Table 2.
Summary of included studies.
| Author (Year) | Country | Period | Sample | Design | Intervention vs. Comparator | Trigger Variable | (NIH Quality Tool) |
|---|---|---|---|---|---|---|---|
| Soto-Rubio A, et al. (2020) [22] |
Spain | Not provided | 60 patients of legal age with advanced or terminal illness and who are cognitively well. | Randomised controlled trial | Patients with standard care versus those provided with the Kibo interview. | Transpersonal spirituality and resilience improved, and demoralisation decreased. The opposite happened in the control group. | 12/14 |
| Van der Geer J, et al. (2016) [23] |
Netherlands | 13 months | 85 patients receiving palliative care with a life expectancy of more than 12 months. | Quasi-experimental study | Training provided by chaplains to health personnel. Indicators are observed 1 month after and before the intervention. | There is a significant effect (p = 0.008) in the health professionals’ attention to patients’ spiritual and existential needs and in favour of patients’ sleep (p = 0.020). | 10/12 |
| Rogers J, et al. (2017) [24] |
United States | 6 months | 150 patients with advanced heart failure and a high risk of 6-month mortality. | Prospective clinical trial | Usual care or usual care+ multidimensional palliative care intervention (UC+PAL)) | Depression improved in UC+PAL patients (p = 0.020), with similar results for anxiety (p = 0.048). Spiritual well-being also improved. | 10/14 |
| Sun XH, et al. (2021) [25] |
China | Not provided | 100 patients over 18 years of age with a histological or cytological diagnosis of a stage III or IV malignant tumour with tumour node metastasis. | Randomised cluster clinical trial. | Current routine care (control group) versus advanced cancer spiritual care intervention in addition to routine care (experimental group) | The overall spiritual health score of the experimental group was higher. The proportion of patients without anxiety was significantly higher (95.45% vs. 60.98%). The proportion of non-depressed patients and quality of life was also higher. |
11/14 |
| Grudzen CR, et al. (2016) [26] |
United States | 12 weeks | 136 patients with known advanced cancer admitted to or observed in hospital. | Single-blind randomised clinical trial | ED-initiated palliative care consultation for advanced cancer patients versus usual care. | Quality of life was higher in the intervention group. Survival estimates were longer, although there was no statistical significance. There were also no differences in depression, ICU admission and discharge to hospice. | 13/14 |
| Kwam C, et al. (2019) [27] |
Hong Kong | Not provided | 109 patients of legal age with a life expectancy of not less than one month | Mixed methods study (randomised controlled trial and qualitative evaluation) | Usual care versus short-term life review intervention | The intervention group showed an improvement in spiritual well-being. Depression and anxiety also improved, although not significantly. | 13/14 |
| Kruizinga R, et al. (2019) [28] |
Netherlands | 2014–2016 (20 months) |
153 patients over 18 years of age with a life expectancy of more than 6 months. | Randomised controlled trial | Usual care versus intervention with a spiritual advisor | There are no significant changes in quality of life and well-being between groups. Quality of life was associated with peace (β = 0.52) and life satisfaction (β = 0.61). |
11/14 |
| Wentlandt K, et al. (2012) [29] |
Canada | 4 months | 469 patients with stage IV gastrointestinal, genitourinary, breast or gynaecological cancer or stage III/IV lung cancer; and a clinical prognosis of 6 months to 2 years. | Randomised cluster clinical trial | Early intervention of the palliative care team versus routine cancer care. | 31% report worrying about their family members, 27% feel a burden. 20% reported financial stress and 16% were afraid of dying. Better preparation at the end of life was associated with better doctor–patient communication; there were also associations with older age of the patient, living alone. |
13/14 |
| Sun V, et al. (2015) [30] |
United States | 12 weeks | 475 non-small cell lung cancer patients scheduled for treatment and 354 family caregivers | Quasi-experimental prospective study | Usual care versus palliative care. | The palliative care group scored best for meaning and peace, and harmony. | 11/12 |
| Sturm I, et al. (2014) [31] |
Germany | 5 weeks | 40 patients of legal age and who are fatigued in active cancer treatment | Randomised controlled clinical trial | Advice versus advice and dance classes | The intervention group (dance) improved fatigue (36% reduction). Quality of life was also improved: emotional and social functioning scales and physical performance (p < 0.05). | 8/14 |
| Warth M, et al. (2021) [32] |
Germany | Not provided | 104 patients receiving palliative treatment, over the age of majority and with a life expectancy of less than 12 months. | Multicentre randomised controlled trial | Music therapy and usual care versus relaxation and usual care. | No significant differences in the primary outcome of psychological quality of life. Spiritual well-being was higher in music therapy (p = 0.04) and ego integrity (p < 0.01), as well as lower distress (p = 0.05). |
13/14 |
| Britt HR, et al. (2019) [33] |
United States | 30 months | 903 patients receiving palliative care with a life expectancy of more than 3 years | Quasi-experimental intervention study | Patients who have usual care (UC) versus those who have LifeCourse (LC). | LC patients show greater improvement in communication and attention than the UC group (p = 0.016). Caregivers of UC patients show greater anxiety and depression. | 11/12 |
| Nguyen HQ, et al. (2018) [34] |
United States | 3 months | 202 patients of legal age with non-small cell lung cancer and 122 FCG (family caregivers). | Quasi-experimental study | Patients with usual care versus palliative care | Patients improved physical, emotional and functional well-being after palliative care (p < 0.01). Caregivers improved quality of life (p = 0.05), spiritual well-being (p = 0.03) and caregiving preparation (p = 0.04). | 11/12 |
| Kozáková R, et al. (2020) [35] |
Czech Republic | 3 months | 291 participants of legal age (151 with progressive neurological disease and 140 family carers). | Randomised controlled trial study design | Standard care (control group) versus multidisciplinary palliative team consultations (intervention group) | Differences in symptom burden (p < 0.001), emotional burden (p < 0.001), social functioning (p = 0.046), spiritual area (non-religious) and quality of life, also in family members. | 11/14 |
| Weru J, et al. (2020) [36] |
Kenya | 6 weeks | 126 adults aged 18–65 with advanced cancers. | Randomised control trial | Dignity therapy versus usual therapy | The dignity therapy group showed no statistical improvement in quality of life. It did show a trend towards anxiety (p = 0.059) and improvement in appetite, reduction in anxiety and improvement in well-being were observed. | 12/14 |
| Rudilla D, et al. (2017) [37] |
Spain | 2 months | 30 patients with advanced or terminal illness and who show an interest in dignity therapy. | Quasi-experimental design. | Dignity therapy versus counselling | The counselling group improved in distress, quality of life and two of the dignity dimensions (existential and dependency distress). The results of the dignity group were similar, except for anxiety, which did not improve after the intervention. There were no significant differences between the two therapies. |
11/12 |
| Zaki-Nejad M, et al. (2020) [38] |
Iran | 2017–2018 | 50 patients diagnosed with stage III or IV cancer, who are aware of their disease. Older than 18 years of age and without cognitive impairment or mental illness. | Quasi-experimentalstudy | Patients with usual care versus patients with dignity therapy. | Dignity therapy improved quality of life (p = 0.001), nausea and vomiting (p = 0.02), insomnia (p < 0.001), appetite (p = 0.02), constipation (p < 0.001), physical and emotional functioning. | 11/12 |
| Keall RM, et al. (2013) [39] |
Australia | Not provided | 10 patients with a life-threatening disease, with a life expectancy of less than 2 years. | Mixed methods study (thematic analysis of audiotaped session pre-and post-intervention) | Nurse-facilitated life preparation and end-of-life intervention. | 8 out of 10 patients found it useful. 7 patients reflected on their life. 9 patients would recommend it. | 13/14 |
| Ferrell B, et al. (2015) [40] |
Not provided | 2011–2014 | 491 palliative care patients. | Quasi-experimental prospective study | Patients with usual care versus patients with interdisciplinary and supportive care | The intervention group improved quality of life (109.1 versus 101.4; p < 0.001), symptomatology (25.8 versus 23.9; p < 0.001), and spiritual well-being (38.1 versus 36.2; p = 0.001). In addition, less psychological distress was found (2.2 versus 3.3; p < 0.001). | 11/12 |
| Zimmermann C, et al. (2014) [41] |
Canada | 4 months | 461 patients of legal age, with advanced cancer, a European Cooperative Oncology Group performance status of 0 to 2 and a clinical prognosis of 6 to 24 months. | Randomised cluster-controlled trial. | Standard patient care versus early comprehensive palliative care and multidisciplinary assessment of distress and support. | The intervention group did not improve quality of life, as measured by the FACIT-Sp scale at 3 months, although it did improve according to the QUAL-E scale. Satisfaction with care also improved. At 4 months, there were significant changes except in CARES-MIS. |
12/14 |
| Lowther K, et al. (2015) [42] |
Kenya | 4 months | 120 patients taking antiretroviral drugs with pain | Randomised controlled trial | Patients with usual care versus palliative care patients. | The intervention had no significant effect on pain (p = 0.95). However, there was an improvement in the intervention group for the mental health dimension. | 11/14 |
| Lim MA, et al. (2021) [43] |
Malaysia | 2 months | 60 patients of legal age in palliative care, with overall distress score ≥ 4/10 (according to distress pictogram). | Randomised controlled trial | Regular meditation (control) versus 5-min love mindfulness (intervention) | Significant improvements in overall and total distress score and spiritual quality of life. Worry, anger, non-acceptance and emptiness also improved. | 13/14 |
| Vermandere M, et al. (2015) [44] |
Belgium | 6 weeks | 99 patients with progressive, potentially life-threatening disease. | Randomised controlled trial | Usual care versus structured spiritual history. Both of them at home. | There was no significant change. No demonstrable effect on SWB, quality of life, patient-provider trust or pain. | 8/14 |
| Breitbart W, et al. (2018) [45] |
United States | 4 months | 321 patients with stage IV solid tumour cancer and at least moderate distress and who are of legal age. | Randomised controlled trial | Patients with individual meaning centred psychotherapy (IMCP) versus those with supportive psychotherapy (SP) versus enhanced usual care | The effect of IMCP was significantly larger than the effect of SP for quality of life and sense of meaning, but not for the rest of the variables. IMCP would result in significantly greater improvements than the other two. | 11/14 |