J.B.A.M. Schilderman

Coping, quality of life, depression, and hopelessness in cancer patients in a curative and palliative, end-of-life care setting

Background: Coping strategies may be important factors influencing quality of life (QOL), depression, and hopelessness. However, most studies on this issue were performed in patients still undergoing anticancer treatment. Unknown is which coping strategies are of importance for palliative-cancer patients who no longer receive treatment. Objective: The objectives of this study were to assess coping strategies in curatively treated and palliative-cancer patients no longer receiving anticancer treatment and to examine the relation of these coping strategies with QOL, depression, and hopelessness. Methods: A descriptive research design was used. Ninety-two curative and 59 palliative patients filled out the COPE-Easy abbreviated version, the European Organisation for Research-and-Treatment of Cancer QOL-Questionnaire version 2.0, Beck Depression Inventory for Primary Care, and Beck Hopelessness Scale. Results: In both curative and palliative patients, active coping strategies and acceptance were beneficial in terms of QOL, depression, and hopelessness, unlike avoidant coping strategies and venting of emotions. Palliative patients scored higher on the coping strategy, seeking moral support. For the outcome variable, emotional functioning, significant interactions were observed between the variable, curative/palliative care setting, and the coping strategy, seeking moral support. For the outcome variable, role functioning, significant interactions were observed between the variable, curative/palliative care setting, and the coping strategy, waiting. Conclusions: Coping strategies were significantly correlated to QOL, depression, and hopelessness. However, this correlation differed in the curative and palliative, end-of-life care setting. Implications for Practice: The observed relations between coping strategies, QOL, depression, and hopelessness give room to cognitive-behavioral nursing interventions. Specific attention is needed for differences in coping strategies between curative and palliative patients.

Images of god in relation to coping strategies of palliative cancer patients.

CONTEXT Religious coping is important for end-of-life treatment preferences, advance care planning, adjustment to stress, and quality of life. The currently available religious coping instruments draw on a religious and spiritual background that presupposes a very specific image of God, namely God as someone who personally interacts with people. However, according to empirical research, people may have various images of God that may or may not exist simultaneously. It is unknown whether ones belief in a specific image of God is related to the way one copes with a life-threatening disease. OBJECTIVES To examine the relation between adherence to a personal, a nonpersonal, and/or an unknowable image of God and coping strategies in a group of Dutch palliative cancer patients who were no longer receiving antitumor treatments. METHODS In total, 68 palliative care patients completed and returned the questionnaires on Images of God and the COPE-Easy. RESULTS In the regression analysis, a nonpersonal image of God was a significant positive predictor for the coping strategies seeking advice and information (β=0.339, P<0.01), seeking moral support (β=0.262, P<0.05), and denial (β=0.26, P<0.05), and a negative predictor for the coping strategy humor (β=-0.483, P<0.01). A personal image of God was a significant positive predictor for the coping strategy turning to religion (β=0.608, P<0.01). Age was the most important sociodemographic predictor for coping and had negative predictive value for seeking advice and information (β=-0.268, P<0.05) and seeking moral support (β=-0.247, P<0.05). CONCLUSION A nonpersonal image of God is a more relevant predictor for different coping strategies in Dutch palliative cancer patients than a personal or an unknowable image of God.

The effect of spiritual interventions addressing existential themes using a narrative approach on quality of life of cancer patients: a systematic review and meta-analysis

The aim of this study was to examine the effect of spiritual interventions on quality of life of cancer patients.

The life in sight application study (LISA): design of a randomized controlled trial to assess the role of an assisted structured reflection on life events and ultimate life goals to improve quality of life of cancer patients

BackgroundIt is widely recognized that spiritual care plays an important role in physical and psychosocial well-being of cancer patients, but there is little evidence based research on the effects of spiritual care. We will conduct a randomized controlled trial on spiritual care using a brief structured interview scheme supported by an e-application. The aim is to examine whether an assisted reflection on life events and ultimate life goals can improve quality of life of cancer patients.Methods/DesignBased on the findings of our previous research, we have developed a brief interview model that allows spiritual counsellors to explore, explicate and discuss life events and ultimate life goals with cancer patients. To support the interview, we created an e-application for a PC or tablet. To examine whether this assisted reflection improves quality of life we will conduct a randomized trial. Patients with advanced cancer not amenable to curative treatment options will be randomized to either the intervention or the control group. The intervention group will have two consultations with a spiritual counsellor using the interview scheme supported by the e-application. The control group will receive care as usual. At baseline and one and three months after randomization all patients fill out questionnaires regarding quality of life, spiritual wellbeing, empowerment, satisfaction with life, anxiety and depression and health care consumption.DiscussionHaving insight into one’s ultimate life goals may help integrating a life event such as cancer into one’s life story. This is the first randomized controlled trial to evaluate the role of an assisted structured reflection on ultimate life goals to improve patients’ quality of life and spiritual well being. The intervention is brief and based on concepts and skills that spiritual counsellors are familiar with, it can be easily implemented in routine patient care and incorporated in guidelines on spiritual care.Trial registrationThe study is registered at ClinicalTrials.gov: NCT01830075

Comparison of Attitudes of Guilt and Forgiveness in Cancer Patients without Evidence of Disease and Advanced Cancer patients in a Palliative Care Setting

Background: Attitudes toward guilt and forgiveness may be important factors determining distress in cancer patients. Direct comparative studies in patients with different life expectancies exploring attitudes toward guilt and forgiveness are lacking. Also, sociodemographic and religious characteristics determining the attitudes toward guilt and forgiveness are unknown. Objective: The objective of this study was to compare attitudes toward guilt and forgiveness in cancer patients without evidence of disease and advanced cancer patients. Methods: A descriptive research design was used. Ninety-seven patients without evidence of disease and 55 advanced cancer patients filled out the Dutch Guilt Measurement Instrument and the Forgiveness of Others Scale. Results: Both groups had an attitude of nonreligious guilt and forgiveness, but not of religious guilt. No significant differences in attitudes toward guilt and forgiveness were observed between the 2 groups. In contrast to sociodemographic characteristics, religious characteristics were relevant predictors for guilt and forgiveness. Significant differences in relations between images of God and attitudes toward guilt were observed between the 2 patient groups. Conclusions: An attitude of nonreligious guilt and forgiveness was found in cancer patients, irrespective of the stage of disease. Religious characteristics were significantly associated with attitudes of guilt and forgiveness. This correlation differed in the early and the advanced setting of disease. Implications for Practice: The observed relations between religious characteristics and attitudes of guilt and forgiveness suggest that a careful examination of the role of religious beliefs and values is relevant in the clinical care of patients with cancer, both in the setting of early and advanced disease.

Professional identity at stake: a phenomenological analysis of spiritual counselors' experiences working with a structured model to provide care to palliative cancer patients

BackgroundGood palliative care requires excellent interprofessional collaboration; however, working in interprofessional teams may be challenging and difficult.AimThe aim of the study is to understand the lived experience of spiritual counselors working with a new structured method in offering spiritual care to palliative patients in relation to a multidisciplinary health care team.DesignInterpretive phenomenological analysis of in-depth interviews, was done using template analysis to structure the data. We included nine spiritual counselors who are trained in using the new structured method to provide spiritual care for advanced cancer patients.ResultsAlthough the spiritual counselors were experiencing struggles with structure and iPad, they were immediately willing to work with the new structured method as they expected the visibility and professionalization of their profession to improve. In this process, they experienced a need to adapt to a certain role while working with the new method and described how the identities of the profession were challenged.ConclusionsThere is a need to concretize, professionalize, and substantiate the work of spiritual counselors in a health care setting, to enhance visibility for patients and improve interprofessional collaboration with other health care workers. However, introducing new methods to spiritual counselors is not easy, as this may challenge or jeopardize their current professional identities. Therefore, we recommend to engage spiritual counselors early in processes of change to ensure that the core of who they are as professionals remains reflected in their work.

Spiritual Care in Patients With Advanced Cancer: What Does It Imply?

TO THE EDITOR: Balboni et al report that patients with advanced cancer whose spiritual needs are met by the medical team have greater odds of receiving hospice care at the end of life. Receiving spiritual care was associated with better quality of life at the end of life. However, it remains unclear what kind of spiritual care was provided to achieve this result. The observations that patients with high religious coping have a higher likelihood of receiving aggressive care at the end of life, which may be reduced when spiritual needs were supported by the medical team, may suggest that the care provided by the medical team to patients with high religious coping either changed their belief system or changed their coping strategies. To allow for the first—a change in belief system—in-depth knowledge of and familiarity with the patient’s religious beliefs and values is required, as well as excellent pastoral skills to counsel a patient toward a different frame of (religious) reference. In fact, going through such a transformation of significance is a difficult and intensive process, requiring professional spiritual care. It is unlikely that support of doctors and nurses would have been sufficient to guide this process. The second option—a change of a patient’s coping strategy—is also unlikely to have occurred. It has been shown previously that cognitive behavioral interventions in patients with advanced cancer may have a positive influence on patients’ well-being, but this required an elaborate support program. It is doubtful that medical professionals could have provided the kind of cognitive behavioral interventions that lead to a change in coping strategies. It is more likely that in this study, discussions of preparation and life completion were crucial in supporting the patients. As has been shown previously, end-of-life discussions are essential and valuable in optimal medical care for patients with advanced cancer. Although it may well be true that patients have labeled this kind of care as spiritual care, in fact, this is not spiritual in terms of the definition of spirituality, viz. “an individual’s relationship to and experience of the transcendent.” Although we agree with the authors that medical caregivers should be educated in providing patient-centered spiritual care, it is unlikely that the current study demonstrated “associations of spiritual care with medical care and quality of life near death,” given that the conceptual and professional validity of the interventions labeled as spiritual care have not been established in the study.

Worldview commitment and narrative foreclosure among older Dutch adults: Assessing the importance of grand narratives

ABSTRACT Grand narratives offered by religion and other worldviews provide a background against which people can narrate their personal life stories. Therefore, the extent of commitment older adults experience toward their worldview is expected to influence the narrative openness of their life story. Regression analyses based on a survey study among 356 older Dutch adults demonstrate that reconsideration of the commitment toward their worldview is associated with “narrative foreclosure”: the premature sentiment that their life story is actually over. Moreover, the association we found between age and narrative foreclosure toward the future emphasizes the lack of vital cultural narratives of aging.

Religion and fear of death among older Dutch adults

ABSTRACT A qualitative study based on in-depth interviews with 26 older Dutch participants was performed to elucidate the complex relationship between religion and death anxiety. Whereas participants expressed seven types of lived religion (lacking, lost, liminal, loose, learned, lasting, and liquid religion), only participants with loose or lost religion expressed death anxiety. This supports previous research indicating that moderately religious people fear death more than nonbelievers or highly religious people. Moreover, the naturalness of death, the length of their life span, the death of others, the goodness of life, and the hope to live on in others also provided acceptance of death.

Exploring Single and Multiple Religious Belonging

This contribution studies the notion of single and multiple religious belonging in a sample of 265 Dutch respondents. We will first focus on modalities of religious belonging and subsequently compare those who claim to draw from just one religion (the monoreligious) with those who indicate that they combine elements from different religious traditions (the multireligious) in terms of their intensities and styles of belonging, loyalty and mobility, and motivations for belonging. In general, multireligious respondents are characterized by their larger flexibility in religious matters as they tend to focus on similarities and common elements in different religions, and less on boundaries between them. By being loyal to themselves in the first place, they feel free to adopt and to leave behind religious beliefs and communities. Emotional and institutional bonds for each religion appear to be less strong than for monoreligious individuals in relation to their single religion.