Traci Pantuso ND, MS

Dr. Pantuso reports no financial relationships relevant to this field of study.

Synopsis: A systematic meta-analysis investigating the effects of spiritual intervention in patients with cancer found that spiritual interventions had significant moderate effects on spiritual well-being, meaning of life, and depression.

Source: Oh PJ, Kim SH. The effects of spiritual interventions in patients with cancer: A meta-analysis. Oncol Nurs Forum 2014;41:E290-E301.

Summary Points

  • Spirituality is related to better quality of life, lower anxiety, and depression.
  • Spiritual interventions demonstrated statistically significant effects on spiritual well-being, meaning of life, and depression in patients with cancer.

see Table 1). The range of participant numbers in studies was from 23-118 and the duration of the studies ranged from 2 days to 16 weeks (see Table 2).

Table 1: Cancer Diagnoses in the Analyzed Studies

Populations of patients

Table 2: Range and Mean of Participant Number, Duration, and Sessions in Studies Analyzed

 

Range

Mean

Participant number in studies

Duration of study

Number of sessions

Time per session

see Table 3). Nurses were the most frequent intervention providers (n = 10), followed by clinical psychologists (n = 4), dieticians (n = 1), and oncologists (n = 1).

Table 3: Intervention Used and Number of Studies

Type of Intervention

Intervention Used

Number
of Studies

Spiritual intervention

Existential intervention

see Table 4). Depression and anxiety were measured as secondary outcomes for this review and also used various assessments (see Table 4). There was a large amount of heterogeneity with an I2 range between 65-87%.

Table 4: Assessment Tools Used to Evaluate Outcomes in Analyzed Studies

Outcome

Assessment Tools Used

in eight studies

in six studies

in nine studies

P = 0.006 and I2 = 65%, which the authors consider a significant moderate effect size (see Table 5). The meaning of life (n = 6) weighted average effect size d = -0.58, (95% CI, -1.05 to -0.11; P = 0.02; I2 = 70%) (see Table 4). For anxiety (n = 6), the weighted average effect size was d = -0.87, (95% CI, -1.59 to -0.16; P = 0.02; I2 = 87%) (see Table 5). The weighted average effect size for depression (n = 9) was moderate (d = -0.62; 95% CI, -1 to -0.25; P = 0.001; I2 = 73%) (see Table 4). The authors considered a Cohen’s d of 0.2 as a small effect size, 0.5 was medium and 0.8 was large, and the –d is the direction of the effect of the intervention.

Table 5: Effect Sizes of Spiritual Interventions

Outcomes

Effect Sizes of Spiritual Interventions
Standard Mean Difference = d (95% CI)

P = 0.006*

P = 0.02*

P = 0.02*

P = 0.001*

COMMENTARY

1-4 Increasing coping ability allows for improvement in psychosocial outcomes and may have various impacts on a patient’s life both during and after treatment.1-4 Spiritual care has been associated with fewer aggressive medical interventions, higher satisfaction with care, and improved quality of life among patients.4 As reviewed in a recent Integrative Medicine Alert issue, spiritual needs cross over to people from all backgrounds, such as Latinas undergoing chemotherapy.5

see Table 3). The authors declare that the “evidence remains weak because of the mixed study design and substantial heterogeneity.” The authors also investigated subgroup analysis that was not hypothesis driven, and these results are quite heterogeneous, making the results questionable.

4 The most frequent type of spiritual care is encouraging or affirming beliefs, which can begin with a spiritual history being taken in an initial evaluation.4 Spiritual histories are infrequently taken by nurses and doctors, with one study reporting that only 10% of patients being asked to give a spiritual history.4 Both spiritual history taking and chaplaincy referrals are underused.4 In a number of studies, nurses are believed to be the provider responsible for spiritual counseling; however, studies have shown that nurses are unable to routinely provide this care within the current system.2

1-4 Understanding how to best implement these interventions into a patient’s treatment will also require more research.

  1. Palliat Med 2015 Apr 20. pii: 0269216315581538. [Epub ahead of print].
  2. Iran J Nurs Midwifery Res 2015;20:25-33.
  3. Support Care Cancer 2015;23:2025-2032.
  4. Am J Hosp Palliat Care 2014;doi 10.1177/1049909114540318.
  5. Kiefer D. Chemotherapy in Latinas: Stress management needs and techniques. Integrative Med Alert 2015;18:65-67.