Responding to the Spiritual Needs of Palliative Care Patients: A Randomized Controlled Trial to Test the Effectiveness of the Kibo Therapeutic Interview.

CONTEXT: The WHO recognizes the need to attend to patients' spiritual needs as being fundamental to comprehensive and high-quality end-of-life care. Spiritual needs must be attended to since the resolution of biological and psychosocial issues is insufficient to reduce patients' suffering. Associations have been found between spiritual needs and other variables of importance for patients in palliative care. Despite the consensus that exists regarding the importance of assessing and attending to spiritual needs, professionals encounter many difficulties in attempting to do so. OBJECTIVES: Our study aims to demonstrate the benefits that the Kibo therapeutic interview in palliative care patients can have for spirituality, demoralization, and resilience. METHODS: A parallel randomized controlled trial of two groups was undertaken. Information on 60 palliative care patients during pre- and post-intervention time points was gathered. RESULTS: ANOVAs showed a statistically significant effect of the intervention on the dimension of transpersonal spirituality. The ANCOVA for the effect of the intervention on resilience also pointed to its effectiveness. When the means of demoralization were examined, a higher decrease in the levels of demoralization for patients in the intervention group was observed, when compared to patients in the control group. CONCLUSION: Our findings point to this interview as an effective means to attend to the spiritual needs of palliative patients, reducing demoralization and increasing resilience. Future research could focus on a broader sample and on the effects of this interview on family caregivers, mourners, and health care professionals. CLINICAL TRIAL REGISTRATION NUMBER: https://clinicaltrials.gov/ct2/show/ Identifier NCT03995095.

Intervenciones psicológicas en espiritualidad en cuidados paliativos: una revisión sistemática / Psychological interventions in spirituality: A systematic review in palliative care

CONTEXTO: La espiritualidad puede entenderse como una condición fundamental del sentido de la persona. Se incluye dentro de los objetivos fundamentales de trabajo de los cuidados paliativos, considerándose que la calidad de vida del paciente no puede favorecerse en su conjunto si no se aborda la dimensión espiritual. Objetivo: El objetivo de esta revisión sistemática es sintetizar la evidencia científica más reciente en espiritualidad en pacientes paliativos con enfermedad avanzada, atendiendo sobre todo a qué tipo de intervención que contemple la dimensión espiritual se ha llevado a cabo con ellos. Se recogen datos sobre el tipo de estudio y resultados estadísticos encontrados en cuanto a espiritualidad. Método: Se llevó a cabo una búsqueda en la literatura científica siguiendo las guías PRISMA en 13 bases bibliográficas electrónicas, resultando 10 estudios experimentales o cuasiexperimentales (1.067 participantes) y 38 revisiones de intervenciones y conceptos teóricos en espiritualidad en cuidados paliativos. Los estudios fueron seleccionados en función del nivel de información que aportaban sobre la evidencia requerida en los objetivos del estudio y siguiendo los criterios de inclusión/exclusión. Resultados: A diferencia de lo que sucede con otros conceptos como el distrés emocional o la dignidad, nuestros resultados sugieren que, aunque la espiritualidad es un aspecto que en cuidados paliativos se contempla de manera continuada, no existe todavía una metodología/protocolo consensuado de trabajo, concreto y sistematizado. La mejoría observada en algunos estudios en aspectos de la espiritualidad es obtenida de manera tangencial o colateral. En cuanto a los instrumentos, el FACIT-Sp es el instrumento más empleado para medir los resultados en espiritualidad. Conclusión: Esta revisión se ha visto muy limitada por la amplia variabilidad de las características de los estudios. Existe una gran dificultad a la hora de seleccionar criterios de comparación, dado que el diseño de los estudios es muy diverso, así como las variables estudiadas y los instrumentos de evaluación. Aunque se han encontrado intervenciones que implican una mejora en la espiritualidad, estas no se centran en el trabajo concreto de esta dimensión. Todo esto dificulta la evaluación de la eficacia de los protocolos de actuación en espiritualidad, obstaculizando el acceso al conocimiento relativo a la atención, por parte de los profesionales de la salud, de las necesidades espirituales del paciente paliativo

CONTEXT: Spirituality can be seen as a fundamental condition of a person's sense of being. It is included among the fundamental objectives of palliative care work, considering that the quality of life of patients cannot be enhanced as a whole if the spiritual dimension is not addressed. OBJECTIVE: The objective of this systematic review is to summarize the latest scientific evidence on spirituality in palliative patients with advanced disease, paying particular attention to the kind of intervention that addresses the spiritual dimension that has been used. Data on the type of study and statistical results regarding spirituality were collected. METHOD: We conducted a search of the scientific literature following the PRISMA guidelines in 13 electronic bibliographic databases, resulting in 10 experimental or quasi-experimental studies (1,067 participants) and 38 reviews of interventions and theoretical concepts on spirituality in the hospice. The studies were selected based on the level of information they supplied for the evidence required in the study objectives and the criteria for inclusion/exclusion. RESULTS: Unlike with other concepts such as emotional distress or dignity, our results suggest that, while spirituality is an aspect that is continually contemplated in palliative care, there is still an agreed, specific and systematic methodology/protocol,. The improvement observed in some studies on aspects of spirituality is obtained tangentially or collaterally. The FACIT-Sp is the instrument most used to measure results in spirituality. CONCLUSION: This review has been severely limited by the wide variability of the characteristics of the studies. There is great difficulty in selecting benchmarks, since the design of the studies is very diverse, as well as the variables and testing instruments. Although interventions were found that implied an improvement in spirituality, they do not focus on the actual work on this element. All this makes an evaluation of the effectiveness of protocols on spirituality difficult and hinders access to knowledge concerning the care by health professionals of the spiritual needs of palliative patients

Spirituality in patients with advanced illness: The role of symptom control, resilience and social network.

In this study, we analyzed the relationships among clinical, emotional, social, and spiritual dimensions of patients with advanced illness. It was a cross-sectional study, with a sample of 108 patients in an advanced illness situation attended by palliative care teams. Statistically significant correlations were found between some dimensions of spirituality and poor symptomatic control, resiliency, and social support. In the structural model, three variables predicted spirituality: having physical symptoms as the main source of discomfort, resiliency, and social support. This work highlights the relevance of the relationships among spirituality and other aspects of the patient at the end of life.

Bienestar emocional y espiritualidad al final de la vida / Emotional and spiritual well-being at the end of life

OBJETIVO: La atención al conjunto de las necesidades físicas, sociales, psicológicas y espirituales de los pacientes es un elemento clave para la disminución del sufrimiento en el marco de los cuidados paliativos. MATERIAL Y MÉTODOS: Desde el modelo antropológico planteado por el Grupo de Espiritualidad de la SECPAL y mediante un nuevo cuestionario desarrollado para evaluar la espiritualidad en 3 niveles: intrapersonal (sentido), interpersonal (armonía) y transpersonal (pertenencia), se han estudiado los recursos y las necesidades espirituales, así como las relaciones entre espiritualidad y funcionamiento emocional, atendiendo a aspectos como ansiedad, depresión y resiliencia. Esta investigación se basa en una muestra de 121 pacientes en situación de cuidados paliativos distribuidos a lo largo de la geografía estatal. Para ello se han llevado a cabo estadísticos descriptivos, correlaciones de Pearson y un modelo de ecuaciones estructurales con un factor y 6 variables observables que ofrece un marco multivariante para la reflexión sobre dichas relaciones. RESULTADOS: Los resultados indican valores similares a los de otras muestras en las variables relativas al bienestar emocional y correlaciones estadísticamente significativas entre espiritualidad, depresión, ansiedad y resiliencia. El modelo se ajustó correctamente, indicando alta capacidad de predicción del grado de espiritualidad sobre la depresión y la ansiedad, en sentido negativo, y una relación positiva entre espiritualidad y resiliencia. CONCLUSIONES: Las conclusiones ponen en relación estos resultados con la literatura previa, aportando evidencia de la importancia que la espiritualidad tiene para el bienestar emocional de los pacientes

OBJECTIVE: The study of the physical, social, psychological and spiritual needs of the patient is a key element in the decreasing of suffering within the palliative care framework. MATERIAL AND METHODS: From the anthropological model proposed by the SECPAL Spirituality Group, and using a new measurement tool developed to assess the spirituality within three levels: intrapersonal (meaning), interpersonal (membership), and transpersonal (harmony), the resources and spiritual needs, together with the relationships between this spirituality and the emotional functioning, including anxiety, depression and resilience. The research is based on a sample of 121 palliative care patients, distributed throughout the country. Several descriptive analyses have been developed for this purpose. Pearson's correlations and a structural equations model with a factor and six observable variables, a technique which offers a multivariate framework to evaluate the results. RESULTS: The results showed values in emotional well-being similar to findings in other studies, with statistically significant correlations between spirituality, depression, anxiety and resilience. The data fit the model properly, indicating high predictive power of the spirituality level on depression and anxiety, in a negative way, and a positive relationship between spirituality and resilience. CONCLUSIONS: Conclusions show that these results are similar to those in previously published studies, providing evidence on the importance of spirituality for the emotional well-being of the patient

Grief support provided to caregivers of palliative care patients in Spain.

Grief support for relatives of patients in palliative care is recognized as a fundamental practice within palliative medicine. The aim of this research was to determine the nature and extent of grief support programs offered to relatives of patients in palliative care in Spain. A postal survey was carried out among members of the Spanish Society of Palliative Care. The members' names were obtained through the Society's 2000 Directory, which lists 160 different teams, of which 50% answered a questionnaire made up of 34 questions, some open-ended and others multiple choice. Results show that 88.6% of the services include grief support, that mainly emotional and one-to-one care is provided (92.4 and 89.9%, respectively), and that the number of psychologists and social workers in each team is limited. The risk factors most commonly taken into account by professionals are: absence of family support (36.92%) and the bereaved's case history (21.54%); while the most widely used diagnostic criteria for complicated bereavement are blame and depression (12.5 and 11.36%). In conclusion, it can be seen that bereavement services are not completely consolidated in Spain and there is a need for a greater variety of intervention strategies.