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4 results

  • Frequency, intensity, and correlates of spiritual pain in advanced cancer patients assessed in a supportive/palliative care clinic

  • Marvin Omar Delgado-Guay, Gary Chisholm, Janet Williams, Susan Frisbee-Hume, Andrea O. Ferguson, Eduardo Bruera
  • Journal:
    Palliative & Supportive Care / Volume 14 / Issue 4 / August 2016
    Published online by Cambridge University Press:
    20 October 2015, pp. 341-348
  • Objective:

    Regular assessments of spiritual distress/spiritual pain among patients in a supportive/palliative care clinic (SCPC) are limited or unavailable. We modified the Edmonton Symptom Assessment Scale (ESAS) by adding spiritual pain (SP) to the scale (0 = best, 10 = worst) to determine the frequency, intensity, and correlates of self-reported SP (≥1/10) (pain deep in your soul/being that is not physical) among these advanced cancer patients.

    Method:

    We reviewed 292 consecutive consults of advanced cancer patients (ACPs) who were evaluated at our SCPC between October of 2012 and January of 2013. Symptoms were assessed using the new instrument (termed the ESAS–FS).

    Results:

    The median age of patients was 61 (range = 22–92). Some 53% were male; 189 (65%) were white, 45 (15%) African American, and 34 (12%) Hispanic. Some 123 of 282 (44%) of ACPs had SP (mean (95% CI) = 4(3.5–4.4). Advanced cancer patients with SP had worse pain [mean (95% CI) = 5.3(4.8, 5.8) vs. 4.5(4.0, 5.0)] (p = 0.02); depression [4.2(3.7, 4.7) vs. 2.1(1.7, 2.6), p < 0.0001]; anxiety [4.2(3.6, 4.7) vs. 2.5(2.0, 3.0), p < 0.0001]; drowsiness [4.2(3.7, 4.7) vs. 2.8(2.3, 3.2), p < 0.0001]; well-being [5.4(4.9, 5.8) vs. 4.5(4.1, 4.9), p = 0.0136]; and financial distress (FD) [4.4(3.9, 5.0) vs. 2.2(1.8, 2.7), p < 0.0001]. Spiritual pain correlated (Spearman) with depression (r = 0.45, p < 0.0001), anxiety (r = 0.34, p < 0.0001), drowsiness (r = 0.26, p < 0.0001), and FD (r = 0.44, p < 0.0001). Multivariate analysis showed an association with FD [OR (95% Wald CI) = 1.204(1.104–1.313), p < 0.0001] and depression [1.218(1.110–1.336), p < 0.0001]. The odds that patients who had SP at baseline would also have SP at follow-up were 182% higher (OR = 2.82) than for patients who were SP-negative at baseline (p = 0.0029). SP at follow-up correlated with depression (r = 0.35, p < 0.0001), anxiety (r = 0.25, p = 0.001), well-being (r = 0.27, p = 0.0006), nausea (r = 0.29, p = 0.0002), and financial distress (r = 0.42, p < 0.0001).

    Significance of results:

    Spiritual pain, which is correlated with physical and psychological distress, was reported in more than 40% of ACPs. Employment of the ESAS–FS allows ACPs with SP to be identified and evaluated in an SCPC. More research is needed.

  • Development of a spiritual pain assessment sheet for terminal cancer patients: Targeting terminal cancer patients admitted to palliative care units in Japan

  • KEIKO TAMURA, KAORI ICHIHARA, EIKO MAETAKI, KEIKO TAKAYAMA, KUMI TANISAWA, MASAYUKI IKENAGA
  • Journal:
    Palliative & Supportive Care / Volume 4 / Issue 2 / June 2006
    Published online by Cambridge University Press:
    09 August 2006, pp. 179-188

  • Objective: This research explores the potential benefit of a spiritual pain assessment sheet to clinical practice. With spiritual pain defined as “pain caused by extinction of the being and meaning of the self,” the spiritual pain assessment sheet was developed by Hisayuki Murata from his conceptual framework reflecting the three dimensions of a human being as a being founded on temporality, a being in relationship, and a being with autonomy. The assessment sheet was developed from reviews of the literature and examinations from a philosophical perspective on the structure of spiritual pain.

    Methods: Patients admitted to palliative care units in Japan were interviewed using the assessment sheet. The responses were analyzed qualitatively. The usefulness of the assessment sheet and the burden placed on the patients by its use were also investigated.

    Results: The spiritual pain elucidated by the assessment sheet was the same as that revealed in the earlier research of Morita. The patients reported that they did not find the use of the assessment sheet a burden, and more than half reported that it was useful. The burden of the assessment sheet on the subjects was thus determined to be low. Positive feedback on the assessment sheet was also received from the nurses who conducted the patient interviews, who said the assessment sheet made it easier to talk with the patients about their spiritual pain.

    Significance of research: The research results indicate that the spiritual pain assessment sheet provided an appropriate assessment of spiritual pain among terminal cancer patients, showing that such a sheet could be used as an assessment tool in the future.

  • Caring for the spiritual pain of patients with advanced cancer: A phenomenological approach to the lived experience

  • KEIKO TAMURA, KAZUKO KIKUI, MICHIYO WATANABE
  • Journal:
    Palliative & Supportive Care / Volume 4 / Issue 2 / June 2006
    Published online by Cambridge University Press:
    09 August 2006, pp. 189-196

  • Objective: The aim of this research was to reveal, from the perspective of the “lived experience” shared by cancer patients and their nurses, how patients facing death create lived experience in the context of palliative care. This research also aims to elucidate the meaning nurses find in patients' experiences while caring for their patients.

    Methods: The participants in this study were cancer patients who were given opportunities to discuss events and concerns in their daily lives, with the interactions guided by the researchers. Transcriptions of conversations with the patients were analyzed using the method for empirical data classification set forth by Giorgi (1985) with appropriate modification.

    Results: This study found that when the nurse correctly interprets the meaning of the concerns (Heidegger, 1962) of the patient facing death and shares that meaning with the patient, fundamental questions naturally arise for the patient. Answering these questions becomes possible only through interactions that require the reexamination of the values of the patient and the nurse.

    Significance of research: This research elucidates the spiritual pain experienced by cancer patients and discusses opportunities for nurses to address the spiritual care of these patients.

  • Spiritual pain and its care in patients with terminal cancer: Construction of a conceptual framework by philosophical approach

  • HISAYUKI MURATA
  • Journal:
    Palliative & Supportive Care / Volume 1 / Issue 1 / March 2003
    Published online by Cambridge University Press:
    29 April 2003, pp. 15-21

  • Objective: In discussing spiritual care of patients with terminal cancer, it is important to clarify the structure of spiritual pain to be evaluated.

    Methods: In this article, spiritual pain is defined as “pain caused by extinction of the being and the meaning of the self,” and its structure was evaluated according to the three dimensions of the human being, that is, a being founded on temporality, a being in relationship, and a being with autonomy.

    Results: As a result, spiritual pain of patients with terminal cancer could be described as meaninglessness of life, loss of identity, and worthlessness of living derived from loss of the future, loss of others, and loss of autonomy of a dying individual.

    Significance of results: On the basis of these understandings, the author deduced principles of spiritual care of terminally ill cancer patients as recovery of the future beyond death, others beyond death, and autonomy toward death in each dimension of the human being.