Mpho Ratshikana-Moloko1, Oluwatosin Ayeni2, Jacob M Tsitsi3, Michelle L Wong4, Judith S Jacobson5, Alfred I Neugut6, Mfanelo Sobekwa7, Maureen Joffe8, Keletso Mmoledi7, Charmaine L Blanchard9, Witness Mapanga10, Paul Ruff11, Herbert Cubasch12, Daniel S O'Neil13, Tracy A Balboni14, Holly G Prigerson15. 1. Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Centre for Palliative Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Non Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa. Electronic address: mpho.ratshikana-moloko@wits.ac.za. 2. Non Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa; Department of Paediatrics, SAMRC/Wits Developmental Pathways to Health Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. 3. Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. 4. Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. 5. Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA. 6. Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA. 7. Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Centre for Palliative Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Non Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa. 8. Non Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa; Department of Paediatrics, SAMRC/Wits Developmental Pathways to Health Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa. 9. Centre for Palliative Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Non Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa. 10. Non Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa. 11. Non Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa; Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa; Division of Medical Oncology, Department of Internal Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa. 12. South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa; Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. 13. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA. 14. Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA. 15. Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA.
Abstract
CONTEXT: When religious and spiritual (R/S) care needs of patients with advanced disease are met, their quality of life (QoL) improves. We studied the association between R/S support and QoL of patients with cancer at the end of life in Soweto, South Africa. OBJECTIVES: To identify R/S needs among patients with advanced cancer receiving palliative care services and to assess associations of receipt of R/S care with patient QoL and place of death. METHODS: A prospective cohort study conducted from May 1, 2016 to April 30, 2018 at a tertiary hospital in Soweto, South Africa. Nurses enrolled patients with advanced cancer and referred them to the palliative care multidisciplinary team. Spiritual counselors assessed and provided spiritual care to patients. We compared sociodemographic, clinical, and R/S factors and QoL of R/S care recipients and others. RESULTS: Of 233 deceased participants, 92 (39.5%) had received R/S care. Patients who received R/S care reported less pain (2.82 ± 1.23 vs. 1.93 ± 1.69), used less morphine, and were more likely to die at home than patients who did not (57.5% compared with 33.7%). On multivariate logistic regression analysis, adjusting for significant confounding influences and baseline African Palliative Care Association Palliative care Outcome Scale scores, receipt of spiritual care was associated with reduced pain and family worry (odds ratio 0.33; 95% CI 0.11-0.95 and odds ratio 3.43; 95% CI 1.10-10.70, respectively). CONCLUSION: Patients with cancer have R/S needs. R/S care among our patients appeared to improve their end-of-life experience. More research is needed to determine the mechanisms by which R/S care may have improved the observed patient outcomes.
CONTEXT: When religious and spiritual (R/S) care needs of patients with advanced disease are met, their quality of life (QoL) improves. We studied the association between R/S support and QoL of patients with cancer at the end of life in Soweto, South Africa. OBJECTIVES: To identify R/S needs among patients with advanced cancer receiving palliative care services and to assess associations of receipt of R/S care with patient QoL and place of death. METHODS: A prospective cohort study conducted from May 1, 2016 to April 30, 2018 at a tertiary hospital in Soweto, South Africa. Nurses enrolled patients with advanced cancer and referred them to the palliative care multidisciplinary team. Spiritual counselors assessed and provided spiritual care to patients. We compared sociodemographic, clinical, and R/S factors and QoL of R/S care recipients and others. RESULTS: Of 233 deceased participants, 92 (39.5%) had received R/S care. Patients who received R/S care reported less pain (2.82 ± 1.23 vs. 1.93 ± 1.69), used less morphine, and were more likely to die at home than patients who did not (57.5% compared with 33.7%). On multivariate logistic regression analysis, adjusting for significant confounding influences and baseline African Palliative Care Association Palliative care Outcome Scale scores, receipt of spiritual care was associated with reduced pain and family worry (odds ratio 0.33; 95% CI 0.11-0.95 and odds ratio 3.43; 95% CI 1.10-10.70, respectively). CONCLUSION:Patients with cancer have R/S needs. R/S care among our patients appeared to improve their end-of-life experience. More research is needed to determine the mechanisms by which R/S care may have improved the observed patient outcomes.
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