Spiritual Care Flashcards
Role of the Chaplain in Palliative Care
- Spiritual care lead on the team (all other team members may be spiritual care ‘generalists’)
- Patients assessed for spiritual distress and provide a spiritual care history to identify who should be referred to a chaplain
Screening questions for spiritual distress
Validated tools:
1. Is religion/spirituality important to you as you cope with your illness? (Y/N)
- (If Y to question 1) How much strength/comfort do you get from your religion/spirituality right now?
- All that I need
- Somewhat less
- Much less (automatic chaplain referral)
- None at all (automatic chaplain referral) - (If N to question 1) Has there ever been a time when religion and spirituality was important to you? (Y/N)
- If Yes, automatic chaplain referral
OR:
“Are you at peace?”
- Weak evidence
Spiritual history
FICA acronym
Faith
- Do you consider yourself spiritual/religious?
- If answer is no, consider asking “What gives your life meaning?”
Importance/influence
2. What importance does your faith or belief have in your life? Have your beliefs influenced how you have coped with this illness?
Community
3. Are you part of a spiritual/religious community? Is there a group of people you really love or who are important to you? How do they support you?
Address
4. How would you like healthcare providers to address these issues?
Categories of spiritual distress
- Guilt
- Hopelessness
- Grief
- Concerns about death/afterlife
- Conflicted or challenged belief system
- Loss of faith/doubts
- Concerns about meaning/purpose in life
- Concerns about relationship with deity
- Conflict between religious beliefs and recommended treatment
- Conflict with/loss of religious community
Tasks of the chaplain
- Facilitating goals of care discussions/family meetings
- Facilitating palliative care meetings
- Facilitating communication when bad news is delivered
- Being present with family members after a death
Spirituality vs religion - definition
Spirituality
- Inclusive term, expressing what it means to be human and a connection to a transcendent domain
- Connection between one’s self, and other
- Concerned with self-directed spiritual growth
- Meaning in the context of the individual
Religion
- Organised system of faith, beliefs, worship, rituals, and relationship with a divine being
- Focussed in institutions
- Provides a discplined framework for individual spiritual growth
- Meaning in through doctrine and stories of the community
Spiritual needs at end of life
Most commonly:
- Finding meaning in life**, which gives suffering meaning and allows patients to have a sense of engaement and purpose
- Overcoming death-related fears**
- Cultivating connections to self, family, friends, and ‘Other’**
Also:
- Finding hope
- Finding spiritual resources
- Concern for family members
- Someone to ‘be there’
- Someone to ‘listen
- Someone to talk to about finding peace
- Someone to talk to about death and dying
- Experiencing love and a sense of belonging
- Spiritual practices (prayer, medication, sacraments)
- Addressing unresolved spiritual issues (may have been previously dormant prior to diagnosis)
- Maintaining healing connections with healthcare providers
- Living in the present
- Making sense of illness
Which aspects of end of life care are most important to cancer patients?
- Receiving adequate pain and symptom management
- Avoiding inappropriate prolongation of dying
- Achieving a sense of spiritual peace
- Relieving burden
- Strengthening relationships with loved ones
Implications for the role of spirituality in suffering
- Often, spirituality offers hope, peace, meaning and purpose
- Negative aspects of spirituality may exacerbate suffering (e.g. patients with enough faith will be healed, punishment by God, feelings of abandonment) and may lead to despair, disillusionment, meaninglessness, and pain
How might spiritual beliefs influence medical care decisions?
- Spiritual or religions beliefs can be cited as reasons for refusing ‘inappropriate’ medical treatments or for demanding medical interventions
- May result in moral distress for care providers who want to be respectful of faith, but also may recognise the importance of differentiating between hope and denial
Recommendations:
- Clinicians should approach such decisions with curiosity and non-judgment in order to understand the reasons behind patient beliefs/decisions
What constitutes spiritual care?
- Fundamental spiritual and existential issues of belief, connection, wholeness, meaning, and purpose
Spiritual pain - definition
- Experience of an individual disconnected and alienated from deepest and most fundamental aspects of him or herself
- May be compounded by physical pain, either as an exacerbating factor or as the underlying source of spiritual pain
Should spiritual care be offered to atheists
- Spirituality may be understood as relating to human meaning and relationships and is often acceptable to atheists
- Spiritual care may be offered through a secular language
What healthcare provider qualities promote healing in the spiritual contex?
- Compassion (sitting versus standing at bedside, inquiring about family and relationships, knocking before entering)
- Caring
- Authenticity
- Unconditional positive regard
- Empathy
- Presence
- Intuitive listening (active listening for areas of meaning and purpose as a relational practice)
What healthcare provider qualities can hinder healing
- Disregard
- Apathy
- Emotional detachment
- Judgement
