Clinicians Need Spiritual Care Training to Meet National End-of-Life Guidelines

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(ChemotherapyAdvisor) – Spiritual care—viewed by patients, nurses, and physicians as an important, appropriate, and beneficial component of end-of-life care—is infrequently provided by clinicians due primarily to lack of training, a study concluded in the Journal of Clinical Oncology online December 17.

These results suggest that spiritual care training “is critical to meeting national end-of-life care guidelines,” reported Tracy A. Balboni, MD, MPH, of Harvard Medical School and the Dana-Farber Cancer Institute, Boston, MA, and colleagues.

Spiritual care, defined as care that supports a patient's spiritual health, recognizes and supports the religiousness and spirituality dimensions of illness. Such care “is considered by patients to be an important aspect of end-of-life care and is also associated with key patient outcomes, including patient quality of life, satisfaction with hospital care, increased hospice use, decreased aggressive medical interventions, and medical costs,” Dr. Balboni noted.

To address why such care is infrequent, the investigators conducted a survey-based, multisite study from March 2006 through January 2009. The survey assessed religiousness and spirituality using items from the validated Multidimensional Measure of Religiousness and Spirituality as well as religious affiliation, religious service attendance, and intrinsic religiosity.

The investigators hypothesized that spiritual care is infrequently provided by nurses and physicians at end-of-life because of perceptions that it is not an important part of end-of-life cancer care; is inappropriate in the patient–practitioner relationship; and does not have a beneficial impact when provided because medical practitioners lack adequate time to provide spiritual care and lack training.

“All eligible patients with advanced cancer receiving palliative radiation therapy and oncology physician and nurses at four Boston academic centers were approached for study participation; 75 patients (total contacted, 103; response rate = 73%) and 339 nurses and physicians (total contacted, 537; response rate = 63%) participated,” they wrote.

“Most patients with advanced cancer had never received any form of spiritual care from their oncology nurses or physicians (87% and 94%, respectively; P for difference=0.043),” they noted. Patients indicated that spiritual care is, at least, a slightly important component of cancer care from nurses (86%) and physicians (87%)(P=0.1).

The majority of nurses (87%) and physicians (80%) believe that spiritual care should at least occasionally be provided (P=0.16); 78% of patients, 93% of nurses, and 87% of physicians endorsed (P=0.01) the appropriateness of the eight example of spiritual care which included, for example, “asking patients about their religious or spiritual background to be aware of whether or not it is important to them.”

Adjusted analyses found the strongest predictor of spiritual care provision by nurses and physicians was reception of spiritual care training (odds ratio [OR] 11.20; 95% CI 1.24–101, P=0.03; and OR 7.22; 95% CI, 1.91–27.30, P=0.004respectively); however, 88% of nurses and 86% of physicians had not received such training (P=0.83).


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