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Spirituality as an ethical challenge in Indian palliative care: A systematic review

Published online by Cambridge University Press:  29 October 2015

Joris Gielen ,
Sushma Bhatnagar  and
Santosh K. Chaturvedi
Joris Gielen*
Affiliation:
Center for Healthcare Ethics, Duquesne University, Pittsburgh, Pennsylvania
Sushma Bhatnagar
Affiliation:
Anesthesiology, Pain, and Palliative Care, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
Santosh K. Chaturvedi
Affiliation:
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
*
Address correspondence and reprint requests to: Joris Gielen, Center for Healthcare Ethics, Duquesne University, 301A Fisher Hall, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282. E-mail: gielenj@duq.edu.
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Abstract

Objective:

Spiritual care is recognized as an essential component of palliative care (PC). However, patients' experience of spirituality is heavily context dependent. In addition, Western definitions and findings regarding spirituality may not be applicable to patients of non-Western origin, such as Indian PC patients. Given the particular sociocultural, religious, and economic conditions in which PC programs in India operate, we decided to undertake a systematic review of the literature on spirituality among Indian PC patients. We intended to assess how spirituality has been interpreted and operationalized in studies of this population, to determine which dimensions of spirituality are important for patients, and to analyze its ethical implications.

Method:

In January of 2015, we searched five databases (ATLA, CINAHL, EMBASE, PsycINFO, and PubMed) using a combination of controlled and noncontrolled vocabulary. A content analysis of all selected reports was undertaken to assess the interpretation and dimensions of spirituality. Data extraction from empirical studies was done using a data-extraction sheet.

Results:

A total of 39 empirical studies (12 qualitative, 21 quantitative, and 6 mixed-methods) and 18 others (10 reviews, 4 opinion articles, and 4 case studies) were retrieved. To date, no systematic review on spirituality in Indian PC has been published. Spirituality was the main focus of only six empirical studies. The content analysis revealed three dimensions of spirituality: (1) the relational dimension, (2) the existential dimension, and (3) the values dimension. Religion is prominent in all these dimensions. Patients' experiences of spirituality are determined by the specifically Indian context, which leads to particular ethical issues.

Significance of results:

Since spiritual well-being greatly impacts quality of life, and because of the substantial presence of people of Indian origin living outside the subcontinent, the findings of our review have international relevance. Moreover, our review illustrates that spirituality can be an ethical challenge and that more ethical reflection on provision of spiritual care is needed.

Keywords

SpiritualityEthicsPalliative careIndiaReligion
Type
Review Article
Information
Palliative & Supportive Care , Volume 14 , Issue 5 , October 2016 , pp. 561 - 582
Copyright
Copyright © Cambridge University Press 2015 

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