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Medical team's support of terminally ill cancer patients' spiritual needs reduces aggressive care, improves well-being at end of life


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Tracy Balboni, MD, MPH

In a new study of terminally ill cancer patients, researchers at Dana-Farber Cancer Institute found support of patients' spiritual needs by the medical team is associated with greater use of hospice, less aggressive care and greater quality of life near death.

The study is published by the Journal of Clinical Oncology on its web site and later will be published in a print edition.

"Recent research has shown that religion and spirituality are major sources of comfort and support for patients confronting advanced disease," says the study's senior author, Tracy Balboni, MD, MPH, of Dana-Farber.

"Our findings indicate that patients whose spiritual needs are supported by their medical team, including doctors, nurses and chaplains, have better quality of life near death and receive less aggressive medical care at the end of life."

The study involved 343 incurable cancer patients at hospital and cancer centers around the country. Participants were interviewed about their means of coping with their illness, the degree to which their spiritual needs were met by the medical team and their preferences regarding end-of-life treatment.

Investigators then tracked each patient's course of care during the remainder of his or her life.

The researchers found that patients whose spiritual needs were largely or completely supported by the medical team were likely to transition to hospice care at the end of life.

Additionally, among patients relying on their religious beliefs to cope with their illness, spiritual support reduced their risk of receiving aggressive medical interventions at the end of life.

Support of patients' spiritual needs by the medical team was also associated with better patient well-being at the end of life, with scores on average being 28 percent higher among those receiving spiritual support.

"Our findings suggest that spiritual care from the medical system has important ramifications for patients at the end of life, including helping them transition to comfort-focused care and improving their well-being near death," said Balboni.

"Furthermore, they highlight the need to educate medical caregivers in being attentive to the frequent role of religion and spirituality in patients' coping with advanced illness and importance of integrating pastoral care into multidisciplinary medical teams."

Financial support for the study was provided by grants from the National Cancer Institute, the National Institute of Mental Health, the American Society of Clinical Oncology, and the Fetzer Institute.

Holly Prigerson, PhD., Director of the Dana-Farber Center for Psycho-oncology and Palliative Care Research is the study's senior author and principal investigator. The study's co-authors include Alexi A.Wright, MD, Elizabeth Trice Loggers, MD, PhD, Michael J. Balboni, M.Div, PhD, Eldrin F. Lewis, MD, Andrea C. Phelps, MD, of Dana-Farber; John Peteet, MD, and Susan D. Block, MD of Dana-Farber and Brigham and Women's Hospital (BWH); and Mary Elizabeth Paulk, MD, of the University of Texas Southwestern Medical Center, Dallas.

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