Nurse and physician barriers to spiritual care provision at the end of life.
BACKGROUND
Spiritual care (SC) from medical practitioners is infrequent at the end of life (EOL) despite national standards.


OBJECTIVE
The study aimed to describe nurses' and physicians' desire to provide SC to terminally ill patients and assess 11 potential SC barriers.


METHODS
This was a survey-based, multisite study conducted from October 2008 through January 2009. All eligible oncology nurses and physicians at four Boston academic centers were approached for study participation; 339 nurses and physicians participated (response rate=63%).


RESULTS
Most nurses and physicians desire to provide SC within the setting of terminal illness (74% vs. 60%, respectively; P=0.002); however, 40% of nurses/physicians provide SC less often than they desire. The most highly endorsed barriers were "lack of private space" for nurses and "lack of time" for physicians, but neither was associated with actual SC provision. Barriers that predicted less frequent SC for all medical professionals included inadequate training (nurses: odds ratio [OR]=0.28, 95% confidence interval [CI]=0.12-0.73, P=0.01; physicians: OR=0.49, 95% CI=0.25-0.95, P=0.04), "not my professional role" (nurses: OR=0.21, 95% CI=0.07-0.61, P=0.004; physicians: OR=0.35, 95% CI=0.17-0.72, P=0.004), and "power inequity with patient" (nurses: OR=0.33, 95% CI=0.12-0.87, P=0.03; physicians: OR=0.41, 95% CI=0.21-0.78, P=0.007). A minority of nurses and physicians (21% and 49%, P=0.003, respectively) did not desire SC training. Those less likely to desire SC training reported lower self-ratings of spirituality (nurses: OR=5.00, 95% CI=1.82-12.50, P=0.002; physicians: OR=3.33, 95% CI=1.82-5.88, P<0.001) and male gender (physicians: OR=3.03, 95% CI=1.67-5.56, P<0.001).


CONCLUSIONS
SC training is suggested to be critical to the provision of SC in accordance with national care quality standards.
Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Center for Psychosocial Epidemiology and Outcomes Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: Michael_Balboni@dfci.harvard.edu.
Michael J
MJ
Balboni
Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.
Adam
A
Sullivan
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Center for Psychosocial Epidemiology and Outcomes Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Andrea C
AC
Enzinger
Harvard Medical School, Boston, Massachusetts, USA.
Zachary D
ZD
Epstein-Peterson
Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
Yolanda D
YD
Tseng
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Christine
C
Mitchell
Harvard Medical School, Boston, Massachusetts, USA.
Joshua
J
Niska
Department of Chaplaincy, Massachusetts General Hospital, Boston, Massachusetts, USA.
Angelika
A
Zollfrank
Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
Tyler J
TJ
VanderWeele
Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Center for Psychosocial Epidemiology and Outcomes Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Tracy A
TA
Balboni
D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D013140:Spiritualism; D029181:Spirituality; D013727:Terminal Care / Q000523:psychology
Palliative care; hidden curriculum; religion; spiritual care; spirituality