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    Spirituality in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Modes of Intervention

    Table 2. Exploring Spiritual/Religious Concerns in Adults With Cancera continued...

    A common concern is whether to offer to pray with patients. Although one study [7] found that more than one-half of the patients surveyed expressed a desire to have physicians pray with them, a large proportion did not express this preference. A qualitative study of cancer patients [8] found that patients were concerned that physicians are too busy, not interested, or even prohibited from discussing religion. At the same time, patients generally wanted their physicians 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?"

    In a study of 70 patients with advanced cancer, 206 oncology physicians, and 115 oncology nurses, all participants were interviewed about their opinions regarding the appropriateness of patient-practitioner prayer in the advanced-cancer setting. Results showed that 71% of advanced-cancer patients, 83% of oncology nurses, and 65% of physicians reported that it is occasionally appropriate for a practitioner to pray with a patient when the request to pray is initiated by the patient. Similarly, 64% of patients, 76% of nurses, and 59% of physicians reported that they consider it appropriate for a religious/spiritual health care practitioner to pray for a patient.[9]

    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 the most viable approach in exploring these issues.

    Hospital Chaplains

    Traditional means of providing assistance to patients has generally been through the services of hospital chaplains.[10,11] 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.[12] 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,[5][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.

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