Provision of spiritual care to patients with advanced cancer

Associations with medical care and quality of life near death

Tracy Anne Balboni, Mary Elizabeth Paulk, Michael J. Balboni, Andrea C. Phelps, Elizabeth Trice Loggers, Alexi A. Wright, Susan D. Block, Eldrin F. Lewis, John R. Peteet, Holly Gwen Prigerson

Research output: Contribution to journalArticle

217 Citations (Scopus)

Abstract

Purpose: To determine whether spiritual care from the medical team impacts medical care received and quality of life (QoL) at the end of life (EoL) and to examine these relationships according to patient religious coping. Patients and Methods: Prospective, multisite study of patients with advanced cancer from September 2002 through August 2008. We interviewed 343 patients at baseline and observed them (median, 116 days) until death. Spiritual care was defined by patient-rated support of spiritual needs by the medical team and receipt of pastoral care services. The Brief Religious Coping Scale (RCOPE) assessed positive religious coping. EoL outcomes included patient QoL and receipt of hospice and any aggressive care (eg, resuscitation). Analyses were adjusted for potential confounders and repeated according to median-split religious coping. Results: Patients whose spiritual needs were largely or completely supported by the medical team received more hospice care in comparison with those not supported (adjusted odds ratio [AOR] = 3.53; 95% CI, 1.53 to 8.12, P = .003). High religious coping patients whose spiritual needs were largely or completely supported were more likely to receive hospice (AOR = 4.93; 95% CI, 1.64 to 14.80; P = .004) and less likely to receive aggressive care (AOR = 0.18; 95% CI, 0.04 to 0.79; P = .02) in comparison with those not supported. Spiritual support from the medical team and pastoral care visits were associated with higher QOL scores near death (20.0 [95% CI, 18.9 to 21.1] v 17.3 [95% CI, 15.9 to 18.8], P = .007; and 20.4 [95% CI, 19.2 to 21.1] v 17.7 [95% CI, 16.5 to 18.9], P = .003, respectively). Conclusion: Support of terminally ill patients' spiritual needs by the medical team is associated with greater hospice utilization and, among high religious copers, less aggressive care at EoL. Spiritual care is associated with better patient QoL near death.

Original languageEnglish (US)
Pages (from-to)445-452
Number of pages8
JournalJournal of Clinical Oncology
Volume28
Issue number3
DOIs
StatePublished - Jan 20 2010

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Patient Care
Quality of Life
Neoplasms
Hospices
Pastoral Care
Odds Ratio
Hospice Care
Terminally Ill
Patient Care Team
Terminal Care
Resuscitation
Prospective Studies

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Provision of spiritual care to patients with advanced cancer : Associations with medical care and quality of life near death. / Balboni, Tracy Anne; Paulk, Mary Elizabeth; Balboni, Michael J.; Phelps, Andrea C.; Loggers, Elizabeth Trice; Wright, Alexi A.; Block, Susan D.; Lewis, Eldrin F.; Peteet, John R.; Prigerson, Holly Gwen.

In: Journal of Clinical Oncology, Vol. 28, No. 3, 20.01.2010, p. 445-452.

Research output: Contribution to journalArticle

Balboni, TA, Paulk, ME, Balboni, MJ, Phelps, AC, Loggers, ET, Wright, AA, Block, SD, Lewis, EF, Peteet, JR & Prigerson, HG 2010, 'Provision of spiritual care to patients with advanced cancer: Associations with medical care and quality of life near death', Journal of Clinical Oncology, vol. 28, no. 3, pp. 445-452. https://doi.org/10.1200/JCO.2009.24.8005
Balboni, Tracy Anne ; Paulk, Mary Elizabeth ; Balboni, Michael J. ; Phelps, Andrea C. ; Loggers, Elizabeth Trice ; Wright, Alexi A. ; Block, Susan D. ; Lewis, Eldrin F. ; Peteet, John R. ; Prigerson, Holly Gwen. / Provision of spiritual care to patients with advanced cancer : Associations with medical care and quality of life near death. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 3. pp. 445-452.
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abstract = "Purpose: To determine whether spiritual care from the medical team impacts medical care received and quality of life (QoL) at the end of life (EoL) and to examine these relationships according to patient religious coping. Patients and Methods: Prospective, multisite study of patients with advanced cancer from September 2002 through August 2008. We interviewed 343 patients at baseline and observed them (median, 116 days) until death. Spiritual care was defined by patient-rated support of spiritual needs by the medical team and receipt of pastoral care services. The Brief Religious Coping Scale (RCOPE) assessed positive religious coping. EoL outcomes included patient QoL and receipt of hospice and any aggressive care (eg, resuscitation). Analyses were adjusted for potential confounders and repeated according to median-split religious coping. Results: Patients whose spiritual needs were largely or completely supported by the medical team received more hospice care in comparison with those not supported (adjusted odds ratio [AOR] = 3.53; 95{\%} CI, 1.53 to 8.12, P = .003). High religious coping patients whose spiritual needs were largely or completely supported were more likely to receive hospice (AOR = 4.93; 95{\%} CI, 1.64 to 14.80; P = .004) and less likely to receive aggressive care (AOR = 0.18; 95{\%} CI, 0.04 to 0.79; P = .02) in comparison with those not supported. Spiritual support from the medical team and pastoral care visits were associated with higher QOL scores near death (20.0 [95{\%} CI, 18.9 to 21.1] v 17.3 [95{\%} CI, 15.9 to 18.8], P = .007; and 20.4 [95{\%} CI, 19.2 to 21.1] v 17.7 [95{\%} CI, 16.5 to 18.9], P = .003, respectively). Conclusion: Support of terminally ill patients' spiritual needs by the medical team is associated with greater hospice utilization and, among high religious copers, less aggressive care at EoL. Spiritual care is associated with better patient QoL near death.",
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