Electronic Thesis and Dissertation Repository

Thesis Format

Alternative Format

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Vafaei, Afshin

2nd Supervisor

Savundranayagam, Marie

Co-Supervisor

Abstract

The global need for palliative care is increasing. Unfortunately, spirituality and its relation and presentation in palliative care is not well understood or researched. It is the least understood aspect of palliative care. Three demographic trends contribute to this rise in palliative care: medical technologies driving longer life expectancy and longevity, increase in the aging population, and increasing number of individuals facing multimorbidity. These factors are increasing the demand for palliative care. The aim of this thesis is to explore how older persons experience and navigate spirituality in palliative care, and therefore provide novel suggestions that ensure palliative care provides whole-person care and understands how spiritual distress may present itself. To map the literature, a scoping review was conducted to identify the original qualitative studies examining the issue. 40 qualitative studies were included in the scoping review and a thematic analysis was conducted to extract themes. In regards to how persons in palliative care experience spirituality, the following three themes emerged: Feelings of stress, and anxiety, Identity crisis/questioning of one’s purpose, Feelings of abandonment and isolation. For the purpose of devising practical solutions, older persons’ interactions with healthcare providers were also reported. The novelty of this scoping review and associated thematic analysis lies in understanding how spiritual distress and suffering may manifest in palliative care, and consequently its effect on how the illness is experienced. Therefore, we offer practical solutions integrating spirituality as a core component in provision of palliative care and ways of addressing palliative patients in totality.

Summary for Lay Audience

Living in an aging world brings multimorbidity and complex health care needs, making a call for comprehensive palliative care. Spiritual care, recognized by the World Health Organization as a “human right to health” and a core component of palliative care, remains to be the most unknown and neglected component of palliative care, despite being the element that is most altered in the last moments of life. A compelling amount of applied and scholarly research has been conducted on building meaningful relationships and promoting social connectedness for older persons. However, older persons’ opportunities to find comfort and hope through their spirituality is an area of research that presents as an opportunity to reimagine hospice and palliative care. Understanding the role of mental health, specifically how purpose and meaning affect older persons’ personal and psychological quality of life, I conducted a scoping review to explore the spiritual experience of older persons receiving palliative care. The aim of this overview was to extend current knowledge and understand the relationship between spirituality and their potential role in shaping self-perception which was framed as an integral aspect of overall quality of life. The following three themes were extracted: Theme 1 - Feelings of Stress and Anxiety, Theme 2 - Identity Crisis / Questioning of one’s purpose, and Theme 3 - Feelings of abandonment and isolation. Although interactions with healthcare providers were scarcely reported, I extracted this theme to demonstrate the lack of communicative action and reasoning behind such discrepancy, and its potential influence on how an individual navigates palliative care. With hopes of knowledge mobilization informing interdisciplinary disciplines and compassionate person-centered care, a scoping review of this nature is intended to derive novel assumptions from current knowledge and understand how spiritual distress and suffering manifests in palliative care.

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