Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Portuguese Institute of Oncology-Coimbra, Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal.
BMC Palliat Care. 2020 Feb 21;19(1):22. doi: 10.1186/s12904-020-0525-3.
Decision-making in palliative care can be complex due to the uncertain prognosis and general fear surrounding decisions. Decision-making in palliative care may be influenced by spiritual and cultural beliefs or values. Determinants of the decision-making process are not completely understood, and spirituality is essential for coping with illness. Thus, this study aims to explore the influence of spirituality on the perception of healthcare decision-making in palliative care outpatients.
A cross-sectional study was developed. A battery of tests was administered to 95 palliative outpatients, namely: sociodemographic questionnaire (SQ), Decisional Conflict Scale (DCS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp), and a semi-structured interview (SSI) to study one's perception of spirituality and autonomy in decision-making. Statistical analyses involved descriptive statistics for SQ and SSI. The Mann-Whitney test was used to compare scale scores between groups and correlations were used for all scales and subscales. The analysis of patients' definitions of spirituality was based on the interpretative phenomenological process.
Spiritual wellbeing significantly correlated with greater levels of physical, emotional and functional wellbeing and a better quality of life. Greater spiritual wellbeing was associated with less decisional conflict, decreased uncertainty, a feeling of being more informed and supported and greater satisfaction with one's decision. Most patients successfully implemented their decision and identified themselves as capable of early decision-making. Patients who were able to implement their decision presented lower decisional conflict and higher levels of spiritual wellbeing and quality of life. Within the 16 themes identified, spirituality was mostly described through family. Patients who had received spiritual care displayed better scores of spiritual wellbeing, quality of life and exhibited less decisional conflict. Patients considered spirituality during illness important and believed that the need to receive spiritual support and specialised care could enable decision-making when taking into consideration ones' values and beliefs.
The impact of spiritual wellbeing on decision-making is evident. Spirituality is a key component of overall wellbeing and it assumes multidimensional and unique functions. Individualised care that promotes engagement in decision-making and considers patients' spiritual needs is essential for promoting patient empowerment, autonomy and dignity.
由于预后不确定和对决策的普遍恐惧，姑息治疗中的决策可能很复杂。姑息治疗中的决策可能受到精神和文化信仰或价值观的影响。决策过程的决定因素尚不完全清楚，而灵性对于应对疾病至关重要。因此，本研究旨在探讨灵性对姑息治疗门诊患者医疗决策感知的影响。
开展了一项横断面研究。对 95 名姑息治疗门诊患者进行了一系列测试，包括：社会人口学问卷（SQ）、决策冲突量表（DCS）、慢性疾病治疗功能评估-精神幸福感量表（FACIT-Sp）和半结构化访谈（SSI），以研究患者对精神性和决策自主性的感知。SQ 和 SSI 的统计分析采用描述性统计。组间量表评分采用 Mann-Whitney 检验进行比较，所有量表和分量表均采用相关性进行分析。患者对灵性的定义分析基于解释现象学过程。
精神幸福感与身体、情感和功能健康水平以及生活质量的提高显著相关。更高的精神幸福感与决策冲突减少、不确定性降低、更有信息感和支持感以及对决策的更高满意度相关。大多数患者成功实施了他们的决策，并认为自己能够做出早期决策。能够实施决策的患者表现出较低的决策冲突和更高的精神幸福感和生活质量。在确定的 16 个主题中，灵性主要通过家庭来描述。接受过精神关怀的患者表现出更好的精神幸福感、生活质量评分，以及较低的决策冲突。患者认为疾病期间的灵性很重要，并认为需要接受精神支持和专业护理，可以在考虑个人价值观和信仰的情况下做出决策。
精神幸福感对决策的影响是显而易见的。灵性是整体幸福感的关键组成部分，它具有多维和独特的功能。个性化护理可以促进决策的参与，并考虑到患者的精神需求，对于促进患者的赋权、自主性和尊严至关重要。
