Interprofessional spiritual care in oncology: a literature review.

Open access Review Interprofessional spiritual care in oncology: a literature review Christina M Puchalski,1 Andrea Sbrana,2 Betty Ferrell,3 Najmeh Jafari,1 Stephen King,4 Tracy Balboni,5 Guido Miccinesi,6 Anna Vandenhoeck,7 Michael Silbermann,8 Lodovico Balducci,9 Julianna Yong,10 Andrea Antonuzzo,11 Alfredo Falcone,2 Carla Ida Ripamonti12 To cite: Puchalski CM, Sbrana A, Ferrell B, et al. Interprofessional spiritual care in oncology: a literature review. ESMO Open 2019;4:e000465. doi:10.1136/ esmoopen-2018-000465 Received 31 October 2018 Revised 10 December 2018 Accepted 11 December 2018 © Author (s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology. For numbered affiliations see end of article. Correspondence to Dr Carla Ida Ripamonti; c arla. Abstract Spiritual care is recognised as an essential element of the care of patients with serious illness such as cancer. Spiritual distress can result in poorer health outcomes including quality of life. The American Society of Clinical Oncology and other organisations recommend addressing spiritual needs in the clinical setting. This paper reviews the literature findings and proposes recommendations for interprofessional spiritual care. Introduction Scientific advances have caused a dramatic increase in the lifespan of patients with cancer over the last 30 years. Attention to the whole person arises from the recognition that patients with cancer experience psychosocial and spiritual suffering, as well as physical; suffering is ‘experienced by persons, not merely by bodies’ and ‘has its source in challenges that threaten the intactness of the person.’1 The concept of total pain was expressed by Cicely Saunders as ‘the suffering that encompasses all of a person's physical, psychological, social, spiritual, and practical struggles.’2 While increased attention in oncology has been given to psychological and social aspects, spiritual care is often neglected. This review will analyse the literature to understand better the importance of spirituality and spirituality-based interventions in cancer care, how spiritual care can be implemented in trajectory of care of patients with cancer and provide recommendations for the integration of spiritual care in oncology. Consensus-based recommendations Attention to patient spirituality is the topic of several consensus-based recommendations from both national and international organisations. These recommendations arose from a desire to reach consensus on how to integrate spirituality into healthcare models for all patients. Puchalski et al published the deliberations of two consensus conferences on the integration of spirituality in systems of care.3 4 These conferences were held in 2012 (‘Creating More Compassionate Systems of Care’) and in 2013 (‘On Improving the Spiritual Dimension of Whole Person Care: The Transformational Role of Compassion, Love and Forgiveness in Health Care’) and were built on the work of a 2009 Consensus Conference, ‘Improving the Quality of Spiritual Care as a Dimension of Palliative Care’, whose deliberations had already been published.3 The 2009 conference described recommendations in these areas: spiritual care models, assessment and treatment, and interdisciplinary collaboration. These latter consensus conferences proposed clinical standards for spiritually centred healthcare systems. They proposed six working groups in research, clinical care, education, policy/advocacy, communication and community involvement. The final deliberation provided an operative model to integrate spiritual care in clinical care systems. A joint statement of the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine5 defined spiritual and cultural care as one of the nine components of high-quality palliative care in oncology practice. Osman et al described the importance of attending to spiritual issues of patients and families in the development of ASCO guidelines for integrating palliative care into general oncology care.6 In 2018, ASCO guidelines for palliative care include spiritual care as an essential element of care with patients with cancer.6 The European Association for Palliative Care created a taskforce to address this matter and produced guidelines on spiritual care in 2014.7 Early in 2006, the European Network for Health Care Chaplaincy issued a statement, signed by 38 European associations, on the importance of spiritual care within palliative care as a result of their consultation on this topic. In the UK, the National Institute for Health and Care Excellence included Puchalski CM, et al. ESMO Open 2019;4:e000465. doi:10.1136/esmoopen-2018-000465 1 Open access spiritual care as a component of care for an adult patient at the end of his/her life.8 This paper presents a literature review of spiritual care within oncology and proposes recommendations for integrating interprofessional spiritual care into oncology. The framework is as follows: 1. To define key terms, including spirituality, spiritual well-being and distress. 2. This report will include a systematic review of the available evidence on spirituality in cancer. 3. Approaches for clinical integration of spiritual issues will be discussed. 4. Recommendations for integrating interprofessional spiritual care into oncology care will be proposed. Definitions of spirituality, spiritual well-being and spiritual distress Spirituality and religion Within palliative care, consensus conferences in the USA and Europe3 4 8 have defined spirituality as a broader construct, inclusive of religious and non-religious forms. Nursing literature defines spirituality as ‘the most human of experiences that seeks to transcend self and find meaning and purpose through connection with others, nature, and/or a Supreme Being, which may or may not involve religious structures or traditions.’9 In the field of psychology, Pargament defines spirituality as the search for the sacred.10 Also, many spirituality definitions are based on the search for ultimate meaning, purpose and connectedness to self, others and the significant or sacred in their lives,3 or as one’s relationship with the transcendent, expressed through one’s attitudes, habits and practices.11 A global consensus-derived definition states, ‘Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.’3 Globalisation is a challenge to the spiritual management of patients with cancer. The values and the beliefs of the patient may be quite different or even at odds with those of the healthcare practitioners. Spiritual care involves understanding and acceptance (...truncated)