Spirituality in Cancer Care - Modes of Intervention
A common concern is whether to offer to pray with patients. Although one study  found that more than one half of the patients surveyed expressed a desire to have physicians pray with them, a large proportion does not express this preference. A qualitative study of cancer patients  found that patients were concerned that physicians are too busy, not interested, or even prohibited from discussing religion. At the same time, they generally wanted their physician to acknowledge the value of spiritual and religious issues. A suggestion was made that physicians might raise the question of prayer by asking, "Would that comfort you?" The most important guideline is to remain sensitive to the patient's preference; therefore, asking patients about their beliefs or spiritual concerns in the context of exploring how they are coping in general is a viable approach in exploring these issues.
Traditional means of providing assistance to patients has generally been through the services of hospital chaplains.[9,10] Hospital chaplains can play a key role in addressing spiritual and religious issues; chaplains are trained to work with a wide range of issues as they arise for medical patients and to be sensitive to the diverse beliefs and concerns that patients may have. Chaplains are generally available in large medical centers, but they may not be available in smaller hospitals on a reliable basis. Chaplains are rarely available in the outpatient settings where most care is now delivered (especially early in the course of cancer treatment, when these issues may first arise). In a large, multisite, longitudinal study of patients with advanced cancer,[Level of evidence: II] only 46% of patients reported receiving pastoral care visits. While these visits were not associated with receipt of end-of-life care (either hospice or aggressive measures), they were associated with better quality of life near death.
Another traditional approach in outpatient settings is having spiritual/religious resources available in waiting rooms. This is relatively easy to do, and many such resources exist; however, a breadth of resources covering all faith backgrounds of patients is highly desirable (refer to the Additional Resources section).
Support groups may provide a setting in which patients may explore spiritual concerns. If spiritual concerns are important to a patient, the health care provider may need to identify whether a locally available group addresses these issues. The published data on the specific effects of support groups on assisting with spiritual concerns is relatively sparse, partly because this aspect of adjustment has not been systematically evaluated. A randomized trial [Level of evidence: I] compared the effects of a mind-body-spirit group to a standard group support program for women with breast cancer. Both groups showed improvement in spiritual well-being, although there were appreciably more differential effects for the mind-body-spirit group in the area of spiritual integration.