A single-arm pilot of MyInspiration: a novel digital resource to support spiritual needs of patients undergoing cancer-directed surgery.

PURPOSE: This study aimed to assess the feasibility, acceptability, and satisfaction associated with the MyInspiration intervention, a digital spiritual support tool for patients undergoing cancer surgery. Additionally, we evaluated changes in spiritual well-being and the ability to find meaning in their experience with cancer before and after the intervention. METHODS: This was a prospective, single-arm pilot study. Feasibility and acceptability were assessed by ratio of participants who completed all assessments among individuals who had signed consent forms. Satisfaction was assessed with 5 Likert-style questions around user experience. Patient spiritual well-being and finding meaning in their experience with cancer were measured at baseline and post-intervention. RESULTS: Forty patients were enrolled, the majority of whom were female (80.0%) and diagnosed with breast cancer (52.5%), with an average age of 54.4 years (SD = 13.7, range 29.0-82.0). Regarding feasibility and acceptability, 76.9% of patients who consented to participate completed the full study protocol. In assessing satisfaction, 59% of patients were satisfied with the overall experience of MyInspiration. There was no difference in spiritual well-being pre-/post-intervention. There was a difference in pre (M = 1.95, SD = .95) and post (M = 2.23, SD = .86) scores relative to "finding meaning in the cancer experience" with a mean difference of 0.28 (p = 0.008). CONCLUSION: MyInspiration was feasible and acceptable to patients, and the majority were satisfied with the tool. The intervention was associated with changes in patients' ability to find meaning within their cancer experience. A randomized control trial is needed to evaluate the efficacy of the tool in a broader population of patients with cancer.

The Influence of Patient and Provider Religious and Spiritual Beliefs on Treatment Decision Making in the Cancer Care Context.

BACKGROUND: Providers often underestimate the influence of patient religious and spiritual (R&S) needs. The current study sought to determine the influence of R&S beliefs on treatment decision making among patients and providers in the context of cancer care. METHODS: We conducted a systematic review of the literature using web-based search engines and discipline-specific databases. Search terms included a combination of the following Medical Subject Headings and key terms: "cancer,""spirituality,""religion," and "decision making." We used Covidence to screen relevant studies and extracted data into Microsoft Excel. RESULTS: Among 311 screened studies, 32 met inclusion/exclusion criteria. Most studies evaluated the patient perspective (n = 29), while 2 studies evaluated the provider perspective and 1 study examined both. In assessing patient R&S relative to treatment decision making, we thematically characterized articles according to decision-making contexts, including general (n = 11), end-of-life/advance care planning (n = 13), and other: specific (n = 8). Specific contexts included, but were not limited to, clinical trial participation (n = 2) and use of complementary and alternative medicine (n = 4). Within end-of-life/advance care planning, there was a discrepancy regarding how R&S influenced treatment decision making. The influence of R&S on general treatment decision making was both active and passive, with some patients wanting more direct integration of their R&S beliefs in treatment decision making. In contrast, other patients were less aware of indirect R&S influences. Patient perception of the impact of R&S on treatment decision making varied relative to race/ethnicity, being more pronounced among Black patients. CONCLUSION: Most articles focused on R&S relative to treatment decision making at the end of life, even though R&S appeared important across the care continuum. To improve patient-centered cancer care, providers need to be more aware of the impact of R&S on treatment decision making.

Spiritual Motivations to Practice Medicine: A Survey of Cancer Care Providers.

BACKGROUND: There is increased interest in the role of spirituality in the cancer care context, but how it may inspire individuals to pursue a career as a healthcare provider is unknown. We sought to determine the relationship between intrinsic religiosity, religious identity, provider role, and spiritual motivations to practice medicine. METHODS: A cross-sectional survey was administered to healthcare providers at a large, Midwest Comprehensive Cancer Center. The relationship between provider type, intrinsic religiosity, religious identity, and spiritual motivations to practice medicine was assessed with binary logistic regression. RESULTS: Among 340 participants, most were female (82.1%) or Caucasian (82.6%) and identified as being religious (57.5%); median age was 35 years (IQR: 31-48). Providers included nurses (64.7%), physicians (17.9%), and "other" (17.4%). Compared with physicians, nurses were less likely to agree that they felt responsible for reducing pain and suffering in the world (OR: 0.12, p = 0.03). Similarly, "other" providers were less likely than physicians to believe that the practice of medicine was a calling (OR: 0.28, p = 0.02). Providers with a high self-reported intrinsic religiosity demonstrated a much greater likelihood to believe that the practice of medicine is a calling (OR:1.75, p = 0.001), as well as believe that personal R&S beliefs influence the practice of medicine (OR:3.57, p < 0.001). Provider religious identity was not associated with spiritual motivations to practice medicine (all p > 0.05). CONCLUSION: Intrinsic religiosity had the strongest relationship with spiritual motivations to practice medicine. Understanding these motivations may inform interventions to avoid symptoms of provider burnout in cancer care.

Mental illness is associated with increased risk of suicidal ideation among cancer surgical patients.

BACKGROUND: Mental illness and depression can be associated with increased risk of suicidal ideation (SI). We sought to determine the association between mental illness and SI among cancer surgical patients. METHODS: Medicare beneficiaries who underwent resection of lung, esophageal, pancreatic, colon, or rectal cancer were analyzed. Patients were categorized as no mental illness, anxiety and/or depression disorders or bipolar/schizophrenic disorders. RESULTS: Among 211,092 Medicare beneficiaries who underwent surgery for cancer, the rate of suicidal ideation was 270/100,000 patients. Antecedent mental health diagnosis resulted in a marked increased SI. On multivariable analysis, patients with anxiety alone (OR 1.49, 95%CI 1.04-2.14), depression alone (OR 2.60, 95%CI 1.92-3.38), anxiety + depression (OR 4.50, 95%CI 3.48-5.86), and bipolar/schizophrenia (OR 7.30, 95%CI 5.27-10.30) had increased odds of SI. CONCLUSIONS: Roughly 1 in 370 Medicare beneficiaries with cancer who underwent a wide range of surgical procedures had SI. An antecedent mental health diagnosis was a strong risk factor for SI.

Intrapersonal Factors Impact Advance Care Planning Among Cancer Patients.

BACKGROUND: Cancer patients infrequently engage in advance care planning processes. Establishing preferences for future medical treatment without advance care planning may not be patient-centered, as it fails to consider important factors that influence these important decisions. OBJECTIVE: The purpose of this study was to assess the influence of patient intrapersonal factors including race, religion, level of depression, and cancer stage on overall preferences for future medical treatment, including the presence of a (DNR), power of attorney, and advance directive. DESIGN: A retrospective chart review design was used. Patients were included who were diagnosed with cancer at The Ohio State University James Comprehensive Cancer Center from 01/2015 to 08/2019. RESULTS: A total of 3,463 patients were included. Median age was 59 years (IQR: 49, 67) and the majority of the patients was female (88.7%). Compared with no religious preference, patients who identified as religious had 61% higher odds (95%CI: 1.08-2.40) of having a DNR and approximately 30% higher odds of having a power of attorney (95%CI: 1.08-1.62) or advance directive (95%CI: 1.02-1.64). Patients with clinically relevant depression had more than twice the odds of having a DNR versus patients with no/lower levels of clinical depression (OR: 2.08; 95%CI: 1.40-3.10). White patients had higher odds of having a power of attorney (OR: 1.57; 95%CI: 1.16-2.13) and an advance directive (OR: 3.10; 95% CI: 1.95-4.93) than African-American/Black patients. CONCLUSIONS: Understanding the factors that affect preferences for future medical treatment is necessary for medical professionals to provide proper care and support to patients diagnosed with cancer and their families.

Identifying subgroups of well-being among patients with cancer: Differences in attitudes and preferences around surveillance after curative-intent surgery.

BACKGROUND: Patient perceptions and preferences related to postoperative surveillance are not yet well defined. METHODS: A cross-sectional analysis of the surveillance practice preferences and attitudes was undertaken based on subgroups derived from clustering participants for measures of well-being, including financial toxicity, emotional, family/social, and functional well-being. RESULTS: Among 212 participants, the average age was 58.1 years and most patients were female (57.1%) and white (90.2%). Common malignancies included melanoma/sarcoma (26.4%), thyroid (25.5%), breast (18.9%), gastrointestinal (18.4%), and lung (7.5%) cancer. Respondents within the highest well-being subgroup rated their perception of communication as being the highest more consistently compared with the other well-being subgroups (P = .005). Participants with the highest level of well-being felt more reassured by follow-up appointments (Subgroup 1, Med = 4.00, interquartile range (IQR) = 0.25 vs subgroup 4, Med = 3.75, IQR = 0.73, P = .023). In contrast, patients with the lowest sense of well-being had the highest level of nervousness related to surveillance (subgroup 1, Med = 1.60, IQR = 1.00 vs subgroup 4, Med = 2.20, IQR = 1.15, P < .001). There were no differences in surveillance frequency preferences among different well-being subgroups. CONCLUSION: Attitudes towards postoperative surveillance varied with regard to perception of provider communication, nervous anticipation, and assuredness depending on overall patient well-being. Providers should attempt to assess patient well-being as part of a tailored approach to postcancer surgery surveillance.

Understanding patient expectations around therapeutic benefits, risks, and the chance of cure.

Conversations around surgical goals of care should focus on relational (e.g., empathy, trust, understanding) instead of transactional processes (e.g., communication). Rather than reducing the patient-surgeon relationship to isolated variables such as "communication," a "relational lens" that considers all the aspects of the patient-surgeon relationship and its dynamic processes is needed.