Describing the Prevalence and Correlates of Spiritual Concerns Using the PC-6 Spiritual Assessment with Palliative Care Patients Near the End of Life.

Abstract

Religious and spiritual (R/S) concerns are common among patients with serious illness. Attending to the R/S concerns of patients is a core component of quality palliative care. Our aim was to describe the prevalence and demographic, medical, and religious correlates of R/S concerns in patients receiving palliative care. Multisite, cross-sectional study. Adult patients in the United States receiving inpatient or outpatient palliative care. Chaplains completed the PC-6, an interview-based spiritual assessment, as part of routine palliative care practice. The PC-6 evaluates six domains of R/S concern: relationships, meaning, legacy, dying, religious/spiritual struggle, and treatment decision-related concerns. Demographic, clinical, and religious affiliation data were obtained from the medical record. A total of 172 palliative care patients were included. Fifty percent were assessed to have moderate or severe concerns in at least one of six spiritual domains, and 17% had concerns in two or more domains. The most prevalent concerns involved relationships (19.2%), dying (14.5%), meaning (14.0%), and legacy (11.0%). In multivariable analyses, patients with no religious affiliation were more than three times more likely to have moderate or severe spiritual concerns compared to those with a Protestant affiliation. Demographic characteristics and primary diagnosis were not associated with the presence of spiritual concerns. Moderate to severe spiritual concerns are prevalent among patients receiving palliative care, including among those without a religious affiliation. Integrating spiritual assessment into palliative care workflows may facilitate specialty spiritual care and comprehensive attention to patients' multidimensional suffering.