Human Development Index and its association with staff spiritual care provision: a Middle Eastern oncology study

Gil Bar-Sela*, Michael J. Schultz, Karima Elshamy, Maryam Rassouli, Eran Ben-Arye, Myrna Doumit, Nahla Gafer, Alaa Albashayreh, Ibtisam Ghrayeb, Ibrahim Turker, Gulcin Ozalp, Sultan Kav, Rasha Fahmi, Sophia Nestoros, Hasanein Ghali, Layth Mula-Hussain, Ilana Shazar, Rana Obeidat, Rehana Punjwani, Mohamad KhleifGulbeyaz Can, Gonca Tuncel, Haris Charalambous, Safa Faraj, Neophyta Keoppi, Mazin Al-Jadiry, Sergey Postovsky, Ma’an Al-Omari, Samaher Razzaq, Hani Ayyash, Khaled Khader, Rejin Kebudi, Suha Omran, Osaid Rasheed, Mohammed Qadire, Ahmet Ozet, Michael Silbermann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background: Although staff spiritual care provision plays a key role in patient-centered care, there is insufficient information on international variance in attitudes toward spiritual care and its actual provision. Methods: A cross-sectional survey of the attitudes of Middle Eastern oncology physicians and nurses toward eight examples of staff provision of spiritual care: two questionnaire items concerned prayer, while six items related to applied information gathering, such as spiritual history taking, referrals, and encouraging patients in their spirituality. In addition, respondents reported on spiritual care provision for their last three advanced cancer patients. Results: Seven hundred seventy responses were received from 14 countries (25% from countries with very high Human Development Index (HDI), 41% high, 29% medium, 5% low). Over 63% of respondents positively viewed the six applied information gathering items, while significantly more, over 76%, did so among respondents from very high HDI countries (p value range, p < 0.001 to p = 0.01). Even though only 42–45% overall were positively inclined toward praying with patients, respondents in lower HDI countries expressed more positive views (p < 0.001). In interaction analysis, HDI proved to be the single strongest factor associated with five of eight spiritual care examples (p < 0.001 for all). Significantly, the Middle Eastern respondents in our study actually provided actual spiritual care to 47% of their most recent advanced cancer patients, compared to only 27% in a parallel American study, with the key difference identified being HDI. Conclusions: A country’s development level is a key factor influencing attitudes toward spiritual care and its actual provision. Respondents from lower ranking HDI countries proved relatively more likely to provide spiritual care and to have positive attitudes toward praying with patients. In contrast, respondents from countries with higher HDI levels had relatively more positive attitudes toward spiritual care interventions that involved gathering information applicable to patient care.

Original languageEnglish
Pages (from-to)3601-3610
Number of pages10
JournalSupportive Care in Cancer
Issue number9
Publication statusPublished - Sept 1 2019


  • Human Development Index
  • Middle East
  • Oncology
  • Palliative care
  • Prayer
  • Spiritual care

ASJC Scopus subject areas

  • Oncology


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