The Place of Spiritual Guidance in Palliative Care

Originally posted on October 27, 2017

"Spirituality is often used as a coping strategy, with prayer, meditation, and mindfulness among the many spiritual resources patients use to help cope with the intensity of the pain they experience."SPIRITUAL CARE: What It Means, Why It Matters in Health Care

This week, along with the rest of the country, we’re celebrating National Spiritual Care Week. As such, we’ve been reflecting on the importance of spiritual care as an integral part of quality palliative care. Although spirituality is one of the four domains of quality of life (physical, psychological, social and spiritual), and a key component of palliative care, it often receives the least attention. Placing spirituality at the bottom of the list is a disservice to palliative care patients, as study after study shows the overwhelming benefits of addressing patients’ spiritual or existential distress as seriously as one would their psychological or physical distress.

What We Mean by Spirituality

For many, spirituality may connote religion, however, that definition is too limited. In palliative care, spirituality “is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred.” (Emphasis added.) This view positions spirituality as a core element of one’s humanity, whether or not one is “religious.” One can see, then, how not only acknowledging but truly supporting a patient’s spirituality–their way to make meaning and purpose in their life–is key to the person-centered approach of palliative care and an essential element in providing quality comprehensive care.

This perspective also recognizes that spirituality plays a role for professionals as well – we derive meaning from providing quality care and being in service to others is often a key motivation for our work. Many of us work in healthcare institutions that were initially established with an explicit mission to care for the most vulnerable among us and may be tied to a particular religious or spiritual philosophy.

Benefits of Spiritual Care

The number of studies examining spirituality and wellness is overwhelming. But here are a few nuggets:

“Studies of patients’ beliefs have shown that 87 percent of patients would call spirituality important in their lives.”

“Research demonstrates that [patients] turn to their spiritual beliefs and resources in order to cope with a wide variety of diseases and experiences of hospitalization.”

“Studies show that people with relatively higher levels of spiritual distress are more likely to have pain, more likely to be depressed, be at higher suicide risk, have higher levels of clinically impactful anxiety, and have higher resting heart rates.”

“Patients who did not receive adequate spiritual support are less likely to receive a week or more in hospice, and are more likely to die receiving aggressive care in the intensive care unit (ICU).”

As champions of palliative care, we recognize the importance of whole person-centered care. Palliative care is ground zero for treating the whole patient, not just the disease. This interprofessional approach dictates that we consider the spiritual health of our patients as a priority.

Spiritual Care in the Palliative Care Setting

Palliative care is inherently interprofessional and collaborative in nature (the current NCP guidelines, recommends that palliative care teams include a physician, nurse, social worker, and chaplain so that they can best address each of the four domains of quality of life. Ideally, we work and train together so that each member of the palliative care team is comfortable identifying (and either addressing or referring to others to meet) the various needs of the patient. For example, if the social worker is meeting with the patient, and she mentions she is experiencing side effects from her medication, the social worker can offer non-medical assistance, and alert the physician or nurse about these concerns. In a similar vein, if the nurse is with a patient and sees signs that he is experiencing existential distress, the nurse can help navigate some of those issues by counseling with the chaplain or by referring to the chaplain for further follow-up.

Unfortunately, many healthcare providers are ill-prepared to recognize or address a patient’s spiritual concerns. High functioning interprofessional teams have cross-training in each of the four domains of patient quality of life so that they are poised to recognize spiritual distress and make referrals as necessary. Each member of the team needs to understand the importance and impact of spirituality as well as how they can “triage” spiritual concerns, just as they might other issues that a patient faces. Chaplains are the spiritual “specialists” on the teams and also have an important role as liaisons with community clergy.

Spiritual Care Resources

At CCCC, it’s important for us to offer education and resources that support all four domains of quality of life. Not only does that mean supporting the chaplains doing the hard work of spiritual care, but assisting the rest of the palliative care team in better understanding the importance of spiritual care. We also work to ensure that patients better what they can expect when they are receiving palliative care.

We offer a variety of resources and training materials for both the palliative care team and community faith leaders.
  1. Faith Leader Toolkits – These Toolkits were created to help community faith leaders support congregation members who are seriously ill. There are three different toolkits available to aid these leaders in helping their congregants navigate serious illness and advance care planning.
  2. CCCC Annual Summit – Our annual palliative care summit gives a unique opportunity for palliative care practitioners to hear from chaplains and other spiritual care experts, and in turn, for those spiritual leaders to hear from other practitioners.
  3. CSU Shiley Haynes Institute for Palliative Care – The CSU Shiley Haynes Institute for Palliative Care offers a range of training and courses for chaplains and faith leaders looking to increase their knowledge around supporting palliative care patients.
Spirituality is too important and too impactful to ignore. We must work together as palliative care advocates to ensure that patients get comprehensive, person-centered care that addresses all aspects of their quality of life. Thank you to all the chaplains and faith leaders out there, who work so tirelessly each day to support patients, their loved ones, and the other care providers.