Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death

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.

Fig 1.

Receipt of hospital/clinic pastoral care services by spiritual support from the medical team among patients with advanced cancer (n = 343). (*) Percentage represents the proportion of patients receiving or not receiving pastoral care visits over total patients in each spiritual support category. (†) χ² test, df = 4. (‡) Medical team includes all health care providers involved in the patient's care in the medical setting, such as doctors, nurses, and chaplains.

Fig 2.

Adjusted estimates of quality of life near death by receipt of spiritual care in patients with advanced cancer (n = 299). All models are adjusted for baseline quality of life, baseline social support, baseline existential well-being, recruitment site, patient-physician relationship, spiritual support from religious communities, receipt of outside-hospital clergy visits, receipt of hospice care at end of life, receipt of any aggressive care at end of life, and the person reporting quality of life near death. Sample has been reduced to 299 patients because of missing data. Analyses were repeated with missing data imputed to their mean values (n = 343), and the results were unchanged. Quality of life in the last week of life, possible scores 0 to 30. Whole sample: mean = 19.0, standard deviation = 7.9.