Spiritual Communication Between Pediatric Oncologists, Caregivers, and Patients With Brain Tumors.

Résumé

BACKGROUND: Spiritual care is recognized as an essential component of standard care for children with cancer and their families. Oncologists lack training in navigating spirituality discussions in primary cancer care. The current landscape of spiritual dialog during clinical oncology encounters remains understudied.PROCEDURES: This qualitative study described the frequency, context, and content of religious and spiritual communication between pediatric neuro-oncologists, caregivers, and patients with brain tumors during disease re-evaluation encounters. This study is part of the U-CHAT trial (NCT02846038), a prospective longitudinal investigation of real-time clinical communication across the trajectory of poor-prognosis cancer. Patients with brain tumors and their caregivers were eligible if their primary oncologist estimated ≤50% survival. All disease re-evaluation encounters for enrolled patients were audio-recorded and underwent rapid qualitative analysis to identify, summarize, and synthesize religious and spiritual communication.RESULTS: Religious or spiritual references were identified in 23 (18%) of 129 total encounters. References usually comprised a single religious or spiritual term, with "prayer"-related language representing the majority of references. Caregivers introduced spiritual dialog more often than oncologists (65% vs. 35%). References were most often identified in the context of a discussion about an uncertain or uncontrollable future.CONCLUSIONS: Results suggest oncologists rarely integrate spiritual care into disease re-evaluation discussions. In light of recommendations from multiple consensus groups to integrate spiritual care into cancer care, future work should explore how generalist spiritual care training could better equip oncologists to attend to spiritual needs that arise along the cancer trajectory.