Annelieke Damen1, Julie Exline2, Kenneth Pargament3, Yingwei Yao4, Harvey Chochinov5, Linda Emanuel6, George Handzo7, Diana J Wilkie4, George Fitchett8. 1. Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands. Electronic address: a.damen@uvh.nl. 2. Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio. 3. Department of Psychology, Bowling Green State University, Bowling Green, Ohio. 4. Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, Florida. 5. Research Institute of Oncology and Hematology, Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada. 6. Buehler Center on Aging, Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, Illinois. 7. Health Services Research & Quality, HealthCare Chaplaincy Network, Caring for the Human Spirit TM, New York, New York. 8. Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois.
Abstract
CONTEXT: Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. This concise measure allows for the assessment of multiple types of r/s struggles for people from different religious backgrounds or none. OBJECTIVES: The aim of the present study was to examine the prevalence, predictors and correlates of r/s struggles as measured by the RSS-14 and its subdomains in a cancer population receiving palliative care. METHODS: Data were collected from six outpatient palliative care services across the US. Inclusion criteria for patients were age 55 or older with a cancer diagnosis. In addition to demographic and r/s characteristics, study measures included the Edmonton Symptom Assessment Scale (ESAS), the Patient Dignity Inventory (PDI) and the Quality of Life at the End of Life (QUAL-E). RESULTS: The study included 331 participants. Some r/s struggle was reported by 66%, moderate to high struggle for at least one item was reported by 20% of the patients. In bivariate analyses, r/s struggle was associated with greater symptom burden, greater dignity-related problems and poorer quality of life; in multivariable analyses, dignity-related problems remained a predictor of total r/s struggle. CONCLUSION: R/S struggles may compromise well-being for cancer patients receiving palliative care. Clinicians should consider periodic screening for r/s struggles and referrals for spiritual care if indicated.
CONTEXT: Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. This concise measure allows for the assessment of multiple types of r/s struggles for people from different religious backgrounds or none. OBJECTIVES: The aim of the present study was to examine the prevalence, predictors and correlates of r/s struggles as measured by the RSS-14 and its subdomains in a cancer population receiving palliative care. METHODS: Data were collected from six outpatient palliative care services across the US. Inclusion criteria for patients were age 55 or older with a cancer diagnosis. In addition to demographic and r/s characteristics, study measures included the Edmonton Symptom Assessment Scale (ESAS), the Patient Dignity Inventory (PDI) and the Quality of Life at the End of Life (QUAL-E). RESULTS: The study included 331 participants. Some r/s struggle was reported by 66%, moderate to high struggle for at least one item was reported by 20% of the patients. In bivariate analyses, r/s struggle was associated with greater symptom burden, greater dignity-related problems and poorer quality of life; in multivariable analyses, dignity-related problems remained a predictor of total r/s struggle. CONCLUSION: R/S struggles may compromise well-being for cancer patients receiving palliative care. Clinicians should consider periodic screening for r/s struggles and referrals for spiritual care if indicated.
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