title: Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death.
abstract: OBJECTIVE
  To determine whether spiritual care from the medical team impacts medical care received and quality of life (QoL) at the end of life (EoL) and to examine these relationships according to patient religious coping.
  
  
  METHODS
  Prospective, multisite study of patients with advanced cancer from September 2002 through August 2008. We interviewed 343 patients at baseline and observed them (median, 116 days) until death. Spiritual care was defined by patient-rated support of spiritual needs by the medical team and receipt of pastoral care services. The Brief Religious Coping Scale (RCOPE) assessed positive religious coping. EoL outcomes included patient QoL and receipt of hospice and any aggressive care (eg, resuscitation). Analyses were adjusted for potential confounders and repeated according to median-split religious coping.
  
  
  RESULTS
  Patients whose spiritual needs were largely or completely supported by the medical team received more hospice care in comparison with those not supported (adjusted odds ratio [AOR] = 3.53; 95% CI, 1.53 to 8.12, P = .003). High religious coping patients whose spiritual needs were largely or completely supported were more likely to receive hospice (AOR = 4.93; 95% CI, 1.64 to 14.80; P = .004) and less likely to receive aggressive care (AOR = 0.18; 95% CI, 0.04 to 0.79; P = .02) in comparison with those not supported. Spiritual support from the medical team and pastoral care visits were associated with higher QOL scores near death (20.0 [95% CI, 18.9 to 21.1] v 17.3 [95% CI, 15.9 to 18.8], P = .007; and 20.4 [95% CI, 19.2 to 21.1] v 17.7 [95% CI, 16.5 to 18.9], P = .003, respectively).
  
  
  CONCLUSIONS
  Support of terminally ill patients' spiritual needs by the medical team is associated with greater hospice utilization and, among high religious copers, less aggressive care at EoL. Spiritual care is associated with better patient QoL near death.
authors.affiliation: Departments of Psycho-Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA 01225, USA. tbalboni@lroc.harvard.edu
authors.forename: Tracy Anne
authors.initials: TA
authors.lastname: Balboni
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Paulk
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Balboni
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Phelps
authors.forename: Elizabeth Trice
authors.initials: ET
authors.lastname: Loggers
authors.forename: Alexi A
authors.initials: AA
authors.lastname: Wright
authors.forename: Susan D
authors.initials: SD
authors.lastname: Block
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.forename: John R
authors.initials: JR
authors.lastname: Peteet
authors.forename: Holly Gwen
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care; D011446:Prospective Studies; D011788:Quality of Life; D012068:Religion and Medicine; D012069:Religion and Psychology; D026443:Spiritual Therapies; D013727:Terminal Care