The influences of spiritual well-being on quality of life in Chinese cancer patients Ying Wang, RN

Transcription

1 The influences of spiritual well-being on quality of life in Chinese cancer patients Ying Wang, RN Hunan Cancer Hospital/ The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University

2 01 Background 02 Methods CONTENT 03 Results 04 Discussions 05 Conclusions

3 1 Background Given shifting trends of medical model in China, spiritual well-being has been increasing among health care providers and researchers. There is an increasing recognition among oncology providers to improve the spiritual well-being of cancer patients..

4 1 Background Having a better understanding the impact of patients' spiritual well-being on healthrelated quality of life may help tailor the use of spiritual interventions. Still little is known about spiritual well-being among patients who are not religious but spiritual.

5 1 Background The present study was conducted to explore the factors of spiritual well-being among patients with cancer and analysis the relationship of spiritual well-being and quality of life.

6 2 Methods Research design This study was a cross-sectional and investigation of the spiritual wellbeing of cancer patients receiving inpatient care in a culture where religion is not a priority.

7 2 Methods Participants and Setting participants were selected from the patients in many types of cancer (e.g. breast, head and neck, lung) hospitalized between March 2017 and April 2017 in a tertiary cancer hospital Inclusion criteria age 18 years with competent language communication ability; mentally stable; informed of his/her disease. Exclusion criteria: did not fill out the questionnaire mentally unstable had major mental disorder

8 2 Methods Measures-----FACT-G FACT-G is a self-reported scale used to measure participants quality of life. It has four subscales which can measure one s physical well-being, emotional well-being, social/family well-being, and functional well-being. All items were scored on a 5-point scale from 0 (not at all) to 4(very much). The range of the total sore is Higher scores indicate better well-being. The FACT-G demonstrates good internal consistency in Chinese population ( =0.884, 0.867, and for each subscale).

9 2 Methods Analysed variables------facit-sp Spiritual wellbeing was assessed by FACIT-Sp, which is a 12-item scale widely used in cancer patients. The scale was developed to measure important aspects of spirituality, such as a sense of meaning in one s life, harmony, peacefulness, and a sense of strength and comfort from one s faith. It is divided into 3 dimensions, which are faith, meaning, and peace. All items have the following response options: not at all, a little bit, somewhat, quite a bit and very much, scoring from 0~4. The total score is the sum of scores of subscales, which ranges from 0 to 48, with a higher score signifying greater spiritual well-being. The Chinese version of scale has showed sound psychometric properties ( =0.831for total scale and 0.711~0.920 for each dimension).

10 2 Methods Statistical analyses All data were analyzed using SPSS version Socio-demographic and medical characteristics of the participants were described as frequencies and percentages. Multiple linear regression analysis was used to determine the relationship between three different types of spiritual well-being and quality of life in the regression model. Quality of life measures consisted to the dependent variable and demographic, clinical and types of spiritual being were all the independent variables. A p<0.05 was considered statistically significant.p<0.05 was considered statistically significant.

11 3 Results Socio-demographic and medical characteristics of the participants A total of 200 cancer patients were recruited in the investigation and 185 out of them completed the questionnaires. Socio-demographic and medical characteristics are presented in table 1. As demonstrated in table 1, more females were presented. The average age was years. Most of the participants (69.7%) had less than 9 years of schooling. The majority of the participants were reported non-religious. Other details are shown in table 1.

12 3 Results Socio-demographic and medical characteristics of the participants

13 3 Results Spiritual well-being and quality of life among the participants Table 2 quality of life and spiritual well-being of the participants (n = 185) PWB, Physical well-being; EWB, Emotional well-being; SWB, Social/family well-being; FWB, Functional well-being; SpWB, spiritual well-being

14 3 Results Associated factors of spiritual well-being of patients with cancer Multiple linear regressions were analyzed to explore the associated factors of spiritual well-being. Hospitalization frequency (B (95%CI) = ( ), β=0.199, p=0.007) was the only variable related to spiritual well-being, which explains 3.9% of the variation. The result of F-test (F=7.522, df=1, p=0.007) indicating that the multiple linear regression equation fits the data well significantly.

15 3 Results The relationship between spiritual well-being and quality of life Multiple linear regression was used with the total score and the each dimension (physical wellbeing, emotional well-being, social/family well-being, functional well-being) of QOL as dependent variables. Five stepwise equations were computed which all fit the data well significantly. The results demonstrated that meaning and peace were significantly related with QOL as a whole. Meaning was positively related to social/family, emotional, and functional well-being. Faith was negatively associated with physical, emotional well-being, and positively related to functional well-being. Peace was positively related to physical, social/family, and functional well-being.

16 3 Results The relationship between spiritual well-being and quality of life

17 4 Discussions Spiritual wellbeing of participants The current study demonstrated that the total score of spiritual well-being among the participants was lower than that of 8,864 cancer survivors which provided as reference values, which indicated that the spiritual well-being of cancer patients in mainland China was impaired.

18 4 Discussions Spiritual wellbeing of participants Possible reasons may be that spiritual well-being may do not evoke much attention in such a secular society and it is more likely to be neglected by health care providers. Secondly, spiritual care was not implemented to cancer patients because of various reasons although spiritual care was recommended as essential elements of care. This may also related to lower level of spiritual well-being. Thirdly, existed study had implied the degree of spiritual well-being may be lower among populations who are not highly religious

19 4 Discussions Spiritual wellbeing of participants In China, the majority of people don t adhere to any religion. They are also different from patients who are not religious in other counties because the Chinese population is influenced by Chinese traditional culture such as Confucianism, Taoists, and Buddhism which advocate establishing good moral character, acting morally, and getting rid of all greed, anger, and delusion.

20 4 Discussions Spiritual wellbeing of participants In this culture, Chinese people attempt to discover the true meaning of life, to find self-worth in the world, and even to explore the core essence of being a human. The highest level of spirituality is expressed as being an integral part of nature, which means find connection with the supreme existence and be harmonious with it. The current study contributes to a deep understanding spirituality of cancer patients in the unique background. It also provides a new perspective of spirituality besides from religiosity.

21 4 Discussions Spiritual wellbeing of participants In this culture, Chinese people attempt to discover the true meaning of life, to find self-worth in the world, and even to explore the core essence of being a human. The highest level of spirituality is expressed as being an integral part of nature, which means find connection with the supreme existence and be harmonious with it. The current study contributes to a deep understanding spirituality of cancer patients in the unique background. It also provides a new perspective of spirituality besides from religiosity.

22 4 Discussions Relationship between spiritual well-being and quality of life Results showed that higher level of meaning and peace are related to better QOL, which is accordance with other results. previous study indicated that meaning and peace had a greater association with QOL, which was also validated in our study

23 4 Discussions Relationship between spiritual well-being and quality of life Faith was proved to not associate with QOL. This result was also confirmed by the findings of many researches.but it is totally different from the results of another research, which found faith emerged as the only component of spirituality that was related to QOL in cancer patients who were close to death. We also found that faith had different effects on each dimension of QOL. It has significant negative associations with physical well-being and emotional well-being, but positive association with functional well-being. However, this was not consistent with another study which found faith was associated with emotional well-being and social/family well-being positively.

24 4 Discussions Clinical implications: integration of spiritual care into palliative care in Chinese patients with cancer Having a better understanding of spiritual well-being and its impact on healthrelated quality of life may help tailor the use of spiritual interventions. Spiritual care, usually given in one-to-one relationship, is completely person centred and makes no assumptions about personal conviction or life orientation, which is not necessarily religious.

25 4 Discussions Clinical implications: integration of spiritual care into palliative care in Chinese patients with cancer From this study, it concluded that spiritual care is an essential element of palliative care for cancer patients. However, there still remain many issues to be settled, such as how and when to deliver spiritual care to non-religious patients with cancer, who will be the main intervener and what the role of medical staff is, et al.

26 References 1. Dhar, N., S. Chaturvedi, and D. Nandan, Spiritual health scale 2011: defining and measuring 4 dimension of health. Indian Journal of Community Medicine Official Publication of Indian Association of Preventive & Social Medicine 2011;4: Davison, S.N. and G.S. Jhangri, The relationship between spirituality, psychosocial adjustment to illness, and health-related quality of life in patients with advanced chronic kidney disease. Journal of Pain & Symptom Management 2013;2: Smith, A.R., How Do I Care for the Spiritual But Not Religious Person? Journal of Christian Nursing 2017;3: Costanzo, E.S., C.D. Ryff, and B.H. Singer, Psychosocial adjustment among cancer survivors: Findings from a national survey of health and well-being. Health Psychology Official Journal of the Division of Health Psychology American Psychological Association 2009;2: National, Cancer, and Institute. Spirituality in cancer care. General information about spirituality [cited 2016 February 29]; Available from: 6. Canada, A.L., et al., A 3-factor model for the FACIT-Sp. Psycho Oncology 2008;9: Jimenez-Fonseca, P., et al., The mediating role of spirituality (meaning, peace, faith) between psychological distress and mental adjustment in cancer patients. 2018;5: Roland, K.B., et al., A literature review of the social and psychological needs of ovarian cancer survivors. Psychooncology 2013;11: Gonzalez, P., et al., Spiritual well-being and depressive symptoms among cancer survivors. Supportive Care in Cancer 2014;9: Paredes, A.C. and M.G. Pereira, Spirituality, Distress and Posttraumatic Growth in Breast Cancer Patients. Journal of Religion and Health Sheppard, V.B., et al., Spirituality in African-American Breast Cancer Patients: Implications for Clinical and Psychosocial Care. Journal of Religion and Health Cour, P.L., N.H. Ausker, and N.C. Hvidt, Six Understandings of the Word Spirituality in a Secular Country. Archive for the Psychology of Religion 2012;1: La, C.P. and N.C. Hvidt, Research on meaning-making and health in secular society: secular, spiritual and religious existential orientations. Social Science & Medicine 2010;7: Mollica, M.A., et al., Spirituality is associated with better prostate cancer treatment decision making experiences. Journal of Behavioral Medicine 2016;1: Mollica, M.A., et al., Spirituality is associated with less treatment regret in men with localized prostate cancer. Psycho-Oncology 2017;11: Chaar, E.A., et al., Evaluating the impact of spirituality on the quality of life, anxiety, and depression among patients with cancer: an observational transversal study. Supportive Care in Cancer Stutzman, H. and S. Abraham, A Correlational Study of Spiritual Well-being and Depression in the Adult Cancer Patient. The Health Care Manager 2017;2: Davis, L.Z., et al., Changes in spiritual well-being and psychological outcomes in ovarian cancer survivors. Psychooncology 2018;2: Gaskin-Wasson, A.L., et al., Spiritual Well-Being and Psychological Adjustment: Mediated by Interpersonal Needs? Journal of Religion and Health Al-Natour, A., S.M.A. Momani, and A.M.A. Qandil, The Relationship Between Spirituality and Quality of Life of Jordanian Women Diagnosed with Breast Cancer. J Relig Health 2017: Bai, M. and M. Lazenby, A Systematic Review of Associations between Spiritual Well-Being and Quality of Life at the Scale and Factor Levels in Studies among Patients with Cancer. Journal of Palliative Medicine 2015;3: Phelps, A.C., et al., Addressing Spirituality Within the Care of Patients at the End of Life: Perspectives of Patients With Advanced Cancer, Oncologists, and Oncology Nurses. Journal of Clinical Oncology 2012;20: Frost, M.H., et al., Spiritual well-being in lung cancer survivors. Supportive Care in Cancer 2013;7: Chonghua, W., et al., Evaluation of Chinese version of Functional Assessment of Cancer Therapy General. Journal of Practical Oncology 2006;1:77-80.

27 References 25. Peterman, A.H., et al., Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Annals of Behavioral Medicine 2002;1: Xiangyu, L., et al., Reliability and validity of the Chinese version of the functional assessment of chronic illness therapy spiritual well-being in cancer patients. Chin J Nurs 2016;09: Munoz, A.R., et al., Reference values of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being: A report from the American Cancer Society's studies of cancer survivors. Cancer 2015;11: Martoni, A.A., et al., Spiritual well-being of Italian advanced cancer patients in the home palliative care setting. European Journal of Cancer Care 2017;4:e Caldeira, S., E.C.D. Carvalho, and M. Vieira, Between spiritual wellbeing and spiritual distress: possible related factors in elderly patients with cancer. Revista Latino-Americana de Enfermagem 2014;1: Whitford, H.S., I.N. Olver, and M.J. Peterson, Spirituality as a core domain in the assessment of quality of life in oncology. Psycho oncology 2010;11: Bovero, A., et al., Spirituality, quality of life, psychological adjustment in terminal cancer patients in hospice. European Journal of Cancer Care 2016;6: Salsman, J.M., et al., Spiritual well-being and health-related quality of life in colorectal cancer: a multi-site examination of the role of personal meaning. Supportive Care in Cancer 2011;6: Mckenzie, R., Spiritual Care in NHS Scotland, A Non-Religious Perspective. Health & Social Care Chaplaincy 2013; Jafari, N., et al., Spiritual Therapy to Improve the Spiritual Well-Being of Iranian Women with Breast Cancer: A Randomized Controlled Trial. Evidence-Based Complementary and Alternative Medicine 2013: Caldeira, S., et al., Spiritual Well-Being and Spiritual Distress in Cancer Patients Undergoing Chemotherapy: Utilizing the SWBQ as Component of Holistic Nursing Diagnosis. Journal of Religion and Health 2017;4: Mackinlay, E. and C. Trevitt, Living in aged care: Using spiritual reminiscence to enhance meaning in life for those with dementia. International Journal of Mental Health Nursing 2010;6: Arutyunyan, T., et al., Religion and Spiritual Care in Pediatric Intensive Care Unit: Parental Attitudes Regarding Physician Spiritual and Religious Inquiry. American Journal of Hospice & Palliative Care 2016;1: Gordon, T. and D. Mitchell, A competency model for the assessment and delivery of spiritual care. Palliative Medicine 2004;7:

28 Thanks for listening!