Spiritual Pain Research Articles

Characteristics of patients with unscheduled versus scheduled visits to outpatient supportive care center (SCC) at a comprehensive cancer center.

144 Background: There is limited literature regarding outpatient palliative care, and even more limited literature describing factors associated with unscheduled visits. Our aim was to identify clinical characteristics of patients who walk-in (present unscheduled) to the outpatient SCC with the hypothesize that the patients who present for unscheduled visits have more severe symptom distress as compared to those patients who present for scheduled appointments. Methods: We compared 183 patients with unscheduled consults (CO) vs a random sample of 361 patients with scheduled CO and 159 patients with unscheduled follow-up (FU) visits vs a random sample of 318 patients with scheduled FU visits. Results: Among 544 total CO visits, unscheduled visits had worse median Edmonton Symptom Assessment Scale (ESAS) symptoms (on a scale from 0 to 10): pain (6.5 vs 4.7, p < .0001), fatigue (p = .002), nausea (p = .017), depression (p = .003), anxiety (p = 0.02), sleep (p = .0002), and overall feeling of well-being (p = 0.0009). There was no statistical difference in shortness of breath, financial distress, nor spiritual pain. Daily opioid dose (MEDD in mg) was significantly higher in unscheduled CO visits (119.7 vs 62.9, p = .0004). Among 344 total FU visits, unscheduled visits had worse median ESAS symptoms: pain (5.7 vs 4.2, p = .0001), fatigue (p = .0006), depression (p = .019), anxiety (p = .014) and higher MEDD (111.3 vs 73.6, p = .0009). There was no difference in type of insurance coverage and better ECOG (p = .015) in unscheduled vs scheduled CO visits. Unscheduled CO visits were more likely to be from outside the Houston area (161/361, 45% vs. 40/133, 30%, p < 0.0001). Conclusions: Patients who are either referred as unscheduled CO visits or who present as unscheduled FU visits have higher levels of physical and psychosocial distress and higher opioid dose. Outpatient palliative care centers need to provide opportunity for walk-in referrals for timely management of these issues.

Factors associated with quality of life in a cohort of patients with palliative advanced cancer from a developing country: Relevance of perception of cancer curability.

93 Background: Improving quality of life (QOL) is a key goal in palliative care for patients with advanced cancer. Most studies about QOL in palliative care patients have been performed in the developed world. However, little is known about the factors that influence patients QOL in developing countries. The aim of this study is to describe factors associated with QOL in a cohort of patients with advanced cancer who were enrolled in the outpatient clinic public hospital in Santiago, Chile. Methods: Patients with advanced cancer admitted to the National Program of Palliative Care at a public Hospital in Santiago, Chile were prospectively enrolled in a study to assess QOL longitudinally. QOL was assessed with the EORTC-QLQ-PAL 15 questionnaire. Demographics, symptom intensity, depression and anxiety were assessed. Descriptive statistics and regression analysis were performed. Information about cancer curability and perception of personal health were also included. Results: In this preliminary report, the first 37 patients were included. Baseline characteristics were: mean patient age was 64, 21 (57%) females, 14 (38%) had GI cancer, 7 (19%) lung cancer, 4 (11%) breast cancer and 12 (22%) other. Mean (SD) QOL was 63 (34) in a 0 to 100 scale. QOL was not associated with age, gender, functionality, depression, anxiety, spiritual pain or financial distress. QOL was negatively associated with total symptom burden (coef -.53, p = .48), and positively associated with believing that cancer was curable (coef 33.3, p = .003). In a multivariate analysis, QOL was independently associated with both lower overall symptom burden (coef -.55, p = .38) and believing that cancer was curable (coef 28.6, p = .009). Conclusions: In palliative care patients with advanced cancer from a developing country, QOL was associated with lower overall symptom burden and with believing that cancer was curable. Further studies are needed to explore whether clarifying prognostic information about cancer curability in developing countries may impact patients’ QOL.

A Novel Picture Guide to Improve Spiritual Care and Reduce Anxiety in Mechanically Ventilated Adults in the Intensive Care Unit.

Hospital chaplains provide spiritual care that helps patients facing serious illness cope with their symptoms and prognosis, yet because mechanically ventilated patients cannot speak, spiritual care of these patients has been limited. To determine the feasibility and measure the effects of chaplain-led picture-guided spiritual care for mechanically ventilated adults in the intensive care unit (ICU). We conducted a quasi-experimental study at a tertiary care hospital between March 2014 and July 2015. Fifty mechanically ventilated adults in medical or surgical ICUs without delirium or dementia received spiritual care by a hospital chaplain using an illustrated communication card to assess their spiritual affiliations, emotions, and needs and were followed until hospital discharge. Feasibility was assessed as the proportion of participants able to identify spiritual affiliations, emotions, and needs using the card. Among the first 25 participants, we performed semistructured interviews with 8 ICU survivors to identify how spiritual care helped them. For the subsequent 25 participants, we measured anxiety (on 100-mm visual analog scales [VAS]) immediately before and after the first chaplain visit, and we performed semistructured interviews with 18 ICU survivors with added measurements of pain and stress (on ±100-mm VAS). The mean (SD) age was 59 (±16) years, median mechanical ventilation days was 19.5 (interquartile range, 7-29 d), and 15 (30%) died in-hospital. Using the card, 50 (100%) identified a spiritual affiliation, 47 (94%) identified one or more emotions, 45 (90%) rated their spiritual pain, and 36 (72%) selected a chaplain intervention. Anxiety after the first visit decreased 31% (mean score change, -20; 95% confidence interval, -33 to -7). Among 28 ICU survivors, 26 (93%) remembered the intervention and underwent semistructured interviews, of whom 81% felt more capable of dealing with their hospitalization and 0% felt worse. The 18 ICU survivors who underwent additional VAS testing during semistructured follow-up interviews reported a 49-point reduction in stress (95% confidence interval, -72 to -24) and no significant change in physical pain that they attributed to picture-guided spiritual care. Chaplain-led picture-guided spiritual care is feasible among mechanically ventilated adults and shows potential for reducing anxiety during and stress after an ICU admission.

Characteristics of patients with advanced lung cancer referred to a rapid-access supportive care clinic.

There is a limited number of pragmatic studies to evaluate the criteria for referral to outpatient palliative care. The aim of our study was to compare the characteristics, symptoms, and survival of patients with advanced non-small-cell lung cancer (NSCLC) referred (RF) versus not referred (NRF) to a novel embedded same-day rapid-access supportive care clinic (RASCC) and to compare the subgroups among referred patients. We reviewed the medical records of all patients who received treatment at the thoracic oncology clinic for advanced non-small-cell lung cancer between August 1, 2012, and June 30, 2013, who were referred to the RASCC and those who were not referred. An oncology-estimated prognosis of ≤6 months and/or severe symptom distress was employed as criteria for referral to the RASCC. Of 410 eligible patients, 155 (37.8%) were referred to the RASCC. RF patients had significantly higher patient-reported scores for pain, fatigue, lack of appetite, and symptom distress, as well as worse performance status and shorter survival than NRF patients. Among the RF patients, those who were referred early (≤3 months) had significantly worse symptom distress and shorter overall survival than patients who were referred later on. The patients treated by thoracic oncologists who referred a smaller proportion of their patients to the RASCC had significantly worse anxiety, well-being, spiritual pain, and symptom distress than patients treated by those who referred a larger proportion of their patients to the RASCC. We found that patients who were referred to the RASCC had higher reported symptom distress and worse survival ratings. Further studies are needed to evaluate the optimal criteria for timely integration of palliative care and oncology care.

Using Art as a Medium for First Nations Youth to Express Their Pain: A Two-Eyed Seeing Qualitative Study

Abstract BACKGROUND: First Nations (FN) youth in Canada have the highest rates of pain-related conditions (ear, dental, headaches) yet may be least likely to be treated for them. Untreated pain has an arresting impact on growth and development and is detrimental to the achievement of life goals. In recent research conducted by the Aboriginal Children’s Hurt & Healing Initiative (ACHH), community participants reported that First Nation children are stoic and are reluctant to talk about their pain (Latimer & Rudderham, 2013). Clinicians are trained to assess pain based on overt signs of expression (cry, facial grimace, ability to describe) however if you do not present your pain this way it may reduce the chance of proper assessment and treatment. OBJECTIVES: Using a Two-Eyed Seeing qualitative perspective (best of Indigenous and Western knowledge) the purpose of this research was to provide FN youth with the method of art making to determine how they express their pain. DESIGN/METHODS: Youth from four FN communities, in three Maritime Provinces were invited to participate in art workshops facilitated by internationally renowned Mi’kmaq artist Alan Syliboy. The workshop began with a conversation circle about pain experiences and then proceeded to the art making. A FN documentary cinematographer captured the workshops and the results are documented in art and film. Three team members independently themed the data using thematic analysis and the inter-rater reliability was >85%. RESULTS: 39 youth aged 10-18 years participated in 4 community-based conversation and art sessions. The themes for the sessions were themed using the four dimensions of the Medicine Wheel. While the overwhelming theme discussed in the conversation sessions was physical pain, when provided the nonverbal, art mode of expression, the youth painted emotional pain more frequently than physical, spiritual and mental pain. There was overlap between the four themes but 70% of the artwork prominently illustrated emotional pain with 54% overlapping with physical, 30% mental and 31% spiritual. CONCLUSION: These results present a more complicated issue regarding the integration of the different types of pain, intertwined together. The finding that when asked-youth primarily discussed physical pain but given the opportunity, more frequently painted emotional pain may shed new light on the degree to which emotional pain is a factor for these youth. The artwork and accompanying narratives are powerful and have implications for understanding the complexity of assessing the different dimensions of pain in a culturally meaningful manner and for clinician education purposes. A sample of the artwork is attached.

The impact of pain on spiritual well-being in people with a spinal cord injury.

The study uses a cross-sectional, group comparison, questionnaire-based design. To determine whether spinal cord injury and pain have an impact on spiritual well-being and whether there is an association between spiritual well-being and measures of pain and psychological function. University teaching hospital in Sydney, New South Wales, Australia. Questionnaires evaluating pain, psychological and spiritual well-being were administered to a group of people with a spinal cord injury (n=53) and a group without spinal cord injury (n=37). Spiritual well-being was assessed using the Functional Assessment of Chronic Illness and Therapy - Spirituality Extended Scale (FACIT-Sp-Ex). Pain and psychological function were also assessed using standard, validated measures of pain intensity, pain interference, mood and cognition. Levels of spiritual well-being in people with a spinal cord injury were significantly lower when compared with people without a spinal cord injury. In addition, there was a moderate but significant negative correlation between spiritual well-being and pain intensity. There was also a strong and significant negative correlation between depression and spiritual well-being and a strong and significant positive correlation between spiritual well-being and both pain self-efficacy and satisfaction with life. Consequences of a spinal cord injury include increased levels of spiritual distress, which is associated, with higher levels of pain and depression and lower levels of pain self-efficacy and satisfaction with life. These findings indicate the importance of addressing spiritual well-being as an important component in the long-term rehabilitation of any person following spinal cord injury. This study was supported by grant funding from the Australian and New Zealand College of Anaesthetists, and the National Health and Medical Research Council of Australia.

Spirituality, symptom distress and quality of life of Latin American patients with advanced cancer (LAAdCa): A multicenter study.

e21656Background: The association between Spirituality(S), religiosity(R), spiritual pain(SP), symptom expression, coping strategies and Quality of life(QOL) have not been well characterized. The m...

Gender differences in cancer-related distress in Japan: a retrospective observation study.

BackgroundCancer care is currently the most important medical issue in Japan. Total pain of cancer patients consists of a combination of four factors: physical, psychological, social distress, and spiritual pain. Previous studies showed female cancer patients ask for more psychological support and seem to suffer different types of distress compared with male patients, for example, appearance-related symptoms. However, other factors of cancer distress related to gender have not been defined comprehensively. The aim of this study is to clarify the gender differences in cancer distress types in order to elucidate the measures that should be taken in Japan to improve the quality of whole cancer care based on gender-based medicine.MethodsThe data of new patients who had visited the psycho-oncology outpatient service of Kinki University Hospital during the period of May 2013 to October 2015 were collected. Demographic factors and all assessed items were extracted from the patients’ medical charts retrospectively. Based on an inquiry of cancer patients in 2010, each item representing the four factors of “total pain” of cancer patients was chosen, i.e., physical distress (pain, changes in appearance), psychological distress (anxiety, depression), social distress (family problems, job-related problems), and spiritual pain; together with sexuality issues, and answers were analyzed. Hospital Anxiety Depression Scale (HADS) was used for the assessment of psychological distress. Chi-square test and Fisher’s exact test were performed for gender differences in the cancer distress types. Pearson’s analysis and multiple logistic regression analysis were performed for the association of gender with each item.ResultsThe data of 101 cancer patients were analyzed and there were more female patients than male patients (female: male ratio = 71:30). Female cancer patients were more likely to suffer from psycho-social issues such as changes in appearance, family problems and sexuality issues than male patients, and male patients were more likely to have spiritual pain.ConclusionsThere were gender differences in the distress types of cancer patients. In order to improve the quality of whole cancer care, more intensive intervention by medical professionals and social support is needed from the viewpoint of gender-based medicine and psycho-oncology.

The Divine Call to be Myself: Anglican Transgender Women and Prayer

prayed frequently to have this desire taken away or to wake up as a girl, but each morning I'd wake up and nothing would have changed. - HopeThese are the words of an English Anglican transgender (often shortened to trans) woman talking about her prayer life as a child. They are words which echo the prayers many of us remember from our own childhoods: prayers that God would change things to make us happy, that we would wake up prettier or more popular or with a pony waiting in the garden. But they are words which also bear a depth of dis-ease with ones own self that is particular to those who were assigned a gender at birth, based on their embodiment, which does not reflect the gender they know themselves to be.I know something from my own experience (limited though such experience is by my own race and class and gender identity as a white, middle-class, straight cisgender1 woman), as well as from my life as a priest and from my academic studies, of what it means to pray as a woman. What know little of is what it is like to pray as part of the journey from living as a man in the eyes of others to becoming the woman one knows oneself to be. In order to learn more have talked in person, via Skype, and by email with six Anglican trans women from Canada, the United Kingdom, and the United States who generously shared with me the way that their journey of transition affected and was affected by their prayer journeys.2These conversations were rich and wide-ranging. Each womans journey, both spiritual and physical, was unique to her, and there was no one way of praying as a trans Anglican woman that was common to all. However, there were a number of themes that believe speak to all of us in their call for authenticity and openness as essential components of our relationship with God in prayer.One of these themes is honesty. Tina, a priest in the Church of England, spoke about the deadening effect not being able to be herself had on her spiritual life: Secrecy-it is the secrecy that's such a problem and leads to so much pain-so much spiritual pain. The women expressed that the secrecy with which their own identity was shrouded in their life in the world had a considerable impact on how honest and open their prayer life could be. This is not to say that prayer wasn't happening; Tina, for instance, has had a regular discipline of prayer that fed and grounded her from long before her transition. Yet for many women there was something constrained, something partial about their prayer: in Tina's words again, I wasn't a complete person for a long time, not firing on all cylinders. Part of me was at home and part of me was away.Tina spoke of the harm of secrecy, and Robyn, a lay woman in the Church of England, spoke of the delights of eventual honesty in prayer, as well as in fife in general. Her prayer life expanded after she had moved into transition: And that was the point at which could then be honest with myself and then be honest with God. was really the point at which transition and my faith blossomed together. could not happen without the So both of them have grown exponentially alongside each other. Robyn's newfound integration of her inner and outer realities-of her knowledge of herself as a woman and living as a woman-brought about a profound shift in her ability to pray. She could now bring her full self into her fife of prayer, feeling confident for the first time that God would accept her for who she is and would call her as a true follower of Christ: That was the point at which really thought, can actually now come before God and be open before God and be sure of my place that is given to me. could follow Jesus. I'm not hiding anything now, not holding anything back.Along with a newfound honesty in prayer a number of the women spoke about a new spaciousness and a sense of peace. This was how Rebecca, a Canadian lay Anglican, spoke of the stillness that she found within herself one morning not long after she had started hormone therapy: One morning woke up realizing that was just still inside, that was calm. …

“Bas Sona”: Healing Versus Sedating Using a Celtic Framework for Total Pain (FR418)

•Discuss the importance of addressing emotional and spiritual needs as an essential components of pain and symptom management.•Describe the relationship between meaning, forgiveness, relatedness, and hope to healing, wellness, and health. One of the problems inherent in our current medical model is the tendency to address and manage suffering as if it were a symptom with a purely physiologic basis that can be “fixed.” According to Michael Kearney, MD, Western medicine has no model to help people live through their suffering. As a result, clinicians often find themselves treating suffering solely through pharmacologic means, which can mask the real opportunities for healing for both the patient and the clinician. In this session, we will identify the four dimensions of spiritual pain, which contribute to Dame Cicely Saunders’ concept of “total pain,” and we will explore the relationship between spiritual pain, healing, and clinician wellness. The attendees will learn about practical tools that can augment pharmacologic management of suffering, explore useful approaches to suffering from ancient wisdom traditions, and experience the impact of a team approach to care that embodies the belief that “WE are the medicine.”

The interrelations between spiritual well-being, pain interference and depressive symptoms in patients with multiple sclerosis.

Depressive symptoms are common in individuals with multiple sclerosis (MS), and are frequently exacerbated by pain; however, spiritual well-being may allow persons with MS to more effectively cope with pain-related deficits in physical and role functioning. We explored the associations between spiritual well-being, pain interference and depressive symptoms, assessing each as a potential mediator, in eighty-one patients being treated for MS, who completed self-report measures: Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, Pain Effects Scale, and Center for Epidemiologic Studies Depression Scale Revised. At the bivariate level, spiritual well-being and its subscale of meaning and peace were negatively associated with depression and pain interference. In mediation models, depression was not related to pain interference via spiritual well-being, or to spiritual well-being via pain interference. Pain interference was related to depression via spiritual well-being and meaning/peace, and to spiritual well-being and meaning/peace via depressive symptoms. Finally, spiritual well-being and meaning/peace were related to depression via pain interference, and to pain interference via depressive symptoms. For patients with MS, a multi-faceted approach to treatment that includes pain reduction and promotion of spiritual well-being may be beneficial, although amelioration of depression remains a critical task.

Spiritual pain from persistent chemotherapy-induced peripheral neuropathy in colon cancer patients in Japan

Abstract The objective of this study was to analyze the spiritual pain from persistent chemotherapy-induced peripheral neuropathy (PCIPN) in colon cancer patients receiving long-term oxaliplatin therapy. The subjects were 20 colon

The challenge of consolation: nurses' experiences with spiritual and existential care for the dying-a phenomenological hermeneutical study.

BackgroundA majority of people in Western Europe and the USA die in hospitals. Spiritual and existential care is seen to be an integral component of holistic, compassionate and comprehensive palliative care. Yet, several studies show that many nurses are anxious and uncertain about engaging in spiritual and existential care for the dying. The aim of this study is to describe nurses’ experiences with spiritual and existential care for dying patients in a general hospital.MethodsIndividual narrative interviews were conducted with nurses in a medical and oncological ward. Data were analyzed using a phenomenological hermeneutical method.ResultsThe nurses felt that it was challenging to uncover dying patients’ spiritual and existential suffering, because it usually emerged as elusive entanglements of physical, emotional, relational, spiritual and existential pain. The nurses’ spiritual and existential care interventions were aimed at facilitating a peaceful and harmonious death. The nurses strove to help patients accept dying, settle practical affairs and achieve reconciliation with their past, their loved ones and with God. The nurses experienced that they had been able to convey consolation when they had managed to help patients to find peace and reconciliation in the final stages of dying. This was experienced as rewarding and fulfilling. The nurses experienced that it was emotionally challenging to be unable to relieve dying patients’ spiritual and existential anguish, because it activated feelings of professional helplessness and shortcomings.ConclusionsAlthough spiritual and existential suffering at the end of life cannot be totally alleviated, nurses may ease some of the existential and spiritual loneliness of dying by standing with their patients in their suffering. Further research (qualitative as well as quantitative) is needed to uncover how nurses provide spiritual and existential care for dying patients in everyday practice. Such research is an important and valuable knowledge supplement to theoretical studies in this field.

PO48 TERMINOLOGY USED IN ADVANCED BREAST CANCER AND THE NEED FOR CONSISTENCY

participated. 146 patients, 34 caregivers, 18 spiritual/community leaders participated. Relief of distressing symptoms reported in 80%. Responses on palliative care analyzed using questionnaires while community/ spiritual leaders participated through focus group discussions. 90% participants expressed need for model that incorporates palliative services into the mainstream of medical therapy should be emphasized as standard care approach. Results/findings: Poor wellbeing, appetite, pain and fatigue were most prevalent symptoms reported by the patients. 50% of the patients reported severe pain and 9% reported no pain. Spiritual pain control had highest correlation to QOL in comparison to functional, emotional, physical and social wellbeing. 90% of patients and caregivers reported free communication about illness. We also need to modify attitudes of caregivers towards psychosocial needs of breast cancer patients and their families. Breast cancer care hospitals must have separate departments for handling these issues. Conclusions/recommendation: This study gives demographic picture of terminal cancer patients and family caregivers in public healthcare system and some aspects of palliative care. Resource-poor-nations need NGO to develop such programs in absence of governmentrun-healthcare-setup. We NGO activists need conference to discuss our project ideas/concerns/difficulties with senior researchers from USA/EUROPE. ESO must take initiative in propagating such efforts in developing-nations. Development of comprehensive breast cancer service program is distant dream in resource poor nations. We NGO patient advocates need international funding support for palliative care programs.

Frequency, intensity, and correlates of spiritual pain in advanced cancer patients assessed in a supportive/palliative care clinic.

Regular assessments of spiritual distress/spiritual pain among patients in a supportive/palliative care clinic (SCPC) are limited or unavailable. We modified the Edmonton Symptom Assessment Scale (ESAS) by adding spiritual pain (SP) to the scale (0 = best, 10 = worst) to determine the frequency, intensity, and correlates of self-reported SP (≥1/10) (pain deep in your soul/being that is not physical) among these advanced cancer patients. We reviewed 292 consecutive consults of advanced cancer patients (ACPs) who were evaluated at our SCPC between October of 2012 and January of 2013. Symptoms were assessed using the new instrument (termed the ESAS-FS). The median age of patients was 61 (range = 22-92). Some 53% were male; 189 (65%) were white, 45 (15%) African American, and 34 (12%) Hispanic. Some 123 of 282 (44%) of ACPs had SP (mean (95% CI) = 4(3.5-4.4). Advanced cancer patients with SP had worse pain [mean (95% CI) = 5.3(4.8, 5.8) vs. 4.5(4.0, 5.0)] (p = 0.02); depression [4.2(3.7, 4.7) vs. 2.1(1.7, 2.6), p < 0.0001]; anxiety [4.2(3.6, 4.7) vs. 2.5(2.0, 3.0), p < 0.0001]; drowsiness [4.2(3.7, 4.7) vs. 2.8(2.3, 3.2), p < 0.0001]; well-being [5.4(4.9, 5.8) vs. 4.5(4.1, 4.9), p = 0.0136]; and financial distress (FD) [4.4(3.9, 5.0) vs. 2.2(1.8, 2.7), p < 0.0001]. Spiritual pain correlated (Spearman) with depression (r = 0.45, p < 0.0001), anxiety (r = 0.34, p < 0.0001), drowsiness (r = 0.26, p < 0.0001), and FD (r = 0.44, p < 0.0001). Multivariate analysis showed an association with FD [OR (95% Wald CI) = 1.204(1.104-1.313), p < 0.0001] and depression [1.218(1.110-1.336), p < 0.0001]. The odds that patients who had SP at baseline would also have SP at follow-up were 182% higher (OR = 2.82) than for patients who were SP-negative at baseline (p = 0.0029). SP at follow-up correlated with depression (r = 0.35, p < 0.0001), anxiety (r = 0.25, p = 0.001), well-being (r = 0.27, p = 0.0006), nausea (r = 0.29, p = 0.0002), and financial distress (r = 0.42, p < 0.0001). Spiritual pain, which is correlated with physical and psychological distress, was reported in more than 40% of ACPs. Employment of the ESAS-FS allows ACPs with SP to be identified and evaluated in an SCPC. More research is needed.

Spiritual Pain in Meals on Wheels' Clients.

Background: Meals on Wheels’ clients are at risk for spiritual pain due to advanced age, social isolation, and failing health. They are also prone to stress, depression, and loneliness, placing them at risk for adverse biological disruptions and health outcomes. The purpose of the study was to examine associations of spiritual pain with psychosocial factors (stress, depression, loneliness, religious coping) and salivary biomarkers of stress and inflammation (cortisol, IL-1β) in Meals on Wheels’ clients. Methods: Data were collected cross-sectionally from 88 elderly (mean age 75.4). Spiritual pain, stress, depression, loneliness, and religious coping were measured with standardized instruments, and salivary biomarkers were assessed with enzyme immunoassays. Results: Spiritual pain was significantly and positively correlated with stress (r = 0.35, p ≤ 0.001), depression (r = 0.27, p = 0.01), and negative religious coping (r = 0.27, p = 0.01). Correlations with loneliness, positive religious coping, and salivary biomarkers were non-significant. Conclusion: Spiritual pain is an important concept in this population. Research should be expanded to understand the significance of spiritual pain in conjunction with psychosocial and biological variables and its potential impact on physical, mental, and cognitive health outcomes in the elderly.

Caregiver symptom burden assessment using the Edmonton Symptom Assessment System (ESAS): A preliminary report.

227 Background: Regular assessment of caregiver symptom burden during patient visits would allow prompt referral for their care. The ESAS is a multidimensional tool used in patients but not caregivers. The objectives of this study were to determine the feasibility of the ESAS in assessing caregiver symptoms defined as completing 9/12 items, assess caregiver-reported usefulness of its completion, determine the association of symptom scores between patients, caregivers and various clinical and psychosocial factors, and determine concurrent validity with the Zarit Burden Interview-12 (ZBI-12). Methods: A prospective study of 90 patient-primary caregiver dyads in an outpatient Supportive Care Center in a cancer center was conducted. The 12 item ESAS-FS was completed by the dyads with other measures of clinical and psychosocial factors [demographics, cancer diagnosis, co-morbidities, caregiving activities, prognostic index and patient’s performance status]. Results: The ESAS is a feasible tool to assess caregiver symptom burden with 90/90 caregivers [100%] completing at least 9/12 items; 66/90 caregivers [73%] found ESAS useful to report their symptom burden. A significant association was found between ESAS scores of caregivers and patients in depression [p &lt; 0.01], psychosocial items [depression, anxiety, well-being, financial distress, spiritual pain; p &lt; 0.01], and total symptom distress scores [p &lt; 0.01]. Caregiver employment status [p = 0.03] and total caregiver activities [p = 0.04] were significantly associated with total caregiver ESAS scores. There was no significant association between patient and caregiver co-morbidities [p = 0.08], prognostic index [0.07] and performance status [p = 0.26] to total caregiver ESAS scores. Caregivers recommended certain physical symptoms such as pain and nausea may be eliminated. Concurrent validity with ZBI-12 was not achieved [r = 0.53, p = 0.74] suggesting that ESAS measured different caregiver dimensions. Conclusions: The ESAS is a feasible tool to measure caregiver symptoms and was found useful by caregivers. Further research is needed to modify the ESAS based on caregiver’s recommendations and further psychometric studies need to be conducted.

Cancer-related pain management in clinical oncology.

Uncontrolled pain is one of the most feared and debilitating symptoms among cancer patients, and many suffer unnecessarily from suboptimal pain control. Cancer-related pain is often multidimensional and can affect all aspects of a patient's life. Hence, achieving adequate pain relief among cancer patients involves a proper assessment of psychosocial, spiritual, and physical pain issues, matched with an individualized treatment plan involving pharmacologic, nonpharmacologic, and procedural therapies when appropriate. Providing effective pain relief can help ease the overall burden of disease among oncology patients while helping them tolerate cancer-directed therapies and achieve the most optimal quality of life throughout all phases of the disease continuum. In this review, the authors will discuss the syndromes, assessment of, and treatment for cancer-related pain in the outpatient setting.

WA16 If my body is ill, who am i? pain relief through expression of whole self.

People rely on mobility and bodily capacity to define who they are. Little has been written about how bodily incapacity towards the end of life affects a person's self-concept. Expressive Movement Therapy (EMT) (also called Dance Movement Psychotherapy) enables people to use creative movement/gestures to express themselves physically, emotionally, socially and spiritually. This is the first known research about EMT in palliative care in the UK. To explore clients' experiences of EMT in a day hospice setting. A phenomenological/case study approach explored four clients' experiences of EMT in depth. Participants used EMT to express how their ill bodies had become obstacles to defining who they are, causing a complex interaction between physical incapacity and emotional, social and spiritual pain. EMT released tension by enabling participants to grieve over these losses of self, and to re-integrate with their estranged bodies to express themselves as "me completely". This research provides a new understanding of the concept of 'total pain'. It links physical suffering to emotional, social, spiritual pain by showing that bodily incapacity prevents people from expressing their sense of whole self. EMT helps relieve this pain by offering people accessible, creative ways to reconnect with their ill, estranged bodies to express themselves as an integrated complete person. The community needs to adopt a holistic approach, which does not just focus on parts of the body, but recognises the importance of helping people sustain their self-narrative as a whole person in all dimensions of their lives.

The Relationship between the Spiritual Health, Anxiety and Pain in Hospitalized Cancer Patients

Purpose: This study is to find relationship between cancer patient’s spiritual health and the level of their anxiety and pain. Methods: From April 27 through May 11, 2012, a survey was conducted with 167 cancer patients hospitalized at a university hospital in Busan. Spiritual health was measured by the Spiritual Health Inventory developed by Highfield (1992). The instrument for anxiety measu rement was the State-Trait Anxiety Inventory by Spielberger (1975) and that for pain was the Visual Analogue Scale (2009). The association between patients’ characteristics and spiritual health, anxiety or pain degree were analyzed using the ANOVA test. The interrelationship between spiritual health, anxiety and pain was analyzed using Pearson’s correlation coefficients. Results: The patients exhibited a moderate degree of spiritual health and anxiety and a mild level of pain. Patients’ spiritual health significantly differed by their religion, educ ation, monthly income of the family, illness conditions, physical conditions, metastasis, daily living and support. Their anxiety level was significantly different according to age, religion, education, illness conditions, physical conditions, metastasis, daily living, family/friends’ support and use of analgesics. Significant differences were also found in the level of pain according to illness conditions, physical conditions, metastasis, daily living, family/friends’ support and use of analgesics. We found a moderately negative correlation between spiritual health and anxiety. Anxiety and pain showed a positive correlation, and spiritual health and pain exhibited a negative correlation. Conclusion: To help cancer patients to manage their spiritual health, anxiety and pain, a program should be develop ed considering the primary factors discussed in this study.