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Summer 2014 Newsletter
Volume 12, Number 3
Published July 6, 2014
Edited by Chaplain John Ehman, Network Convener
Network members are encouraged to submit articles for upcoming issues.
The Newsletter is published three times a year: Fall, Winter-Spring, and Summer.
Table of Contents
1. Grounded, Curious & Growing: Research Is Essential to ACPE --by Trace Haythorn
2. Research Imperative and Call to Action by the European Network of Healthcare Chaplaincy
3. Research from Chaplains at Yale-New Haven Hospital
4. Steve Overall's "Five Questions I Wish Research Would Address"
5. COMISS Surveys Regarding Research Publications in Specialized Ministry
6. Crossroads ...a Newsletter Exploring Research on Religion, Spirituality, and Health
7. Proceedings of the 2014 Healthcare Chaplaincy Network's Caring for the Human Spirit Conference
8. Spiritual Assessment and Spiritual Injury App
9. Journals' Special Theme Issues
10. Sources Regarding Anton Boisen and Helen Flanders Dunbar
11. Notable Research from 2013 Not Previously Cited on the Research Network Website
1. Grounded, Curious & Growing: Research Is Essential to ACPE --by Trace Haythorn, ACPE Executive Director
[Note: This item was originally written for the Research Network's flyer for the ACPE national conference, in Austin, Texas, May 7-10, 2014.]
Upon arriving at ACPE as the new executive director, several members encouraged me to read Paging God: Religion in the Halls of Medicine by Wendy Cadge. My first reaction was, “Why have I never heard of this study before?” My second reaction was, “Why are there so few studies like this one?” As an association of educators, our practices cannot be guided simply by trial and error, by hunches or by assumption. Granted, all three may be useful, but our practice must be fundamentally grounded in research. We must encourage and support quantitative and qualitative methodologies and enter into dialogue not only with each other about our studies but also with those of other disciplines. Further, we must help our students learn these tools not simply for their own research work but also as essential competencies for the practices of pastoral care, for ministry, and for community service.
The American Educational Research Association has crafted the following definition of "scientifically-based research":
"The term ‘principles of scientific research’ means the use of rigorous, systematic, and objective methodologies to obtain reliable and valid knowledge. Specifically, such research requires:
- development of a logical, evidence-based chain of reasoning;
- methods appropriate to the questions posed;
- observational or experimental designs and instruments that provide reliable and generalizable findings;
- data and analysis adequate to support findings;
- explication of procedures and results clearly and in detail, including specification of the population to which the findings can be generalized;
- adherence to professional norms of peer review;
- dissemination of findings to contribute to scientific knowledge; and
- access to data for reanalysis, replication, and the opportunity to build on findings."
[―from the AERA website at http://goo.gl/yMc36x]
Amidst so many ambiguities within the field of spiritual care, we need such a foundation that informs our current practice, that helps us frame future practice, and that informs accountability among individuals and centers. We are fortunate to have committed pioneers serving not only our association but the field of clinical pastoral education who are committed to research. As we look to the future and seek to address questions as broad ranging as best practice, sustainability, and ethics, we must be informed by a rich, diverse, and trustworthy research base. Without it, we cannot continue to grow internally or externally.
2. Research Imperative and Call to Action by the European Network of Healthcare Chaplaincy
The European Network of Healthcare Chaplaincy issued the following statement at the conclusion of its May 28-June 1, 2014 meeting in Salzburg, Austria, as part of a summery communication. Attending the meeting, as a consultation speaker, was George Handzo, Director, Health Services, Research and Quality, at Healthcare Chaplaincy (New York). --JE
Research Imperative
Although it is not straightforward to evaluate spiritual care practice it is important to conduct research in order to improve the quality of care. Therefore, the European healthcare chaplaincy community actively promotes research as an integral part of chaplaincy activity. This research must measure "outcomes" rather than "processes." All chaplains must develop their ongoing practice in the light of current research.
Research is a vital part of today's healthcare. Care delivered by chaplains must also be informed by research that is practice based. Chaplains are well equipped to conduct narrative research because listening to and interpreting patients' stories is a core part of their work. They can use and develop strategic alliances with other healthcare disciplines in research.
Sharing research findings will also inform healthcare providers and faith communities of the role and importance of chaplaincy and thus promote chaplaincy services.
Call to Action
In order to provide "Best Spiritual Care," we call upon:
All chaplains to keep informed of current research and to develop their practice in the light of this. Some chaplains to lead the research agenda to ensure that high quality research is conducted into healthcare chaplaincy outcomes.
Healthcare providers to require their chaplains to develop their practice in the light of current research and to support those chaplains who conduct research.
Faith and belief communities to support models of healthcare chaplaincy that are research based.
3. Research from Chaplains at Yale-New Haven Hospital
Chaplain Resident Jason S. Glombicki and Palliative Care Chaplain Jane Jeuland, from Yale-New Haven Hospital (New Haven, CT) have published in the Journal of Palliative Medicine results from a quality improvement project, "Exploring the importance of chaplain visits in a palliative care clinic for patients and companions" (vol. 17, no. 2, pp. 131-132). Data were obtained from 21 outpatients and 12 of their companions during clinic visits. Among the findings, patients and their companions valued a chaplain's visit as part of their "overall visit" (average of 3.93 on a 5-point scale). If a medical provider introduced the patient or companion to the chaplain, the chaplain's visit was rated at an average of 4.38 vs. 3.43 for when there was no such introduction. Also, "Data suggested that 12.82 minutes was considered 'enough' time for an outpatient visit, challenging previous studies' hypotheses that SRE [i.e., spiritual, religious, existential] support in outpatient settings may be difficult due to complexity of providing SRE with limited time" [p. 131]. Analysis of comments by the patients and companions also suggested a handful of themes regarding how chaplains were positively valued:
- Chaplain visits are different from other fields
- Helpful in the expression of thoughts and feelings
- Generally valuable in the outpatient setting
- Gives additional layer of support
- Communicates encouragement.
Illustrative quotes are given in a table [--see p. 131].
Jason Glombicki has recently moved to parish ministry at the Wicker Park Lutheran Church in Chicago, IL. Jane Jeuland continues to develop her research interests with the Palliative Care Service at Yale-New Haven Hospital. She is currently pursuing IRB approval for a national survey of palliative care chaplains to help identify and refine Standards of Practice and Best Practices in the field. She also hopes to develop a future study on referrals to chaplains. Network members may contact Chaplain Jeuland at jane.jueland@ynhh.org.
4. Steve Overall's "Five Questions I Wish Research Would Address"
From the Editor: This is the third in a series for our Newsletter, whereby members of our Network are invited to suggest five practical questions for research that could be valuable for chaplains and/or the ACPE. This is the sort of generative thinking that often takes place informally at chaplaincy gatherings but seldom reaches a wider audience. Steve Overall, MDiv, ACPE Supervisor, has been a long-time advocate for the incorporation of research and its incorporation into CPE curricula. In 2013, he retired as Director of the Clinical Pastoral Education Program at Saint Luke’s Hospital, Kansas City, MO and now lives in Chattanooga, TN. He may be contacted at overall.swodown@gmail.com. --JE
1) What are the distinguishing characteristics between a "multi-disciplinary" care team and an "interdisciplinary" care team? In healthcare, much has been said about the value of a "team approach" in patient care. How would one go about discerning which approach is of optimum value to patients, family members and to the "team" itself?
2) What do patients say about the quality of care they receive in faith-based hospitals vs. other hospitals (including not-for-profit and for-profit hospitals)? Does an institution aligned with a particular religious community receive higher patient satisfaction scores than non-aligned institutions? Which type of healthcare institution is likely to receive more Medicare reimbursement resulting from a 90% or higher patient satisfaction rating?
3) A large segment of our nation's healthcare institutions report fewer and fewer hospitalized persons self-identifying a religious preference. What might be the major reasons people don't wish to be identified by their faith practice or lack thereof? What are the implications for hospitals (faith-based or otherwise) in maintaining an in-house spiritual wellness care program with the majority of patients opting out of such registration information. In a related matter, the Joint Commission for Accreditation Healthcare Organizations has continued to require every accredited hospital to have in place a plan for providing spiritual care services to its patients, how might research help to guide hospitals in the types of services necessary to meet this Joint Commission's requirements?
4) Thinking in terms of the value of spiritual care for better patient care outcomes, who is best suited to offer spiritual assessment and follow-up integrated care in hospitals: chaplains, social workers, nurses, doctors, or others? More and more the term spiritual is used in a variety of ways that do not necessarily translate into a religious category or imply a need for a religiously trained practitioner.
5) In the ever increasing world of technology in healthcare, there may come a time when a chaplain need not be physically present to offer a "ministry of presence" but could be summoned or requested to go online and offer spiritual comfort, pastoral care, or ethical consultation directly to patients, families, staff and ethics committees. How would such a service be beneficial to healthcare systems concerned about keeping down salary costs and benefits offered to full time Chaplains?
5. COMISS Surveys Regarding Research Publications in Specialized Ministry
On January 12-13, 2014, the COMISS Network on Ministry in Specialized Settings (formerly known as the Coalition on Ministry in Specialized Settings) held its annual Forum in Alexandria, VA, on the theme of What Research Says About Chaplains, and for the second year the Forum received a Research-from-the-Field report by Russell H. Davis, ACPE Supervisor, Professor, and Rev. Robert B. Lantz Chair of Patient Counseling, School of Allied Health Professions, Virginia Commonwealth University, Richmond, VA. That report, "Update on Research 2013: Survey of COMISS Network Membership Constituency Regarding Research Publications in Specialized Ministry," covered articles/chapters/books published in during the year, research in progress by members of the COMISS Network, and recommended classic/favorite articles. It has now been formalized in a paper available online from the COMISS website. (Our ACPE Research Network is noted on as a resource on p. 17.) Also available from the website is the initial report for 2012, given at the January 14, 2013 Forum. These are good bibliographic sources and also give a picture of the research work and interests of the COMISS Network.
6. Crossroads ...a Newsletter Exploring Research on Religion, Spirituality, and Health
Crossroads, the newsletter of the Center for Spirituality, Theology and Health at Duke University, is a monthly source for news about research, special events, and funding opportunities. The publication is now in its fourth year, and all issues are available online. A link at the bottom of the archive page allows for a subscription, to get an e-mail notice of new issues. The editors state: "Our goal is to create a community of researchers, clinicians, clergy, and laypersons interested in spirituality and health and keep them informed and updated" [vol. 4, no. 1 (July 2014): 1], and they invite input from anyone. This is not only a source for information but an opportunity to spread news of projects and events.
7. Proceedings of the 2014 Healthcare Chaplaincy Network's Caring for the Human Spirit Conference
Six major chaplaincy studies were reported at the Healthcare Chaplaincy Network's March 31-April 3, 2014 conference, Caring for the Human Spirit: Driving the Research Agenda for Spiritual Care in Health Care, in New York City. The event brought to fruition a three-year project funded by a grant from the John Templeton Foundation and focused on "the role of chaplaincy care interventions in the treatment of diverse patient groups including an ICU, pediatric inpatients, inpatients at the end of life, outpatients with advanced cancer, and a diverse urban population" [--from the HCCN website]. A listing of the studies was noted in our Winter 2014 Newsletter (see section #6).
The conference proceedings have now been covered in a special open-access issue of the Healthcare Chaplaincy Network's online publication Plainviews [vol. 11, no. 6 (4/9/2014)], available as a PDF.
8. Spiritual Assessment and Spiritual Injury App from Chaplain Gary E. Berg
ACPE member Gary E. Berg (St. Cloud, MN) has recently added a Spiritual Injury App to his Spiritual Assessment website (www.spiritualassessment.com). He writes to our Network:
A program for assessing individual spiritual injuries that compromise spiritual health and well-being is now available on the Internet. It is an eight item instrument used by clinicians, pastoral counselors and chaplains to identify spiritual concerns that warrant therapeutic interventions and pastoral care and counseling. This instrument, referred to as the Spiritual Injury Scale or SIS, is useful in conducting research and for supporting pastoral care interventions in clinical care and treatment. It can be accessed by going to the www.spiritualassessment.com website and clicking on the menu item SpiritualInjuryApp. A manual on the same website further describes the instrument.
Chaplain Berg also plans to make available very soon a longer form assessment, which he mentions in the Manual section of the site.
9. Journals' Special Theme Issues
Three health care journals had published special issues this spring, indicating an open interest by those editorial boards to the topic of Spirituality & Health.
The first is Rhode Island Medicine, an open-access journal at www.rimed.org/rimedicaljournal-2014-03.asp. The April 2014 issue (vol. 97, no. 3), edited by Gowri Anandarajah, MD, contains the following articles: "A qualitative study of physicians' views on compassionate patient care and spirituality: medicine as a spiritual practice?" (pp. 17-22); "Spirituality in medicine: a surgeon's perspective" (pp. 23-25); "Spirituality and coping with chronic disease in pediatrics" (pp. 26-30); "The role of spirituality in diabetes self-management in an urban, underserved population: a qualitative exploratory study" (pp. 31-35); "Spirituality and treatment of addictive disorders" (pp. 36-38); and "Professional chaplains in comprehensive patient-centered care" (pp. 39-42).
The second is Issues in Mental Health Nursing (informahealthcare.com/journal/mhn), whose April 2014 issue (vol. 35, no. 4) is edited by Inez Tuck, PhD, RN, MDiv. Articles include: "The relationship between spiritual resources and life attitudes of African American homeless women" (pp. 238-250); "Could spirituality and religion promote stress resilience in survivors of childhood trauma?" (pp. 251-256); "Promoting resilience and recovery in a Buddhist mental health support group" (pp. 257-264); "The effectiveness of yoga for depression: a critical literature review" (pp. 265-276); "Forgiveness, flourishing, and resilience: the influences of expressions of spirituality on mental health recovery" (pp. 277-282); "Religiousness/spirituality and anger management in community-dwelling older persons" (pp. 283-291); "Mental health recovery and quilting: evaluation of a grass-roots project in a small, rural, Australian Christian church" (pp. 292-298); and "Spiritual interventions and the impact of a faith community nursing program" (pp. 299-305). There is also a book review on Spirituality and Autism. See more from the Table of Contents page.
A third is a special issue of the online open-access journal, Evidence-Based Complementary and Alternative Medicine, containing 15 articles from 2013-2014, at www.hindawi.com/journals/ecam/si/352539. The editors are Arndt Büssing, Klaus Baumann, Niels Christian Hvidt, Harold G. Koenig, Christina M. Puchalski, and John Swinton. Most of the articles focus on European populations, but chaplains in the US may enjoy browsing the Table of Contents and exploring such titles as, "Faith as a resource in patients with Multiple Sclerosis is associated with a positive interpretation of illness and experience of gratitude/awe"; "Spiritual needs in patients suffering from Fibromyalgia"; "Compassionate love as a predictor of reduced HIV disease progression and transmission risk"; and "Spiritual dryness as a measure of a specific spiritual crisis in Catholic priests: associations with symptoms of burnout and distress." Perhaps more importantly, though, the journal has issued a call for new papers, with a manuscript deadline of October 10, 2014.
10. Sources Regarding Anton Boisen and Helen Flanders Dunbar
During his May 10, 2014 plenary address at the national ACPE Conference in Austin, TX, "Innovation: Research and Thinking as Our Future," George Fitchett referenced a source on Anton Boisen from the Universidad InterAmericana de Puerto Rico (www.metro.inter.edu/facultad/esthumanisticos/anton_boisen.asp). The site contains sample blank case analysis form and two papers: Glenn H. Asquith, Jr.'s "The Case Study Method of Anton T. Boisen" [Journal of Pastoral Care 34, no. 2 (June 1980): 84-94] and Robert Charles Powell's "Religion in Crisis and Custom: Formation and Transformation -- Discover and Recovery -- of Spirit and Soul" [address to the 8th Asia Pacific Congress on Pastoral Care and Counseling, August 8, 2005].
Regarding Helen Flanders Dunbar, The Journal of Religion and Health has published [53, no. 3 (2014): 778-788]: Biography as an Art Form: The Story of Helen Flanders Dunbar, M.D., Ph.D., B.D., and Med. Sci. D," by Curtis W. Hart, the abstract for which is as follows:
Helen Flanders Dunbar (1902-1959) was a physician, medieval and Renaissance scholar, theologian, and founder of the American Psychosomatic Society and its journal Psychosomatic Medicine. Her contributions are not currently well known but deserve recognition from all those involved or interested in the dialogue between medicine and spirituality. This essay explores Dunbar's personal history and professional achievements. It focuses particular attention on a feminist perspective regarding her life and work. It will conclude with a discussion of how biography, as an art form, transforms both author and audience. This essay was originally presented as the Second Annual J. R. Williams Memorial Lecture on Spirituality and Medicine at the Tulane School of Medicine in fall 2013.
[Also, readers interested in CPE's foundational figures may recall that an article about Richard C. Cabot was highlighted in our Fall 2003 Newsletter (section #4).]
11. Notable Research from 2013 Not Previously Cited on the Research Network Website
Our Network highlights a fair number of studies in the course of a year, but many good articles are not featured. The following 25 have until now not been cited on our site but may yet be of special interest to chaplains. They are taken from an annual annotated bibliography of 235 Medline-indexed articles, available from the Penn Medicine Department of Pastoral Care.
Ai, A. L., Hopp, F., Tice, T. N. and Koenig, H. [Florida State University, School of Social Work, Tallahassee]. "Existential relatedness in light of eudemonic well-being and religious coping among middle-aged and older cardiac patients." Journal of Health Psychology 18, no. 3 (March 2013): 368-382. [(Abstract:) This study examined the prediction of preoperative faith factors for perceived spiritual support, indicating existential relationship as a dimension of eudemonic well-being (EWB), at 30 months after cardiac surgery (N=226). The study capitalized on data from preoperative surveys and the Society of Thoracic Surgeons' National Database. Controlling for demographics, cardiac indices, and mental health, hierarchical regression showed that preoperative prayer coping, subjective religiousness, and internal control were positive predictors of spiritual support. Negative religious coping was a negative predictor. Internal control mediated the role of positive religious coping. Certain faith-based experiences may enhance aspects of EWB, but future research should investigate mechanisms.]
Balboni, M. J., Sullivan, A., Amobi, A., Phelps, A. C., Gorman, D. P., Zollfrank, A., Peteet, J. R., Prigerson, H. G., Vanderweele, T. J. and Balboni, T. A. [Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA]. "Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training." Journal of Clinical Oncology 31, no. 4 (February 1, 2013): 461-467. [(Abstract:) PURPOSE: To determine factors contributing to the infrequent provision of spiritual care (SC) by nurses and physicians caring for patients at the end of life (EOL). PATIENTS AND METHODS: This is a survey-based, multisite study conducted from March 2006 through January 2009. All eligible patients with advanced cancer receiving palliative radiation therapy and oncology physician and nurses at four Boston academic centers were approached for study participation; 75 patients (response rate = 73%) and 339 nurses and physicians (response rate = 63%) participated. The survey assessed practical and operational dimensions of SC, including eight SC examples. Outcomes assessed five factors hypothesized to contribute to SC infrequency. RESULTS: Most patients with advanced cancer had never received any form of spiritual care from their oncology nurses or physicians (87% and 94%, respectively; P for difference = .043). Majorities of patients indicated that SC is an important component of cancer care from nurses and physicians (86% and 87%, respectively; P = .1). Most nurses and physicians thought that SC should at least occasionally be provided (87% and 80%, respectively; P = .16). Majorities of patients, nurses, and physicians endorsed the appropriateness of eight examples of SC (averages, 78%, 93%, and 87%, respectively; P = .01). In adjusted analyses, the strongest predictor of SC provision by nurses and physicians was reception of SC training (odds ratio [OR] = 11.20, 95% CI, 1.24 to 101; and OR = 7.22, 95% CI, 1.91 to 27.30, respectively). Most nurses and physicians had not received SC training (88% and 86%, respectively; P = .83). CONCLUSION: Patients, nurses, and physicians view SC as an important, appropriate, and beneficial component of EOL care. SC infrequency may be primarily due to lack of training, suggesting that SC training is critical to meeting national EOL care guidelines.]
Bonelli, R. M. and Koenig, H. G. [Sigmund Freud University, Vienna, Austria]. "Mental disorders, religion and spirituality 1990 to 2010: a systematic evidence-based review." Journal of Religion & Health 52, no. 2 (June 2013): 657-673. [(Abstract:) Religion/spirituality has been increasingly examined in medical research during the past two decades. Despite the increasing number of published studies, a systematic evidence-based review of the available data in the field of psychiatry has not been done during the last 20 years. The literature was searched using PubMed (1990-2010). We examined original research on religion, religiosity, spirituality, and related terms published in the top 25 % of psychiatry and neurology journals according to the ISI journals citation index 2010. Most studies focused on religion or religiosity and only 7% involved interventions. Among the 43 publications that met these criteria, thirty-one (72.1%) found a relationship between level of religious/spiritual involvement and less mental disorder (positive), eight (18.6%) found mixed results (positive and negative), and two (4.7%) reported more mental disorder (negative). All studies on dementia, suicide, and stress-related disorders found a positive association, as well as 79% and 67% of the papers on depression and substance abuse, respectively. In contrast, findings from the few studies in schizophrenia were mixed, and in bipolar disorder, indicated no association or a negative one. There is good evidence that religious involvement is correlated with better mental health in the areas of depression, substance abuse, and suicide; some evidence in stress- related disorders and dementia; insufficient evidence in bipolar disorder and schizophrenia, and no data in many other mental disorders.]
Bulkley, J., McMullen, C. K., Hornbrook, M. C., Grant, M., Altschuler, A., Wendel, C. S. and Krouse, R. S. [Center for Health Research, Northwest/Hawaii/Southeast, Kaiser Permanente Northwest, Portland, OR]. "Spiritual well-being in long-term colorectal cancer survivors with ostomies." Psycho-Oncology 22, no. 11 (NovEMBER 2013): 2513-2521. [(Abstract:) OBJECTIVE: Spiritual well-being (SpWB) is integral to health-related quality of life. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We analyzed the SpWB of CRC survivors with ostomies. METHODS: Two-hundred-eighty-three long-term (> 5 years) CRC survivors with permanent ostomies completed the modified City of Hope Quality of Life-Ostomy (mCOH- QOL-O) questionnaire. An open-ended question elicited respondents' greatest challenge in living with an ostomy. We used content analysis to identify SpWB responses and develop themes. We analyzed responses on the three-item SpWB sub-scale. RESULTS: Open-ended responses from 52% of participants contained SpWB content. Fifteen unique SpWB themes were identified. Sixty percent of individuals expressed positive themes such as "positive attitude", "I am fortunate," "appreciate life more," and "strength through religious faith." Negative themes, expressed by only 29% of respondents, included "struggling to cope," "not feeling 'normal'," and "loss." Fifty-five percent of respondents expressed ambivalent themes including "learning acceptance," "an ostomy is the price for survival," "reason to be around despite suffering," and "continuing to cope despite challenges." The majority (64%) had a high SpWB sub-scale score. CONCLUSIONS: Although CRC survivors with ostomies infrequently mentioned negative SpWB themes as a major challenge, ambivalent themes were common. SpWB themes were often mentioned as a source of resilience or part of the struggle to adapt to an altered body after cancer surgery. Interventions to improve the quality of life of cancer survivors should contain program elements designed to address SpWB that support personal meaning, inner peace, inter connectedness, and belonging.]
Carter, J. L., Trungale, K. R. and Barnes, S. A. "From bedside to graveside: increased stress among healthcare chaplains." Journal of Pastoral Care & Counseling 67, nos. 3-4 (Sep-Dec 2013): 4 [electronic journal article designation]. [(Abstract:) The authors conducted a survey of Baylor Health Care System chaplains in an attempt to understand the stress they experience when leading funeral services of staff, staff family members, and patients. The intensity of stress experienced by these chaplains appears to be related to the cause of death, the deceased's age, and the relationship the deceased had with the chaplain. Further research is needed to corroborate these findings as well as to investigate how chaplains manage their own grief when they are involved in the grief experiences of patients and families.]
Delgado-Guay, M. O., Parsons, H. A., Hui, D., De la Cruz, M. G., Thorney, S. and Bruera, E. [Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston]. "Spirituality, religiosity, and spiritual pain among caregivers of patients with advanced cancer." American Journal of Hospice and Palliative Medicine 30, no. 5 (Aug 2013): 455-461. [(Abstract:) BACKGROUND: Caregivers of patients with advanced cancer often face physical, social, and emotional distress as well as spiritual pain. Limited research has focused on the spiritual aspects of caregivers' suffering in the palliative care setting. METHODS: We interviewed 43 caregivers of patients with advanced cancer in our palliative care outpatient clinic. We determined demographic characteristics, religious affiliation, and relationship to the patient. Levels of spirituality, religiosity, and spiritual pain were self-reported using numeric rating scales (0 = lowest; 10 = highest). The participants completed various validated questionnaires to assess sleep disturbances, psychosocial distress, coping skills, and quality of life (QOL). RESULTS: The median age was 52 years (range, 21-83); 29 (67%) were women, 34 (78%) were white, 7 (17%) were African American, and 2 (5%) were Hispanic; 39 (91%) were Christian, 1 (2%) was Jewish, and 1 (2%) was agnostic; 37 (86%) were married; 18 (42%) were working full time; and 25 (58%) were spouses. All considered themselves spiritual, and 98% considered themselves religious, with median scores of 8 (interquartile range, 6-10) and 8 (interquartile range, 4-9), respectively. All the caregivers reported that spirituality and religiosity helped them cope with their loved one's illness, and many reported that spirituality and religiosity had a positive impact on their loved one's physical (58%) and emotional (76%) symptoms. Spiritual pain was reported by 23 (58%), with a median score of 5 (interquartile range, 2-8). Caregivers with spiritual pain had higher levels of anxiety (median 10 vs 4; P = .002), depression (6 vs 2; P = .006), and denial (3 vs 2; P = .01); more behavioral disengagement (3 vs 2; P = 0.011) more dysfunctional coping strategies (19 vs 16; P < .001) and worse QOL (70 vs 51; P < .001) than those who did not have spiritual pain. CONCLUSIONS: The majority of caregivers of patients with advanced cancer considered themselves spiritual and religious. Despite this, there is high prevalence of spiritual pain in this population. Caregivers with spiritual pain experienced worse psychological distress and worse QOL. These findings support the importance of spiritual assessment of and spiritual support for caregivers in this setting.]
Ellis, M. R., Thomlinson, P., Gemmill, C. and Harris, W. [Cox Family Medicine Associates, 3850 S. National Ave., Ste. 520, Springfield, MO]. "The spiritual needs and resources of hospitalized primary care patients." Journal of Religion & Health 52, no. 4 (Dec 2013): 1306-1318. [(Abstract:) Previous studies have recognized the importance of hospitalized primary care patients' spiritual issues and needs. The sources patients consult to address these spiritual issues, including the role of their attending physician, have been largely unstudied. We sought to study patients' internal and external resources for addressing spiritual questions, while also exploring the physician's role in providing spiritual care. Our multicenter observational study evaluated 326 inpatients admitted to primary care physicians in four midwestern hospitals. We assessed how frequently these patients identified spiritual concerns during their hospitalization, the manner in which spiritual questions were addressed, patients' desires for spiritual interaction, and patient outcome measures associated with spiritual care. Nearly 30% of respondents (referred to as "R/S respondents") reported religious struggle or spiritual issues associated specifically with their hospitalization. Eight-three percent utilized internal religious coping for dealing with spiritual issues. Chaplains, clergy, or church members visited 54% of R/S respondents; 94% found those visits helpful. Family provided spiritual support to 45% of R/S respondents. Eight percent of R/S respondents desired, but only one patient actually received, spiritual interaction with their physician, even though 64% of these patients' physicians agreed that doctors should address spiritual issues with their patients. We conclude that inpatients quite commonly utilize internal resources and quite rarely utilize physicians for addressing their spiritual issues. Spiritual caregiving is well received and is primarily accomplished by professionals, dedicated laypersons, or family members. A significantly higher percentage of R/S patients desire spiritual interaction with their physician than those who actually receive it.]
Fairfield, B., Mammarella, N. and Di Domenico, A. [University of Chieti, Psychological Sciences, Chieti, Italy]. "Centenarians' 'holy' memory: Is being positive enough?" Journal of Genetic Psychology 174, no. 1 (January-February 2013): 42-50. [(From the abstract:) The authors compared 18 centenarians' (M age = 100.1 years, SD = 1.8 years) recognition memory for emotional (positive, negative, and religious) pictures with 18 older adults…. Participants observed a series of images that varied in emotional valence and meaning and were later asked to discriminate between old and new images in a series of pictures that included studied images as well as new images. Centenarians showed decreased recognition memory for positive and negative images items compared with older adults…. In addition, a significant age by valence interaction was observed highlighting how centenarians remembered religious pictures better while older adults favored positive information when only positive pictures were taken into consideration. Results are interpreted in terms of possible age-linked changes in meaningful goals that lead centenarians to focus on meaningful religious self-relevant information rather than simply on positive information.]
Frenk, S. M., Mustillo, S. A., Foy, S. L., Arroyave, W. D., Hooten, E. G., Lauderback, K. H. and Meador, K. G. [Carolina Population Center and the Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill]. "Psychotropic medication claims among religious clergy." Psychiatric Quarterly 84, no. 1 (March 2013): 27-37. [(Abstract:) This study examined psychotropic medication claims in a sample of Protestant clergy. It estimated the proportion of clergy in the sample who had a claim for psychotropic medication (i.e., anti-depressants and anxiolytics) in 2005 and examined associations between sociodemographic characteristics, occupational distress and having a claim. Protestant clergy (n = 749) from nine denominations completed a mail survey and provided access to their pharmaceutical records. Logistic regression models assessed the effect of sociodemographic characteristics and occupational distress on having a claim. The descriptive analysis revealed that 16% (95% Confidence interval [CI] 13.3%- 18.5%) of the clergy in the sample had a claim for psychotropic medication in 2005 and that, among clergy who experienced frequent occupational distress, 28% (95% CI 17.5 %-37.5%) had a claim. The regression analysis found that older clergy, female clergy, and those who experienced frequent occupational distress were more likely to have a claim. Due to recent demographic changes in the clergy population, including the increasing mean age of new clergy and the growing number of female clergy, the proportion of clergy having claims for psychotropic medication may increase in the coming years. To the best of our knowledge, this is the first study to examine the use of psychotropic medication among clergy.]
Griffin, A. [Southern Illinois University, Edwardsville]. "The lived spiritual experiences of patients transitioning through major outpatient surgery." AORN Journal 97, no. 2 (February 2013): 243-252. [(From the abstract:) Dramatic changes in outpatient surgery have occurred in recent years, but the basic care needs of surgical patients remain constant. Most outpatients face the same spiritual and coping issues that inpatients do, but outpatient surgery requires that patients cope with the surgery at an accelerated pace. This phenomenological study describes the meanings of the lived spiritual experiences of patients transitioning through major outpatient surgery. Analysis of interviews with participants resulted in four distinct themes: a point in time, holy other, vulnerability in the OR, and appraisals of uncertainty.]
Grossoehme, D. H., Cotton, S. and McPhail, G. [Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, OH]. "Use and sanctification of complementary and alternative medicine by parents of children with cystic fibrosis." Journal of Health Care Chaplaincy 19, no. 1 (2013): 22-32. [(Abstract:) Complementary and alternative medicine (CAM) use, including spiritual modalities, is common in pediatric chronic diseases. However, few users discuss CAM treatments with their child's physician. Semi-structured interviews of 25 parents of children who have cystic fibrosis (CF) were completed. Primary themes were identified by thematic analyses. Most parents (19/25) used at least one CAM modality with their child. Only two reported discussing CAM use with their child's pulmonologist. Most reported prayer as helpful (81%) and multi-faceted, including individual and group prayer; using aromatherapy or scented candles as an adjunct for relaxation; and the child's sleeping with a blessed prayer. Parents ascribed sacred significance to natural oral supplements. CAM use is relevant to the majority of participating parents of children under age 13 with CF. Chaplains can play a significant role by reframing prayer's integration into chronic disease care, co-creating rituals with pediatric patients, and mediating conversations between parents and providers.]
Grossoehme, D. H., Szczesniak, R., McPhail, G. L. and Seid, M. [Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, OH]. "Is adolescents' religious coping with cystic fibrosis associated with the rate of decline in pulmonary function? A preliminary study." Journal of Health Care Chaplaincy 19, no. 1 (2013): 33-42. [(Abstract:) Religious coping is associated with health outcomes in adolescents with chronic disease. Identifying potentially modifiable spiritual factors is important for improving health outcomes. The purpose of this study was to determine if associations exist between rate of change in pulmonary function and subsequent religious coping by adolescents with cystic fibrosis (CF). Retrospective cohort design employing the Brief R-COPE and calculated decline in lung function over a three-year period were utilized. Data were obtained for 28 adolescents; median age 13.5 years. Use of pleading or negative religious coping was associated with a worse clinical trajectory. Pleading may be ineffective as disease progression is modifiable through adherence to evidence-based treatments. Given established relationships of religious coping with general coping, the effects of declining pulmonary function may be broader. Changes in pulmonary function suggest opportunities for chaplains to explore options to cognitively reframe negative religious coping.]
Hayward, R. D. and Krause, N. [University of Michigan, School of Public Health, Ann Arbor]. "Patterns of change in religious service attendance across the life course: evidence from a 34-year longitudinal study." Social Science Research 42, no. 6 (November 2013): 1480-1489. [(Abstract:) Although a number of studies have uncovered evidence of age differences in religious involvement across the life course, there has been a lack of long-term longitudinal data to test the extent to which these differences are due to changes within individuals over time. This study tracks trajectories of change in religious service attendance using data collected longitudinally over the course of up to 34 years, between 1971 and 2005, and in ages ranging from 15 to 102. Piecewise growth curve modeling was used to examine changes in the patterns of age- related change in three distinct developmental periods: the transition from adolescence to young adulthood, middle adulthood, and older adulthood. Attendance showed an average pattern of quadratic decline in adolescence, stability in middle adulthood, and a quadratic pattern of more rapid increase followed by decrease over the course of older adulthood. These results suggest that developmental factors play a role in changing patterns of religious participation across the adult life course, and may account for some of the apparent differences between age groups.]
Hayward, R. D. and Krause, N. [Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor]. "Trajectories of late-life change in God-mediated control." Journals of Gerontology Series B-Psychological Sciences and Social Sciences 68, no. 1 (January 2013): 49-58. [(Abstract:) OBJECTIVE: To track within-individual change during late life in the sense of personal control and God-mediated control (the belief that one can work collaboratively with God to achieve one's goals and exercise control over life events) and to evaluate the hypothesis that this element of religion is related to declining personal control. METHOD: A longitudinal survey representative of older White and Black adults in the United States tracked changes in personal and God-mediated control in four waves over the course of 7 years. RESULTS: Growth curve analysis found that the pattern of change differed by race. White adults had less sense of God-mediated control at younger ages, which increased among those who were highly religious but decreased among those who were less religious. Black adults had higher God-mediated control, which increased over time among those with low personal control. DISCUSSION: These results indicate that God-mediated control generally increases during older adulthood, but that its relationships with personal control and religious commitment are complex and differ between Black and White adults.]
Jegindo, E. M., Vase, L., Skewes, J. C., Terkelsen, A. J., Hansen, J., Geertz, A. W., Roepstorff, A. and Jensen, T. S. [Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark; else-marie@cfin.dk]. "Expectations contribute to reduced pain levels during prayer in highly religious participants." Journal of Behavioral Medicine 36, no. 4 (August 2013): 413-426. [(Abstract:) Although the use of prayer as a religious coping strategy is widespread and often claimed to have positive effects on physical disorders including pain, it has never been tested in a controlled experimental setting whether prayer has a pain relieving effect. Religious beliefs and practices are complex phenomena and the use of prayer may be mediated by general psychological factors known to be related to the pain experience, such as expectations, desire for pain relief, and anxiety. Twenty religious and twenty non-religious healthy volunteers were exposed to painful electrical stimulation during internal prayer to God, a secular contrast condition, and a pain-only control condition. Subjects rated expected pain intensity levels, desire for pain relief, and anxiety before each trial and pain intensity and pain unpleasantness immediately after on mechanical visual analogue scales. Autonomic and cardiovascular measures provided continuous non-invasive objective means for assessing the potential analgesic effects of prayer. Prayer reduced pain intensity by 34% and pain unpleasantness by 38% for religious participants, but not for non-religious participants. For religious participants, expectancy and desire predicted 56-64% of the variance in pain intensity scores, but for non-religious participants, only expectancy was significantly predictive of pain intensity (65-73%). Conversely, prayer-induced reduction in pain intensity and pain unpleasantness were not followed by autonomic and cardiovascular changes.]
Kianpour, M. [Department of the Social Sciences, Isfahan University, Iran]. "Mental health and hospital chaplaincy: strategies of self-protection (case study: Toronto, Canada)." Iranian Journal of Psychiatry & Behavioral Sciences 7, no. 1 (2013): 69-77. [(Abstract:) Objective: This is a study about emotion management among a category of healthcare professional - hospital chaplains - who have hardly been the subject of sociological research about emotions. The aim of the study was to understand how chaplains manage their work- related emotions in order to protect their mental health, whilst also providing spiritual care. Methods: Using in-depth, semi structured interviews, the author spoke with 21 chaplains from five faith traditions (Christianity, Islam, Judaism, Buddhism and modern paganism) in different Toronto (Canada) Hospitals to see how they manage their emotion, and what resources they rely on in order to protect their mental health. Data analysis was perfumed according to Sandelowski's method of qualitative description. Results: The average age and work experience of the subjects interviewed in this study are 52 and 9.6 respectively. 11 chaplains worked part-time and 10 chaplains worked full- time. 18 respondents were women and the sample includes 3 male chaplains only. The findings are discussed, among others, according to the following themes: work-life balance, self-reflexivity, methods of self-care, and chaplains' emotional make-up. Conclusion: Emotion management per se is not a problem. However, if chaplains fail to maintain a proper work-life balance, job pressure can be harmful. As a strategy, many chaplains work part-time. As a supportive means, an overwhelming number of chaplains regularly benefit from psychotherapy and/or spiritual guidance.]
Krumrei, E. J., Pirutinsky, S. and Rosmarin, D. H. [Department of Psychology, Social Science Division, Pepperdine University, Malibu, CA]. "Jewish spirituality, depression, and health: an empirical test of a conceptual framework." International Journal of Behavioral Medicine 20, no. 3 (September 2013): 327-336. [(Abstract:) BACKGROUND: Little is known about the links between spirituality and mental health among Jews. PURPOSE: This study assessed trust/mistrust in God and religious coping and examined their relationships to depressive symptoms and physical health. Religious affiliation and intrinsic religiousness were examined as moderating variables and religious coping was examined as a mediator. METHOD: Anonymous internet surveys were completed by 208 Jewish women and men of diverse denominations who resided primarily in the USA. RESULTS: Trust in God and positive religious coping were associated with lower levels of depressive symptoms and mistrust in God and negative religious coping were associated with greater depressive symptoms. Intrinsic religiosity showed a small moderation effect for mistrust in God and negative religious coping in relation to depressive symptoms and for trust in God in relation to physical health. Further, positive religious coping fully mediated the link between trust in God and less depressive symptoms and negative religious coping fully mediated the relationship between mistrust in God and greater depressive symptoms. CONCLUSION: The data lend themselves to a possible integrative cognitive-coping model, in which latent core beliefs about the Divine activate coping strategies during times of distress, which in turn impact psychological health. The findings highlight the potential clinical significance of spirituality to mental health among Jews and provide a basis for future longitudinal, experimental, and treatment outcome research.]
McFarland, M. J., Pudrovska, T., Schieman, S., Ellison, C. G. and Bierman, A. [Princeton University, Center for Research on Child Wellbeing and Office of Population Research, NJ]. "Does a cancer diagnosis influence religiosity? Integrating a life course perspective." Social Science Research 42, no. 2 (March 2013): 311-320. [(Abstract:) Based on a life course framework we propose that a cancer diagnosis is associated with increased religiosity and that this relationship is contingent upon three social clocks: cohort (1920-1945, 1946-1964, 1964+), age-at-diagnosis, and years-since-diagnosis. Using prospective data from the National Survey of Midlife Development (N=3443), taken in 1994-1995 and 2004-2006, we test these arguments. Results showed that a cancer diagnosis was associated with increased religiosity. Moreover, we found: (a) no evidence that the influence of cancer varied by cohort; (b) strong evidence that people diagnosed with cancer at earlier ages experienced the largest increases in religiosity; and (c) no evidence that changes in religiosity are influenced by years-since-diagnosis. Our study emphasizes how personal reactions to cancer partly reflect macro-level processes, represented by age-at-diagnosis, and shows that the religion-health connection can operate such that health influences religiosity. The study also highlights the sociological and psychological interplay that shapes people's religiosity.]
Merritt, M. M. and McCallum, T. J. [Department of Psychology and Center on Age and Community, University of Wisconsin]. "Too much of a good thing? Positive religious coping predicts worse diurnal salivary cortisol patterns for overwhelmed African American female dementia family caregivers." American Journal of Geriatric Psychiatry 21, no. 1 (January 2013): 46-56. [(Abstract:) OBJECTIVES: Religious coping arguably prevents negative health outcomes for stressed persons. This study examined the moderating role of religious coping (positive, negative, and combined) in the connection of care recipient functional status with diurnal salivary cortisol patterns among dementia family caregivers. METHODS: Thirty African American (AA) female dementia caregivers and 48 AA noncaregivers completed the Religious Coping (RCOPE) scale, the Activities of Daily Living scale, and the Revised Memory and Behavior Problem Checklist (RMBPC) and collected five saliva samples daily (at awakening, 9 A.M., 12 P.M., 5 P.M., and 9 P.M.) for 2 straight days. RESULTS: Hierarchical regression tests with mean diurnal cortisol slope as the outcome illustrated surprisingly that higher combined and positive (but not negative) RCOPE scores were associated with increasingly flatter or worse cortisol slope scores for caregivers (but not noncaregivers). Of note, the RCOPE by RMBPC interaction was significant. Among caregivers who reported higher RMBPC scores, higher combined and positive (but not negative) RCOPE scores were unexpectedly associated with increasingly flatter cortisol slopes. CONCLUSIONS: These results extend current findings by showing that being AA, a caregiver, and high in positive religious coping may predict increased daily stress responses, mainly for those with higher patient behavioral problems. Because religious coping is a central coping strategy for AA caregivers, it is vital that epidemiologic assessments of religious coping in health and aging as well as tailored interventions focus on the unique reasons for this disparity.]
Park, C. L., Cho, D., Blank, T. O. and Wortmann, J. H. [Dept. of Psychology, University of Connecticut, Storrs]. "Cognitive and emotional aspects of fear of recurrence: predictors and relations with adjustment in young to middle-aged cancer survivors." Psycho-Oncology 22, no. 7 (July 2013): 1630-1638. [(From the abstract:) We investigated predictors of emotional (worry) and cognitive (perceived risk) dimensions of fear of recurrence (FOR) and their relationships with psychological well-being in a sample of young and middle-aged adult cancer survivors. ...Eligible participants were survivors between 18 and 55 years old and diagnosed from 1 to 3 years prior. A total of 250 participants were recruited, and 167 responded to a 1-year follow-up. Demographic and psychosocial variables were assessed at baseline, and FOR and psychological well-being were assessed at follow-up. ...Hierarchical regression analyses showed that spirituality was the only predictor of perceived risk independent of the effect of race, even when worry about general health was controlled....]
Proeschold-Bell, R. J., Miles, A., Toth, M., Adams, C., Smith, B. W. and Toole, D. [Duke Global Health Institute, Center for Health Policy and Inequalities Research, Duke University, Durham, NC]. "Using effort-reward imbalance theory to understand high rates of depression and anxiety among clergy." Journal of Primary Prevention 34, no. 6 (December 2013): 439- 453. [(Abstract:) The clergy occupation is unique in its combination of role strains and higher calling, putting clergy mental health at risk. We surveyed all United Methodist clergy in North Carolina, and 95% (n = 1,726) responded, with 38% responding via phone interview. We compared clergy phone interview depression rates, assessed using the Patient Health Questionnaire (PHQ-9), to those of in-person interviews in a representative United States sample that also used the PHQ-9. The clergy depression prevalence was 8.7%, significantly higher than the 5.5% rate of the national sample. We used logistic regression to explain depression, and also anxiety, assessed using the Hospital Anxiety and Depression Scale. As hypothesized by effort-reward imbalance theory, several extrinsic demands (job stress, life unpredictability) and intrinsic demands (guilt about not doing enough work, doubting one's call to ministry) significantly predicted depression and anxiety, as did rewards such as ministry satisfaction and lack of financial stress. The high rate of clergy depression signals the need for preventive policies and programs for clergy. The extrinsic and intrinsic demands and rewards suggest specific actions to improve clergy mental health.]
Rosmarin, D. H., Bigda-Peyton, J. S., Kertz, S. J., Smith, N., Rauch, S. L. and Bjorgvinsson, T. [Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA]. "A test of faith in God and treatment: the relationship of belief in God to psychiatric treatment outcomes." Journal of Affective Disorders 146, no. 3 (April 25, 2013): 441-446. [(Abstract:) BACKGROUND: Belief in God is very common and tied to mental health/illness in the general population, yet its relevance to psychiatric patients has not been adequately studied. We examined relationships between belief in God and treatment outcomes, and identified mediating mechanisms. METHODS: We conducted a prospective study with n=159 patients in a day-treatment program at an academic psychiatric hospital. Belief in God, treatment credibility/expectancy, emotion regulation and congregational support were assessed prior to treatment. Primary outcomes were treatment response as well as degree of reduction in depression over treatment. Secondary outcomes were improvements in psychological well-being and reduction in self-harm. RESULTS: Belief in God was significantly higher among treatment responders than non-responders F(1,114)=4.81, p<.05. Higher levels of belief were also associated with greater reductions in depression (r=.21, p<.05) and self-harm (r=.24, p<.01), and greater improvements in psychological well-being (r=.19, p<.05) over course of treatment. Belief remained correlated with changes in depression and self-harm after controlling for age and gender. Perceived treatment credibility/expectancy, but not emotional regulation or community support, mediated relationships between belief in God and reductions in depression. No variables mediated relationships to other outcomes. Religious affiliation was also associated with treatment credibility/expectancy but not treatment outcomes. CONCLUSIONS: Belief in God, but not religious affiliation, was associated with better treatment outcomes. With respect to depression, this relationship was mediated by belief in the credibility of treatment and expectations for treatment gains.]
Rosmarin, D. H., Bigda-Peyton, J. S., Ongur, D., Pargament, K. I. and Bjorgvinsson, T. [Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA]. "Religious coping among psychotic patients: relevance to suicidality and treatment outcomes." Psychiatry Research 210, no. 1 (November 30, 2013): 182-187. [(Abstract:) Religious coping is very common among individuals with psychosis, however its relevance to symptoms and treatment outcomes remains unclear. We conducted a prospective study in a clinical sample of n=47 psychiatric patients with current/past psychosis receiving partial (day) treatment at McLean Hospital. Subjects completed measures of religious involvement, religious coping and suicidality prior to treatment, and we assessed for psychosis, depression, anxiety and psychological well-being over the course of treatment. Negative religious coping (spiritual struggle) was associated with substantially greater frequency and intensity of suicidal ideation, as well as greater depression, anxiety, and less well-being prior to treatment (accounting for 9.0-46.2% of the variance in these variables). Positive religious coping was associated with significantly greater reductions in depression and anxiety, and increases in well-being over the course of treatment (accounting for 13.7-36.0% of the variance in change scores). Effects remained significant after controlling for significant covariates. Negative religious coping appears to be a risk factor for suicidality and affective symptoms among psychotic patients. Positive religious coping is an important resource to this population, and its utilization appears to be associated with better treatment outcomes.]
Sirilla, J. and Overcash, J. [James Cancer Hospital and Solove Research Institute, Ohio State University Comprehensive Cancer Center, Columbus]. "Quality of life (QOL), supportive care, and spirituality in hematopoietic stem cell transplant (HSCT) patients." Supportive Care in Cancer 21, no. 4 (April 2013): 1137-1144. [(Abstract:) For many patients, a hematopoietic stem cell transplant (HSCT) can be challenging to physical and emotional health. Supportive care needs can be overwhelming for many patients and families. The purpose of this study was to evaluate the effect of quality of life (QOL), spiritual well-being, and supportive care resources post-HSCT. This descriptive, repeated-measures study included people over the age of 18 years undergoing HSCT for any cancer diagnosis. The Functional Assessment in Cancer Therapy--Bone Marrow Transplant scale, the Functional Assessment of Chronic Illness Therapy--Spiritual--12 scale, and a resource questionnaire were administered prior to HSCT and following HSCT at 30, 60, 90, and 180 days. Three groups of HSCT patients were examined: allogeneic, autologous, and overall. Data analysis included descriptive statistics and correlations. In the sample (n=159), the autologous HSCT group reported the highest QOL scores. Spirituality scores increased for the autologous HSCT group at 90 days, but decreased for the overall and allogeneic groups. The type of supportive care resources most used were information from the physician and nurse, the Leukemia and Lymphoma Society Support as the most used form of support group, and Faith, Prayer and Spiritual Healing. QOL and spiritual well-being scores correlated best at 180 days (6 months) for autologous and allogeneic patients.]
Winter, L. [Philadelphia VA Medical Center, Philadelphia, PA]. "Patient values and preferences for end-of-life treatments: Are values better predictors than a Living Will?" Journal of Palliative Medicine 16, no. 4 (April 2013): 362-368. [(Abstract:) BACKGROUND: Advance care planning is widely considered important for good treatment decision making. Patient values have been proposed as superior to standard living wills as guides to end-of-life (EOL) care decisions on behalf of decisionally incapacitated patients. Little research has examined whether values outperform living wills as predictors of treatment preferences. OBJECTIVE: The study aimed to test whether patient values are associated with treatment preferences, compare values and preferences to responses from a standard living will, and determine whether some values are better predictors than others. DESIGN: Community-dwelling elderly men and women (n=304) were interviewed in their homes by telephone. The interview consisted of an eight-item EOL values scale, a standard living will question, preferences for four life-prolonging treatments in each of six scenarios, and sociodemographic questions. RESULTS: Principal components analysis of the EOL values revealed two factors: (1) dignity, pain management, and reluctance to burden others; and (2) religiosity and desire for longevity and following family wishes. In regression analyses, stronger preferences for life-prolonging treatments were correlated with higher scores on factor 1 and lower scores on factor 2. But when living will responses were also entered into the regression model, only religiosity, longevity, and following family wishes predicted treatment preferences independently of the living will responses. CONCLUSIONS: Providing better guidance than a living will in determining a patient's EOL treatment preferences are (1) knowledge about a patient's religiosity, (2) patient's wishes for longevity, and (3) patient's wishes for following family preferences. Wishes for dignity and pain management and reluctance to burden others do not offer better guidance than a living will.]
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