Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Seccion de Cuidados Continuos y Paliativos, Pontificia Universidad Católica de Chile, Santiago, Chile.
J Palliat Med. 2021 Nov;24(11):1606-1615. doi: 10.1089/jpm.2020.0776. Epub 2021 Apr 12.
The purpose of this multicenter study was to characterize the association between spirituality, religiosity, spiritual pain, symptom distress, coping, and quality of life (QOL) among Latin American advanced cancer patients. Three hundred twenty-five advanced cancer patients from palliative care clinics in Chile, Guatemala, and the United States completed validated assessments: Faith, Importance and Influence, Community, and Address (FICA) (spirituality/religiosity), Edmonton Symptom Assessment Scale-Financial/Spiritual (ESAS-FS), including spiritual pain, Penn State Worry Questionnaire-Abbreviated (PSWQ-A), Center for Epidemiologic Studies Depression Scale (CES-D), Brief-coping strategies (COPE) and Brief religious coping (RCOPE) and RCOPE, respectively, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Expanded version (FACIT-Sp-Ex). Median age: 58 years (range: 19-85); 60% female; and 62% Catholic and 30% Christian, but not Catholic. Three hundred fifteen patients (97%) considered themselves spiritual and 89% religious, with median intensities of 7 (interquartile range [IQR]: 5-10) and 7 (5-9), respectively (0-10 scale, 10 = "very much"). Median importance of spirituality/religiosity was 10 (IQR: 8-10). The frequency and associations between spirituality/religiosity and various items were as follows: helps to cope with illness (98%; = 0.66303; < 0.0001), positive effect on physical symptoms (81%; = 0.42067; < 0.0001), and emotional symptoms (84%; = 0.16577; < 0.0001). One hundred ninety-five patients (60%) reported that their spiritual/religious needs had not been supported by the medical team. Spiritual pain was reported in 162/311 patients (52%), with median intensity of 6 (IQR: 5-8). Spiritual pain was associated with pain ( = 0.0225), depression ( < 0.0001), anxiety ( < 0.0001), worry ( < 0.001), behavioral disengagement ( = 0.0148), FACIT-Sp-Ex score ( = 0.0002), and negative RCOPE ( < 0.0001). Spirituality and religiosity are frequent, intense, and rarely addressed among Latin American patients. Spirituality/religiosity was associated with positive COPE and higher QOL. Spiritual pain was also frequent and associated with physical and psychosocial distress. These patients need increased spiritual/religious support.
本多中心研究旨在描述拉丁美洲晚期癌症患者的灵性、宗教信仰、精神痛苦、症状困扰、应对方式和生活质量（QOL）之间的关联。来自智利、危地马拉和美国姑息治疗诊所的 325 名晚期癌症患者完成了经过验证的评估：信仰、重要性和影响、社区和解决（FICA）（灵性/宗教信仰）、埃德蒙顿症状评估量表-金融/精神（ESAS-FS），包括精神痛苦、宾夕法尼亚州担忧问卷-缩写（PSWQ-A）、流行病学研究抑郁量表（CES-D）、简要应对策略（COPE）和简要宗教应对（RCOPE），以及慢性疾病治疗的功能评估-精神健康，扩展版（FACIT-Sp-Ex）。中位年龄：58 岁（范围：19-85）；60%为女性；62%为天主教徒，30%为基督教徒，但不是天主教徒。315 名患者（97%）认为自己有灵性，89%有宗教信仰，灵性强度中位数分别为 7（四分位距[IQR]：5-10）和 7（5-9）（0-10 分制，10=“非常多”）。灵性/宗教信仰的重要性中位数为 10（IQR：8-10）。灵性/宗教信仰与各种项目之间的频率和关联如下：有助于应对疾病（98%； = 0.66303； < 0.0001）、对身体症状（81%； = 0.42067； < 0.0001）和情绪症状（84%； = 0.16577； < 0.0001）有积极影响。195 名患者（60%）报告称，他们的精神/宗教需求未得到医疗团队的支持。311 名患者中有 162 名（52%）报告存在精神痛苦，中位数强度为 6（IQR：5-8）。精神痛苦与疼痛（ = 0.0225）、抑郁（ < 0.0001）、焦虑（ < 0.0001）、担忧（ < 0.001）、行为解脱（ = 0.0148）、FACIT-Sp-Ex 评分（ = 0.0002）和消极的 RCOPE（ < 0.0001）有关。灵性和宗教信仰在拉丁美洲患者中很常见、强烈，但很少得到关注。灵性/宗教信仰与积极的应对方式和更高的 QOL 相关。精神痛苦也很常见，与身体和心理困扰有关。这些患者需要更多的精神/宗教支持。
