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Factors influencing spiritual well-being in terminally ill cancer inpatients in Japan

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Abstract

Purpose

Spiritual well-being is very important in patients undergoing palliative care. Although psychosocial factors have been suggested to be associated with spiritual well-being, the relationship between physical signs and spiritual well-being has not been fully elucidated. The aim of this study was to explore diverse factors associated with spiritual well-being among palliative care patients in Japan.

Methods

This study is a secondary analysis of a multicenter prospective cohort study involving patients admitted to palliative care units in Japan. Physicians recorded all data prospectively on a structured sheet designed for the study. The spiritual well-being score was measured using the Integrated Palliative Outcome Scale after patients’ death in regard to symptoms over the previous 3 days. We classified each patient into “better” score (0–1) and “worse” score (2–4) groups and examined diverse factors associated with spiritual well-being.

Results

Among the 1896 patients enrolled, 1313 were evaluated. In the multivariate analysis, seven variables were significantly associated with “worse” score: worse spiritual well-being on admission (2–4) (p < 0.0001), younger age (< 80) (p = 0.0001), hyperactive delirium over 3 days before death (mild/moderate/severe) (p = 0.0001), expressed wish for hastened death (yes) (p = 0.0006), worse communication among patients and families (Support Team Assessment Schedule score 2–4) (p = 0.0008), pleural effusion (present) (p = 0.037), and marital status (unmarried) (p = 0.0408).

Conclusion

Recognizing factors associated with spiritual well-being is potentially useful for identifying high-risk groups with lower spiritual well-being at the end of life. Further study is required to investigate factors associated with patient-reported spiritual well-being.

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Data Availability

The data that support the findings of this study are available from the corresponding author (Y.H.), upon reasonable request.

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Acknowledgements

We thank Hugh McGonigle, from Edanz Group (www.edanzediting.com/ac), for editing a draft of the manuscript.

This study was performed as part of the East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED). The participating study sites and site investigators in Japan were as follows: Satoshi Inoue, M.D. (Seirei Hospice, Seirei Mikatahara General Hospital); Naosuke Yokomichi, M.D., Ph.D. (Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital); Kengo Imai, M.D. (Seirei Hospice, Seirei Mikatahara General Hospital); Hiroaki Tsukuura, M.D., Ph.D. (Department of Palliative Care, Tums Urayasu Hospital); Toshihiro Yamauchi, M.D. (Seirei Hospice, Seirei Mikatahara General Hospital); Akemi Shirado Naito, M.D. (Department of Palliative Care, Miyazaki Medical Association Hospital); Yu Uneno, M.D. (Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University); Akira Yoshioka, M.D., Ph.D. (Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital); Shuji Hiramoto, M.D. (Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital); Ayako Kikuchi, M.D. (Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital); Tetsuo Hori, M.D. (Department of Respiratory Surgery, Mitsubishi Kyoto Hospital); Yosuke Matsuda, M.D. (Palliative Care Department, St. Luke's International Hospital); Hiroyuki Kohara, M.D., Ph.D. (Hiroshima Prefectural Hospital); Hiromi Fanaki, M.D. (Hiroshima Prefectural Hospital); Keiko Tanaka, M.D., Ph.D. (Department of Palliative Care, Tokyo Metropolitan Cancer & Infectious Diseases Center Komagome Hospital); Kozue Suzuki, M.D. (Department of Palliative Care, Tokyo Metropolitan Cancer & Infectious Diseases Center Komagome Hospital); Tina Kamei, M.D. (Department of Palliative Care, NTT Medical Center Tokyo); Yukari Azuma, M.D. (Home Care Clinic Aozora Shin-Matsudo); Koji Amano, M.D. (Department of Palliative Medicine, Osaka City General Hospital); Teruaki Uno, M.D. (Department of Palliative Medicine, Osaka City General Hospital); Jiro Miyamoto, M.D. (Department of Palliative Medicine, Osaka City General Hospital); Hirofumi Katayama, M.D. (Department of Palliative Medicine, Osaka City General Hospital); Hideyuki Kashiwagi, M.D., MBA. (Aso Iizuka Hospital/Transitional and Palliative Care); Eri Matsumoto, M.D. (Aso Iizuka Hospital/Transitional and Palliative Care); Kiyofumi Oya, M.D. (Aso Iizuka Hospital/Transitional and Palliative Care); Takeya Yamaguchi, M.D. (Japan Community Health Care Organization Kyushu Hospital/Palliative Care); Tomonao Okamura, M.D., MBA (Aso Iizuka Hospital/Transitional and Palliative Care); Hoshu Hashimoto, M.D., MBA (Inoue Hospital/Internal Medicine); Shunsuke Kosugi, M.D. (Department of General Internal Medicine, Aso Iizuka Hospital); Nao Ikuta, M.D. (Department of Emergency Medicine, Osaka Red Cross Hospital); Yaichiro Matsumoto, M.D. (Department of Transitional and Palliative Care, Aso Iizuka Hospital); Takashi Ohmori, M.D. (Department of Transitional and Palliative Care, Aso Iizuka Hospital); Takehiro Nakai, M.D. (Immuno-Rheumatology Center, St Luke's International Hospital); Takashi Ikee, M.D. (Department of Cardiology, Aso Iizuka Hospital); Yuto Unoki, M.D. (Department of General Internal Medicine, Aso Iizuka Hospital); Kazuki Kitade, M.D. (Department of Orthopedic Surgery, Saga-Ken Medical Centre Koseikan); Shu Koito, M.D. (Department of General Internal Medicine, Aso Iizuka Hospital); Nanao Ishibashi, M.D. (Environmental Health and Safety Division, Environmental Health Department, Ministry of the Environment); Masaya Ehara, M.D. (TOSHIBA); Kosuke Kuwahara, M.D. (Department of General Internal Medicine, Aso Iizuka Hospital); Shohei Ueno, M.D. (Department of Hematology/Oncology, Japan Community Healthcare Organization Kyushu Hospital); Shunsuke Nakashima, M.D. (Oshima Clinic); Yuta Ishiyama, M.D. (Department of Transitional and Palliative Care, Aso Iizuka Hospital); Akihiro Sakashita, M.D., Ph.D. (Department of Palliative Medicine, Kobe University School of Medicine); Ryo Matsunuma, M.D. (Department of Palliative Medicine, Kobe University Graduate School of Medicine); Hana Takatsu, M.D. (Division of Palliative Care, Konan Medical Center); Takashi Yamaguchi, M.D., Ph.D. (Division of Palliative Care, Konan Medical Center); Toru Terabayashi, M.D. (Hospice, The Japan Baptist Hospital); Jun Nakagawa, M.D. (Hospice, The Japan Baptist Hospital); Tetsuya Yamagiwa, M.D., Ph.D. (Hospice, The Japan Baptist Hospital); Takuhiro Yamaguchi, Ph.D. (Professor of Biostatistics, Tohoku University Graduate School of Medicine); Mitsunori Miyashita, R.N., Ph.D. (Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine); Saran Yoshida, Ph.D. (Graduate School of Education, Tohoku University); Watanabe Hiroaki, M.D. (Department of Palliative Care, Komaki City Hospital); Odagiri Takuya, M.D. (Department of Palliative Care, Komaki City Hospital); Tetsuya Ito, M.D., Ph.D. (Department of Palliative Care, Japanese Red Cross Medical Center); Masayuki Ikenaga, M.D. (Hospice, Yodogawa Christian Hospital); Keiji Shimizu, M.D., Ph.D. (Department of Palliative Care Internal Medicine, Osaka General Hospital of West Japan Railway Company); Akira Hayakawa, M.D., Ph.D. (Hospice, Yodogawa Christian Hospital); Lena Kamura, M.D. (Hospice, Yodogawa Christian Hospital); Takeru Okoshi, M.D., Ph.D. (Okoshi Nagominomori Clinic); Kazuhiro Kosugi, M.D. (Department of Palliative Medicine, National Cancer Center Hospital East); Yasuhiro Shibata, M.D. (Kawasaki Municipal Ida Hospital, Kawasaki Comprehensive Care Center); Takahiro Higashibata, M.D., Ph.D. (Department of General Medicine and Primary Care, Palliative Care Team, University of Tsukuba Hospital); Ritsuko Yabuki, M.D. (Department of Palliative Medicine, Tsukuba Medical Center Hospital); Shingo Hagiwara, M.D. (Department of Palliative Medicine, Tsukuba Medical Center Hospital); Miho Shimokawa, M.D. (Department of Palliative Medicine, Tsukuba Medical Center Hospital); Satoshi Miyake, M.D., Ph.D. (Professor, Department of Clinical Oncology Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)); Junko Nozato, M.D. (Specially Appointed Assistant Professor, Department of Internal Medicine, Palliative Care, Medical Hospital, Tokyo Medical and Dental University); Hiroto Ishiki, M.D. (Department of Palliative Medicine, National Cancer Center Hospital); Mika Baba, M.D., Ph.D. (Department of Palliative Medicine, Suita Tokushukai Hospital); Tomofumi Miura, M.D., Ph.D. (Department of Palliative Medicine, National Cancer Center Hospital East); Yoshihisa Matsumoto, M.D., Ph.D. (Department of Palliative Medicine, National Cancer Center Hospital East); Ayumi Okizaki, M.D., Ph.D. (Department of Palliative Medicine, National Cancer Center Hospital East); Yuki Sumazaki Watanabe, M.D. (Department of Palliative Medicine, National Cancer Center Hospital East); Kazuhiro Kosugi, M.D. (Department of Palliative Medicine, National Cancer Center Hospital East); Yuko Uehara, M.D. (Department of Palliative Medicine, National Cancer Center Hospital East); Eriko Satomi, M.D. (Department of Palliative Medicine, National Cancer Center Hospital); Kaoru Nishijima, M.D. (Department of Palliative Medicine, Kobe University Graduate School of Medicine),;Junichi Shimoinaba, M.D. (Department of Hospice Palliative Care, Eikoh Hospital); Ryoichi Nakahori, M.D. (Department of Palliative Care, Fukuoka Minato Home Medical Care Clinic); Takeshi Hirohashi, M.D. (Eiju General Hospital); Jun Hamano, M.D., Ph.D. (Assistant Professor, Faculty of Medicine, University of Tsukuba); Natsuki Kawashima, M.D. (Department of Palliative Medicine, Tsukuba Medical Center Hospital); Takashi Kawaguchi, Ph.D. (Tokyo University of Pharmacy and Life Sciences Department of Practical Pharmacy); Megumi Uchida, M.D., Ph.D. (Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences); Ko Sato, M.D., Ph.D. (Hospice, Ise Municipal General Hospital); Yoichi Matsuda, M.D., Ph.D. (Department of Anesthesiology & Intensive Care Medicine/Osaka University Graduate School of Medicine); Yutaka Hatano, M.D., Ph.D. (Hospice, Gratia Hospital); Satoru Tsuneto, M.D., Ph.D. (Professor, Department of Human Health Sciences, Graduate School of Medicine, Kyoto University Department of Palliative Medicine, Kyoto University Hospital); Sayaka Maeda, M.D. (Department of Palliative Medicine, Kyoto University Hospital); Yoshiyuki Kizawa M.D., Ph.D., FJSIM, DSBPMJ (Designated Professor and Chair, Department of Palliative Medicine, Kobe University School of Medicine); Hiroyuki Otani, M.D. (Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center); and Hiroki Sakurai, M.D., Ph.D. (Department of Palliative Medicine, Toranomon Hospital).

Funding

This work was supported in part by a Grant-in-Aid from the Japanese Hospice Palliative Care Foundation.

Author information

Authors and Affiliations

  1. Department of Palliative Medicine, Tohoku University School of Medicine, 2-1 Seiryomachi, Sendai, Miyagi, 980-8575, Japan

    Yusuke Hiratsuka, Tomoo Ikari, Keita Tagami & Akira Inoue

  2. Hospice & Palliative Care Center, Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea

    Sang-Yeon Suh

  3. Department of Medicine, Dongguk University Medical School, Seoul, South Korea

    Sang-Yeon Suh

  4. Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan

    Isseki Maeda

  5. Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan

    Tatsuya Morita & Masanori Mori

  6. Hospice, The Japan Baptist Hospital, Kyoto, Japan

    Satoko Ito

  7. Kawasaki Municipal Ida Hospital, Kawasaki Comprehensive Care Center, Kawasaki, Japan

    Tomohiro Nishi

  8. Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan

    Takayuki Hisanaga

  9. Department of Internal Medicine, Palliative Care, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan

    Tetsuji Iriyama

  10. Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan

    Keisuke Kaneishi

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  1. Yusuke Hiratsuka
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  2. Sang-Yeon Suh
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  3. Isseki Maeda
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  7. Tomohiro Nishi
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  8. Takayuki Hisanaga
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  11. Tomoo Ikari
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  12. Keita Tagami
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  13. Akira Inoue
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Contributions

Yusuke Hiratsuka: conceptualization; data curation; formal analysis, investigation; methodology; project administration; writing, original draft; writing, review and editing

Sang-Yeon Suh: conceptualization, investigation, methodology, supervision, writing—review and editing

Isseki Maeda: investigation, writing—review and editing

Tatsuya Morita: investigation, writing—review and editing

Masanori Mori: conceptualization, investigation, methodology, project administration, resources, supervision, writing—review and editing

Satoko Ito: investigation, writing—review and editing

Tomohiro Nishi: investigation, writing—review and editing

Takayuki Hisanaga: investigation, writing—review and editing

Tetsuji Iriyama: investigation, writing—review and editing

Keisuke Kaneishi: investigation, writing—review and editing

Tomoo Ikari: conceptualization, investigation, writing—review and editing

Keita Tagami: investigation, writing—review and editing

Akira Inoue: conceptualization, data curation, investigation, methodology, project administration, writing—original draft

Corresponding author

Correspondence to Yusuke Hiratsuka.

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The authors declare that there is no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the independent ethics committee of Tohoku University School of Medicine (approval no. 2016-1-689) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written consent was unnecessary, and patients were provided the opportunity to opt out.

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Hiratsuka, Y., Suh, SY., Maeda, I. et al. Factors influencing spiritual well-being in terminally ill cancer inpatients in Japan. Support Care Cancer 29, 2795–2802 (2021). https://doi.org/10.1007/s00520-020-05802-5

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