Patients' spirituality perspectives at the end of life: a qualitative evidence synthesis

Abstract

BackgroundUnderstanding patient perceptions of their spiritual needs when approaching the end of life is essential to support the delivery of patient-centred care.AimTo conduct a qualitative evidence synthesis on spirituality and spiritual care needs at the end of life in all healthcare settings from the patients’ perspective.DesignStudies were included where they were primary qualitative studies exploring spirituality in patients with a life expectancy of 12 months or less in any setting. Two reviewers independently screened titles, extracted data and conducted methodological quality appraisal. A thematic synthesis was conducted. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) - Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to summarise the certainty of the evidence.Data sourcesSix databases (Medline, Embase, Cochrane, CINAHL, PsycINFO, Applied Social Science Index and Abstracts) were searched from inception up to January 2019.ResultsFifty papers (42 unique datasets), incorporating data from 710 patients were included. Studies recruited from a mix of inpatient, outpatient, hospice and community settings across 12 different countries. Three overarching themes were generated: the concept of spirituality, spiritual needs and distress, and spiritual care resources. Relationships were an intrinsic component of spirituality.ConclusionMeeting patients’ spiritual needs is an integral part of end-of-life care. This work emphasises that supporting relationships should be a central focus of spiritual care for patients at the end of life.PROSPERO registration numberCRD42019122062

Toward a socio-spiritual approach? A mixed-methods systematic review on the social and spiritual needs of patients in the palliative phase of their illness

“…34 Previous reviews only incorporated qualitative studies. [30][31][32] (Cagle, Bunting and Kelemen, 2017).…”

“…Previous reviews have identified recurrent themes that encompass patients' needs concerning the spiritual dimension. [30][31][32] These themes concern, amongst others, a "need for meaning," "need for relationships," "need for control" and "need for independence." Throughout these reviews and some primary studies, these themes frequently recur, although sometimes phrased differently.…”

“…Previous reviews have identified recurrent themes that encompass patients’ needs concerning the spiritual dimension. 30 – 32 These themes concern, amongst others, a “need for meaning,” “need for relationships,” “need for control” and “need for independence.” Throughout these reviews and some primary studies, these themes frequently recur, although sometimes phrased differently. Given the recurrence of the same themes throughout studies, it is unlikely for a new study to find patients’ needs concerning the spiritual dimension that do not fit already identified themes.…”

Identifying Core Domains to Assess the “Quality of Death”: A Scoping Review

“…This includes factors related to physical environment (e.g., infrastructure related both in terms of equipment and to create a private, personalized, and comfortable space such as a single room with a window and less visible technology), 49,53,64,[103][104][105][106][107][108][109] organizational environment (e.g., healthcare setting and design characteristics that promote familiarity and openness), 69,76,110 and social environment (e.g., environmental facilitation of social interactions that allow closeness to others such as with regular caregiver visits, stimulating activities that are 'positive distractions', and activities of daily living including the practice of spirituality). 108,109,111,112 These resource elements account for the influence of environment on facilities functioning, including safety. 103,108,113 Sub-domain 5, knowledge and evidence for policy and practice, is premised on the collection and utilization of accurate patient-centered data, 114 alongside other health system performance indicators, and development of applicable metrics that capture local needs.…”

“…93 Integrating access to clergy or chaplain was reported to provide comfort and healing for spirit maintenance. 111,191 Sub-domain 5, access to social care, is for professional management of social distress by social care specialists or social workers that facilitate support and access to resources. 30,170,192 It is interconnected with psychological suffering and contributes to addressing psychosocial needs.…”