Addressing spirituality within the care of patients at the end of life: perspectives of patients with advanced cancer, oncologists, and oncology nurses.
Addressing spirituality within the care of patients at the end of life: perspectives of patients with advanced cancer, oncologists, and oncology nurses.
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DOI：
10.1200/jco.2011.40.3766
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发表时间：
2012-07-10
期刊：
影响因子：
--
通讯作者：
Balboni TA
中科院分区：
文献类型：
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作者：
Phelps AC;Lauderdale KE;Alcorn S;Dillinger J;Balboni MT;Van Wert M;Vanderweele TJ;Balboni TA
关注患者的宗教和精神需求被纳入国家临终关怀质量指南，但很少有数据来指导精神护理。癌症护理中的宗教和精神研究是一项多机构、定量和定性研究，研究对象是75名晚期癌症患者和339名癌症医生和护士。患者接受了半结构化访谈，护理提供者完成了一项基于网络的调查，探讨了他们对医生和护士日常提供精神护理的看法。主题提取按照跨学科分析的三角化程序进行。多变量有序逻辑回归模型评估了被试特征与精神关怀态度之间的关系。大多数患者（77.9%）、医生（71.6%）和护士（85.1%）认为常规的精神护理对患者有积极的影响。只有25%的患者以前接受过精神护理。在患者中，既往精神护理（调整优势比[AOR]， 14.65; 95% CI， 1.51至142.23）、增加教育（AOR, 1.26; 95% CI， 1.06至1.49）和宗教应对（AOR, 4.79; 95% CI， 1.40至16.42）与良好的精神护理认知相关。医生对精神护理的负面看法高于患者（P< 0.001）和护士（P= 0.008）。定性分析确定了精神护理的好处，包括支持患者的情感健康和加强医患关系。对属灵护理的反对常常与职业角色冲突有关。参与者描述了理想的精神护理是个性化的，自愿的，包括牧师/神职人员，并基于评估和支持病人的精神。大多数晚期癌症患者、肿瘤学家和肿瘤学护士都重视精神关怀。所描述的主题为参与临床护理中的精神问题提供了经验基础。
Attention to patients’ religious and spiritual needs is included in national guidelines for quality end-of-life care, but little data exist to guide spiritual care. The Religion and Spirituality in Cancer Care Study is a multi-institution, quantitative-qualitative study of 75 patients with advanced cancer and 339 cancer physicians and nurses. Patients underwent semistructured interviews, and care providers completed a Web-based survey exploring their perspectives on the routine provision of spiritual care by physicians and nurses. Theme extraction was performed following triangulated procedures of interdisciplinary analysis. Multivariable ordinal logistic regression models assessed relationships between participants’ characteristics and attitudes toward spiritual care. The majority of patients (77.9%), physicians (71.6%), and nurses (85.1%) believed that routine spiritual care would have a positive impact on patients. Only 25% of patients had previously received spiritual care. Among patients, prior spiritual care (adjusted odds ratio [AOR], 14.65; 95% CI, 1.51 to 142.23), increasing education (AOR, 1.26; 95% CI, 1.06 to 1.49), and religious coping (AOR, 4.79; 95% CI, 1.40 to 16.42) were associated with favorable perceptions of spiritual care. Physicians held more negative perceptions of spiritual care than patients (P<.001) and nurses (P=.008). Qualitative analysis identified benefits of spiritual care, including supporting patients’ emotional well-being and strengthening patient-provider relationships. Objections to spiritual care frequently related to professional role conflicts. Participants described ideal spiritual care to be individualized, voluntary, inclusive of chaplains/clergy, and based on assessing and supporting patient spirituality. Most patients with advanced cancer, oncologists, and oncology nurses value spiritual care. Themes described provide an empirical basis for engaging spiritual issues within clinical care.