Medical providers are called upon to address a wide range of psychosocial issues, under increasing time constraints. Spiritual/existential distress was one of 18 issues covered in a survey of oncologists' (n=94) and oncology nurses' (n=267) attitudes and practices regarding psychosocial issues. The survey included patient vignettes at good, moderate and poor prognosis levels, and questions regarding attitudes toward patient care, typical and ideal services, and expectation for impact. A substantial proportion of both oncologists (37.5%) and nurses (47.5%) identified themselves as primarily responsible for addressing spiritual distress in their setting. However, over 85% of both MDs and RNs felt that ideally a chaplain should address such issues. Working in an inpatient setting predicted that nurses, but not doctors, would confer with chaplains. When ranking spiritual distress as important to address in comparison to 17 other issues, only 11.8% of MDs and 8.5% of RNs ranked it in the top three for the poor prognosis vignette, with yet lower values with better prognoses. For the poor prognosis, younger MDs were more likely to address spirituality (r=-0.26) and were also more likely to address anxiety or depression (r=0.25) and family distress (r=0.20). For RNs, no such relationships appeared. Perceived impact was also a predictor of whether spirituality issues were addressed. These results suggest that spiritual distress experienced by cancer patients may be under-addressed due to time constraints, lack of confidence in effectiveness, and role uncertainty.
Copyright 1999 John Wiley & Sons, Ltd.