Improving End of Life Cancer Outcomes Through Development and Implementation of a Spiritual Care Advocate Program

Am J Hosp Palliat Care. 2021 Dec;38(12):1441-1450. doi: 10.1177/1049909121995413. Epub 2021 Mar 5.


Background: Explored whether increased support for spiritual concerns between the healthcare team and patients through the provision of a Spiritual Care Advocate (SCA) would improve end of life outcomes in a metastatic cancer population.

Design: Newly diagnosed metastatic cancer patients were recruited at the University of Chicago Medical Center and received spiritual support from a Spiritual Care Advocate during chemotherapy treatments. The final sample consisted of 42 patients (58% of those approached) who completed the baseline survey and had known survival status.

Measurement: Patients completed pre/post surveys measuring spiritual support and palliative quality of life. Baseline measurements of religious practice and externalizing religious health beliefs were also obtained. Receipt of aggressive EOL care was derived from the electronic medical record.

Result: Median age was 61 years, with 48% Black, and predominantly male (62%). Of the 42 patients, 30 (70%) had died by the time of this analysis. Perceived spiritual support from the medical team increased in 47% of those who received non-aggressive EOL care and by 40% in those who received aggressive EOL care (p=0.012). Patient perceptions of spiritual support from the medical community increased from 27% at baseline to 63% (p=0.005) after the SCA intervention. Only 20% of recipients received aggressive treatments at end of life.

Conclusion: The SCA model improved the perceived spiritual support between the healthcare team and patients. Although limited by a small sample size, the model was also associated with an improvement in EOL patients' quality of life, spiritual wellbeing, and decreased aggressive EOL care.

Keywords: African Americans; Blacks; aggressive outcomes; end of life; health equity; healthcare disparities; palliative care; religion; spirituality.

MeSH terms

  • Death
  • Humans
  • Male
  • Middle Aged
  • Neoplasms* / therapy
  • Palliative Care
  • Quality of Life
  • Spiritual Therapies*
  • Spirituality
  • Terminal Care*