Culture and spirituality: essential components of palliative care

Abstract

Palliative care advocates a holistic, multiprofessional approach to the care of people with life-threatening disease. In addition to the control of physical symptoms attention should also be paid to psychosocial, cultural and spiritual aspects of the patient's experience of illness. Guidance documents and research evidence reflect the complexity of the patient's journey and the need to regularly assess these areas of need over time. Cultural background can shape how patients respond to life-threatening illness, as can the beliefs held by the patients, whether religious or more broadly spiritual. Research evidence shows the importance of identifying and addressing cultural and spiritual aspects of care held by patients, families and staff. These are often neglected in clinical practice due to the focus on biomedical concerns and staff discomfort in engaging with beliefs and culture. Recent studies have highlighted gaps in the research, and some methodological difficulties and indicate many patients welcome healthcare staff enquiring about the importance of their beliefs and culture. Identifying research priorities is necessary to guide future research and strengthen the evidence base.

Culture and Palliative Care: Preferences, Communication, Meaning, and Mutual Decision Making

“…Religious beliefs are important in this process, often providing essential meaning to loss. 76 We also have to understand meanings within larger collective cultural histories. A study of Inuit families in Quebec concluded that the group's cultural history of oppression under colonial policies was interwoven into how individuals and families made sense of bereavement.…”

Cultural Factors Influencing Advance Care Planning in Progressive, Incurable Disease: A Systematic Review With Narrative Synthesis

“…We explicitly included research that considered the influence of religion/spirituality on ACP uptake because religion and spirituality are intimately related to and expressed via culture and can influence how and whether a patient identifies with a particular culture. 34 All study designs were included if inclusion criteria were met and the research was published in full, to achieve a comprehensive understanding of cultural factors in ACP. Only original research was included, as the review aimed to synthesize empirical evidence.…”

Effectiveness of a brief manualized intervention, Managing Cancer and Living Meaningfully (CALM), adapted to the Italian cancer care setting: Study protocol for a single-blinded randomized controlled trial

“…The encouraging results in preliminary studies [ 25 , 27 ] and in a large randomized controlled trial in Toronto [ 28 ] suggest that CALM is a promising intervention for patients with advanced or metastatic cancer. Since culture molds the cognitive, emotional, and behavioural responses to cancer and cancer treatment, the awareness and knowledge of treatment options, and the acceptance of psychological interventions [ [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ] the application of a specific intervention such as CALM requires examination in specific cultural contexts. Currently, studies examining CALM are being carried out in Toronto, Canada, by Rodin and his research arm, and in collaboration with other investigators in Germany [ 40 ], United Kingdom, The Netherlands, China and Portugal.…”

“…However, it may also be that cultural differences in the doctor-patient relationship and communication, family, and social roles in the management of severe illness, and concepts of spirituality, faith and mortality should be taken into account in such interventions. [ [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. We therefore conducted an unblinded phase II RCT in Ferrara, Italy to assess the feasibility, acceptability and preliminary efficacy of CALM in an Italian setting and to determine the sample size needed for a larger RCT [ 39 ].…”