Impact of spiritual interventions in individuals with cancer: A systematic review and meta-analysis.

PURPOSE: This meta-analysis aimed to determine how spiritual interventions affect cancer patients' physical, emotional, and spiritual outcomes and quality of life. METHODS: Between 2012 and May 2024, the Cochrane Library, Scopus, PubMed, and Web of Science were searched considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Twenty-six randomized controlled trials were included, and 16 were synthesized in the meta-analysis. Bias risk was evaluated using the Cochrane risk-of-bias methodology for randomized studies. The Grading of Recommendations, Assessment, Development, and Evaluations tool was employed for evidence certainty. Heterogeneity was expressed through I2 and Q statistics. Hedge's g was calculated for effect sizes. Egger's and Kendall's Tau were used for publication bias. RESULTS: Spiritual interventions yielded beneficial effects on fatigue (Hedges's g = 0.900, p < 0.001) and pain (Hedges's g = 0.670, p < 0.001) but not for overall symptom burden (Hedges's g = 0.208, p = 0.176). Significant effects were found for anxiety (Hedges's g = 0.301, p < 0.001), depression (Hedges's g = 0.175, p = 0.016), and psychological distress (Hedges's g = 0.178, p = 0.024), except for hopelessness (Hedges's g = 0.144, p = 0.091). Spiritual interventions enhanced faith (Hedges's g = 0.232, p = 0.035), the meaning of life (Hedges's g = 0.259, p = 0.002), spiritual well-being (Hedges's g = 0.268, p < 0.001), and quality of life (Hedges's g = 245, p < 0.001). Moderator analysis pointed out that cancer stage, total duration, delivery format, providers' qualification, content, and conceptual base of spiritual interventions significantly affect physical, emotional, and spiritual outcomes and quality of life. CONCLUSION: This meta-analysis highlighted the benefits of spiritual interventions with varying effect sizes on patients' outcomes, as well as quality of life in cancer, and shed on how to incorporate these approaches into clinical practice.

Efectos del cuidado espiritual en la ansiedad situacional de pacientes quirúrgicos / Effects of Spiritual Care on Situational Anxiety of Surgical Patients

Introducción: Las personas con tratamiento quirúrgico presentan ansiedad, lo cual impide llegar al periodo operatorio en óptimas condiciones. El cuidado espiritual puede resultar efectivo en momentos como este. Objetivo: Evaluar el efecto del cuidado espiritual en el nivel de ansiedad situacional en pacientes quirúrgicos. Métodos: Investigación cuantitativa, preexperimental con pretest postest, en el Hospital Regional de Ayacucho, Perú, durante marzo a mayo de 2016. Población constituida por 123 pacientes quirúrgicos, entre los que se seleccionaron 30 entre 24 y 57 años, con ansiedad y dispuestos a participar en la investigación. La ansiedad se midió con el Test de Zung, las necesidades espirituales con un cuestionario validado por expertos y pilotaje con alfa de Cronbach > 0,75. Para los ejes temáticos y metodológicos de la intervención (cuidados espirituales) se revisó bibliografía sobre el tema, tuvieron en cuenta las necesidades de cuidados y niveles de ansiedad identificada. Se procesó la información con frecuencias absolutas, porcentajes, media, desviación típica, valor mínimo y máximo. Para contrastar hipótesis se utilizó la Prueba no paramétrica de rangos con signo de Wilcoxon. Para la relación entre necesidad de cuidado espiritual y evolución del nivel de ansiedad se utilizó Chi-cuadrada de Pearson (X2), con probabilidad de error del 5 por ciento. Resultados: El nivel de ansiedad situacional previo a la aplicación del cuidado espiritual fue de marcada a severa en 86,66 por ciento, aplicado el cuidado espiritual estuvo ausente en el 96,66 por ciento. Conclusión: La intervención con cuidados espirituales aplicada resultó efectiva en la disminución del nivel de ansiedad situacional en pacientes quirúrgicos estudiados(AU)

Introduction: People who should undergo surgical treatment present anxiety, which keeps them from reaching the operative period in optimal conditions. Spiritual care can be effective at times like this. Objective: To assess the effect of spiritual care on the level of situational anxiety in surgical patients. Methods: Quantitative pre-experimental research with pre- and post-test carried out in the Regional Hospital of Ayacucho, Peru, during March to May 2016. The population was made up of 123 surgical patients, of which 30 aged 24-57, with anxiety and willing to participate in the study were chosen. Anxiety was measured with the Zung test; spiritual needs, with a questionnaire validated by experts; and piloting, with Cronbach's alpha > 0.75. For the thematic and methodological axes of the intervention (spiritual care), a bibliography on the subject was reviewed, taking into account the care needs and levels of anxiety identified. The information was processed with absolute frequencies, percentages, mean, standard deviation, minimum and maximum values. The Wilcoxon signed rank test was used to test hypotheses. Pearson's chi-square (X2) was used for the relationship between need for spiritual care and evolution of anxiety level, with a probability of error of 5 percent. Results: The level of situational anxiety prior to the application of spiritual care was remarkable to severe in 86.66%; applied spiritual care was absent in 96.66 percent.. Conclusion: The intervention with spiritual care applied was effective in reducing the level of situational anxiety in the surgical patients studied.(AU)

Perceptions and practices of spiritual care among hospice physicians and nurses in a Taiwanese tertiary hospital: a qualitative study.

BACKGROUND: Spiritual care is frequently cited as a key component of hospice care in Taiwanese healthcare and beyond. The aim of this research is to gauge physicians and nurses' self-reported perspectives and clinical practices on the roles of their professions in addressing spiritual care in an inpatient palliative care unit in a tertiary hospital with Buddhist origins. METHODS: We performed semi-structured interviews with physicians and nurses working in hospice care over a year on their self-reported experiences in inpatient spiritual care. We utilized a directed approach to qualitative content analysis to identify themes emerging from interviews. RESULTS: Most participants identified as neither spiritual nor religious. Themes in defining spiritual care, spiritual distress, and spiritual care challenges included understanding patient values and beliefs, fear of the afterlife and repercussions of poor family relationships, difficulties in communication, the patient's medical state, and a perceived lack of preparedness and time to deliver spiritual care. CONCLUSIONS: Our study suggests that Taiwanese physicians and nurses overall find spiritual care difficult to define in practice and base perceptions and practices of spiritual care largely on patient's emotional and physical needs. Spiritual care is also burdened logistically by difficulties in navigating family and cultural dynamics, such as speaking openly about death. More research on spiritual care in Taiwan is needed to define the appropriate training, practice, and associated challenges in provision of spiritual care.

Spirituality in cancer patients on phase 1 clinical trials.

OBJECTIVES: Patients with cancer who are at a transition to Phase I investigational treatments have been identified as an underserved population with regard to palliative care. This disease transition is often accompanied by spiritual and existential concerns. The study objective was to conduct a secondary analysis of data from a larger study testing a palliative care intervention. This paper reports the findings of this secondary focus on the spiritual needs of this population. METHODS: Patients (n = 479) were accrued to this study prior to initiating a Phase I clinical trial with data collected at baseline, and 4, 12, and 24 week follow-up. RESULTS: Qualitative data revealed that the transition to Phase 1 trial participation is a time of balancing hope for extended life with the reality of advancing disease. Quantitative results demonstrated increased spirituality over time in both religious- and non-religious-affiliated patients. CONCLUSIONS: Patients entering Phase I trials have important spiritual needs as they face treatment decisions, advancing disease, and often mortality. Spiritual care should be provided to seriously ill patients as a component of quality care.

The assessment of spiritual well-being in cancer patients with advanced disease: which are its meaningful dimensions?

BACKGROUND: Spirituality is particularly important for patients suffering from life-threatening illness. Despite research showing the benefits of spiritual assessment and care for terminally ill patients, their spiritual needs are rarely addressed in clinical practice. This study examined the factor structure and reliability of the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) in patients with advanced cancer. It also examined the clinical meaning and reference intervals of FACIT-Sp scores in cancer patients subgroups through a literature review. METHODS: A forward-backward translation procedure was adopted to develop the Italian version of the FACIT-Sp, which was administered to 150 terminally ill cancer patients. Exploratory factor analysis was used for construct validity, while Cronbach's α was used to assess the reliability of the scale. RESULTS: This study replicates previous findings indicating that the FACIT-Sp distinguish well between features of meaning, peace, and faith. In addition, the internal consistency of the FACIT-Sp was acceptable. The literature review also showed that terminal cancer patients have the lowest scores on the Faith and Meaning subscales, whereas cancer survivors have the highest scores on Faith. CONCLUSIONS: The Italian version of the FACIT-Sp has good construct validity and acceptable reliability. Therefore, it can be used as a tool to assess spiritual well-being in Italian terminally ill cancer patients. This study provides reference intervals of FACIT-Sp scores in newly diagnosed cancer patients, cancer survivors, and terminally ill cancer patients and further highlights the clinical meaning of such detailed assessment.

Remembrance and Renewal: Health Care Staff Spiritual Self-Care.

Relationship-based care (RBC), a holistic framework of caring, models partnerships in caring to permeate at levels of patient, provider-self, provider-teams, and community. Remembrance and Renewal (R&R) is a RBC practice addressing spiritual self-care. At a dedicated time and space, R&R is offered monthly, rotating through six different buildings at an academic, medical center. To date, close to 2,000 visits have occurred. Those engaging in the practice express appreciation for the space to grieve and space to renew their spirit. R&R is a RBC practice in alignment with the scope and standards of holistic nursing practice and addresses the Quadruple Aim of improving health care staff's work-life balance.

Predisposing and precipitating risk factors for delirium in palliative care patients.

OBJECTIVE: Delirium is a common complication in palliative care patients, especially in the terminal phase of the illness. To date, evidence regarding risk factors and prognostic outcomes of delirium in this vulnerable population remains sparse. METHOD: In this prospective observational cohort study at a tertiary care center, 410 palliative care patients were included. Simple and multiple logistic regression models were used to identify associations between predisposing and precipitating factors and delirium in palliative care patients. RESULTS: The prevalence of delirium in this palliative care cohort was 55.9% and reached 93% in the terminally ill. Delirium was associated with prolonged hospitalization (p < 0.001), increased care requirements (p < 0.001) and health care costs (p < 0.001), requirement for institutionalization (OR 0.11; CI 0.069-0.171; p < 0.001), and increased mortality (OR 18.29; CI 8.918-37.530; p < 0.001). Predisposing factors for delirium were male gender (OR 2.19; CI 1.251-3.841; p < 0.01), frailty (OR 15.28; CI 5.885-39.665; p < 0.001), hearing (OR 3.52; CI 1.721-7.210; p < 0.001), visual impairment (OR 3.15; CI 1.765-5.607; p < 0.001), and neoplastic brain disease (OR 3.63; CI 1.033-12.771; p < 0.05). Precipitating factors for delirium were acute renal failure (OR 6.79; CI 1.062-43.405; p < 0.05) and pressure sores (OR 3.66; CI 1.102-12.149; p < 0.05). SIGNIFICANCE OF RESULTS: Our study identified several predisposing and precipitating risk factors for delirium in palliative care patients, some of which can be targeted early and modified to reduce symptom burden.

Intercessory Prayer on Spiritual Distress, Spiritual Coping, Anxiety, Depression and Salivary Amylase in Breast Cancer Patients During Radiotherapy: Randomized Clinical Trial.

The goal of this study was to assess the effect of intercessory prayer in the psychological, spiritual and biological scores of breast cancer patients who are undergoing radiotherapy. Double-blind RCT comprising a sample of 31 participants (15 in the Control Group and 16 in the Intervention Group). Data collection was performed in three time points (T0, T1 and T2). Significant changes have been identified in the intra-group analysis, concerning the decrease in spiritual distress score; negative religious/spiritual coping prevailed, while the total religious/spiritual coping increased between the posttest T2 to T0. Intercessory prayer was effective in religious and spiritual scores.

Effect of Spiritual Care Based on Ghalbe Salim on Anxiety in Adolescent with Cancer.

Cancer is one of the chronic and rare diseases in children that is associated with psychological trauma that can cause fear and anxiety in patients. Considering that spirituality as a solid base may be a strong factor in controlling the tense conditions, this study aimed to investigate the effect of true heart spiritual care on cancer anxiety in Mashhad. This is a case-control study on 40 children referred to Dr. Sheikh Mashhad Children's Therapeutic Center in 2017. Sampling was done randomly in two groups of test and control. The experimental group received the training program in five sessions in 4 weeks. The data were collected using a demographic questionnaire and Marx children's anxiety scale and entered into spssv.20 software. There was no difference the score of anxiety before intervention in any of the dimensions of anxiety and the general dimension of anxiety in the case and control (P < 0.01). However, the mean of anxiety score in the SC group before and after intervention was significantly (75.25 ± 15.2) (44.55 ± 7.62), respectively. So that 50% of the posttest changes are due to the effect of the intervention. Regarding the effect of SC on reducing cancer anxiety, it is recommended that therapists, counselors and clinical psychologists use the spiritual care education method to reduce anxiety.

Multidisciplinary staff perspectives on the integration of spiritual care in a new setting: Israel.

OBJECTIVE: Integrating spiritual care into multidisciplinary care teams has seen both successful thoughtful collaboration and challenges, including feelings of competition and poor cross-disciplinary understanding. In Israel, where the profession is new, we aimed to examine how spiritual care is perceived by other healthcare professionals learning to integrate spiritual caregivers into their teams. METHOD: Semi-structured qualitative interviews of 19 professionals (seven physicians, six nurses, three social workers, two psychologists, and one medical secretary) working with spiritual caregivers in three Israeli hospitals, primarily in oncology/hematology. The interviews were transcribed and subjected to thematic analysis. RESULTS: Respondents' overall experience with adding a spiritual caregiver was strongly positive. Beneficial outcomes described included calmer patients and improved patient-staff relationships. Respondents identified reasons for a referral not limited to the end of life. Respondents distinguished between the role of the spiritual caregiver and those of other professions and, in response to case studies, differentiated when and how each professional should be involved. CONCLUSION: Despite its relative newness in Israel, spiritual care is well received by a wide variety of professionals at those sites where it has been integrated. Steps to improve collaboration should include improving multidisciplinary communication to broaden the range of situations in which spiritual caregivers and other professionals work together to provide the best possible holistic care.

Comparing dyadic cognitive behavioral therapy (CBT) with dyadic integrative body-mind-spirit intervention (I-BMS) for Chinese family caregivers of lung cancer patients: a randomized controlled trial.

PURPOSE: The study adopted a randomized controlled trial to compare the effect of culturally compatible psychosocial interventions on multiple aspects of quality of life (QoL) for family caregivers of lung cancer patients. METHODS: 157 Chinese informal caregivers of lung cancer patients were recruited together with the family members for whom they were providing care, and randomly assigned to either integrative body-mind-spirit intervention (I-BMS) or cognitive behavioral therapy (CBT). Patient-caregiver dyads attended the same arm of intervention in separate groups for 8 weeks. Assessments of generic QoL, anxiety, depression, perceived stress, insomnia, and caregiving burden were measured before intervention (T0), within 1-week (T1), 8-week (T2), and 16-week (T3) post-intervention. RESULTS: Adopting the intention-to-treat analysis, family caregivers in receipt of both I-BMS and CBT exhibited a statistically significant improvement in generic QoL immediately following intervention and at follow-up assessments, with moderate effect size. Improvement of insomnia was found at T1 for both modes, which deteriorated at follow-up; both modes reduced anxiety and perceived stress at follow-up. No intervention effect was observed in depression and domains of caregiving burden. There was no significant interaction effect between intervention type and time. No main or interaction effect between sample background variables and intervention type was found to predict symptomatic changes at T1 and T3. CONCLUSIONS: Culturally attuned I-BMS and CBT exhibited equivalent effectiveness in improving psychological distress and generic QoL for family caregivers of lung cancer patients. To improve the evaluation of outcomes, future study could benefit from incorporating a usual care control.

Spiritual Care: Minimizing the Vulnerability of Parents Whose Children With Cancer Face the End of Life.

There is a distinct lack of literature related to the spiritual care of parents whose children with cancer are at the end of life. This has led to a dearth in evidence about how nurses may intervene with spiritual care interventions to best support these vulnerable parents. The purpose of this scoping review was to examine the evidence regarding the value of spirituality/spiritual care in minimizing the vulnerability of parents whose children were diagnosed with cancer and who faced the end of life. The Arksey and O'Malley methodological framework guided the analysis of the reviewed quantitative and qualitative literature. Spirituality and spiritual care provided bereaved parents and parents of children with cancer with necessary support and enhanced coping to allow them to better deal with this devastating experience. Spirituality and spiritual care instilled hope, assisted in the search for meaning and purpose, and guided parents to develop continuing bonds with their child. Through skillful communication, pediatric oncology nurses may guide parents of children who face the end of life to strengthen relationships that offer support, plan activities that provide opportunities for hope and connection, and identify sources of meaning in their experiences.

Validation of a Korean Version of the Spiritual Care Competence Scale: Focused on the Hospice and Palliative Care Setting.

This study aimed to examine the reliability and validity of a scale to assess the competence of Korean nurses who provide spiritual care for patients with terminal illnesses. The reliability and validity were examined using Cronbach α, item analysis, and exploratory factor analysis. The participants were 248 hospice nurses working at 40 hospices and palliative hospitals in South Korea. The results showed that the reliability was high, as indicated by a Cronbach α of .942. The exploratory factor analysis revealed 6 dimensions (assessment and implementation of spiritual care, professionalization and improvement of the quality of spiritual care, personal support and patient counseling, referral to professionals, attitude toward the patient's spirituality, and communication) with 27 items. The 6 factors explained 68.20% of the variance in the Korean version of the Spiritual Care Competence Scale. From the results, the Korean version of the Spiritual Care Competence Scale may serve as an appropriate measure for provision of spiritual care for patients with terminal illness. In addition, it may be useful in assessing hospice and palliative nurses' ability for spiritual care.

Yoga Protocol for Cancer Patients: A Systematic Exploration of Psychophysiological Benefits.

BACKGROUND: Several studies report that practicing Yoga may lead to numerous psychophysiological benefits in patients undergoing treatment for cancer. Moreover, it may result in an effective alternative for coping with sleep disturbances, anxiety, depression and fatigue symptoms. A study based on the "Yoga in Oncology" project of the Foundation Poliambulanza was carried out, and it was designed to explore the benefits of Yoga, therefore corroborating Yoga as a therapeutic activity that can have a beneficial impact on patients diagnosed with cancer. METHODS: Seventy patients were recruited, of whom 20% were males and 80% were females 18 years of age and older. All patients were being treated at the oncology department for gastrointestinal, mammary or genital carcinoma, and the disease was metastatic in 80% of patients. Data were collected between April 2013 and May 2017. The protocol consisted of a weekly 90-minute Yoga lesson for 8 consecutive weeks, and the data collection was carried out in 2 phases: (T0) preprotocol assessment and (T1) postprotocol assessment. Psychophysiological assessment was carried out with the following scales: the (BFI) Brief Fatigue Inventory, (HADS) Hospital Anxiety and Depression Scale and (PSQI) Pittsburgh Sleep Quality Index. RESULTS: Data analysis showed a significant difference between the (T0) and (T1) HADS (Hospital Anxiety and Depression Scale) scores. The constructs of this scale consist of psychological variables for the assessment of anxiety and depression. In contrast, scores from the (BFI) Brief Fatigue Inventory and (PSQI) Pittsburgh Sleep Quality Index did not show significant differences between (T0) and (T1): such scales are relative to psychophysiological variables for an assessment of the perception of fatigue and quality of sleep. CONCLUSION: It is noteworthy that the data, once analyzed, showed a significant difference between preprotocol and postprotocol levels of anxiety and depression but not for the perception of fatigue or the quality of sleep. In accordance with the scientific literature, data from this study highlight that practicing Yoga may promote changes in the levels of perceived anxiety and depression in patients undergoing treatment for cancer, thus positively affecting their (QoL). It is clear that the difference in significance between the psychological and physiological variables considered here and the statistical significance found only in levels of anxiety and depression encourage further studies to account for the nature of fatigue and sleep disturbances and how to address these symptoms in oncological patients. Moreover, other points of interest for future clinical research regard the evaluation of the reason for the possible denial to participate to this kind of study, as well as the social-cultural differences in patients' behavior.

Effectiveness of spiritual care using spiritual pain assessment sheet for advanced cancer patients: A pilot non-randomized controlled trial.

OBJECTIVE: To obtain preliminary knowledge to design a randomized controlled trial to clarify the effects of spiritual care using the Spiritual Pain Assessment Sheet (SpiPas). METHOD: The study was designed as a nonrandomized controlled trial. The study took place between January 2015 and July 2015 in a hematology and oncology ward and two palliative care units in Japan. Among 54 eligible patients with advanced cancer, 46 were recruited (24 in the control group vs. 22 in the intervention group). The intervention group received spiritual care using SpiPas and usual care; the control group received usual care. The primary outcome was the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp). The secondary outcomes were the Hospital Anxiety and Depression Scale (HADS) and Comprehensive Quality of Life Outcome (CoQoLo).ResultA total of 33 (72%) and 23 (50%) patients completed 2- and 3-week follow-up evaluations, respectively. The differences in the changes during 2 weeks in total scores of FACIT-Sp and HADS were significant (95% confidence intervals, 3.65, 14.4, p < 0.01; -11.2 to -1.09, p = .02, respectively). No significant changes were observed in the total score of CoQoLo.Significance of resultsSpiritual care using the SpiPas might be useful for improving patient spiritual well-being. This controlled clinical trial could be performed and a future clinical trial is promising if outcomes are obtained within 2 weeks.

Meaning-Centered Interventions for Patients With Advanced or Terminal Cancer: A Meta-analysis.

BACKGROUND: For patients with advanced or terminal cancer undergoing hospice or palliative care, spiritual care based on meaning-centered intervention (MCI) has become an essential form of support. OBJECTIVE: The aim of this study was to characterize MCI systematically and the effectiveness of hospice and palliative care for patients with advanced or terminal cancer. METHODS: MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean electronic databases were searched from inception to May 2017. The RevMan 5.3 program of the Cochrane Library was used for data analysis. RESULTS: A meta-analysis was conducted of 10 controlled trials (6 randomized and 4 nonrandomized) featuring 623 patients with cancer. Meaning-centered interventions were compared with usual care control groups or other psychosocial interventions. The weighted average effect sizes across studies were -0.96 (P < .001, I = 7%) for meaning in life, -0.37 (P = .002, I = 0%) for spiritual well-being, -0.48 (P < .001, I = 0%) for quality of life, -0.28 (P = .02, I = 0%) for anxiety, and -0.31 (P = .02, I = 17%) for physical symptoms. CONCLUSION: Spiritual care based on MCI may help to improve the physical, psychosocial, and spiritual well-being of patients with advanced or terminal cancer. IMPLICATION FOR PRACTICE: Meaning-centered interventions could be a valuable way to enhance quality of life at the end stage for patients with advanced or terminal cancer.

Efficacy of a written prayer technique on the anxiety of mothers of children with cancer.

OBJECTIVE: To investigate the effect of a written prayer technique on the anxiety of mothers of children with cancer. METHOD: This clinical trial recruited 90 mothers of children with cancer admitted to the Medical Centre of Tehran. Using a convenience sampling method, we randomly assigned the participants to two groups: control (n = 45) and intervention (n = 45). Data were collected through the Spielberger's anxiety scale and a demographic questionnaire. Maternal anxiety was measured before the intervention, immediately after the three-day intervention, and five weeks after the intervention. We used a writing technique in the intervention and control groups for 20 minutes over three consecutive days. In the intervention group, participants wrote down their sincere desires and wishes that they demanded from God without any worry or stress. The control group spent 20 minutes writing their normal daily schedules; for example, feeding their children or changing their children's clothes. During the three consecutive days of intervention, we asked both groups not to worry about grammar or spelling errors. Finally, the data were analyzed using descriptive and analytical statistical methods.ResultA statistically significant difference was observed between the two groups (intervention and control mean, 34.9 ± 9.9 and 47.9 ± 16.2, respectively) relative to anxiety after the intervention (p < 0.001). After five weeks, the intervention group continued to exhibit significantly reduced anxiety compared with the control group (intervention and control mean, 34.7 ± 9.6 and 48.5 ± 16.4; p < 0.001).Significance of resultsThe written prayer technique appears to be an effective, efficient, cost-effective, and practical method for reducing anxiety in mothers of children with cancer.

Palliative Nursing and Sacred Medicine: A Holistic Stance on Entheogens, Healing, and Spiritual Care.

The fields of palliative and holistic nursing both maintain a commitment to the care of the whole person, including a focus on spiritual care. Advanced serious illness may pose a plethora of challenges to patients seeking to create meaning and purpose in their lives. The purpose of this article is to introduce scholarly dialogue on the integration of entheogens, medicines that engender an experience of the sacred, into the spiritual and holistic care of patients experiencing advanced serious illness. A brief history of the global use of entheogens as well as a case study are provided. Clinical trials show impressive preliminary findings regarding the healing potential of these medicinal agents. While other professions, such as psychology, pharmacy, and medicine, are disseminating data related to patient outcomes secondary to entheogen administration, the nursing literature has not been involved in raising awareness of such advancements. Research is illustrating their effectiveness in achieving integrative experiences for patients confronting advanced serious illness and their ability to promote presence, introspection, decreased fear, and increased joy and acceptance. Evidence-based knowledge surrounding this potentially sensitive topic is necessary to invite understanding, promote scientific knowledge development, and create healing environments for patients, nurses, and researchers alike.

Are spiritual interventions beneficial to patients with cancer?: A meta-analysis of randomized controlled trials following PRISMA.

BACKGROUND: In addition to the physical burden, the quality of life and survival in patients with cancer may also be reduced because of psychological distress, such as spiritual crisis, anxiety, and depression. Many studies have verified that spirituality could reduce anxiety and depression and improve quality of life and adjustment to cancer. However, there is uncertainty regarding the effectiveness of spiritual interventions in patients with cancer. The purpose of this meta-analysis is to use randomized controlled trials (RCTs) to evaluate the effects of spiritual interventions on spiritual and psychological outcomes and quality of life in patients with cancer. METHODS: All RCTs using spiritual interventions relevant to the outcomes of patients with cancer were retrieved from the following databases: Embase, PubMed, PsycINFO, Ovid, Springer Online Library, Wiley Online Library, Oxford Journals, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. The reference lists of identified RCTs were also screened. The Cochrane risk of bias tool was used to evaluate the quality of the studies, RevMan (5.3) was used to analyze the data, and GRADE (3.6.1) was used to evaluate the evidence quality of the combined results. RESULTS: Ten RCTs involving 1239 patients were included. Spiritual interventions were compared with a control group receiving usual care or other psychosocial interventions. The weighted average effect size across studies was 0.46 (P = .003, I = 78%) for spiritual well-being, 0.19 (P = .005, I = 46%) for quality of life, -0.33 (P = .01, I = 50%) for depression, -0.58 (P = .03, I = 77%) for anxiety, and -0.38 (P = .008, I = 0%) for hopelessness. In subgroup analysis according to the type of cancer, only the weighted average effect size of spiritual well-being in patients with breast cancer had statistical significance (standardized mean difference 0.78, P = .01, I = 70%). CONCLUSION: Spiritual interventions may improve spiritual well-being and quality of life, and reduce depression, anxiety, and hopelessness for patients with cancer. However, due to the mixed study design and substantial heterogeneity, some evidence remains weak. More rigorously designed research is needed.