Spirituality and Quality of Life in HIV/AIDS Patients

Introduction

Recent trends in medical treatment place increasing emphasis on the connection between healing of the body and healing of the mind. This is especially true for diseases with life-limiting characteristics, such as HIV/AIDS. As a result, scholarly literature examining the necessity and effects of spirituality and religion on the quality of life of these patients is beginning to emerge. This topic was chosen out of a belief that spirituality and attention to the mental needs of the patient are an important part of the healing process, and a desire to improve techniques of patient care. This literature review explores the state of the topic in relation to the healthcare outcomes of HIV/AIDS patients by summarizing and analyzing relevant scholarly research.

The topic of spirituality and religion and its role in patient care is just beginning to appear in journal articles. The earliest articles were primarily concerned with how the mental state of the patient affects clinical outcomes. More recent trends in scholarly research reveal a shift toward studying and defining quality of life for HIV/AIDS patients. Much of the current research focuses on defining the meaning of spirituality and determining how it can be applied to the healthcare profession in an unbiased way. Research is beginning to emerge that highlights the importance of spiritual issues as an integral part of nursing care, with the goal of improving quality of life for patients with terminal illnesses.

Defining Spirituality in Clinical Research

The first set of research studies attempts to define research methods and develop an operational definition of spirituality that can be used for research into the care of HIV/AIDS patients. This is an important step for future inquiry in the field. Many of these studies employed qualitative and comparative methods, a choice well suited to subject matter that resists purely numerical measurement. Qualitative methods provided the flexibility needed to explore meanings that extend beyond anticipated outcomes.

Spirituality represents an important aspect of life for persons with potentially life-shortening illnesses such as HIV/AIDS. Using content analysis, responses from both HIV-positive individuals and healthy adults were compared. The sample consisted of three groups — two test groups and one control group. Content analysis of the responses revealed six emergent themes: spiritual belief in God, spirituality as a source of help, spirituality as a source of strength, spirituality expressed through actions such as prayer or meditation, God as present and giving, and spirituality as one's essence or center (Tuck & Thinganjana, 2007). Various definitions of spirituality emerged across the groups, underscoring the need for qualitative approaches when studying this construct.

An exploration of demographic factors and their relationship to the importance placed on religious and spiritual matters among HIV patients found that religion and spirituality were important issues to a majority of participants (Lorenz, Hays, & Shapiro et al., 2005). Certain demographic groups reported a higher degree of importance — for example, those over 45 years of age and those with higher educational levels. This longitudinal study used a quantitative survey approach. The results directly addressed the study's hypothesis and goals, and the study demonstrated excellent external validity due to its large and demographically diverse sample.

Exploring spirituality in the healthcare profession presents numerous challenges. Care must be taken to ensure that bias toward any particular religious viewpoint does not compromise a study's integrity. Power (2006) evaluated a range of spiritual assessment tools used in healthcare settings using a comparative approach, presenting findings in a subjective format. While the study offered a well-reasoned critical assessment of existing research methods, it did not provide conclusive evidence as to which method is best suited for studying spiritual issues in healthcare. Nevertheless, it made a key contribution by establishing guidelines for the development and use of spiritual assessment measures in clinical practice, and by identifying the caveats that must be considered when applying these tools.

Effects of Spirituality and Mind-Body Techniques on Quality of Life

The next set of research studies explored the effects of spirituality and religion on patient outcomes. The first study examined clinical outcomes directly; subsequent studies focused on mental and perceived well-being. Because the primary goal was to measure improvement in ways applicable to daily patient care, many of the studies in this group used quantitative methods. However, quality of life and spirituality are inherently subjective and can be difficult to operationalize for empirical research — a key shortcoming identified across this cluster of studies. Future research should take care to define ambiguous terms precisely.

Relaxation techniques combined with acupuncture have been used to improve quality of life for HIV/AIDS patients. In a randomized quantitative pilot study using a quality-of-life scale, HIV/AIDS patients in the intervention group demonstrated improved scores compared with a control group (Chang, Boehmer, & Zhao et al., 2007). The sample consisted of HIV/AIDS patients receiving acupuncture at a clinic; the control group listened to soft music while the intervention group listened to instructional relaxation recordings. The intervention group showed linear improvement over the course of the study and reported a better quality of life. The authors conclude that relaxation recordings may be added to acupuncture sessions to improve quality of life and the spiritual and mental health of patients. As a pilot trial, the study's external validity would benefit from a larger sample size in future replications.

A larger and more representative study conducted by Szaflarski, Ritchey, & Leonard et al. (2006) found that spirituality and religion were associated — both directly and indirectly — with patients' perception that their lives had improved as a result of their faith. This study reinforced the body of research suggesting that spirituality and religion are important components of quality-of-life perception in HIV/AIDS patients. Additional support came from a similar study using a comparable sample and data collection method, which found that spirituality and religion have a positive effect on patients' outlook and their perception of a higher quality of life (Cotton, Puchalski, & Sherman et al., 2006).

A cross-sectional survey was used to explore the connection between quality of life and spirituality among HIV-positive patients in a clinical setting (Grimsley, 2006). The author used a sample of 101 participants — determined to be sufficient relative to the clinic's population — and administered a 10-item survey of spiritual behaviors and beliefs using Likert-scale responses. Statistical measures confirmed a high degree of reliability, making this study a meaningful contribution to the field.

Conclusion

Research into the effects of spirituality on the quality of life and clinical outcomes of HIV/AIDS patients is a relatively new area of inquiry. As such, significant research gaps remain, and many questions have yet to be answered. The overarching goal of this field is to translate the knowledge gained into practical guidance for nurses and all others responsible for the care of HIV/AIDS patients. The studies reviewed here represent important early steps in that process.

The body of literature examined in this review suggests that attention to spirituality and religion plays an important role in improving quality of life for HIV/AIDS patients. Perhaps the most significant finding was that, while spiritual needs are demonstrably important to patient outcomes, patients reported that nurses were often unable to meet those needs due to the demands and pace of clinical environments. This gap between patient need and care capacity represents a pressing area requiring further clinical attention. There is a clear and understandable imperative among researchers to find practical ways of integrating spiritual care knowledge into the daily routines of those who care for individuals with HIV/AIDS — with the ultimate goal of improving patient outcomes through a more holistic model of care.

References

Chang, B., Boehmer, U., & Zhao, Y. et al. (2007). The combined effect of relaxation response and acupuncture on quality of life in patients with HIV: A pilot study. The Journal of Alternative and Complementary Medicine, 13(8), 807–815.

Cotton, S., Puchalski, C., & Sherman, S. et al. (2006). Spirituality and religion in patients with HIV/AIDS. Journal of General Internal Medicine, S5–S13.

Grimsley, L. (2006). Spirituality and quality of life in HIV-positive persons. Journal of Cultural Diversity, 13(2), 113–118.

Hermann, C. (2007). The degree to which spiritual needs of patients near the end of life are met. Oncology Nursing Forum, 34(1), 70–78.

Leeuwen, L., Tiesinga, L., & Post, D. et al. (2006). Spiritual care: Implications for nurses' professional responsibility. The Authors Journal Compilation. Blackwell Publishing, 875–884. doi:10.1111/j.1365-2702.2006.01615.x

Lorenz, K., Hays, R., & Shapiro, M. et al. (2005). Religiousness and spirituality among HIV-infected Americans. Journal of Palliative Medicine, 8(4), 774–781.

Power, J. (2006). Spiritual assessment: Developing an assessment tool. Nursing Older People, 18(2), 16–18.

Szaflarski, M., Ritchey, P., & Leonard, A. et al. (2006). Modeling the effects of spirituality/religion on patients' perceptions of living with HIV/AIDS. Journal of General Internal Medicine, 528–538.

Tuck, I., & Thinganjana, W. (2007). An exploration of the meaning of spirituality voiced by persons living with HIV disease and healthy adults. Issues in Mental Health Nursing.