Original Article
Spirituality, quality of life, psychological adjustment in terminal cancer patients in hospice
A. Bovero PsyD,
P. Leombruni MD,
M. Miniotti PsyD,
G. Rocca MD,
R. Torta MD,
A. Bovero PsyD
Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, Torino, Italy
Search for more papers by this authorP. Leombruni MD
Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, Torino, Italy
Search for more papers by this authorCorresponding Author
M. Miniotti PsyD
Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, Torino, Italy
Correspondence address: Marco Miniotti, Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, 15, Via Cherasco, 10126 Torino, Italy (e-mail: [email protected]).Search for more papers by this authorG. Rocca MD
Psychiatric Section, Department of Neurosciences, University of Turin, Torino, Italy
Search for more papers by this authorR. Torta MD
Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, Torino, Italy
Search for more papers by this author
A. Bovero PsyD,
P. Leombruni MD,
M. Miniotti PsyD,
G. Rocca MD,
R. Torta MD,
A. Bovero PsyD
Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, Torino, Italy
Search for more papers by this authorP. Leombruni MD
Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, Torino, Italy
Search for more papers by this authorCorresponding Author
M. Miniotti PsyD
Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, Torino, Italy
Correspondence address: Marco Miniotti, Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, 15, Via Cherasco, 10126 Torino, Italy (e-mail: [email protected]).Search for more papers by this authorG. Rocca MD
Psychiatric Section, Department of Neurosciences, University of Turin, Torino, Italy
Search for more papers by this authorR. Torta MD
Clinical Psychology and Psycho-Oncology Unit, Department of Neurosciences, University of Turin, Torino, Italy
Search for more papers by this authorAbstract
The purpose of this study was to show the different components of spirituality in the last few weeks of life for advanced cancer patients admitted to hospice and to evaluate quality of life (QoL), pain, anxiety, depression and psychological adjustment to cancer. One hundred and fifteen patients were interviewed with a series of rating scales: the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale, the Hospital Anxiety and Depression Scale, the Visual Analogue Scale for pain, the Brief Coping Orientation to Problem Experienced and the Functional Assessment of Cancer Therapy Scale – General Measure. Workers and single patients with higher education level showed a worse QoL. Moreover, anxiety and pain were negatively associated with QoL, while spirituality and ‘Instrumental Support’ coping style were positively associated with QoL. In the Italian sample, it was observed that when patients are close to death, faith is a more important component of spirituality than meaning/peace. This study confirms that QoL could be related to physical and psychological symptoms, and this reiterates the importance of faith in end-of-life care.
References
- Alcorn S.R., Balboni M.J., Prigerson H.G., Reynolds A., Phelps A.C., Wright A.A., Block S.D., Peteet J., Kachnic L. & Balboni T.A. (2010) “If God wanted me yesterday, I wouldn't be here today”: religious and spiritual themes in patients' experiences of advanced cancer. Journal of Palliative Medicine 13, 581–588.
- Balboni T.A., Paulk M.E., Balboni M.J., Phelps A.C., Loggers E.T., Wright A.A., Block S.D., Lewis E.F., Peteet J. & Prigerson H.G. (2010) Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. Journal of Clinical Oncology 28, 445–452.
- Bjelland I., Dahl A.A., Haug T.T. & Neckelmann D. (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research 52, 69–77.
- Bovero A., Valentini F., Aitoro F. & Torta R. (2010) Pain, depression, spirituality in advanced cancer patients. Palliative Medicine 24, 111–112.
- Brady M.J., Peterman A.H., Fitchett G., Mo M. & Cella D. (1999) A case for including spirituality in quality of life measurement in oncology. Psychooncology 8, 417–428.
10.1002/(SICI)1099-1611(199909/10)8:5<417::AID-PON398>3.0.CO;2-4 CASPubMedWeb of Science®Google Scholar
- Brintzenhofe-Szoc K.M., Levin T.T., Li Y., Kissane D.W. & Zabora J.R. (2009) Mixed anxiety/depression symptoms in a large cancer cohort: prevalence by cancer type. Psychosomatics 50, 383–391.
- Carver C.S., Scheier M.F. & Weintraub J.K. (1989) Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology 66, 184–195.
- Castelli L., Binaschi L., Caldera P., Mussa A. & Torta R. (2011) Fast screening of depression in cancer patients: the effectiveness of the HADS. European Journal of Cancer Care 20, 528–533.
- Cella D.F., Tulsky D.S., Gray G., Sarafian B., Linn E., Bonomi A., Silberman M., Yellen S.B., Wincour P. & Brannon J. (1993) The Functional Assessment of Cancer therapy Scale: development and validation of the general measure. Journal of Clinical Oncology 11, 1407–1418.
- De Graeff A., de Leeuw J.R., Ros W.J., Hordjik G.J., Blijham G.H. & Winnubst J.A. (2001) Sociodemographic factors and quality of life as prognostic indicators in head and neck cancer. European Journal of Cancer 37, 332–339.
- Donahue M.J. (1985) Intrinsic and extrinsic religiousness: review and meta-analysis. Journal of Personality and Social Psychology 48, 400–419.
- Edwards A., Pang N., Shiu V. & Chan C. (2010) The understanding of spirituality and the potential role of spiritual care in end of life and palliative care: a meta-study of qualitative research. Palliative Medicine 24, 753–770.
- Elkins D.N., Hedstrom L.J., Hughes L.L., Leaf J.A. & Saunders C. (1988) Toward a humanistic-phenomenological spirituality: definition, description, and measurement. Journal of Humanistic Psychology 28, 5–18.
- Ellerhorst-Ryan J.M. (1988) Measuring aspects of spirituality. In: Instruments for Clinical Nursing Research (ed. M. Frank-Stromborg), pp. 141–149. Appleton and Lange, Norwalk, CT, USA.
- Emblen J.D. (1992) Religion and spirituality defined according to current use in nursing literature. Journal of Professional Nursing 8, 41–47.
- Fatone A.M., Moadel A.B., Foley F.W., Fleming M. & Jandorf L. (2007) Urban voices: the quality of life experience among women of color with breast cancer. Palliative and Supportive Care 5, 115–125.
- Field M.J. & Cassel C.K. (1997) Approaching death: improving care at the end of life. A Cancer Journal for Clinicians 1, 85–87.
- Folkman S. & Moskowitz J.T. (2000) Positive affect and the other side of coping. American Psychologist 55, 647–654.
- Folstein M., Folstein S. & McHugh P. (1975) “Mini-mental-state”: a practical method of grading the cognitive state of patients for the clinicians. Journal of Psychiatric Research 12, 189–198.
- Gathchel R.J. & Oordt M.S. (2003) Coping with chronic illness. In: Clinical Health Psychology and Primary Care: Practical Advice and Clinical Guidance for Successful Collaboration (eds R.J. Gathchel & M.S. Oordt), pp. 213–233. American Psychological Association, Washington, DC, USA.
10.1037/10592-013 Google Scholar
- Grant L., Murray S.A. & Sheikh A. (2010) Spiritual dimensions of dying in pluralist societies. British Medical Journal 1, 341.
- Hills J., Paice J.A., Cameron J.R. & Shott S. (2005) Spirituality and distress in palliative care consultation. Journal of Palliative Medicine 8, 782–788.
- Kobayashi K., Morita S., Shimonagayoshi M., Kobayashi M., Fujiki Y., Uchida Y. & Yamaguchi K. (2008) Effects of socioeconomic factors and cancer survivors worries on their quality of life in Japan. Psychoncology 17, 606–611.
- Kolva E., Rosenfeld B., Pessin H., Breibart W. & Brescia R. (2011) Anxiety in terminally cancer patients. Journal of Pain and Symptom Management 42, 691–701.
- Kutner J.S., Bryant L.L., Beaty B.L. & Fairclough D.L. (2007) Time course and characteristics of symptom distress and quality of life at the end of life. Journal of Pain and Symptom Management 34, 227–236.
- Low J., Perry R. & Wilkinson S. (2005) A qualitative evaluation of the impact of palliative care day services: the experiences of patients, informal carers, day unit managers and volunteer staff. Palliative Medicine 19, 65–70.
- McClain C.S., Rosenfeld B. & Breibart W. (2003) Effect of spiritual well-being on end of life despair in terminally-ill cancer patients. The Lancet 361, 1603–1607.
- McCoubrie R.C. & Davies A.N. (2006) Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer? Supportive Care in Cancer 14, 379–385.
- Miller W.R. & Thoresen C.E. (2003) Spirituality, religion, and health. An emerging research field. American Psychologist 58, 24–35.
- Muldoon M. & King N. (1995) Spirituality, health care, and bioethics. Journal of Religion and Health 34, 329–349.
- Murray S.A., Kendall M., Boyd K., Worth A. & Benton T.F. (2004) Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and carers. Palliative Medicine 18, 39–45.
- Nekolaichuk C.L., Faisinger R.L., Aass N., Hjermstad M.J., Knudsen A.K., Klepstad P., Currow D.C. & Kaasa S. & European Palliative Care research Collaborative (EPCRC) (2013) The Edmonton Classification System for Cancer Pain: comparison of pain classification features and pain intensity across diverse palliative care settings in eight countries. Journal of Palliative Medicine 16, 516–513.
- Nelson C.J., Rosenfeld B., Breibart W. & Gallietta M. (2002) Spirituality, religion, and depression in the terminally ill. Psychosomatics 43, 213–220.
- Nelson C.J., Jacobson C.M., Weinberger M.I., Bhaskaran V., Rosenfeld B., Breibart W. & Roth A.J. (2009) The role of spirituality in the relationship between religiosity and depression in prostate cancer patients. Annals of Behavioral Medicine 38, 105–114.
- Noorani N.H. & Montagnini M. (2007) Recognizing depression in palliative care patients. Journal of Palliative Medicine 10, 458–464.
- Passalacqua R., Caminiti C., Salvagni S., Barni S., Beretta G.D., Carlini P., Contu A., Di Costanzo F., Toscano L. & Campione F. (2004) Effect of media information on cancer patients' opinions, feelings, decision-making process and physician-patient communication. Cancer 100, 1077–1084.
- Peterman A.H., Fitchett G., Brady M.J., Hernandez L. & Cella D. (2002) Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Annals of Behavioral Medicine 24, 49–58.
- Puchalski C.M., Kilpatrick S.D., McCullough M.E. & Larson D.B. (2003) A systematic review of spiritual and religious variables in Palliative Medicine, American Journal of Hospice and Palliative Care, Hospice Journal, Journal of Palliative Care and Journal of Pain and Symptom Management. Palliative and Supportive Care 1, 7–13.
- Rodin G., Lo C., Mikulincer M., Donner A., Gagliese L. & Zimmermann C. (2009) Pathways to distress: the multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients. Social Science and Medicine 68, 562–569.
- Schag C.C., Heinrich R.L. & Ganz P.A. (1984) Karnofsky performance status revised: reliability, validity and guidelines. Journal of Clinical Oncology 2, 187–193.
- Scott J. & Huskisson E.C. (1979) Graphic representation of pain. Pain 2, 175–184.
10.1016/0304-3959(76)90113-5 Google Scholar
- Spencer R., Nilsson M., Wright A., Pirl W. & Prigerson H. (2010) Anxiety disorders in advanced cancer. Cancer 116, 1810–1819.
- Stephens C., Stein K. & Landrine H. (2010) The role of acculturation in life satisfaction among Hispanic cancer survivors: results of the American Cancer Society's study of cancer survivors. Psychooncology 19, 376–383.
- Sulmasy D.P. (2002) A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist 42, 24–33.
- Tarakeshwar N., Vanderwerker L.C., Paulk E., Pearce M.J., Kasl S.V. & Prigerson H.G. (2006) Religious coping is associated with the quality of life of patients with advanced cancer. Journal of Palliative Medicine 9, 646–657.
- Vaughan R., Wittine B. & Walsh R. (1988) Transpersonal Psychology and the Religious Person. In: Religion and the Clinical Practice of Psychology (ed. E.P. Shafranske), pp. 483–509. American Psychological Association, Washington, DC, USA.
- Visser A., Garssen B. & Vingerhoets A. (2010) Spirituality and well-being in cancer patients: a review. Psychooncology 19, 565–572.
- Walker M.S., Zona D.M. & Fisher E.B. (2006) Depressive symptoms after lung cancer surgery: their relation to coping style and social support. Psychooncology 15, 684–693.
- Wan G., Counte M., Cella D., Hernandez L., McGuire D.B., Deasay S., Shiomoto G. & Hahn E.A. (1999) The impact of socio-cultural and clinical factors on health related quality of life reports among Hispanic and African-American cancer patients. Journal of Outcome Measurement 8, 14–26.
- Wang Y., Shen J. & Xu Y. (2011) Symptoms and quality of life of advanced cancer patients at home: a cross sectional study in Shanghai, China. Supportive Care in Cancer 19, 789–797.
- Wilson K.G., Chochinov H.M., Skiro M.G., Allard P., Chary S., Gagnon P.R., Macmillan K., De Luca M., O'Shea F., Kuhl D., Faisinger R.L. & Clinch J.J. (2007) Depression and anxiety disorders in palliative cancer care. Journal of Pain and Symptom Management 33, 118–129.
- World Health Organization (1983) Cancer Pain Relief and Palliative Care: Report of a WHO Expert Committee. Schüler SA, Geneva, Switzerland.
- Yanez B., Edmonson D., Stanton A., Park C.L., Kwan L., Ganz P.A. & Blank T.O. (2009) Facets of spirituality as predictors of adjustment to cancer: relative contributions of having faith and finding meaning. Journal of Consulting and Clinical Psychology 77, 730–741.
- Yates J.W., Chalmer J.W. & McKegney F.P. (1980) Evaluation of patients with advanced cancer using the Karnofsky Performance Status. Cancer 45, 2220–2224.
10.1002/1097-0142(19800415)45:8<2220::AID-CNCR2820450835>3.0.CO;2-Q CASPubMedWeb of Science®Google Scholar
- Yates Y.W., Chalmer B.L., James P., Follansbee M. & McKegney F.P. (1981) Religion in patients with advanced cancer. Medical and Pediatric Oncology 9, 121–128.
- Zigmond A.S. & Snaith R.P. (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361–370.
