Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-04T21:38:18.215Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  20 October 2015

Marvin Omar Delgado-Guay ,
Gary Chisholm ,
Janet Williams ,
Susan Frisbee-Hume ,
Andrea O. Ferguson  and
Eduardo Bruera
Marvin Omar Delgado-Guay*
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Gary Chisholm
Affiliation:
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
Janet Williams
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Susan Frisbee-Hume
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Andrea O. Ferguson
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas Department of Spiritual Care and Education, The University of Texas MD Anderson Cancer Center, Houston, Texas
Eduardo Bruera
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
*
Address correspondence and reprint request to Marvin Omar Delgado-Guay, Palliative Care and Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030-4009. E-Mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Spiritual painSupportive care/Palliative careOutpatient center
Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 4 , August 2016 , pp. 341 - 348
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Alcorn, S.R., Balboni, M.J., Prigerson, H.G., et al. (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.CrossRefGoogle ScholarPubMed
Arnold, B.L. (2011). Mapping hospice patients' perception and verbal communication of end-of-life needs: An exploratory mixed methods inquiry. BMC Palliative Care, 10, 1.Google Scholar
Astrow, A.B., Wexler, A., Texeira, K., et al. (2007). Is failure to meet spiritual needs associated with cancer patients' perceptions of quality of care and their satisfaction with care? Journal of Clinical Oncology, 25(36), 5753–5757.Google Scholar
Balboni, T., Vanderwerker, L, Block, S., et al. (2007). Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. Journal of Clinical Oncology, 25, 550–560.CrossRefGoogle ScholarPubMed
Balboni, T.A., Paulk, M.E., Balboni, M.J., et al. (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(3), 445–452.CrossRefGoogle ScholarPubMed
Bruera, E., Kuehn, N., Miller, M.J., et al. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7, 6–9.Google Scholar
Delgado-Guay, M.O. (2014). Spirituality and religiosity in supportive and palliative care. Current Opinion in Supportive and Palliative Care, 8(3), 308–313.Google Scholar
Delgado-Guay, M.O., Hui, D., Parsons, H.A., et al. (2011). Spirituality, religiosity, and spiritual pain in advanced cancer patients. Journal of Pain and Symptom Management, 41(6), 986–994.Google Scholar
Delgado-Guay, M.O., Parsons, H.A., Hui, D., et al. (2013). Spirituality, religiosity, and spiritual pain among caregivers of patients with advanced cancer. The American Journal of Hospice & Palliative Care, 30, 455–461.CrossRefGoogle ScholarPubMed
Fitchett, G. & Risk, J.L. (2009). Screening for spiritual struggle. Journal of Pastoral Care & Counseling, 62(1–2), 1–12.Google Scholar
Handzo, G. (2011). Spiritual care for palliative patients. Current Problems in Cancer, 35(6), 365–371.CrossRefGoogle ScholarPubMed
Koenig, H.G. (2005). Faith and mental health: Religious resources for healing. West Conshohocken, PA: Templeton Foundation Press.Google Scholar
Koenig, H.G., King, D. & Carson, V.B. (2012). Handbook of religion and health, 2nd ed.New York: Oxford University Press.Google Scholar
Lunder, U., Furlan, M. & Simonic, A. (2011). Spiritual needs assessments and measurements. Current Opinion in Supportive and Palliative Care, 5(3), 273–278.CrossRefGoogle ScholarPubMed
Mako, C., Galek, K. & Poppito, S.R. (2006). Spiritual pain among patients with advanced cancer in palliative care. Journal of Palliative Medicine, 9, 1106–1113.CrossRefGoogle ScholarPubMed
Miller, I., Wickramaratne, P., Gameroff, M.J., et al. (2012). Religiosity and major depression in adults at high risk: A ten-year prospective study. The American Journal of Psychiatry, 169(1), 89–94.Google Scholar
Moritz, S., Kelly, M.T., Xu, T.J., et al. (2011). A spirituality teaching program for depression: Qualitative findings on cognitive and emotional change. Complementary Therapies in Medicine, 19(4), 201–207.Google Scholar
Nadarajah, S., Berger, A.M. & Thomas, S.A. (2013). Current status of spirituality in cardiac rehabilitation programs: A review of the literature. Journal of Cardiopulmonary Rehabilitation and Prevention, 33, 135–143.Google Scholar
Peteet, J.R. (2012). Spiritually integrated treatment of depression: A conceptual framework. Depression Research and Treatment, 2012, 1–6.Google Scholar
Philip, J., Smith, W., Craft, P., et al. (1998). Concurrent validity of the modified Edmonton Symptom Assessment Scale (ESAS) with the Rotterdam Symptom Checklist and the Brief Pain Inventory. Supportive Care in Cancer, 6, 539–541.CrossRefGoogle Scholar
Porzio, G, Ricevuto, E., Aielli, F., et al. (2005). The supportive care task force at the University of L'Aquila: Two-years experience. Supportive Care in Cancer, 13, 351–355.CrossRefGoogle Scholar
Rees, E., Hardy, J., Ling, J., et al. (1998). The use of the Edmonton Symptom Scale (ESAS) within a palliative care unit in the UK. Palliative Medicine, 15, 213–214.Google Scholar
Ross, L. & Austin, J. (2015). Spiritual needs and spiritual support preferences of people with end-stage heart failure and their carers: Implications for nurse managers. Journal of Nursing Management, 23(1), 87–95.CrossRefGoogle ScholarPubMed
Stromgren, A.S., Groenvold, M., Peterson, M.A., et al. (2004). Pain characteristics and treatment outcome for advanced cancer patients during the first week of specialized palliative care. Journal of Pain and Symptom Management, 27, 104–113.CrossRefGoogle ScholarPubMed
Watanabe, S.M., Nekolaichuk, C.L. & Beaumont, C. (2012). The Edmonton Symptom Assessment System, a proposed tool for distress screening in cancer patients: Development and refinement. Psycho-Oncology, 21, 977–985.CrossRefGoogle ScholarPubMed
Williams, J.A., Meltzer, D., Arora, V., et al. (2011). Attention to inpatients' religious and spiritual concerns: Predictors and association with patient satisfaction. Journal of General Internal Medicine, 26(11), 1265–1271.CrossRefGoogle ScholarPubMed
Yennurajalingam, S., Urbauer, D.L., Casper, K.L., et al. (2011). Impact of a palliative care consultation team on cancer-related symptoms in advanced cancer patients referred to an outpatient supportive care clinic. Journal of Pain and Symptom Management, 41(1), 49–56.CrossRefGoogle Scholar