Wellness Check: Spirituality

Spirituality may influence the aggressiveness of end-of-life treatments in cancer patients

1. In this scoping review, spiritual care offered by the medical team typically led to more referrals to hospice and was associated with less aggressive end-of-life treatments.

2. In addition, it was found that end-of-life preferences differ based on religious denominations: Buddhists and Taoists received more aggressive end-of-life care, while Catholics were less likely to sign a do-not-resuscitate order.

Evidence Rating Level: 2 (Good)

It is well known that religiosity/spirituality/religious-spiritual coping (RS) may have an impact on end-of-life (EOL) care in cancer patients. However, there is a paucity of evidence concerning preferences across different religious affiliations in cancer patients. As a result, the objective of the present scoping review was to qualify the relationship between RS and the type of treatments preferred or received during EOL care in cancer patients.

Of 6140 identified records, 17 (n=3766 patients) studies were included from various databases from 2005-2022. Studies were included if they examined RS variables and their association with care preferred or received by cancer patients. Studies were excluded if they did not have cancer-specific data. The review was performed using PRISMA guidelines. Quality was assessed using the Newcastle Ottawa scale (NOS). The primary outcome was the treatment preferred or received during EOL care.

The results demonstrated that although RS was associated with more aggressive EOL treatments, spiritual care offered by the medical team led to more referrals to hospice and less aggressive treatments. In addition, there were differences in EOL preferences depending on religious affiliation. For instance, Buddhists and Taoists received more aggressive EOL care, while Catholics were less likely to sign a do-not-resuscitate order. Despite these results, the study was limited by the fact that the role of patient health insurance was not taken into consideration, which may have influenced EOL treatment preferences. Nonetheless, the present study provided additional insight into the role of RS on treatment preferences during EOL care.

Religious affiliation may influence the type of contraception used by women in the postpartum period

1. In this systematic review, the main factors influencing contraceptive choice included parity, education, and personal and family beliefs about contraception.

2. Additionally, contraceptive method choice was influenced by sociocultural factors, such as religion.

Evidence Rating Level: 1 (Excellent)

Contraception remains an important topic for women who wish to remain sexually active in the postpartum period. Research has demonstrated that many healthcare professionals do not consider the personal wishes of patients during the selection of a contraceptive and focus primarily on the medical indications and contraindications. As a result, the objective of the present qualitative systematic review was to identify the factors that may influence the choice of contraception during the postpartum period.

Of 4529 identified records, 34 studies were included from various databases from 2000-2021. Studies were included if they studied the contraceptive preferences of women of childbearing age, regardless of culture, ethnicity, or marital status. Studies were excluded if women were not in the postpartum period. The review was performed following PRISMA guidelines. The risk of bias was assessed using Cochrane’s randomized controlled trial tool. Statistical analysis was performed using a thematic analysis. The primary outcome was factors influencing the type of postpartum contraception.

The results demonstrated the main factors that tended to influence contraceptive choice were parity, level of education, and both personal and familial beliefs about contraception. Religious affiliation was one of the sociocultural factors that was found to influence contraceptive choice. For instance, Muslim women tended to favor intrauterine devices, whereas Christian women were more likely to choose implantable devices. Despite these results, the study was limited by the lack of focus on methods of sterilization, which may have influenced contraceptive choice. Nonetheless, the findings of the present study indicated that physicians should inquire about personal preferences when choosing a method of contraception during the postpartum period.

Yoga helps alleviate symptoms of mild to moderate asthma in adults

1. In this meta-analysis, asthma patients who used yoga breathing exercises reported better symptom control and quality of life.

2. In addition, breathing and meditation were found to improve several variables in pulmonary function testing compared to standard care.

Evidence Rating Level: 1 (Excellent)

Breathing, meditation, and posture exercises are prevalent in yoga and have previously been shown to be beneficial in lower respiratory diseases, such as asthma. Currently, the studies exploring this link have had several shortcomings, such as limited sample size, poor quality, and several other biases. As a result, the objective of the present study was to provide an updated meta-analysis of the literature to evaluate the effects of yoga on symptoms and quality of life in asthmatic patients.

Of 631 identified records, 15 studies were included from various sources from database inception to 2022. Studies were included if they investigated adult patients suffering from mild to moderate asthma, as defined by the Global Initiative for Asthma guidelines. Studies were excluded if participants had asthma exacerbations or other health conditions that could interfere with yoga exercises. The review was performed using PRISMA guidelines. The risk of bias was assessed using the GRADE pro approach. The primary outcome was the impact of yoga on asthmatic disease control, including pulmonary function tests, asthma control tests, and quality of life.

The results demonstrated that yoga was associated with an improvement in overall quality of life and asthma control. In addition, exercises such as breathing and meditation improved several variables in pulmonary function testing compared to usual care. Despite these results, the study was limited by the heterogeneity of the included studies and few studies exploring certain variables which may have affected the overall effect size. Nonetheless, the present study provided updated evidence on the utility of yoga as a complementary therapy in patients who suffer from mild to moderate asthma.

Gastrointestinal cancer patients may have low spiritual well-being

1. In this cross-sectional study, the mean score for spiritual well-being among patients with gastrointestinal (GI) cancer was relatively low.

2. In addition, several factors such as positivity, expectancy, and search for meaning were associated with spiritual well-being in GI cancer patients.

Evidence Rating Level: 2 (Good)

Gastrointestinal (GI) cancers are known to carry a poor prognosis, and treatment options often lead to several adverse side effects. Spiritual well-being may play an important role in patient outcomes, however the majority of studies have focused mainly on mixed cancer types. As a result, the objective of the present cross-sectional study was to evaluate the spiritual well-being of GI cancer patients.

The present study included 237 (mean age=54 years) GI cancer patients through convenience sampling from May to October 2022 from a single center in China. Participants who were informed of their illness and were able to read and understand the questions posed to them were included. Participants were excluded if they had cognitive impairments or if they were receiving other psychological interventions. Participants completed multiple questionnaires to assess their spiritual well-being, including the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Herth Hope Index, and Meaning in Life Questionnaire The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Statistical analysis was performed using multiple linear regression analysis. The primary outcome was spiritual well-being.

The results demonstrated that the mean score for spiritual well-being was 31.5 among study participants. This score of spiritual well-being was described as low compared to the reference value from the American Cancer Society’s studies of cancer survivors. Several factors, such as the presence of meaning, inner positive readiness and expectancy, residence, and search for meaning, were associated with the highest variance in spiritual well-being among GI cancer patients. Despite these results, the study was limited by the study population being predominantly liver cancer patients, which may limit the study’s generalizability to patients with other GI cancers. Nonetheless, the present study added an important understanding of the spiritual well-being of patients with GI cancer.

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