Abstract 1268P
Background
Though the positive impact of palliative care physicians and nurses on end of life medical outcomes is increasingly well-established, little is known about the impact of spiritual caregivers, psychologists, and social workers on desired end of life medical outcomes. In particular, on reduced use of aggressive care in the final two weeks of life, having more time after the last active oncological treatment and before death, and increased hospice use.
Methods
Prospective study of 180 cancer patients and their families, their interactions with social work, psychology, and spiritual care, and the above three treatment outcomes.
Results
The key psycho-social-spiritual interventions associated with reduced end of life aggressive care were having one or more spiritual care visits (adjusted odds ratio 2.02; p=0.04), having more quality visits with the psychologist (p=0.01), and speaking with someone about one's inner resources (AOR=2.25; p=0.03). The key interventions correlating with increased time after final treatment were a greater number of visits with the spiritual caregiver or the social worker (AOR=1.30; p<0.001), and speaking about the medical treatment (AOR=1.54; p<0.001) and about interpersonal relationships (AOR=2.28; p<0.001). Earlier palliative care conversations with the physician correlated with both these outcomes as well. A subjectively good-quality connection with the spiritual caregiver correlated with increased hospice use (AOR=10.00; p=0.01). Each profession contributed to these outcomes in distinct ways.
Conclusions
Ensuring provision of spiritual care, psychology, and social work to cancer patients at the end of life can help reduce futile aggressive measures, improve quality of life, and reduce costs.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
The Joint Distribution Committee – Eshel and the Government of Israel's Ministry of Health, as part of the National Program for Palliative Care.
Disclosure
All authors have declared no conflicts of interest.