Yusuke Hiratsuka1, Sang-Yeon Suh2,3, Isseki Maeda4, Tatsuya Morita5, Masanori Mori5, Satoko Ito6, Tomohiro Nishi7, Takayuki Hisanaga8, Tetsuji Iriyama9, Keisuke Kaneishi10, Tomoo Ikari11, Keita Tagami11, Akira Inoue11. 1. Department of Palliative Medicine, Tohoku University School of Medicine, 2-1 Seiryomachi, Sendai, Miyagi, 980-8575, Japan. hiratsuka.med.t@gmail.com. 2. Hospice & Palliative Care Center, Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea. 3. Department of Medicine, Dongguk University Medical School, Seoul, South Korea. 4. Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan. 5. Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 6. Hospice, The Japan Baptist Hospital, Kyoto, Japan. 7. Kawasaki Municipal Ida Hospital, Kawasaki Comprehensive Care Center, Kawasaki, Japan. 8. Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan. 9. Department of Internal Medicine, Palliative Care, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan. 10. Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan. 11. Department of Palliative Medicine, Tohoku University School of Medicine, 2-1 Seiryomachi, Sendai, Miyagi, 980-8575, Japan.
Abstract
PURPOSE: Spiritual well-being is very important in patients undergoing palliative care. Although psychosocial factors have been suggested to be associated with spiritual well-being, the relationship between physical signs and spiritual well-being has not been fully elucidated. The aim of this study was to explore diverse factors associated with spiritual well-being among palliative care patients in Japan. METHODS: This study is a secondary analysis of a multicenter prospective cohort study involving patients admitted to palliative care units in Japan. Physicians recorded all data prospectively on a structured sheet designed for the study. The spiritual well-being score was measured using the Integrated Palliative Outcome Scale after patients' death in regard to symptoms over the previous 3 days. We classified each patient into "better" score (0-1) and "worse" score (2-4) groups and examined diverse factors associated with spiritual well-being. RESULTS: Among the 1896 patients enrolled, 1313 were evaluated. In the multivariate analysis, seven variables were significantly associated with "worse" score: worse spiritual well-being on admission (2-4) (p < 0.0001), younger age (< 80) (p = 0.0001), hyperactive delirium over 3 days before death (mild/moderate/severe) (p = 0.0001), expressed wish for hastened death (yes) (p = 0.0006), worse communication among patients and families (Support Team Assessment Schedule score 2-4) (p = 0.0008), pleural effusion (present) (p = 0.037), and marital status (unmarried) (p = 0.0408). CONCLUSION: Recognizing factors associated with spiritual well-being is potentially useful for identifying high-risk groups with lower spiritual well-being at the end of life. Further study is required to investigate factors associated with patient-reported spiritual well-being.
PURPOSE: Spiritual well-being is very important in patients undergoing palliative care. Although psychosocial factors have been suggested to be associated with spiritual well-being, the relationship between physical signs and spiritual well-being has not been fully elucidated. The aim of this study was to explore diverse factors associated with spiritual well-being among palliative care patients in Japan. METHODS: This study is a secondary analysis of a multicenter prospective cohort study involving patients admitted to palliative care units in Japan. Physicians recorded all data prospectively on a structured sheet designed for the study. The spiritual well-being score was measured using the Integrated Palliative Outcome Scale after patients' death in regard to symptoms over the previous 3 days. We classified each patient into "better" score (0-1) and "worse" score (2-4) groups and examined diverse factors associated with spiritual well-being. RESULTS: Among the 1896 patients enrolled, 1313 were evaluated. In the multivariate analysis, seven variables were significantly associated with "worse" score: worse spiritual well-being on admission (2-4) (p < 0.0001), younger age (< 80) (p = 0.0001), hyperactive delirium over 3 days before death (mild/moderate/severe) (p = 0.0001), expressed wish for hastened death (yes) (p = 0.0006), worse communication among patients and families (Support Team Assessment Schedule score 2-4) (p = 0.0008), pleural effusion (present) (p = 0.037), and marital status (unmarried) (p = 0.0408). CONCLUSION: Recognizing factors associated with spiritual well-being is potentially useful for identifying high-risk groups with lower spiritual well-being at the end of life. Further study is required to investigate factors associated with patient-reported spiritual well-being.
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Keywords:
Advanced cancer; End of life; Palliative care; Palliative care unit; Spirituality