Spirituality in Cancer Care - Modes of Intervention
One trial,[Level of evidence: II] with a sample of 115 mixed-diagnosis patients (54% under active treatment), evaluated a 5-minute semistructured inquiry into spiritual and religious concerns. The four physicians' personal religious backgrounds included two Christians, one Hindu, and one Sikh; 81% of patients were Christian. Unlike the history-oriented interviews noted above, this inquiry was informed by brief patient-centered counseling approaches that view the physician as an important source of empowerment to help patients identify and address personal concerns (see Table 2 below for the content). After 3 weeks, the intervention group had larger reductions in depression, had more improvement in quality of life, and rated their relationship with the physician more favorably. Effects for quality of life remained after statistically adjusting for change in other variables. More improvement was also seen in patients who scored lower in spiritual well-being, as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) at baseline. Acceptability was high, with physicians rating themselves as "comfortable" in providing the intervention during 85% of encounters. Seventy-six percent of patients characterized the inquiry as "somewhat" to "very" useful. Physicians were twice as likely to underestimate the usefulness of the inquiry to patients rather than to overestimate it, in relation to the patient ratings.
The statements in Table 2 may be used to initiate a dialogue between health care provider and patient.
Table 2. Exploring Spiritual/Religious Concerns in Adults With Cancera
a Adapted from Kristeller et al.
|Health Care Provider Action||Possible Patient Response||Health Care Provider Reply|
|Introduce issue in neutral inquiring manner.||�||When dealing with a serious illness, many people draw on religious or spiritual beliefs to help cope. It would be helpful to me to know how you feel about this.|
|Inquire further, adjusting inquiry to patient's initial response.||Positive-Active Faith Response||What have you found most helpful about your beliefs since your illness?|
|Neutral-Receptive Response||How might you draw on your faith or spiritual beliefs to help you?|
|Spiritually Distressed Response (e.g., expression of anger or guilt)||Many people feel that way...what might help you come to terms with this?|
|Defensive/Rejecting Response||It sounds like you're uncomfortable that I brought this up. What I'm really interested in is how you are coping...can you tell me about that?|
|Continue to explore further as indicated.||�||I see. Can you tell me more (about....)?|
|Inquire about ways of finding meaning and a sense of peace.||�||Is there some way in which you are able to find a sense of meaning or peace in the midst of this?|
|Inquire about resources.||�||Whom do you have to talk to about this/these concerns?|
|Offer assistance as appropriate and available.||�||Perhaps we can arrange for you to talk to someone./There's a support group I can suggest./There are some reading materials in the waiting room.|
|Bring inquiry to a close.||�||I appreciate you discussing these issues with me. May I ask about it again?|