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Perspectives on spirituality at the end of life: A meta-summary

Published online by Cambridge University Press:  25 October 2006

ANNA-LEILA WILLIAMS
ANNA-LEILA WILLIAMS
Affiliation:
Yale University School of Nursing, New Haven, Connecticut
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Abstract

Objective: A meta-summary of the qualitative literature on spiritual perspectives of adults who are at the end of life was undertaken to summarily analyze the research to date and identify areas for future research on the relationship of spirituality with physical, functional, and psychosocial outcomes in the health care setting.

Methods: Included were all English language reports from 1966 to the present catalogued in PubMed, Medline, PsycInfo, and CINAHL, identifiable as qualitative investigations of the spiritual perspectives of adults at the end of life. The final sample includes 11 articles, collectively representing data from 217 adults.

Results: The preponderance of participants had a diagnosis of cancer; those with HIV/AIDS, cardiovascular disease, and ALS were also represented. Approximately half the studies were conducted in the United States; others were performed in Australia, Finland, Scotland, and Taiwan. Following a process of theme extraction and abstraction, thematic patterns emerged and effect sizes were calculated. A spectrum of spirituality at the end of life encompassing spiritual despair (alienation, loss of self, dissonance), spiritual work (forgiveness, self-exploration, search for balance), and spiritual well-being (connection, self-actualization, consonance) emerged.

Significance: The findings from this meta-summary confirm the fundamental importance of spirituality at the end of life and highlight the shifts in spiritual health that are possible when a terminally ill person is able to do the necessary spiritual work. Existing end-of-life frameworks neglect spiritual work and consequently may be deficient in guiding research. The area of spiritual work is fertile ground for further investigation, especially interventions aimed at improving spiritual health and general quality of life among the dying.

Keywords

SpiritualitySpiritual healthEnd of lifeTerminal illnessMeta-summary
Type
REVIEW ARTICLE
Information
Palliative & Supportive Care , Volume 4 , Issue 4 , December 2006 , pp. 407 - 417
Copyright
© 2006 Cambridge University Press

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References

REFERENCES

Astrow, A.B., Puchalski, C.M., & Sulmasy, D.P. (2001). Religion, spirituality, and health care: Social, ethical, and practical considerations. American Journal of Medicine, 110, 283–287.Google Scholar
Breitbart, W. (2003). Reframing hope: Meaning-centered care for patients near the end of life. Interview by Karen S. Heller. Journal of Palliative Medicine, 6, 979–988.Google Scholar
Breitbart, W., Gibson, C., Poppito, S.R., et al. (2004). Psychotherapeutic interventions at the end of life: A focus on meaning and spirituality. Canadian Journal of Psychiatry, 49, 366–372.Google Scholar
Burkhardt, M.A. (1989). Spirituality: An analysis of the concept. Holistic Nursing Practice, 3, 69–77.Google Scholar
Chao, C.C., Chen, C., & Yen, M. (2002). The essence of spirituality of terminally ill patients. Journal of Nursing Research, 10, 237–244.Google Scholar
Clark, D. (2002). Cicely Saunders, founder of the hospice movement: Selected letters 1959–1999. Oxford: Oxford University Press.
Delgado, C. (2005). A discussion of the concept of spirituality. Nursing Science Quarterly, 18, 157–162.Google Scholar
Derrickson, B.S. (1996). The spiritual work of the dying: A framework and case studies. Hospice Journal, 11, 11–30.Google Scholar
Dobratz, M.C. (2004). Life-closing spirituality and the philosophic assumptions of the Roy adaptation model. Nursing Science Quarterly, 17, 335–338.Google Scholar
Ehman, J.W., Ott, B.B., Short, T.H., et al. (1999). Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Archives of Internal Medicine, 159, 1803–1806.Google Scholar
Emanuel, E.J. & Emanuel, L.L. (1998). The promise of a good death. Lancet, 351(Suppl. 2), S21–29.Google Scholar
Emblen, J.D. (1992). Religion and spirituality defined according to current use in nursing literature. Journal of Professional Nursing, 8, 41–47.Google Scholar
Fiori, K.L., Hays, J.C., & Meador, K.G. (2004). Spiritual turning points and perceived control over the life course. International Journal of Aging & Human Development, 59, 391–420.Google Scholar
Fryback, P.B. & Reinert, B.R. (1999). Spirituality and people with potentially fatal diagnoses. Nursing Forum, 34, 13–22.Google Scholar
Halstead, M.T. & Roscoe, S.T. (2002). Restoring the spirit at the end of life: Music as an intervention for oncology nurses. Clinical Journal of Oncology Nursing, 6, 332–336, 352–353.Google Scholar
Hart, A., Jr., Kohlwes, R.J., Deyo, R., et al. (2003). Hospice patients' attitudes regarding spiritual discussions with their doctors. American Journal of Hospice & Palliative Care, 20, 135–139.Google Scholar
Hermann, C.P. (2001). Spiritual needs of dying patients: A qualitative study. Oncology Nursing Forum, 28, 67–72.Google Scholar
Holt, J. (2004). Psychiatry and spirituality at the end of life: A case report. Psychiatric Services, 55, 618–619.Google Scholar
Institute of Medicine. (1997). Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Press.
Kuuppelomaki, M. (2000). Cancer patients', family members' and professional helpers' conceptions and beliefs concerning death. European Journal of Oncology Nursing, 4, 39–47.Google Scholar
Lin, H. & Bauer-Wu, S.M. (2003). Psycho-spiritual well-being in patients with advanced cancer: An integrative review of the literature. Journal of Advanced Nursing, 44, 69–80.Google Scholar
Luskin, F. (2004). Transformative practices for integrating mind-body-spirit. Toward optimal healing environments in health care: Second American Samueli Symposium, January 22–24, 2004. Journal of Alternative and Complementary Medicine, 10(Suppl. 1), S-15–S-23.Google Scholar
McGrath, P. (2003). Spiritual pain: A comparison of findings from survivors and hospice patients. American Journal of Hospice & Palliative Care, 20, 23–33.Google Scholar
Meraviglia, M.G. (1999). Critical analysis of spirituality and its empirical indicators: Prayer and meaning in life. Journal of Holistic Nursing, 17, 18–33.Google Scholar
Murray, S.A., Kendall, M., Boyd, K., et al. (2004). Exploring the spiritual needs of people dying of lung cancer or heart failure: A prospective qualitative interview study of patients and their carers. Palliative Medicine, 18, 39–45.Google Scholar
Newlin, K., Knafl, K., & Melkus, G.D. (2002). African-American spirituality: A concept analysis. Advances in Nursing Science, 25, 57–70.Google Scholar
Nolan, M.T. & Mock, V. (2004). A conceptual framework for end-of-life care: A reconsideration of factors influencing the integrity of the human person. Journal of Professional Nursing, 20, 351–360.Google Scholar
O'Brien, M.E. (2003). Spirituality in Nursing: Standing on Holy Ground, 2nd ed. Boston, MA: Jones and Bartlett.
Paterson, B.L., Thorne, B.L., Canam, C., et al. (2001). Meta-Study of Qualitative Health Research. Thousand Oaks, CA: Sage Publications.
Reed, P.G. (1991). Preferences for spiritually related nursing interventions among terminally ill and nonterminally ill hospitalized adults and well adults. Applied Nursing Research, 4, 122–128.Google Scholar
Roche, J. (1994). The story: A primary spiritual tool. Health Progress, 75, 60–63.Google Scholar
Ross, L. (1997). The nurse's role in assessing and responding to patients' spiritual needs. International Journal of Palliative Nursing, 3, 37–42.Google Scholar
Sandelowski, M. & Barroso, J. (2003). Creating metasummaries of qualitative findings. Nursing Research, 52, 226–233.Google Scholar
Sandelowski, M., Lambe, C., & Barroso, J. (2004). Stigma in HIV-positive women. Journal of Nursing Scholarship, 36, 122–128.Google Scholar
Saunders, C., Baines, M., & Dunlop, R. (1995). Living with Dying: A Guide to Palliative Care. Oxford: Oxford University Press.
Singer, P.A., Martin, D.K., & Kelner, M. (1999). Quality end-of-life care: Patients' perspectives. JAMA, 281, 163–168.Google Scholar
Smith, J. & McSherry, W. (2004). Spirituality and child development: A concept analysis. Journal of Advanced Nursing, 45, 307–315.Google Scholar
Steinhauser, K.E., Clipp, E.C., McNeilly, M., et al. (2000). In search of a good death: Observations of patients, families, and providers. Annals of Internal Medicine, 132, 825–832.Google Scholar
Stephenson, P.L., Draucker, C.B., & Martsolf, D.S. (2003). The experience of spirituality in the lives of hospice patients. Journal of Hospice and Palliative Nursing, 5, 51–58.Google Scholar
Sulmasy, D.P. (2001a). Addressing the religious and spiritual needs of dying patients. Western Journal of Medicine, 175, 251–254.Google Scholar
Sulmasy, D.P. (2001b). At wit's end: Forgiveness, dignity, and the care of the dying. Journal of General Internal Medicine, 16, 335–338.Google Scholar
Sulmasy, D.P. (2002). A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist, 42(Spec 3), 24–33.Google Scholar
SUPPORT Principal Investigators. (1995). A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA, 274, 1591–1598.Google Scholar
Tanyi, R.A. (2002). Towards clarification of the meaning of spirituality. Journal of Advanced Nursing, 39, 500–509.Google Scholar
Thomas, J. & Retsas, A. (1999). Transacting self-preservation: A grounded theory of the spiritual dimensions of people with terminal cancer. International Journal of Nursing Studies, 36, 191–201.Google Scholar
Trueman, I. & Parker, J. (2004). Life review in palliative care. European Journal of Palliative Care, 11, 249–253.Google Scholar
Williams, A., Selwyn, P., Liberti, L., et al. (2005). A randomized controlled trial of meditation and massage effects on quality of life in people with late-stage disease: A pilot study. Journal of Palliative Medicine, 8, 939–952.Google Scholar
Yang, M. & Mcilfatrick, S. (2001). Intensive care nurses' experiences of caring for dying patients: A phenomenological study. International Journal of Palliative Nursing, 7, 435–441.Google Scholar