Imminent pain and death from cancer stir up sticky questions in the human condition: What is the point of life? Why must humans suffer? Why me?
It is no wonder then that a recent study in the Journal of Clinical Oncology found that 88 percent of terminal cancer patients reported that religion was at least somewhat important to them. Yet more than 72 percent of the patients said that hospital chaplains and others in the health-care system were not helping them with their spiritual needs.
The much-discussed results underscored themes familiar to Betty Ferrell, Ph.D., R.N., research scientist in City of Hope’s Department of Nursing Research & Education, who wrote an editorial accompanying the study.
“There is a seriously unmet need in the vast majority of patients in our care,” said Ferrell. “The findings apply not only to patients at the end of life, but to all patients with cancer, regardless of their stage of disease.”
In her Feb. 10 editorial, Ferrell urged health-care professionals to evaluate patients’ spiritual needs, assess their own beliefs and how they may impact patients’ care, and advocate for the importance of chaplains at medical centers.
She suggests oncologists use a simple series of questions to understand spiritual beliefs’ importance to patients, and then act on them accordingly. Crediting work by researchers at George Washington University, she points to a standard series of questions that begin to address patients’ faith in general. “What gives your life meaning?” an oncologist may ask. The physicians may follow up by asking about specific beliefs that might influence health-care decisions, or whether patients are part of a religious support community. Finally, they may ask how health-care providers should address spiritual issues in carrying out the patient’s care.
Physicians may benefit from understanding how their own beliefs shape their recommendations to patients, too. “Oncologists may unintentionally impose their own religious beliefs or values on patients and disregard strongly held beliefs about the sanctity of life, the belief in miracles, hope and divine control over life-and-death decisions,” Ferrell said. By understanding how their own beliefs affect their attitudes, physicians may be better able to follow patients’ wishes.
Some of those wishes may depend on increasing interaction with spiritual caregivers. Chaplains and spiritual caregivers within the hospital setting provide an especially valuable resource for patients who have spiritual needs but cannot travel to attend services — a common challenge for seriously ill patients — so Ferrell suggests that physicians speak out to preserve and even expand spiritual care at medical centers.
Researchers in the Department of Nursing Research & Education are widely recognized experts in quality end-of-life care. They advocate care that addresses not only patients’ physical needs, but their emotional, psychological and spiritual needs as well.
Last year, the National Cancer Institute granted the department $1.5 million to educate social workers, psychologists and chaplains nationwide about palliative care for cancer patients. Advocating for Clinical Excellence: Transdisciplinary Palliative Care Education, or the ACE Project, aims to fundamentally advance the quality of end-of-life care in the United States. The Department of Nursing Research & Education’s Shirley Otis-Green, L.C.S.W., M.S.W., leads the ACE Project.
The Coping with Cancer Study
A National Cancer Institute-funded, multicenter study led by Harvard University radiation oncologist Tracy Balboni, M.D., shed light on spirituality’s significance among cancer patients. Among the findings:
- 68 percent of participants reported that religion was very important
- 89 percent of African-Americans and 79 percent of Latinos reported that religion was very important
- Patients who reported better overall spiritual support also reported better quality of life
- Those who considered themselves very religious or spiritual also believed in taking aggressive measures to extend their lives