Palliative Caregivers' Spirituality, Views About Spiritual Care, and Associations With Spiritual Well-Being: A Mixed Methods Study.

BACKGROUND: Spiritual care is integral to palliative care. It engenders a sense of purpose, meaning, and connectedness to the sacred or important and may support caregiver well-being. AIM: To examine caregivers' spirituality, religiosity, spiritual well-being, and views on spiritual/religious support. DESIGN: A mixed-methods study across 4 Australian sites, recruiting caregivers of patients with a life expectancy of under 12 months. The anonymous semistructured questionnaire used included research team developed and adapted questions examining religion/spirituality's role and support and views on hospitals supporting spiritual/religious requirements. It additionally included the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12). RESULTS: One hundred nine caregivers participated (47.4% responded). Median spiritual well-being was 30.5 on FACIT-Sp-12. Religious affiliation was associated with higher Faith subscores (P < .001). Spirituality was very important to 24.5%, religiosity to 28.2%, and unimportant to 31.4% and 35.9%, respectively. Caregivers prayed (P = .005) and meditated (P = .006) more following patients' diagnoses, gaining comfort, guidance, and strength. Caregivers whose spiritual/religious needs were met to moderate/full extent by external religious/faith communities (23.8%) reported greater spiritual well-being (P < .001). Hospitals supported moderate/full caregiver spiritual needs in 19.3%. Pastoral care visits comforted 84.4% of those who received them (n = 32) but elicited discomfort in 15.6%. Caregivers also emphasized the importance of humane staff and organizational tone in supporting spiritual care. CONCLUSIONS: Hospital-based spiritual care providers should seek to identify those who seek pastoral or religiously orientated care. Genuine hospitality of showing concern for the other ensures the varied yet inevitably humanist requirements of the caregiver community are met.

Perhaps quality of life should not be used as a trigger for discussing resuscitation and advance care plans.

As a subjective measure, quality of life should not be used as a trigger for discussing resuscitation, goals of care or advanced care plans. Limitations and challenges in measurement and assessment of quality of life have been recognised. It is a fluid construct and subject to changes and response shifts. Surrogate quality of life estimations may misrepresent individual worth and self-perceived quality of life. Disagreement over quality of life statements may cause harm.

Novel modification of the Reported Edmonton Frail Scale.

OBJECTIVES: The Reported Edmonton Frail Scale (REFS) uses clock drawing as a measure of cognition. However, many patients in the acute hospital setting present with an inability to clock-draw. We considered an alternative method for assessing cognition based on a history of cognitive impairment. METHODS: We created a modified version of the REFS (mod-REFS), utilising the same domains as the REFS, in which a screening question of cognition substitutes the clock-drawing task. Data were collected from a prospective cohort study. RESULTS: Of 181 participants, frailty measured with either the REFS or the mod-REFS found equivalence. A comparison between clock drawing and cognitive question scores demonstrated a complete agreement for 152 patients (84%), a reduction in cognition score for 25 (14%) and an increase for 4 (2%). CONCLUSION: We suggest the mod-REFS will improve the frailty assessment in the acute hospital setting, overcoming the limitations associated with clock drawing.