Kelly Elizabeth Palmer, Myers Brian, Henderson Brent, Sprik Petra, White Kelsey B, Pawlik Timothy M
The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
The Ohio State University, Columbus, OH, USA.
Med Decis Making. 2022 Jan;42(1):125-134. doi: 10.1177/0272989X211022246. Epub 2021 Jul 1.
Providers often underestimate the influence of patient religious and spiritual (R&S) needs. The current study sought to determine the influence of R&S beliefs on treatment decision making among patients and providers in the context of cancer care.
We conducted a systematic review of the literature using web-based search engines and discipline-specific databases. Search terms included a combination of the following Medical Subject Headings and key terms: "cancer,""spirituality,""religion," and "decision making." We used Covidence to screen relevant studies and extracted data into Microsoft Excel.
Among 311 screened studies, 32 met inclusion/exclusion criteria. Most studies evaluated the patient perspective ( = 29), while 2 studies evaluated the provider perspective and 1 study examined both. In assessing patient R&S relative to treatment decision making, we thematically characterized articles according to decision-making contexts, including general ( = 11), end-of-life/advance care planning ( = 13), and other: specific ( = 8). Specific contexts included, but were not limited to, clinical trial participation ( = 2) and use of complementary and alternative medicine ( = 4). Within end-of-life/advance care planning, there was a discrepancy regarding how R&S influenced treatment decision making. The influence of R&S on general treatment decision making was both active and passive, with some patients wanting more direct integration of their R&S beliefs in treatment decision making. In contrast, other patients were less aware of indirect R&S influences. Patient perception of the impact of R&S on treatment decision making varied relative to race/ethnicity, being more pronounced among Black patients.
Most articles focused on R&S relative to treatment decision making at the end of life, even though R&S appeared important across the care continuum. To improve patient-centered cancer care, providers need to be more aware of the impact of R&S on treatment decision making.
医疗服务提供者常常低估患者宗教和精神需求的影响。本研究旨在确定在癌症护理背景下，宗教和精神信仰对患者及医疗服务提供者治疗决策的影响。
我们使用基于网络的搜索引擎和特定学科数据库对文献进行系统综述。检索词包括以下医学主题词和关键词的组合：“癌症”“精神性”“宗教”和“决策”。我们使用Covidence筛选相关研究，并将数据提取到Microsoft Excel中。
在311项筛选出的研究中，32项符合纳入/排除标准。大多数研究评估了患者的观点（n = 29），2项研究评估了医疗服务提供者的观点，1项研究同时考察了两者。在评估患者宗教和精神信仰与治疗决策的关系时，我们根据决策背景对文章进行了主题分类，包括一般情况（n = 11）、临终/预立医疗计划（n = 13）和其他：特定情况（n = 8）。特定情况包括但不限于参与临床试验（n = 2）和使用补充与替代医学（n = 4）。在临终/预立医疗计划中，宗教和精神信仰对治疗决策的影响存在差异。宗教和精神信仰对一般治疗决策的影响既有积极的也有消极的，一些患者希望在治疗决策中更直接地融入他们的宗教和精神信仰。相比之下，其他患者则较少意识到宗教和精神信仰的间接影响。患者对宗教和精神信仰对治疗决策影响的认知因种族/民族而异，在黑人患者中更为明显。
尽管宗教和精神信仰在整个护理过程中似乎都很重要，但大多数文章关注的是其与临终治疗决策的关系。为了改善以患者为中心的癌症护理，医疗服务提供者需要更加意识到宗教和精神信仰对治疗决策的影响。
