Association between Spirituality, Religiosity, Spiritual Pain, Symptom Distress, and Quality of Life among Latin American Patients with Advanced Cancer: A Multicenter Study
Publication: Journal of Palliative Medicine
Volume 24, Issue Number 11
Abstract
Objectives: The purpose of this multicenter study was to characterize the association between spirituality, religiosity, spiritual pain, symptom distress, coping, and quality of life (QOL) among Latin American advanced cancer patients.
Methods: Three hundred twenty-five advanced cancer patients from palliative care clinics in Chile, Guatemala, and the United States completed validated assessments: Faith, Importance and Influence, Community, and Address (FICA) (spirituality/religiosity), Edmonton Symptom Assessment Scale-Financial/Spiritual (ESAS-FS), including spiritual pain, Penn State Worry Questionnaire-Abbreviated (PSWQ-A), Center for Epidemiologic Studies Depression Scale (CES-D), Brief-coping strategies (COPE) and Brief religious coping (RCOPE) and RCOPE, respectively, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Expanded version (FACIT-Sp-Ex).
Results: Median age: 58 years (range: 19–85); 60% female; and 62% Catholic and 30% Christian, but not Catholic. Three hundred fifteen patients (97%) considered themselves spiritual and 89% religious, with median intensities of 7 (interquartile range [IQR]: 5–10) and 7 (5–9), respectively (0–10 scale, 10 = “very much”). Median importance of spirituality/religiosity was 10 (IQR: 8–10). The frequency and associations between spirituality/religiosity and various items were as follows: helps to cope with illness (98%; r = 0.66303; p < 0.0001), positive effect on physical symptoms (81%; r = 0.42067; p < 0.0001), and emotional symptoms (84%; r = 0.16577; p < 0.0001). One hundred ninety-five patients (60%) reported that their spiritual/religious needs had not been supported by the medical team. Spiritual pain was reported in 162/311 patients (52%), with median intensity of 6 (IQR: 5–8). Spiritual pain was associated with pain (p = 0.0225), depression (p < 0.0001), anxiety (p < 0.0001), worry (p < 0.001), behavioral disengagement (p = 0.0148), FACIT-Sp-Ex score (p = 0.0002), and negative RCOPE (p < 0.0001).
Significance of Results: Spirituality and religiosity are frequent, intense, and rarely addressed among Latin American patients. Spirituality/religiosity was associated with positive COPE and higher QOL. Spiritual pain was also frequent and associated with physical and psychosocial distress. These patients need increased spiritual/religious support.
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References
1. Delgado-Guay MO, Hui D, Parsons HA, et al.: Spirituality, religiosity, and spiritual pain in advanced cancer patients. J Pain Symptom Manage 2011;41:986–994.
2. Delgado-Guay MO: Spirituality and religiosity in supportive and palliative care. Curr Opin Support Palliat Care 2014;8:308–313.
3. Campesino M, Schwartz GE: Spirituality among Latinas/os: Implications of culture in conceptualization and measurement. ANS Adv Nurs Sci 2006;29:69–81.
4. Greer JA, Applebaum AJ, Jacobsen JC, et al.: Understanding and addressing the role of coping in palliative care for patients with advanced cancer. J Clin Oncol 2020;38:915–925.
5. Angela AS: An examination of the folk healing practice of curanderismo in the hispanic community. J Commun Health Nurs 2018;35:148–161.
6. Rand KL, Cripe LD, Monahan PO, et al.: Illness appraisal, religious coping, and psychological responses in men with advanced cancer. Support Care Cancer 2012;20:1719–1728.
7. Carrion IV, Nedjat-Haiem F, Macip-Billbe M, Black R: “I Told Myself to Stay Positive” perceptions of coping among Latinos with a cancer diagnosis living in the United States. Am J Hospice Palliat Med 2017;34:233–240.
8. Carrion IV, Nedjat-Haiem FR, Martinez TD, Castaneda H: An Exploratory study of advance care planning among Colombians, Mexicans, and Puerto Ricans with a cancer diagnosis. Support Care Cancer 2013;21:1233–1239.
9. Hsiao A-F, Wong MD, Goldstein MS, et al.: Variation in complementary and alternative medicine (CAM) use across racial/ethnic groups and the development of ethnic-specific measures of CAM use. J Altern Complement Med 2006;12:281–290.
10. Mikhail N, Wall S, Ziment I: Use of alternative medicine among Hispanics. J Altern Complement Med 2004;10:851–859.
11. Kronenberg F, Cushman LF, Wade CM, et al.: Race/ethnicity and women's use of complementary and alternative medicine in the United States: Results of a national survey. Am J Public Health 2006;96:1236–1242.
12. Ortiz BI, Shields KM, Clauson KA, Clay PG: Complementary and alternative medicine use among Hispanics in the United States. Ann Pharmacother 2007;41:994–1004.
13. Graham RE, Ahn AC, Davis RD: Use of complementary and alternative medical therapies among racial and ethnic minority adults: Results from the 2002 National Health Interview Survey. J Natl Med Assoc 2005;97:535–545.
14. Mendez-luck CA, Applewhite SR, Lara VE, Toyokawa N: The concept of Familism in the lived experiences of Mexican-origin caregivers. J Marriage Fam 2016;78:813–829.
15. Rote S, Angel J, Hinton L: Characteristics and consequences of family support in Latino dementia care. J Cross Cult Gerontol 2019;34:337–354.
16. Balbim GM, Marques IG, Cortez C, et al.: Coping strategies utilized by middle-aged and older Latino caregivers of loved ones with Alzheimer's disease and related dementia. J Cross Cult Gerontol 2019;34:355–371.
17. Puchalski C, Romer A: Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med 2000;3:129–137.
18. Borneman T, Ferrell B, Puchalski CM: Evaluation of the FICA tool for spiritual assessment. J Pain Symptom Manage 2010;40:163–173.
19. Mako C, Galek K, Poppito SR: Spiritual pain among patients with advanced cancer in palliative care. J Palliat Med 2006;9:1106–1113.
20. Cotton S, Tsevat J, Szaflarski M, et al.: Changes in religiousness and spirituality attributed to HIV/AIDS. Are there sex and race differences? J Gen Intern Med 2006;21:14–20.
21. Chang VT, Hwang SS, Feuerman M: Validation of the Edmonton Symptom Assessment Scale. Cancer 2000;88:2164–2171.
22. Delgado Guay MO, Moreno H, Chisholm G, et al.: Frequency, intensity, and correlates of spiritual pain among advanced cancer patients assessed in a supportive/palliative care clinic (SCPC). Palliat Support Care 2016;14:341–348.
23. Delgado-Guay M, Ferrer J, Rieber AG, et al.: Financial distress and its associations with physical and emotional symptoms and quality of life among advanced cancer patients. Oncologist 2015;20:1092–1098.
24. Mor V, Laliberte L, Morris JN, Wiemann M: The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer 1984;53:2002–2007.75.
25. Schag CC, Heinrich RL, Ganz PA: Karnofsky performance status revisited: Reliability, validity, and guidelines. J Clin Oncol 1984;2:187–193.
26. Carver C: You want to measure coping but your protocol's too long: Consider the Brief COPE. Int J Behav Med 1997;4:92–100.
27. Carver CS, Scheier MF, Weintraub JK: Assessing coping strategies: A theoretically based approach. J Pers Soc Psychol 1989;56:267–283.
28. Pargament K, Koenig H, Perez L: The many methods of religious coping: Development and initial validation of the RCOPE. J Clin Psychol 2000;56:519–543.
29. Bruera E, Moyano J, Seifert L, et al.: The frequency of alcoholism among patients with pain due to terminal cancer. J Pain Symptom Manage 1995;10:599–60373.
30. Bruera E, Watanabe S: New developments in the assessment of pain in cancer patients. Support Care Cancer 1994;2:312–318
31. Peterman AH, Fitchett G, Brady MJ, et al.: Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale (FACIT-Sp). Ann Behav Med 2002;24:49–58.
32. Hopko D, Reas D, Beck J, et al.: Assessing worry in older adults: Confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model. Psychol Assess 2003;15:173–183.
33. Radloff LS: The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385–401.
34. Eaton WW, Muntaner C, Smith C, et al.: Center for Epidemiologic Studies Depression Scale: Review and revision (CESD and CESD-R). In: Maruish ME (ed). The Use of Psychological Testing for Treatment Planning and Outcomes Assessment, 3rd ed. Mahwah, NJ: Lawrence Erlbaum, 2004, pp. 363–377.
35. Stolley J, Koenig K: Religion/spirituality and health among elderly African Americans and Hispanics. J Psychosoc Nurs 1997;35:32–38.
36. Changing Faiths: Latinos and the transformation of American religion. www.pewhispanic.org/2007/04/25/changing-faiths-latinos-and-the-transformation-of-american-religion/ (Last accessed May 10, 2019).
37. Puchalski C, Ferrell B, Virani R, et al.: Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. J Palliat Med 2009;12:885–904.
38. Puchalski CM, Vitillo R, Hull SK, et al.: Improving the spiritual dimension of whole person care: Reaching national and international consensus. J Palliat Med 2014;17:642–656.
39. Puchalski CM, Sbrana A, Ferrell B, et al.: Interprofessional spiritual care in oncology: A literature review. ESMO Open 2019;4:e000465.
40. Puchalski C, Jafari N, Buller H, et al.: Interprofessional spiritual care education curriculum: A milestone toward the provision of spiritual care. J Palliat Med 2020;23:777–784.
41. Peselow T, Pi S, Lopez E, et al.: The impact of spirituality before and after treatment of major depressive disorder. Innov Clin Neurosci 2014;11:17–23.
42. Lo C, Zimmermann C, Gagliese L, et al.: Sources of spiritual well-being in advanced cancer. BMJ Support Palliat Care 2011;1:149–153.
43. Egondi T, Kabiru C, Beguy D, et al.: Adolescent home-leaving and the transition to adulthood: A psychosocial and behavioral study in the slums of Nairobi. Int J Behav Dev 2013;37:298–308.
44. Chen F, Berchtold A, Barrense-Dias Y, Suris JC: Spiritual belief and its link with potentially addictive behaviors in a youth sample in Switzerland. Int J Adolesc Med Health 2018;33.
45. Alcorn SR, Balboni MJ, Prigerson HG, et al.: “If God wanted me yesterday, I wouldn't be here today”: Religious and spiritual themes in patients' experiences of advanced cancer. J Palliat Med 2010;13:581–588.
46. Acklin MW, Brown EC, Mauger PA: The role of religious values in coping with cancer. J Relig Health 1983;22:322–333.
47. Valenzuela E, Bargsted M, Somma N: ¿En qué creen los chilenos? Naturaleza y alcance del cambio religioso en Chile. Temas de la Agenda Pública. 2013. https://politicaspublicas.uc.cl/wp-content/uploads/2015/02/serie-n59-en-que-creenlos-chilenos-naturaleza-y-alcance-del-cambio-religioso-enchile.pdf (Last accessed November 10, 2020).
48. Pérez-Cruz PE, Langer P, Carrasco C, et al.: Spiritual pain is associated with decreased quality of life in advanced cancer patients in palliative care: An exploratory study. J Palliat Med 2019;22:663–669.
49. Balboni TA, Balboni M, Enzinger AC, et al.: Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life; JAMA Intern Med 2013;173:1109–1117.
50. Best M, Leget C, Goodhead A, Paal P: An EAPC white paper on multi-disciplinary education for spiritual care in palliative care. BMC Palliat Care 2020;19:9.
51. Delgado-Guay MO: Developing a healing environment for broken souls of patients with life-threatening illnesses and their caregivers. J Pain Symptom Manage 2018;55:1231–1236.
52. Delgado-Guay MO, Chisholm G, Williams J, et al.: The association between religiosity and resuscitation status preference among patients with advanced cancer. Palliat Support Care 2015;13:1435–1439.
53. Lunder U, Furlan M, Simonic A: Spiritual needs assessments and measurements. Curr Opin Support Palliat Care 2011;5:273–278.
54. Ferrell BR, Twaddle ML, Melnick A, Meier DE: National consensus project clinical practice guidelines for quality palliative care guidelines, 4th Edition. J Palliat Med 2018;21:1684–1689.
Information & Authors
Information
Published In
Journal of Palliative Medicine
Volume 24 • Issue Number 11 • November 2021
Pages: 1606 - 1615
PubMed: 33844951
Copyright
Copyright 2021, Mary Ann Liebert, Inc., publishers.
History
Published in print: November 2021
Published online: 27 October 2021
Published ahead of print: 12 April 2021
Accepted: 16 February 2021
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Author Disclosure Statement
No competing financial interests exist.
Funding Information
Dr. M.O.D.-G. is supported, in part, by National Institutes of Health grants R01CA200867 (M.O.D.-G.); R01NR010162-01A1, R01CA122292-01, and R01CA124481-01 (E.B.); and P30CA016672 (used the Biostatistics Resource Group).
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