Spiritual Interventions

STUDY PURPOSE: To evaluate the effects of spiritual interventions in patients with cancer

TYPE OF STUDY: Meta-analysis and systematic review

• FINAL NUMBER STUDIES INCLUDED = 15
• TOTAL PATIENTS INCLUDED IN REVIEW = 827
• SAMPLE RANGE ACROSS STUDIES: 24–120 patients

PHASE OF CARE: Multiple phases of care 

APPLICATIONS: Palliative care

Primary outcomes were spiritual well-being and meaning of life. Anxiety and depression were secondary outcomes. Nine studies examined effects on depression, and six examined effects on anxiety. Seven studies were randomized, controlled trials. There was a moderate effect on spiritual well-being. A large effect size was seen for anxiety (d = - 0.87, p = 0.02), and a moderate effect size for depression was found (d = - 0.62, p = 0.001). The largest effect sizes were seen in studies that were not randomized, controlled trials. Interventions were categorized as religious or existential. Religious interventions had an impact on depression, and existential interventions had an effect on anxiety. There was substantial heterogeneity. This article reports numerous subgroup analysis results based on type of intervention, the intervention provider, and other variables. In the majority of cases, interventions were provided by nurses.

The findings of this meta-analysis suggest that religious and existential spiritual interventions have a positive and at least moderate effect on anxiety and depression as well as spiritual well-being and meaning of life.

The review included nonpeer-reviewed doctoral dissertation results, and an analysis showed a probable publication bias, suggesting that studies with negative findings may not have been retrievable. There was substantial heterogeneity and a varied risk of bias across studies. The highest effect sizes were seen in nonrandomized, controlled studies, which also had the highest risk of bias and heterogeneity. Most studies were of patients at the end of life, so findings may not be applicable to patients at other stages of care.

The findings of this meta-analysis suggest that spiritual interventions, particularly at the end of life, can be beneficial in reducing anxiety and depression and increasing a sense of spiritual well-being and meaning of life. Nurses traditionally recognize the importance of the spiritual dimensions of care, and these findings support that view. The findings must be viewed with caution given the limitations of these results. However, spiritual interventions are low-risk and, as shown here, can be delivered by nurses who already have relevant proficiencies such as engagement, caring, support, and communication.

To evaluate the effect of prayer on the anxiety of patients with cancer receiving chemotherapy

Participants were interviewed about sociodemographic and clinical characteristics. They were then given the Duke University Religion Index (DUREL) to measure three dimensions of religiosity. Then, they applied the State-Trait Anxiety Inventory (STAI-S and STAI-T). Preintervention data collection included a repeat STAI-S and a saliva and vital sign measurement taken by the same examiner. The prayer intervention was then conducted by the researcher. The intervention consisted of a specific Christian prayer delivered in an audio recording over 11 minutes. Thirty minutes after prayer, the STAI-S and salivary sample and vital signs were repeated. The control group received the same protocol with no prayer intervention.

• N = 20  
• AGE = > 18
• MALES: 75%, FEMALES: 25%
• KEY DISEASE CHARACTERISTICS: Cancer diagnosis
• OTHER KEY SAMPLE CHARACTERISTICS: Receiving continuous IV chemotherapy; willing to receive prayer; and clinically stable

• SITE: Single site    
• SETTING TYPE: Inpatient    
• LOCATION: Minas Gerais, Brazil

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care and palliative care 

Quasi-experimental, pre- and postintervention study with a control group

• State-Trait Anxiety Inventory (STAI): Two-part STAI-T and STAI-S
• Duke University Religion Index (DUREL)
• BioEstat 5.0 program used to chart and analyze results
• The Wilcoxon signed-rank test compared state anxiety levels, salivary cortisol, blood pressure, and heart and respiratory rate pre- and postintervention.

The sample revealed a high level of religiosity. Anxiety state was influenced by nonorganizational religious activity (p = 0.01), and a correlation with age group (p = 0.01) existed. The anxiety profile measure before the intervention displayed moderate levels of anxiety. A comparison of pre- and postintervention means demonstrated modified values for state anxiety, blood pressure, and respiration rate. The STAI-S showed reduced anxiety after prayer at each moment. Values related to anxiety levels and vital signs were reduced after each intervention and for all three repetitions of pre- and postintervention observation (anxiety levels [p < 0.00], respiratory rate [p = 0.04], blood pressure [p = 0.00]).

The authors concluded that prayer is effective in reducing the anxiety of patients receiving chemotherapy. Evaluating anxiety by measuring vital signs is recommended as a simple technique. The nursing application of a standardized prayer protocol in the clinical environment addresses patients' spiritual dimensions and could reduce anxiety.

• Small sample (< 30)
• Risk of bias (no control group)
• Risk of bias (no random assignment)
• Findings not generalizable
• Questionable protocol fidelity
• Other limitations/explanation: The researcher was the creator, administrator, and evaluator of the intervention.

The spiritual care of patients with cancer is an important dimension of care. Continued research on the effectiveness of prayer for patients who value prayer can be meaningful in reducing anxiety.

RESOURCE TYPE: Consensus-based guideline

PHASE OF CARE: Not specified or not relevant

• Recommends psychological interventions with or without antianxiety or antidepressants to treat anxiety
• Recommends psychological interventions with or without antidepressants to treat depression
• Provides algorithms for social work counseling and chaplain interventions

Limited information on the quality of evidence was retrieved. All recommendations were mainly consensus based.

This guideline provides very general level treatment algorithms based on the results of an initial distress screening, and recommends further assessment and intervention determination if overall distress is 4 or above on the distress thermometer.