Background: This review was conducted to identify and map spiritual care interventions to address spiritual needs and alleviate suffering of patients in the context of palliative care by the multidisciplinary team. The main review question was: What interventions are provided to address spiritual needs and/or alleviate suffering? Other questions addressed were: What are the characteristics of the interventions? Which members of the Palliative Care team developed the intervention? What were the dependent variables and the instruments used to measure outcomes? Which outcomes were found after the intervention was implemented? I chose this study because I am lacking in knowledge in this area of Palliative Care.
Design and Participants: This review was conducted between October 2022 and January 2023, according to the guidelines of the JBI and PRISMA ScR checklist. A 3-step search strategy of databases was used to identify studies meeting the inclusion criteria, which included adult patients aged 18 or older who are terminally ill and assisted by palliative care teams. Children and adolescents were excluded. Two independent reviewers assessed the full texts. Disagreements were resolved through a third reviewer. The data were extracted to identify the research questions noted above.
Results: The researchers identified 1254 studies of which 401 were duplicates. Screening excluded an additional 777 studies. Another 31 were excluded after full-text assessment, but 25 additional studies were identified through manual searches of other sources (websites, organizations, and expert recommendations). 47 total studies were included in the final review. Most of the studies were quantitative designs. Other study types included mixed-methods, qualitative, case studies, and reviews. The settings of the studies varied and included communities, hospices, hospitals, palliative care units, and nursing homes. The review identified 8 types of spiritual care intervention: conversations between the patients and a team member, religious practice interventions, therapeutic presence, music therapy, multidisciplinary interventions, guided meditation, art therapy, and combined interventions. Guided conversations rely on structured or semi-structured questions to facilitate dialog and reflection (i.e. legacy intervention), whereas unstructured conversations are characterized by free listening. Interventions of religious practice are typically carried out by a chaplain or facilitated by other members of the staff. Therapeutic presence is giving time and being physically present with the patient to facilitate the transcendence of suffering. Other interventions include music therapy, art therapy, mindfulness interventions, and a combination of the above. All interventions were characterized as individual, and most were performed by nurses, physicians, and psychologists. Assessment tools included sociodemographic, clinical, psychological, and spiritual tools, and quality of life questionnaires. FACIT-Sp and FICA were the most commonly used tools to assess spiritual well-being. The studies were able to demonstrate that the interventions increased patients’ spiritual well-being, increased ego integrity, reinforced spirituality, increased spiritual assessment and treatment, and end of life preparation and acceptance. Improvements in physical and psychological symptoms included improvements in breathing, reduced anxiety and depression, and reduced pain.
Commentary: This scoping review provided a general analysis and mapping of the current spiritual care interventions in palliative care to alleviate suffering and assess spiritual needs in adult patients. They noted a gradual increase in the number of studies and a transition from descriptive to evidenced-based evaluation of interventions over the years. Many of the spiritual interventions could be offered by any member of the team, although most were performed by nurses.
Bottom Line: This review illustrated the many forms of interventions available to address the spiritual needs and alleviate suffering for adult patients in the context of palliative care. It reinforced that these interventions can mostly be carried out by any member of the team and may result in improvement in spiritual well-being, as well as physical and psychological symptoms.
Source: Jaman-Mewes P, Caetano da Silva de Oliveira M, Regina Mazotti M, Salvetti MG. Spiritual care interventions for palliative care patients: A scoping review. Palliat Support Care. 2024 Oct;22(5):1449-146.
spiritual-care-interventions-for-palliative-care-patients-a-scoping-review.pdf
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