Spirituality in Brazilian family caregivers of patients with cancer from the end-of-life care to bereavement.

Although spirituality can be a source of support during end-of-life and engage a transformative experience after loss, few studies report family members' spiritual and existential needs considering their experiences over time. We conducted a longitudinal interpretative phenomenological analysis from audio-recorded interviews of 10 family caregivers while providing end-of-life care for cancer patients and during bereavement. Participants' spirituality experiences were presented in three superordinate themes: connectedness with religious beliefs and the deceased; re-signifying relationships, life, and loss; suffering and the family caregiver's needs. Finding connection through relationships, greater existential and spiritual suffering post-loss were important issues involved in expressing their spirituality.

"You begin to give more value in life, in minutes, in seconds": spiritual and existential experiences of family caregivers of patients with advanced cancer receiving end-of-life care in Brazil.

PURPOSE: Facing the end of life may trigger significant distress in family caregivers of patients with advanced cancer. However, few studies have addressed the spiritual and existential concerns of these family caregivers in their end-of-life care journey. This study aimed to understand the spiritual and existential experience of family caregivers of patients with advanced cancer facing the end of life in Brazil. METHODS: A purposive sample of 16 family caregivers of hospitalized terminally ill cancer patients in Brazil participated in in-depth interviews. Data collection and analysis were based on interpretative phenomenological analysis. RESULTS: Three superordinate themes in their spiritual and existential experience were identified: (i) connectedness through caregiving, personal relationships, and spiritual beliefs; (ii) shifting hope: from death as a possibility to preparation for impending death; (iii) reframing suffering and meaning. For these caregivers, the relationship with the patient and with others, their spiritual beliefs, and hope were significant sources of meaning. Hope was sustained by death avoidance, oscillating with death acceptance and hope that it would occur with comfort. Family caregivers also experienced existential and spiritual suffering in the form of guilt, suppressed emotions, and loneliness. CONCLUSION: Health care providers should address and support caregivers' spiritual needs and their relationships with the patient and others during end-of-life care and facilitate reflection regarding existential concerns, meaning, and preparation for impending death.

'The experience of spirituality in family caregivers of adult and elderly cancer patients receiving palliative care: A meta-synthesis'.

INTRODUCTION: Spirituality is a multidimensional aspect of human experience. In the context of palliative care, it is an individual resource that can be used to cope with illness and to assign new meanings to suffering. Qualitative studies that aim to investigate the experience of spirituality and the needs of family caregivers in this context are rare. OBJECTIVE: This meta-synthesis aimed to synthesise qualitative studies on the experience of spirituality in family caregivers of adult and elderly cancer patients receiving palliative care. METHODS: A systematic review was performed in six databases, and 14 studies were included in this meta-synthesis. RESULTS: The results are presented as a thematic synthesis divided into two analytical themes: (1) The interweaving of spirituality with end-of-life care and (2) The dimensions of suffering and spirituality in the dying process of the loved one. Each analytical theme is explained by two descriptive themes. The results showed that family caregivers express their spirituality in a multidimensional way, giving meaning to the care provided and reassessing the meanings of their lives and their suffering. CONCLUSION: Investigating the suffering and spiritual needs of family members in this context may be of value to inform comprehensive and multi-professional psychosocial care.

Significados da espiritualidade para pacientes com câncer em cuidados paliativos / Significance of spirituality for patients with cancer receiving palliative care

Resumo Este estudo teve por objetivo compreender as vivências de pacientes com câncer em cuidados paliativos e o significado da espiritualidade ante a dor do adoecimento e a possibilidade de morte. Participaram 10 pacientes adultos e idosos com diagnóstico de câncer avançado, atendidos na enfermaria de cuidados paliativos/dor de um hospital oncológico. Foi utilizado o método fenomenológico para coleta e análise dos relatos, que foram obtidos a partir de entrevistas individuais. Desvelaram-se duas categorias temáticas: Fé como esperança de cura, apoio e confiança e a busca de sentido/ressignificação da vida; e A busca de sentido na morte e nas crenças sobre o pós-morte e a vivência da transcendência. Evidenciou-se a importância da dimensão espiritual na vivência do processo de morrer, possibilitando a busca de sentidos para a vida e para a morte. Este estudo revelou que estar ante a morte leva à veneração da vida, remetendo às crenças pessoais e ao que se busca como sentidos para o viver.

Abstract This study aimed to understand the experiences of cancer patients receiving palliative care and the significance of spirituality when coping with the pain caused by the illness and facing the possibility of death. A total of 10 adults and older adult patients diagnosed with advanced cancer being treated in the palliative care/pain ward of a cancer hospital participated in this study. The phenomenological method was used to collecting and analyzing patients’ reports, which were obtained by individual interviews. Two thematic categories emerged, namely: Faith as hope for healing, support, and trust, and search for life meaning and resignification; and Search for meaning of death and beliefs in an afterlife and in a transcendence realm. The importance of the spiritual dimension was highlighted in the experience of the dying process, allowing the search for the meaning of life and death. The present study revealed that facing death leads people to greatly cherish life, connecting them to their personal beliefs and to their search for a purpose in life.