Spirituality in Cancer Care - Modes of Intervention
Various modes of intervention or assistance might be considered to address the spiritual concerns of patients. These include the following:
- Exploration by the physician or other health care provider within the context of usual medical care.
- Encouragement for the patient to seek assistance from his or her own clergy.
- Formal referral to a hospital chaplain.
- Referral to a religious or faith-based therapist.
- Referral to a range of support groups that are known to address spiritual issues.
Two survey studies [1,2] found that physicians consistently underestimate the degree to which patients want spiritual concerns addressed. An Isreali study found that patients expressed the desire that 18% of a hypothetical 10-minute visit be spent addressing such concerns, while their providers estimated that 12% of the time should be spent in this way. This study also found that while providers perceived that a patient's desire for addressing spiritual concerns related to a broader interest in complementary and alternative medicine (CAM) modalities, patients viewed CAM-related issues and spiritual/religious concerns as quite separate.
A task force  of physicians and end-of-life specialists suggested several guidelines for physicians who wish to respond to patients' spiritual concerns:
- Respect the patient's views and follow the patient's lead.
- Make a connection by listening carefully and acknowledging the patient's concerns, but avoid theological discussions or engaging in specific religious rituals.
- Maintain one's own integrity in relation to one's own religious beliefs and practices.
- Identify common goals for care and medical decisions.
- Mobilize other resources of support for the patient, such as referring the patient to a chaplain or encouraging contact with the patient's own clergy.
Inquiring about religious or spiritual concerns by physicians or other health care professionals may provide valuable and appreciated support to patients. Most cancer patients appear to welcome a dialogue about such concerns, regardless of diagnosis or prognosis. In a large survey of cancer outpatients, between 20% and 35% expressed a desire for religious and spiritual resources, help with talking about finding meaning in life, help with finding hope, talking about death and dying, and finding peace of mind.[Level of evidence: II] It is appropriate to initiate such an inquiry once initial diagnosis and treatment issues have been discussed and considered by the patient (approximately a month after diagnosis or later). In a large, multisite, longitudinal study of patients with advanced cancer,[Level of evidence: II] there was considerable variation in whether spiritual concerns were addressed by medical staff, with about 50% reporting at least some support at three of the settings, in contrast to fewer than 15% reporting some support at the other four settings. Support received from the medical team predicted greater quality of life, greater likelihood of receiving hospice care at the end of life, and for patients who have high levels of religious coping, less aggressive care.