By Austine Duru
Dr. Tracy Balboni, associate professor of radiation oncology at Harvard Medical School and director of the supportive palliative radiation oncology service at Dana-Faber/Brigham and Women’s Cancer Center in Boston, has been chosen as a plenary speaker for the 2014 NACC National Conference. To help introduce her to our members and readership, we would like to highlight some of her research work.
Her primary research interests include the intersection of oncology, palliative care, and the role of religion and spirituality in the experience of serious illness. Below is a brief presentation of three of her works (in collaboration with other investigators) that seek to forge new partnerships and improved dialogue between academic theology, religious communities, and the field of medicine. Open access links are provided for further reading.
Balboni, T., Balboni, M., Paulk, M. E., Phelps, A., Wright, A., Peteet, J., … & Prigerson, H. (2011). Support of cancer patients’ spiritual needs and associations with medical care costs at the end of life. Cancer, 117(23), 5383-5391.
We featured this article in the last edition of Vision Research Abstract on palliative care, but it is worth repeating here with new insight into the authors’ body of work on this topic and the rationale for the research. The cost of health care is known to skyrocket towards the end of life, due in part to aggressive treatment and use of the intensive care facilities. In this prospective, multisite study, Tracy Balboni and her colleagues investigate whether the infrequency of spiritual care at the EOL affects the cost of medical care. The study followed 339 advanced cancer patients from an outpatient center between 2002 and 2007. Spiritual care was measured by patients’ reports on how well the healthcare team met their spiritual needs. The results suggest, “Cancer patients reporting that their spiritual needs are not well supported by the healthcare team have higher EOL costs, particularly among minorities and higher religious coping patients.” The authors leave the readers with the following questions: Is the lack of spiritual care by the healthcare team associated with medical care costs at EOL? And given higher rates of aggressive EOL care among racial/ethnic minorities and high religious coping patients, is insufficient attention to spiritual needs associated with greater EOL costs among these at-risk patient groups? Given these statistics, the authors “hypothesized that patients whose spiritual needs are not well supported by the healthcare team would have increased EOL medical care costs, and that cost implications would be greatest among racial/ethnic minorities and high religious coping patients.” To read more, click here.
Vallurupalli, M., Lauderdale, K., Balboni, M. J., Phelps, A. C., Block, S. D., Ng, A. K., … & Balboni, T. A. (2012). The role of spirituality and religious coping in the quality of life of patients with advanced cancer receiving palliative radiation therapy. The journal of supportive oncology, 10(2), 81-87.
Research in religion, spirituality and science has long established the importance of religion/spirituality in the trajectory of illness and disease process and how individuals harness this resource to cope with their illness or new diagnosis. In palliative oncology, however, it appears that the relevance of religion and/or spirituality of the patient as a significant resource for coping is not yet fully appreciated. This study by Tracy Balboni and colleagues looks at three variables of religiousness, spirituality, and religious coping to see how these affect the quality-of-life outcomes, and assesses how patients perceive spiritual care in the oncology setting. This cross-sectional study surveyed 69 advanced cancer patients who were receiving palliative radiation therapy across multiple sites. Multivariable models assessed the relationship of spirituality and R/S coping to patient’s QOL. The authors conclude, in spite of the limitations, that “Patients receiving palliative RT rely on R/S beliefs to cope with advanced cancer. Furthermore, spirituality and religious coping are contributors to better QOL.” These findings underscore the relevance of spirituality in oncology care. It also has significant implications for the training of physicians and nurses on how to provide appropriate spiritual care interventions. To read more, click here.
Balboni, T. A., Balboni, M., Enzinger, A. C., Gallivan, K., Paulk, M. E., Wright, A., Steinhauser, K., VanderWeele, T. J. and Prigerson, H. G. (2013). Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. JAMA Internal Medicine, 173(12), 1109-1117.
This research article has generated significant media attention since its publication. However, as always, some of the media spin does not do justice to the broader view and significance of this research work. Tracy Balboni and her team of investigators wanted to look at the influence of clergy and religious communities and “to determine where spiritual support from religious communities influences terminally ill patients’ medical care and quality of life near death.” The findings were astonishing, and the results were intriguing, with significant implications for the training of chaplains, medical students, nursing students and other clinical staff members. It also has important significance for community clergy, associations and for-profit healthcare facilities where spiritual care may not be high on the list of their patients’ needs. John Ehman, ACPE Research Network convener, presents a robust and elaborate summary of Balboni’s article in the May 2013 Article of the Month for the ACPE Research Network. To read the summary, click here. To read the entire article, click here.
For a list of the significant research work done by Tracy A. Balboni and Michael Balboni in collaboration with other researchers click here.
Austine Duru, BCC, is director of mission and pastoral care at St. Elizabeth Regional Medical Center and Nebraska Heart Health in Lincoln, NE.