Enhancing Palliative Care Clinicians' Skills for Discussing Spirituality in Serious Illness

• Published in: Journal of pain and symptom management Vol. 63; no. 4; p. 628
• Main Author: Lally, Kate
• Format: Journal Article
• Language: English
• Published: Madison Elsevier Limited 01-04-2022
• Subjects: Care plans; Chaplains; Clergy; Clinical decision making; Communication; Curricula; Decision making; Drugs; Emotions; God; Health care; Helping behavior; Holidays & special occasions; Interdisciplinary aspects; Karma; Medical referrals; Medical screening; Modesty; News; Nutrition; Pain; Palliative care; Patients; Psychological distress; Religion; Spiritual well being; Spirituality; Teams
• ISSN: 0885-3924
• DOI: 10.1089/jpm.2021.0522

Background: Most people with serious illness indicate the importance and helpfulness of religion and spirituality (R/S).1–3 How can medical providers recognize patients' spiritual and religious pain? Design and Participants: This article described tips to enhance palliative care (PC) clinicians' skills while offering guidance for screening for spiritual distress (SD) and an overview of partnering with interprofessional colleagues to heal SD and ensure patients receive values-aligned spiritual care. Results: Tips include: 1) Use the communication tools you have already mastered (responding to challenging emotions, delivering bad news, providing medical care with cultural humility/sensitivity); 2) Repeatedly screen all patients for SD; 3) Many patients want you to ask about R/S, and taking an R/S history is a way to do that (FICA4); 4) Though any team member can screen for SD and uncover R/S needs and resources, chaplains are experts at doing so; 5) R/S factor into advance care planning, so clinicians should ask patients and families about the role of faith in their decision making; 6) If patients and families mention they believe in miracles, this can be used to segue into goals of care discussions (rather than seeing it as a rejection of science and medicine); 7) If patients ask if you are spiritual or religious, you can give a general statement affirming your care and your desire to hear what is important to them; 8) It is not required that you tell a patient you are making a chaplain referral; 9) Listen for key words, phrases, and themes (e.g., deferring control to God/karma) as prompts for chaplain referral; 10) Be sensitive and humble regarding domains impacted by cultural, religious, and spiritual backgrounds (e.g., nutrition, medication/treatments, modesty, ritual objects, religious garb, holy days, decision making). Commentary: Although most clinicians agree that addressing SD is a core aspect of PC, many do not feel comfortable exploring spiritual concerns with their patients. Most studies indicate that the two most common reasons clinicians are reluctant to explore spiritual concerns are lack of training and lack of time. Therefore, it is critical that PC include specific training, such as the recently developed Interprofessional Spiritual Care Education Curriculum (ISPEC), for spiritual issues. The training helps integrate spiritual care into clinical care in a time-effective manner. PC clinicians are already familiar with high-quality communication, interdisciplinary care and an inquisitive approach to understanding a patient's experience are familiar concepts. With additional training on how to assess for spiritual distress and spiritual well-being and how to work with chaplains on attending to the spiritual needs for patients, more clinicians will be able to integrate spiritual care in their practice. Bottom Line: Many PC providers feel uncomfortable asking about spiritual concerns; however, they already have many of the skills necessary to identify SD. They must hone these skills to ensure they are meeting patient needs.