Nursing Care for Spiritual Pain in Terminal Cancer Patients: A Non-Randomized Controlled Trial

Context Spiritual well-being is important for terminal cancer patients; however, appropriate interventions remain to be established. Objectives To evaluate the effectiveness of nursing care to alleviate spiritual pain in daily clinical practice using a Spiritual Pain Assessment Sheet-based spiritual care program for nurses (SpiPas-SCP-N). Methods A nonrandomized controlled trial was conducted in five palliative care units in Japan. The intervention group received spiritual care based on SpiPas-SCP-N by ward nurses. The primary outcome was the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp). Secondary outcomes included: Hospital Anxiety and Depression Scale (HADS), Comprehensive Quality of life Outcome (CoQoLo), and the Japanese version of the M.D. Anderson Symptom Inventory (MDASI-J). Propensity score matching was used for adjustment. Results Terminal cancer patients were assigned to the control and intervention groups (n = 140 and 157, respectively); of whom, 97 (69.8%) and 106 (68.0%), respectively, completed two weeks. Seventy-three patients were matched in each group. The total score of FACIT-Sp increased in the intervention group and decreased in the control group; however, there was no significant difference (95% CI, -3.98, 1.41, P = 0.347). HADS total score significantly increased (95% CI, 0.15, 3.87, P = 0.035), whereas there were no significant changes in CoQoLo and MDASI-J scores. The effect size of changes in FACIT-Sp subscales were 0.25 in the meaning/peace subscale and 0.04 in the faith subscale. Conclusion SpiPas-SCP-N for spiritual pain may have a positive impact on terminal cancer patients. Future research using larger samples, randomized design, and the meaning/peace subscale of FACIT-Sp as the primary outcome is necessary as well as supervision and continuous training in daily nursing practice.