title: Spiritual beliefs near the end of life: a prospective cohort study of people with cancer receiving palliative care.
abstract: OBJECTIVE
  Despite growing research interest in spirituality and health, and recommendations on the importance of spiritual care in advanced cancer and palliative care, relationships between spiritual belief and psychological health near death remain unclear. We investigated (i) relationships between strength of spiritual beliefs and anxiety and depression, intake of psychotropic/analgesic medications and survival in patients with advanced disease; and (ii) whether the strength of spiritual belief changes as death approaches.
  
  
  METHODS
  We conducted a prospective cohort study of 170 patients receiving palliative care at home, 97% of whom had a diagnosis of advanced cancer. Data on strength of spiritual beliefs (Beliefs and Values Scale [BVS]), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), psychotropic/analgesic medications, daily functioning, global health and social support were collected at recruitment then 3 and 10 weeks later. Mortality data were collected up to 34 months after the first patient was recruited.
  
  
  RESULTS
  Regression analysis showed a slight increase in strength of spiritual belief over time approaching statistical significance (+0.16 BVS points per week, 95% CI [-0.01, 0.33], p = 0.073). Belief was unrelated to anxiety and depression (-0.15 points decrease in HADS for 10 points increased in BVS (95% CI [-0.57, 0.27], p = 0.49) or consumption of psychotropic medication). There was a non-significant trend for decreasing analgesic prescription with increasing belief. Mortality was higher over 6 months in participants with lower belief at recruitment.
  
  
  CONCLUSIONS
  Results suggest that although religious and spiritual beliefs might increase marginally as death approaches, they do not affect levels of anxiety or depression in patients with advanced cancer.
authors.affiliation: UCL Mental Health Sciences Unit, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.forename: Henry
authors.initials: H
authors.lastname: Llewellyn
authors.forename: Baptiste
authors.initials: B
authors.lastname: Leurent
authors.forename: Faye
authors.initials: F
authors.lastname: Owen
authors.forename: Gerard
authors.initials: G
authors.lastname: Leavey
authors.forename: Adrian
authors.initials: A
authors.lastname: Tookman
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D001007:Anxiety; D003469:Culture; D003863:Depression; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D010166:Palliative Care / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D012067:Religion; D012959:Socioeconomic Factors; D029181:Spirituality; D011795:Surveys and Questionnaires; D013727:Terminal Care; D013997:Time Factors; D016896:Treatment Outcome
keywords: cancer; end-of-life; oncology; religion; spirituality; wellbeing