Provision of spiritual care to advanced cancer patients by doctors and nurses in the Middle East

Abstract

Background: In the US, ∼75% of advanced cancer patients want doctors and nurses to provide some spiritual care, and a similar percentage of staff believe they should do so. When patients feel spiritually supported by staff, we find a higher QoL, increased use of hospice, and reduced use of aggressive treatments in EoL. Yet only ∼25% of patients actually receive spiritual care, a service gap that bears understanding and addressing. Relatively little is known about staff spiritual care provision in the Middle East, which the present study aims to address.

Methods: We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items include how often respondents think members of their profession should provide spiritual care, how often they themselves do so in practice, and their perceived barriers to spiritual care provision.

Results: We had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. Eighty percent of respondents think staff should provide patients with spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. Of their last three incurable patients, respondents offered some form of spiritual care to 47%. In a multivariate analysis (MVA), predictors of spiritual care provision include spirituality, nurses more than doctors, and working in palliative care. How "developed" a country is (following the rankings of the Human Development Index) actually negatively predicts spiritual care provision (p < 0.001). Staff most commonly cite lack of time (67%) and of private space (58%) as reasons they provide spiritual care less often than they think they should. Yet in MVA vs. actual spiritual care provision, these reasons did not correlate with non-care provision. Only the third most commonly cited reason, lack of adequate training (55%), remained significant in the MVA (p = 0.004).

Conclusions: Staff spiritual care provision in the Middle East is higher than in the US, but we still see a large gap between its desirability and its actual provision. The greatest barrier to spiritual care provision in practice is lack of training, which only 22% received.