritual pain, coping, and quality of life among Latin American patients receiving palliative care for advanced cancer at three US, Guatemalan, and Chilean institutions. Patients completed validated assessments: the Faith, Importance and Influence, Community, and Address tool; Edmonton Symptom Assessment Scale-Financial/Spiritual; Penn State Worry Questionnaire-Abbreviated; Center for Epidemiologic Studies Depression Scale; Brief-coping strategies (COPE); Brief religious coping (RCOPE); and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Expanded version (FACIT-Sp-Ex). Descriptive statistics, frequency tabulation, the Kruskal-Wallis test, and Spearman correlation were used. Results: Patients (N = 325) were age median 58 years (range = 19–85), 60% female, and 62% Catholic (30% Christian not Catholic). Ninety-seven percent considered themselves spiritual (intensity median = 7 [IQR = 5–10], 0–10 scale) and 89% religious (7 [5–9]). Spirituality/religiosity importance was median 10 (IQR = 8–10). The frequency and associations between spirituality/religiosity and various items were: helps to cope with illness (98%, r = 0.66), is a source of strength/comfort (99%, r = 0.73), has positive effect on physical (81%, r = 0.42) and emotional symptoms (84%, r = 0.17), and helps caregivers cope (100%, r = 0.40) (all P<0.0001). Sixty percent reported their spiritual/religious needs had not been supported by the medical team; 52% reported spiritual pain (intensity median = 6 [IQR = 5–8]). Spiritual pain was associated with pain, fatigue, depression, anxiety, worry, behavioral disengagement, FACIT-Sp-Ex score, and negative RCOPE (all P<0.05). Commentary: Latin American patients often are underserved by the palliative care and hospice community. This multicenter study surveyed 325 Latin American patients with advanced cancer subjects regarding the association of spirituality with their quality of life and symptoms. Participants considered themselves both spiritual and religious and felt these beliefs had a positive impact on their lives. On the other hand, half had spiritual pain which was associated with physical pain and other symptoms. Surprisingly, 60% of patients enrolled in specialty palliative care clinics did not feel supported by the medical team. There were no data presented evaluating the association of spiritual pain and not feeling supported, nor information about the chaplain staffing in the clinics. Bottom Line: Spiritual support is often seen as nonessential to medical care and may be cut at the first sign of institutional belt tightening. To provide better, quality care, not just hospice and palliative medicine but the rest of the medical/business/industrial complex needs to understand and embrace the bio/psycho/social/spiritual model of care. Reviewer: Gregory L. Phelps, MD MPH FAAAHPM, Alleo Health System/Hospice of Chattanooga, Chattanooga, TN Source: Delgado-Guay MO, Palma A, et al. Association between spirituality, religiosity, spiritual pain, symptom distress, and quality of life among Latin American patients with advanced cancer: a multicenter study [published online ahead of print April 12, 2021]. J Palliat Med. doi: 10.1089/jpm.2020.0776