Palliative care and spirituality: an integrative literature review

thirty-nine publications were identifi ed and their textual analysis facilitated through four thematic approaches: the meaning of spirituality in the context of palliative care; palliative care and spiritual support; spirituality and relief of pain and other symptoms in patients under palliative care; and instruments to evaluate the spiritual dimension of the scope of palliative care.

Conclusion:

this study examined the relevance of the spiritual dimension in the care of patients with palliative care and the need for developing new studies to disseminate knowledge about this topic.

Descriptors:

Palliative Care; Palliative Care at End of Live; Spirituality; Religion; Health.

Descriptors:
Palliative Care; Palliative Care at End of Live; Spirituality; Religion; Health

Title	Year/country	Outline	Intervention	Outcome
Spirituality and religiosity in palliative care: learning to govern	2014 Brazil	Review n = 6 books and 1 handbook	Speeches about R/S	Literature approaches R/S as part of the PC
Cuestionarios de evaluación e intervención espiritual en cuidados paliativos: una revisión crítica	2014 Spain	Review n = 57 instruments	Evaluation of instruments approaching spirituality employed in the PC	There are limitations to instruments.
“To Cherish Each Day as it Comes”: a qualitative study of spirituality among persons receiving palliative care	2013 Iceland	Qualitative, phenomenological n = 10 patients	Meaning of spirituality according to patients under PC	Spirituality is considered to be important and can involve religion or not.
Spirituality in palliative home care: a framework for the clinician	2013 Belgium	Qualitative n = 35 experts	Identification of spiritual support elements in the context of palliative home care	It identified 14 elements of spiritual support.
Spiritual coping and anxiety in palliative care patients: a pilot study	2013 USA	Pilot study n = 31 patients	Link between spiritual coping and anxiety	Anxiety was inversely related to coping (P < 0.01).
Atención espiritual em cuidados paliativos. Valoración y vivencia de los usuarios	2013 Spain	Quantitative, descriptive, comparative of a crosssectional cohort n = 1 patient, 55 caregivers	Perception of patients under PC and caregivers about spiritual support	Spiritual support helps to give hope (88%), comfort (83%) and meaning (79.1%).
GPs’ views concerning spirituality and the use of the FICA tool in palliative care in Flanders: a qualitative Study	2012 Belgium	Qualitative n = 23 general practitioners	Verification of points of view about the FICA for spiritual evaluation	The FICA could be a feasible instrument to evaluate spirituality.
Can Spirituality Be Taught to Health Care Professionals?	2012 Australia	Quantitative, longitudinal n = 113 professionals	Evaluation of workshops to improve the PC team’s knowledge about spirituality	Increase was observed for spirituality, spiritual support, and trust after the workshops (p < 0.001).
Spirituality and spiritual caring: nurses’ perspectives and practice in palliative and acute care environments	2012 Australia	Quantitative, crosssectional n = 42 PC nurses and 50 intensive care nurses	Link between caring and the spiritual perspective	There was a link between caring and the spiritual perspective (p = 0.02).
What can we learn about the spiritual needs of palliative care patients from the research literature?	2012 United Kingdom	Review n = 35 studies/1,374 patients	Evidence about the spirituality of patients under PC	There was a prevalence of studies with reductive representations of spirituality.
The ‘‘Spirit 8’’ successfully captured spiritual well-being in African palliative care: factor and Rasch analysis	2012 England	Quantitative, crosssectional n = 285 patients	Evaluation of spiritual well-being of patients under PC	Being a patient from Uganda (p = 0.002) or having HIV (p = 0.002) was associated with a lower well-being.
The role of spirituality and religious coping in the quality of life of patients with advanced cancer palliative radiation therapy	2012 USA	Quantitative, crosssectional n = 69 patients	Characterization of R/S and religious coping	Most of the participants (84%) use R/S to deal with the disease.
The frequency and correlates of spiritual distress among patients with advanced cancer admitted to an acute palliative care unit	2011 USA	Quantitative n = 113 patients	Analysis of factors associated with spiritual distress	Distress was associated with age (OR = 0.96, P = 0.012) and depression (OR = 1.27, P = 0.020).
Spirituality, distress, depression, anxiety, and quality of life in patients with advanced cancer	2011 India	Quantitative, descriptive, crosssectional n = 50 patients	Influence of spiritual well-being on distress and depression	It showed a negative association between distress, sadness, depression, anxiety, and spiritual well-being (p < 0.005).
A psychometric evaluation of measures of spirituality validated in culturally diverse palliative care populations	2011 England	Review n = 191 articles, 85 instruments	Evaluation of instruments approaching spirituality in PC	No instrument met all the psychometric criteria.
The central importance of spirituality in palliative care	2011 England	Review n = not informed	Evaluation of the importance of spirituality in PC	Spirituality is crucial in cases of terminal disease.
Perspectives on spiritual support at Hospice Africa Uganda	2011 Africa	Qualitative, phenomenological n =15 professionals	Understanding spiritual support in the African context.	Financial resources and beliefs were regarded as harmful for spiritual support.
The measurement of spirituality in palliative care and the content of tools validated cross culturally: a systematic review	2011 England	Review n = 191 articles, 85 instruments	Evaluation of instruments that approach spirituality in PC	Nine instruments were validated in a cross-cultural way among PC populations.
Spirituality of parents of children in palliative care	2011 USA	Quantitative n = 121 parents of children with terminal diseases	Identification of factors associated with the spirituality of parents	Being married and having children with higher sight and hearing capacities were associated with higher spirituality (p < 0.05).
Spirituality and end-of-life care in disadvantaged men dying of prostate cancer	2011 USA	Quantitative n = 35 men with prostate cancer	Association between spirituality and care received	Care of patients at the end of life was similar between men with higher or lower spirituality.
How parents of children receiving pediatric palliative care use religion, spirituality, or life philosophy in tough times	2011 USA	Qualitative, prospective cohort n = 64 parents of children under PC.	Role played by spirituality, religion, or philosophy with regard to parents	Religion, spirituality, and philosophy were relevant to help parents deal with the situation.
Meanings and practices of spirituality in the context of palliative care for adult cancer patients	2011 Brazil	Review n = 11 articles	Meanings and practices of spirituality in the PC context	Spirituality assists individuals in better coping with end-of-life situations.
Spirituality in the interdisciplinary team that works with palliative Care to cancer patients	2011 Brazil	Qualitative, descriptive, exploratory n = 8 professionals	Meaning of spirituality to the interdisciplinary team working in PC	Spirituality involved provision of integral and holistic care, and was related to faith.
La mejora de la calidad de los cuidados espirituales como una dimensión de los cuidados paliativos: el informe de la Conferencia de Consenso	2011 USA	Qualitative n = 40 leaders	Recommendations about the use of spirituality in PC.	Recommendations involve practices to implement spiritual support and integrate spirituality in therapy.
The understanding of spirituality and the potential role of spiritual support in end-of-life and palliative care: a meta-study of qualitative research	2010 United Kingdom	Review n = 19 articles, 178 patients, and 116 professionals	Summary about spirituality and spiritual support at the end of life	Several obstacles to spiritual support were found.
The spirit of palliative practice: a qualitative inquiry into the spiritual journey of palliative care physician	2010 Canada	Qualitative, descriptive n = 6 physicians working in palliative care	The influence of PC practice on spirituality and spiritual growth	Spirituality had an impact on care and growth that resulted from interaction with the patient.
Content and spiritual items of quality-of-life instruments appropriate for use in palliative care: a review	2010 Holland	Review n = 29 instruments	Evaluation of QOL instruments used in PC	It showed that 15 instruments approached the spiritual domain.
Impact of spirituality on palliative care physicians: personally and professionally	2009 Canada	Qualitative, phenomenological n = 10 physicians	PC physicians’ understanding about spirituality	Understanding involved the concept of spirituality and its difference from religion.
Bienestar espiritual de enfermos terminales y de personas aparentemente sanas	2009 Colombia	Quantitative, descriptive, comparative n = 44 patients and 44 healthy individuals	Comparison between the spiritual well-being of individuals at the end of life and healthy individuals	Healthy individuals presented more spiritual well-being (p = 0.034) and a higher existential component (p = 0.000).
Measures of spiritual issues for palliative care patients: a literature review	2008 United Kingdom	Review n = 29 instruments	Evaluation of instruments that approach spirituality in PC	There were few spirituality instruments specifically for PC.
Spirituality and the care of patients at the end of-life: an essential component of care	2008 USA	Review n = not informed	Approach of PC and spirituality-related issues	Spirituality is crucial for treating terminal patients.
Analysis of the nature of spiritual pain in terminal patients and the resignification process through the relaxation, mental images and spirituality (RIME) intervention	2008 Brazil	Quanti-qualitative, phenomenological n = 11 terminal patients	Investigation about the new meanings of spiritual pain during the RIME application	The RIME has promoted peacefulness, dignity, and quality of life in the process of dying.
Incorporating spirituality and religiosity in pain management and palliative care	2007 Brazil	Review n = not informed	Strategies used in patients suffering from chronic pain related to R/S	There is a wide range of R/S strategies aimed at patients with chronic pain; however, they lack scientific evidence.
Training program about the therapeutical intervention "relaxation, mental images and spirituality" (RIME) for re-signify the spiritual pain of terminal patients	2007 Brazil	Quanti-quali, phenomenological n = 11 patients and 6 professionals	Evaluation of the training program for the RIME intervention	The training program proved to be efficacious to prepare health professionals to use the RIME intervention.
Collective soul: The spirituality of an interdisciplinary palliative care team	2006 Canada	Qualitative, selfethnographic n = 20 professionals	A PC team’s understanding about spirituality	Participants showed difficulty in defining spirituality.
A Thematic Review of the Spirituality Literature within Palliative Care	2006 Canada	Review n = 58 articles	Analysis of spirituality within the PC scope	Most of the discussions approach conceptual issues about spirituality
Spirituality, psychotherapy and music in palliative cancer care: research projects in psycho-oncology at an oncology center in Switzerland	2005 Switzerland	Qualitative n = 135 patients with terminal cancer	Feasibility of music, psychotherapy, and spiritual support for patients with cancer	Music therapy, psychotherapy, and spiritual support provide essential methods to PC.
Spirituality and Distress in Palliative Care Consultation	2005 USA	Pilot study n = 31 patients	Link between spirituality, religious coping, and distress symptoms	Negative religious coping was associated with distress, confusion, and depression (P <& 0.05).
New perspectives in palliative care: ethics, geriatrics, gerontology, communication and spirituality	2005 Brazil	Review n = not informed	Understanding the dimensions of life	The study emphasized the important role of spirituality in face of mortality.

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[1] CORRESPONDING AUTHOR Carla Braz Evangelista E-mail: carlabrazevangelista@gmail.com