Heart failure patients’ desires for spiritual care

Little information is available about HF patients’ desires regarding having their healthcare providers address their spiritual concerns, feeling constrained in doing so, and the extent to which their spiritual needs go unmet | Psychology, Health & Medicine

Nearly half of our sample reported high levels of unmet spiritual needs and reported moderately strong desires to have their doctor or other healthcare professional attend to their spiritual needs, and moderately strong feelings of constraint in doing so. Spiritual constraint and unmet spiritual needs were associated with poorer spiritual, psychological and physical well-being, but these effects varied, depending on patients’ desire to discuss spiritual needs. These findings have important implications for clinical management of HF patients.

Full reference: Park, C.L. & Sacco, S.J. (2017)Heart failure patients’ desires for spiritual care, perceived constraints, and unmet spiritual needs: relations with well-being and health-related quality of life. Psychology, Health & Medicine. Vol. 22 (no.9) pp. 1011-1020

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The impact of healthcare professionals’ personality and religious beliefs on the decisions to forego life sustaining treatments

The aim of this study was to assess the opinion of intensive care unit (ICU) personnel and the impact of their personality and religious beliefs on decisions to forego life-sustaining treatments (DFLSTs) | BMJ Open

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Results: The participation rate was 65.7%. Significant differences in DFLSTs between doctors and nurses were identified. 71.4% of doctors and 59.8% of nurses stated that the family was not properly informed about DFLST and the main reason was the family’s inability to understand medical details. 51% of doctors expressed fear of litigation and 47% of them declared that this concern influenced the information given to family and nursing staff. 7.5% of the nurses considered DFLSTs dangerous, criminal or illegal. Multivariate logistic regression identified that to be a nurse and to have a high neuroticism score were independent predictors for preferring the term ‘passive euthanasia’ over ‘futile care’ (OR 4.41, 95% CI 2.21 to 8.82, p<0.001, and OR 1.59, 95% CI 1.03 to 2.72, p<0.05, respectively). Furthermore, to be a nurse and to have a high-trust religious profile were related to unwillingness to withdraw mechanical ventilation. Fear of litigation and non-disclosure of the information to the family in case of DFLST were associated with a psychoticism personality trait (OR 2.45, 95% CI 1.25 to 4.80, p<0.05).

Conclusion: We demonstrate that fear of litigation is a major barrier to properly informing a patient’s relatives and nursing staff. Furthermore, aspects of personality and religious beliefs influence the attitudes of ICU personnel when making decisions to forego life-sustaining treatments.

Full reference: Ntantana, A, et al. (2017) The impact of healthcare professionals’ personality and religious beliefs on the decisions to forego life sustaining treatments: an observational, multicentre, cross-sectional study in Greek intensive care units. BMJ Open. 7:e013916.

Integrating chaplaincy into healthcare

Spiritual care can be an important source of support for patients dealing with chronic or terminal illnesses, and it is a key component of palliative care | BMJ Supportive & Palliative Care

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Studies have shown that patients would like more frequent discussions on religion and spirituality (R/S) while in the hospital, but many patients do not have the chance to do so. One way to ensure that R/S is addressed during a hospital stay is via chaplain referrals. One study showed that chaplain visits are associated with increased patient satisfaction, and patients more often endorsed that staff met their emotional and spiritual needs, although research shows differences among professionals in chaplaincy referral rates; nurses have been shown to have higher likelihood of referring than physicians and social workers (SWs).

With the advent of the electronic health record (EHR), we felt it was important to explore whether or not healthcare professionals (HCPs) are interested in technology for requesting chaplains, and therefore improve access to spiritual care for patients. In fact, some initial research shows potential benefits of using electronic means to better identify and target patients in need of a chaplain visit, and one innovative palliative care service using pagers for referrals was reported as highly valuable by nurses to patients and the clinical team.

Here, we report results from a quality improvement (QI) project aimed at improving chaplaincy referrals, and therefore spiritual care, at a major academic centre in New York City, with a focus on gauging interest in technology-driven means for chaplain referrals.

Full reference: Rhee, J.Y. et al. (2017) Integrating chaplaincy into healthcare: a survey shows providers are interested in technology-based options. BMJ Supportive & Palliative Care. Published Online First: 7th July 2017. 

Organization-level principles and practices to support spiritual care at the end of life

Holyoke, P. & Stephenson, B. BMC Palliative Care | Published online: 11 April 2017

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Background: Though most models of palliative care specifically include spiritual care as an essential element, secular health care organizations struggle with supporting spiritual care for people who are dying and their families. Organizations often leave responsibility for such care with individual care providers, some of whom are comfortable with this role and well supported, others who are not. This study looked to hospice programs founded and operated on specific spiritual foundations to identify, if possible, organizational-level practices that support high-quality spiritual care that then might be applied in secular healthcare organizations.

Conclusions: These Principles, and the practices underlying them, could increase the quality of spiritual care offered by secular health care organizations at the end of life.

Read the article here

People who are dying should be asked about their spiritual beliefs

NICE has published new guidance calling on healthcare professionals to ask adults in the final days of life about their religious or spiritual beliefs.

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Cultural preferences and spiritual beliefs should be included in discussions about the care a person, and those close to them, want to receive, says NICE.

Knowing if someone holds a religious belief can be important for providing the care they desire. For example, someone who is Catholic may wish to receive the last prayers and ministrations.

The 2016 End of Life Care Audit reported nearly half of all deaths in England occurred in hospital. Spiritual wishes were only documented for one in 7 people who were able to communicate their desires.

Read the full overview here

Read the full guidance here

Spiritual care in palliative care influences patient-reported outcomes

van de Geer, J. et al. Palliative Medicine. Published online: November 9 2016

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Background: Spiritual care is reported to be important to palliative patients. There is an increasing need for education in spiritual care.

Aim: To measure the effects of a specific spiritual care training on patients’ reports of their perceived care and treatment.

Design: A pragmatic controlled trial conducted between February 2014 and March 2015.

Setting/participants: The intervention was a specific spiritual care training implemented by healthcare chaplains to eight multidisciplinary teams in six hospitals on regular wards in which patients resided in both curative and palliative trajectories. In total, 85 patients were included based on the Dutch translation of the Supportive and Palliative Care Indicators Tool. Data were collected in the intervention and control wards pre- and post-training using questionnaires on physical symptoms, spiritual distress, involvement and attitudes (Spiritual Attitude and Involvement List) and on the perceived focus of healthcare professionals on patients’ spiritual needs.

Results: All 85 patients had high scores on spiritual themes and involvement. Patients reported that attention to their spiritual needs was very important. We found a significant (p = 0.008) effect on healthcare professionals’ attention to patients’ spiritual and existential needs and a significant (p = 0.020) effect in favour of patients’ sleep. No effect on the spiritual distress of patients or their proxies was found.

Conclusion: The effects of spiritual care training can be measured using patient-reported outcomes and seemed to indicate a positive effect on the quality of care. Future research should focus on optimizing the spiritual care training to identify the most effective elements and developing strategies to ensure long-term positive effects.

Read the abstract here

culturally- and spiritually-sensitive end-of-life care

BMC Geriatrics

Background

Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool.

Methods

To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June–August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004–2014.

Results

The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making.

Conclusions

This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented.

Full reference Mei Lan Fang et.al.   A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review BMC Geriatrics (2016) 16:107