Spiritual Distress and Pulmonary Disease at End of Life: Implications for COVID-19
Purpose: The author will present findings from a larger study related to spiritual distress and pulmonary disease in adults newly admitted to hospice and will discuss the implications of these findings to palliative care during the current COVID-19 pandemic.
Background/Rationale: Multiple studies explore spiritual distress in the cancer population and to a lesser extent in those with heart disease; however, the current literature lacks exploration of spiritual distress in other serious or terminal illnesses, including pulmonary disease, at any point in the disease trajectory. Furthermore, end-stage pulmonary disease causes severe respiratory symptoms comparable to those seen in some severe cases of COVID-19. Therefore, research findings related to advanced pulmonary disease in palliative or end of life care may be applicable to COVID-19 palliative intervention.
Methods: For the larger retrospective correlational study, pre-existing data were extracted from a large hospice electronic health record to examine multiple factors, including hospice diagnosis and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N=3484). Descriptive, bivariate, and multivariate analyses were conducted.
Results: The age range for this sample was 25 to 107 years old with a mean age of 82 (SD = 12.08). Over half of the sample were female and white. Nearly 10% of the total sample experienced spiritual distress. Of the total sample, 7.8% had a hospice diagnosis of pulmonary disease; that proportion increased to 11.4% in the spiritual distress sample. In the bivariate analysis, hospice diagnosis (χ2 (5, N = 3481) = 22.66, p < .001, was significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, p < .001, with the greatest predictor variable for spiritual distress being pulmonary disease (OR = 1.8, p = .02).
Implications: Given the nature of COVID-19 symptomology, these findings suggest COVID-19 patients with respiratory complications may experience heightened spiritual distress due in part to symptom similarities with pulmonary disease. Future research should examine the unique contribution of diagnosis, particularly pulmonary disease, COVID-19, and other respiratory disorders, in predicting spiritual distress. Author: Katie Robinson, PhD, RN, CHPN, CSU San Marcos