Spiritual Support in Advanced Heart Failure: A Randomized Controlled Feasibility Study
Issue: Vol 9 No. 2 (2021)
Journal: Health and Social Care Chaplaincy
Subject Areas: Healthcare Communication
Heart failure is a complex, progressive disease with an uncertain trajectory. Those with advanced heart failure (AHF) experience substantial spiritual needs. Spiritual interventions may enhance quality of life and reduce anxiety and depression, but studies are limited and none have focused exclusively on the AHF patient population. This is the first feasibility randomized controlled trial (RCT) to ascertain the clinical and cost effectiveness of a spiritual intervention (spiritual support) in AHF patients. A total of 47 AHF patients were randomized to control (standard care, n = 25) or intervention (standard care plus spiritual support, n = 22) groups. Spiritual support consisted of a one-hour discussion facilitated by trained volunteers using a “Spiritual Enquiry Tool” at two-monthly intervals over six months. Participants completed validated measures of spiritual well-being, depression/anxiety, and health-related quality of life (QoL). Purpose-designed questionnaires gathered information on demographics, NHS resource use, confounding factors, and satisfaction with spiritual support. The new information was to help researchers design an RCT to determine the clinical and cost effectiveness of spiritual support within a holistic model of care for AHF patients. Future trends worthy of further investigation include (i) the possible positive effect of spiritual support on QoL and anxiety, and (ii) possible lower NHS resource use and cost savings in patients receiving spiritual support. Overall, the key message of this study is that researchers must evaluate whether the cost of running a well-designed trial of this nature is justified in the current economic climate, where funding bodies are looking for value for money.
Author: Jackie Miles, Linda Ross, Paul Jarvis, Sara Pickett
Abu, H. O., Ulbricht, C., Ding, E., Allison, J. J., Salmoirago-Blotcher, E., Goldberg, R. J., & Kiefe, C. I. (2018). Association of religiosity and spirituality with quality of life in patients with cardiovascular disease: A systematic review. Quality of Life Research, 27(11), 2777–2797. https://doi.org/10.1007/s11136-018-1906-4
Austin, J., Williams, R., Ross, L., Moseley, L., & Hutchinson, S. (2005). Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. European Journal of Heart Failure, 7(3), 444–417. https://doi.org/10.1016/j.ejheart.2004.10.004
Balboni, T. A., Fitchett, G., Handzo, G. F., Johnson, K. S., Koenig, H. G., Pargament, K., … & Steinhauser, K. E. (2017). State of the science of spirituality and palliative care research part II: Screening, assessment, and interventions. Journal of Pain and Symptom Management, 54(3), 441–453. https://doi.org/10.1016/j.jpainsymman.2017.07.029
Boero, M. E., Caviglia, M. L., Monteverdi, R., Braida, V., Fabello, M., & Zorzella, L. M. (2005). Spirituality of health workers: A descriptive study. International Journal of Nursing Studies, 42(8), 915–921. https://doi.org/10.1016/j.ijnurstu.2004.11.007
Boyle, D., Crilly, T., & Malby, B. (2017). Can volunteering help create better health and care? Commissioned by the HelpForce Fund, London South Bank University. https://helpforce.community/wp-content/uploads/Helpforce-Can-volunteering-help-create-better-health-and-care.pdf
British Heart Foundation (2020). Heart failure. Retrieved August 2020 from https://heartfailure.bhf.org
Cockell, N., & Mcsherry, W. (2012). Spiritual care in nursing: An overview of published international research. Journal of Nursing Management, 20(8), 958–969. https://doi.org/10.1111/j.1365-2834.2012.01450.x
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. British Medical Journal, 337, a1655. https://doi.org/10.1136/bmj.a1655
Curtis, L., & Burns, A. (2015). PSSRU: Unit costs of health & social care 2015. Retrieved 13 April 2017 from https://www.pssru.ac.uk/pub/uc/uc2015/full.pdf
Curtis, L., & Burns, A. (2016). PSSRU: Unit Costs of Health & Social Care 2016. Retrieved 13 April 2017 from https://www.pssru.ac.uk/pub/uc/uc2016/full.pdf
CV Outcomes, Inc. (2017) Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Retrieved 7 June 2017 from http://cvoutcomes.org/pages/3214
Department of Health (2016). NHS reference costs 2015 to 2016. National schedule of reference costs: The main schedule. Retrieved 9 March 2020 from https://www.gov.uk/government/publications/nhs-reference-costs-2015-to-2016
European Commission (2010). Europe 2020: A strategy for smart, sustainable and inclusive growth. Brussels: European Commission. http://hdl.voced.edu.au/10707/89925
EuroQol Group (1990). EuroQol – a new facility for the measurement of health‐related quality of life. Health Policy, 16(3), 199–208. https://doi.org/10.1016/0168-8510(90)90421-9
Goebel, J. R., Doering, L. V., Lorenz, K. A., Maliski, S. L., Nyamathi, A. M., Maliski, S. L., & Evangelista, L. S. (2009). Caring for special populations. Total pain theory in advanced heart failure: Applications to research and practice. Nursing Forum, 44(3), 175–185. Malden, USA: Blackwell Publishing Inc. https://doi.org/10.1111/
Gwent Healthcare NHS Trust (2006). Clinical futures strategy. Wales: NHS.
Higginson, I. J., Evans, C., Grande, G., Preston, N., Morgan, M., McCrone, P., Lewis, P., Fayers, P., Harding, R., Hotopf, M., Murray, S. A., Benalia, H., Gysels, G., Farquhar, M., & Todd, C. (2013). Evaluating complex interventions in end of life care: The MORECare Statement on good practice generated by a synthesis of transparent expert consultations and systematic reviews. Bio Med Central Medicine, 11, 111. https://doi.org/10.1186/1741-7015-11-111
Hsu, P., Krageloh, C. U., Shepherd, D., & Billington, R. (2009). Religion/spirituality and quality of life of international tertiary students in New Zealand: An exploratory study. Mental Health, Religion & Culture, 12(4), 385–399. https://doi.org/10.1080/13674670902752920
Joint Formulary Committee (2017). British National Formulary, March 2017. London: BMJ Group and Pharmaceutical Press. Retrieved 9 March 2017 from http://www.medicinescomplete.com
Koenig, H. G. (2009). Research on religion, spirituality, and mental health: A review. Canadian Journal of Psychiatry, 54(5), 283–291. https://doi.org/10.1177/070674370905400502
Koenig, H., King, D., & Carson, V. B. (2012). Handbook of religion and health. New York: Oxford University Press.
McClain, C. S., Rosenfeld, B., & Breitbart, W. (2003). Effect of spiritual well‐being on end‐of‐life despair in terminally-ill cancer patients. Lancet, 361(9369), 1603–1607. https://doi.org/10.1016/S0140-6736(03)13310-7
McIlvennan, C. K., & Allen, L. A. (2016). Palliative care in patients with heart failure. British Medical Journal, 353, i1010. https://doi.org/10.1136/bmj.i1010
Murray, S. A., Kendall, M., Boyd, K., Worth, A., & Benton, T. F. (2004). Exploring the spiritual needs of people dying of lung cancer or heart failure: A prospective qualitative interview study of patients and their carers. Palliative Medicine, 18(1), 39–45. https://doi.org/10.1191/0269216304pm837oa
Murray, S. A., Kendall, M., Grant, E., Boyd, K., Barclay, S., & Sheikh, A. (2007). Patterns of social, psychological and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management, 34(4), 393–402. https://doi.org/10.1016/j.jpainsymman.2006.12.009
Murray, S. A., Kendall, M., Boyd, K., Grant, E., Highet, G., & Sheikh, A. (2010). Archetypal trajectories of social, psychological and spiritual wellbeing and distress in family care givers of patients with lung cancer: Secondary analysis of serial qualitative interviews. British Medical Journal, 340, c2581 https://doi.org/10.1136/bmj.c2581
National Institute for Cardiovascular Outcomes Research (2012). National heart failure audit April 2010–March 2011. NHS Digital IC17110110. London: University College London.
National Institute for Health and Care Excellence (2013). Guide to the methods of technology appraisal 2013. https://www.nice.org.uk/process/pmg9/resources/guide-to-the-
National Institute for Health and Care Excellence (2015). Care of dying adults in the last days of life. Retrieved 7 June 2017 from https://www.nice.org.uk/guidance/ng31
National Institute for Health and Care Excellence (2016). Guidance on loneliness in older people. Nice.org.uk/guidance/qs133/resources/mental-well-being-and-independence-for-
NHS Education for Scotland (2009). Spiritual care matters. An Introductory resource for all NHS Scotland Staff. Edinburgh; NHS Education for Scotland. 2068KB. https://www.nes.scot.nhs.uk
NHS Education for Scotland (2020). Spiritual care. Edinburgh: NHS Education for Scotland. Retrieved July 2020 from https://www.nes.scot.nhs.uk/education-and-training/by-discipline/spiritual-care/areas-of-education/ccl-scotland.aspx
Nolan, S., Saltmarsh, P., & Leget, C. (2011). Spiritual care in palliative care: Working towards an EAPC task force. European Journal of Palliative Care, 18(2), 86–89. https://www.eapcnet.eu/Portals/0/EJPC18_2_EAPC_update_Spiritual.pdf
Nursing & Midwifery Council (2018). Future nurse: Standards of proficiency for registered nurses. NMC: London. https://www.nmc.org.uk
Park, C. L. (2008). Estimated longevity and changes in spirituality in the context of advanced congestive heart failure. Palliative and Supportive Care, 6(1), 3–11. https://doi.org/10.1017/S1478951508000023
Ross, L. A. (1997). Elderly patients’ perceptions of their spiritual needs and care: A pilot study. Journal of Advanced Nursing, 26(4), 710–715. https://doi.org/10.1046/j.1365-2648.1997.00393.x
Ross, L. A. (2006). Spiritual care in nursing: An overview of the research to date. Journal of Clinical Nursing, 15(7), 852–862. https://doi.org/10.1111/j.1365-2702.2006.01617.x
Ross, L. A., & Austin, J. (2015). Spiritual needs and spiritual support preferences of people with end-stage heart failure and their carers: Implications for nurse managers. Journal of Nursing Management, 23(1), 87–95. https://doi.org/10.1111/jonm.12087
Ross, L., & Miles, J. (2019). Spirituality in heart failure: A review of the literature from 2014 to 2019 to identify spiritual care needs and spiritual interventions. Current Opinion in Supportive and Palliative Care, 14(1), 9–18. https://doi.org/10.1097/SPC.0000000000000475
Royal College of Nursing (2011). Spirituality in nursing care: A pocket guide. Retrieved 27 March 2020 from https://www.rcn.org.uk
Saunders, C. (1996). A personal therapeutic journey. British Medical Journal, 313(7072), 1599–1601. https://doi.org/10.1136/bmj.313.7072.1599
Scottish Government (2009). Spiritual care and chaplaincy. Edinburgh: The Stationery Office.
Spertus, J. A., & Jones, P. G. (2015). Development and validation of a short version of the Kansas City Cardiomyopathy Questionnaire. Circulation: Cardiovascular Quality and Outcomes, 8(5), 469–476. https://doi.org/10.1161/CIRCOUTCOMES.115.001958
Thorn, J. C., Coast, J., Cohen, D., Hollingworth, W., Knapp, M., Noble, S. M., … & Hughes, D. (2013). Resource‐use measurement based on patient recall: Issues and challenges for economic evaluation. Applied Health Economics and Health Policy, 11(3), 155–161. https://doi.org/10.1007/s40258-013-0022-4
van Reenan, M., & Oppe, M. (2015). EQ‐5D‐3L user guide: Basic information on how to use the EQ‐5D‐3L instrument. Version 5.1. Rotterdam, EuroQol Research Foundation: 1–25.
Welsh Government (2005). Designed for life. A world class health service for Wales. http://new.wales.gov.uk/topics/health/health_social_care_strategies
Welsh Government (2015). Health and care standards. Cardiff: Crown.
Welsh Government (2017). Heart conditions delivery plan. Retrieved 18 July 2017 from http://gov.wales/topics/health/nhswales/plans/heart_plan/?lang=en
World Health Organization (2002). WHOQOL‐SRPB field-test instrument. Geneva: WHO. https://www.who.int/mental_health/media/en/622.pdf
WHOQOL SRPB Group (2006). A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life. Social Science and Medicine, 62(6), 1486–1497. https://doi.org/10.1016/j.socscimed.2005.08.001
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x