Spiritual Care, Pain Reduction, and Preferred Place of Death Among Advanced Cancer Patients in Soweto, South Africa

• Published in: Journal of pain and symptom management 2020-07, Vol.60 (1), p.37-47
• Main Authors: Ratshikana-Moloko, Mpho, MD, MPhil, Ayeni, Oluwatosin, MBChB, MSc, Tsitsi, Jacob M., MBChB, FCP(SA), Wong, Michelle L., MBBCh, FCP(SA), FCCP, FRCP(Lond), Jacobson, Judith S., MBA, DrPh, Neugut, Alfred I., MD, DrPh, Sobekwa, Mfanelo, MBChB, Joffe, Maureen, PhD, Mmoledi, Keletso, CPN, MPH, Blanchard, Charmaine L., MBBCh, MPhil, Mapanga, Witness, MPH, PhD, Ruff, Paul, MBBCh, MMed, FCP(SA), Cubasch, Herbert, MD, O'Neil, Daniel S., MD, MPH, Balboni, Tracy A., MD, MPH, FAAHPM, Prigerson, Holly G., PhD
• Format: Article
• Language: English
• Subjects: Anesthesia; Cancer; cancer patients; Clinical outcomes; Cohort analysis; Death & dying; End of life decisions; Enrollments; Morphine; Multidisciplinary teams; Pain; Pain Medicine; Palliative care; Patients; Place of death; Quality of life; Regression analysis; Religion; Sociodemographics; Spirituality
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2020.01.019

AbstractContextWhen 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. ObjectivesTo 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. MethodsA 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. ResultsOf 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). ConclusionPatients 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.