Association of pain management and positive expectations with psychological distress and spiritual well‑being among terminally ill cancer patients admitted to a palliative care unit

Abstract

Background Although palliation of psycho-spiritual distress is of great importance in terminally ill cancer patients, there is a little information about screening patients who benefit from palliative care and identifying the cancer care targets. This study explored the relationship of pain management and positive expectations with depression, anxiety and spiritual well-being (SWB) in terminal cancer patients admitted to a palliative care unit. Methods Eighty-four terminal cancer inpatients were recruited from the Hospice Ward, Shengjing Hospital of China Medical University. Optimism and general self-efficacy (GSE) were evaluated at admission. Patients completed self-report questionnaires on SWB, depression, anxiety and pain both on admission and one week later. The repeated designed analysis of variance was used to explore the correlates of depression, anxiety and SWB (meaning, peace, faith). Results In our sample, only cancer pain diminished significantly one week later. For depression (p = 0.041) and faith (p = 0.013), there was a significant pain group (relieved vs. not relieved) × time interaction effect, such that those with satisfied pain control experienced the improved psycho-spiritual outcomes at 1 week. The relationship between positive expectations, peace and faith was also statistically significant, indicating that the improvement of peace or faith was significant in the low group of optimism and GSE. Conclusions Our findings indicated that pain management lied at the center of depression and SWB, meaning that effective pain management may reduce depression, and improve SWB among terminal cancer patients. Moreover, positive expectations, especially for optimism, may be the new target for SWB-related intervention research. Palliative care nurse should require the identification of terminal cancer patients who may more benefit from short-term palliative care, and target them with effective cancer care.

Cancer pain intensity and perceived social support in palliative care: 1-week prospective study

“…Given the multidimensional nature, pain not only has a biological basis but also affects and is affected by psychosocial factors, 1–4 resulting in great difficulty in adequate management of cancer pain. Pharmacological method around pain control is of particularly high priority in Chinese palliative settings, 11 12 which may underestimate psychosocial issues in pain management.…”

“…This was a secondary analysis of prospective studies conducted at the Shengjing Hospital of China Medical University between July 2019 and October 2020. 11 12 A consecutive sample of 147 patients were recruited at the hospice ward. Eligible patients were ≥18 years who had incurable cancer.…”

“…The NRS was categorised as no pain (NRS=0), mild pain (NRS=1–3), moderate pain (NRS=4–6), severe pain (NRS=7–9) and worst pain (NRS=10). 11 13 …”

The Role of Spirituality in Pain Experiences among Adults with Cancer: An Explanatory Sequential Mixed Methods Study

“…While the relationship between spirituality and pain-related catastrophizing has not yet been explored among people with cancer, one recent study reported a significant relationship between faith and positive expectations (i.e., optimism and general self-efficacy) among people with cancer [ 45 ]. Given that pain-related catastrophizing includes components of magnification, helplessness, and expectation of negative outcomes [ 33 ], interventions focused on enhancing faith, optimism, and self-efficacy could improve pain-related catastrophizing.…”

“…Though spirituality can effectively reduce cancer pain [ 2 ], research is needed to clarify which participant characteristics, contexts, and/or types of pain might create conditions for spirituality-centered interventions to be optimized. Interestingly, higher levels of pain are associated with greater spiritual distress [ 35 ], and effective pain management may improve spiritual well-being and psychosocial outcomes among people with cancer [ 45 ], opening possibilities of spirituality and pain existing together in a more complex, reciprocal relationship. Based on these findings, our adapted theoretical framework [ 25 ] may be well suited to additional modification to explore this possibility.…”