# Hope and Acceptance at the End of Life: Impact of Spirituality on Patients in Palliative Care

## TL;DR

This study explores how spirituality influences hope and acceptance in palliative care patients, finding that support from a community team improves emotional well-being.

## Contribution

The study introduces a community-based palliative care model that demonstrates improved hope and acceptance through spiritual and emotional support.

## Key findings

- Patients receiving community-based palliative care showed significant improvement in hope (p = 0.03).
- Qualitative feedback indicated increased acceptance and positive emotions after 14 days of follow-up.
- Hope levels in the intervention group reached similar levels to the control group despite functional decline.

## Abstract

Introduction: Palliative care aims to improve the quality of life of patients with serious illnesses. In this type of care, spirituality is placed alongside other dimensions: physical, psychological, and social. The end of life brings confrontation with dilemmas such as "none of this makes sense" or "was it worth it?" The acceptance or rejection of the journey presents spirituality as a dimension that accompanies the person in their existence. Interventions that allow for a review of life help facilitate reflection on regrets, unresolved issues, and an understanding of the legacy that generates comfort and dignity. The objective of this research was to evaluate the evolution of hope and acceptance among patients visited by the Palliative Care Community Support Team from Baixo Mondego (PCCST-BM) in Portugal.

Materials and methods: A prospective, controlled, non-blind, longitudinal research study with an intervention, featuring pre- and post-evaluation. The intervention group (IG) corresponded to patients referred to the PCCST-BM, and the control group (CG) corresponded to selected users registered at the Nautilus Family Health Unit (FHU-N) or the Coimbra Centro Family Health Unit (FHU-CC), with severe pathology, comorbidities, and a reserved prognosis. PCCST-BM patients could not have had previous contact with palliative care or have been the subject of prior home visits. In the IG, the questionnaire was administered twice: during the first home visit and the second time after 14 days. In the CG, the questionnaire was administered only once. The questionnaire included sociodemographic and clinical data, the Herth Hope Index scale - Portuguese version (HHI-PT), and open-ended questions. Descriptive and inferential quantitative and qualitative analyses were performed.

Results: Each group consisted of 10 patients, for a total of 20. The results showed a significant improvement in hope among patients in the IG (p = 0.03). The average hope between home visits also increased, reaching values similar to the CG on the second visit, despite functional decline. In the qualitative assessment, patients in the IG reported greater acceptance and positive feelings after fourteen days.

Discussion and conclusion: The follow-up carried out by the team showed improvement in hope and acceptance, with results similar to those of a specific home-based intervention study conducted in Portugal, suggesting that this approach is helpful in this context. The small sample size due to the exclusion of patients with clinical deterioration and the variable number of home visits were relevant biases. The existence of only a few studies in this area highlights the importance of further research with larger samples and other tools.