Managing spiritual distress in patients with advanced cancer pain.

Cancer threatens our very existence; when pain is also present, suffering is compounded and leads to spiritual distress. This article presents a nursing strategy to deal with the responses of clients and families in such complex situations. Four case studies were analyzed to describe the methodology and applicability of an approach based upon the Dungan model of dynamic integration. The goal of the first appointment was to teach clients how to effectively deal with the advanced cancer pain that brought them to the center. Presence, caring, genuine concern, and active listening facilitated the therapeutic relationship and were the hallmarks of nursing modalities. Daily appointments with the nurse continued for 6-10 days while clients were also being treated by medical staff. Trust was established by reaching the mutual goal of giving the client control over pain. Spiritual assessment confirmed the diagnosis. Grief was a characteristic of spiritual distress experienced by all clients. Therefore, grief counseling was instituted early and reinforced daily. Spiritual counseling, cognitive reframing, crisis intervention, and reminiscence were used selectively. Because of the complexity of problems faced by families, multi-disciplinary referrals were required by all clients. Outcomes were evaluated positively by participants. All clients increased hope, participated in the grief process, and integrated the possibility of death in such a way as to promote personally defined "quality of life" through their waning days.