The Role of Spirituality in Patient-Centered Care

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1 Th Rol of Spirituality in Patint Cntrd Car 4.3 Disclosur Th Rol of Spirituality in Patint-Cntrd Car Mlissa M. Carbajal, MD Assistant Profssor Baylor Collg of Mdicin Dpartmnt of Pdiatrics Sction of Nonatology No Rlvant Financial Rlationships with any Commrcial Intrsts I hav nothing to disclos. Pag 1 xxx00.#####.ppt 9/10/2013 4:02:16 PM Goals Vido Clip Attmpt to provid a functional dfinition for Spirituality and Rligion To introduc a body of litratur highlighting th bnfits of intgratd spirituality/rligion in clinical practic To introduc a varity of Spiritual Assssmnt Tools and Spiritual History Taking Tchniqus Pag 2 Pag 3 Objctivs To hav an incras awarnss of patints spirituality and thir dsir to hav it addrssd by thir physician To bcom familiar with th currnt litratur dmonstrating th bnfits of intgrating spirituality/rligion in clinical practic To formulat a rspctful rspons to your patint s (or family s) spirituality or blif in God To idntify and ovrcom barrirs to intgrating spirituality/rligion in clinical practic To bgin using spiritual assssmnt tools in a clinical stting as a way to intgrat spirituality/rligion into your clinical practic. Why do I car? A convrsation btwn a parnt and a nonatologist Pag 4 Pag 5 1

2 Th Rol of Spirituality in Patint Cntrd Car 4.3 Why should YOU car? Gallup Poll Rport 2011 mor than 9 in 10 Amricans continu to bliv in God or a Univrsal Spirit CBS Poll in % of Amricans blivd in th haling powr of prayr 63% flt that physicians should pray with patints who rqustd it Why should YOU car? Slf-Ratd Rligious Coping* 40% us rligion as thir most important sourc of coping Whil 90% rportd rligion btwn most to modratly important sourc *Rsponss by 337 conscutivly admittd patints to Duk Hospital (Konig 1998) Pag 6 Pag 7 Why should YOU car? A national survy of strss ractions aftr th Sptmbr 11, 2001, trrorist attacks Schustr MA, Stin BD, Jaycox L, Collins RL, Marshall GN, Elliott MN, Zhou AJ, Kanous DE, Morrison JL, Brry SH. Why should YOU car? Do Patints Want Physicians to Inquir About Thir Spiritual or Rligious Blifs If Thy Bcom Gravly Ill? JW Ehman, BB Ott, TH Short, RC Ciampa, J Hansn-Flaschn NEJM 2001; 345; Pag 8 Pag 9 Lt s Ask ourslvs What did w larn? What is a physician? noun - a prson skilld in th art of haling What is Haling? vrb - to rstor to halth What is Halth? noun - th condition of bing sound in body, mind, or spirit Matrialism Only physical things truly xist Naturalism All phnomna can b xplaind in trms of natural causs and laws m Doctrin concrning th natur of a dity Th study of a dity s rlationship to th univrs A sarch for th Sacrd Pag 10 Pag 11 2

3 Th Rol of Spirituality in Patint Cntrd Car 4.3 Mdical Training Ovr th Last 30 Yars Thn Now Mdical Training Ovr th Last 30 Yars Association of Amrican Mdical Collgs Part III of th Mdical School Objctivs Projct Rport Communication in Mdicin MD = Boss Frudian Thory Marxian Thory Family Cntrd Car Cultural Comptncy Spiritual Awarnss Th ability to licit a spiritual history An undrstanding that th spiritual dimnsion of popl s livs is an avnu for compassionat car giving An undrstanding of th studnt s own spirituality and how it can b nurturd as part of thir profssional growth, promotion of thir wll bing and th basis of thir calling as a physician. Pag 12 Pag 13 Mdical Training Ovr th Last 30 Yars Mdical School and Rsidncy Toward a Prson-cntrd Mdicin: Rligious Studis in th Mdical Curriculum: 1995 Journal of Acadmic Mdicin Mdical Training Ovr th Last 30 Yars Th intnsivist in a spiritual car training program adaptd for clinicians Th Dvlopmnt of Profssionalism: Curriculum Mattrs: 2000 Journal of Acadmic Mdicin Th Rol of Spirituality in Patint Car: Incorporating Spirituality Training into Mdical School Curriculum: 2002 Journal of Acadmic Mdicin Implmnting a Mdicin Spirituality Curriculum in a Community-basd Intrnal Mdicin Rsidncy Program: 2002 Acadmic Mdicin Spirituality and Mdicin: A workshop for Mdical Studnts and Rsidnts: 2006 Journal of Gnral Intrnal Mdicin Pag 14 Pag 15 Mdical Training Ovr th Last 30 Yars Spirituality or Rligion? GW School of Mdicin and Halth Scincs Spirituality Instituts Txas Mdical Cntr Duk Univrsity School of Mdicin Spirituality Individually orintd inward xprinc Aw and wondr Mystry snsing Valu snsing Hop Rflction Purpos Sacrd Lov Rligion Community orintd outward xprinc Doctrins and Crds Rituals and Routins Larnd storis and prayrs Pag 16 Pag 17 3

4 Th Rol of Spirituality in Patint Cntrd Car 4.3 Spirituality Rligion Pag 18 Pag 19 How do w com to think about Spirituality/Rligion? Piagt s Stags of Cognitiv Dvlopmnt How do w com to think about Spirituality/Rligion? Erikson Faith Corrlats Th Snsorimotor Stag: (birth to 2 yrs) Th Proprational Stag: (2 to 6 yrs) Th Concrt Oprational Stag: (7 to 11 yrs) Th Formal Oprational Stag: (12yrs to adulthood) Joyc Eady Myrs, B. A. (2009). "CHILDREN S SPIRITUAL DEVELOPMENT" Dissrtation. Joyc Eady Myrs, B. A. (2009). "CHILDREN S SPIRITUAL DEVELOPMENT" Dissrtation. Pag 20 Pag 21 How do w com to think about Spirituality/Rligion? Fowlr s Stags of Faith How do w com to think about Spirituality/Rligion? Fowlr s Stags of Faith Spiritual Assssmnt and Car PowrPoint with th Touro Institut at th Univrsity of Minnsota Spiritual Assssmnt and Car PowrPoint with th Touro Institut at th Univrsity of Minnsota Pag 22 Pag 23 4

5 Th Rol of Spirituality in Patint Cntrd Car 4.3 How do w com to think about Spirituality/Rligion? Fowlr s Stags of Faith How do w com to think about Spirituality/Rligion? Fowlr s Stags of Faith Spiritual Assssmnt and Car PowrPoint with th Touro Institut at th Univrsity of Minnsota Spiritual Assssmnt and Car PowrPoint with th Touro Institut at th Univrsity of Minnsota Pag 24 Pag 25 How do w com to think about Spirituality/Rligion? Fowlr s Stags of Faith How do w com to think about Spirituality/Rligion? Fowlr s Stags of Faith Spiritual Assssmnt and Car PowrPoint with th Touro Institut at th Univrsity of Minnsota Spiritual Assssmnt and Car PowrPoint with th Touro Institut at th Univrsity of Minnsota Pag 26 Pag 27 How do w com to think about Spirituality/Rligion? Fowlr s Stags of Faith How do w com to think about Spirituality/Rligion? Comparing th Thoris Spiritual Assssmnt and Car PowrPoint with th Touro Institut at th Univrsity of Minnsota Joyc Eady Myrs, B. A. (2009). "CHILDREN S SPIRITUAL DEVELOPMENT" Dissrtation. Pag 28 Pag 29 5

6 Th Rol of Spirituality in Patint Cntrd Car 4.3 Christianity So in vrything, do to othrs what you would hav thm do to you, for this sums up th Law and th Prophts (Matthw 7:12). How do w com to think about Spirituality/Rligion? Th Goldn Rul Confucianism - Do not do to othrs what you would not lik yourslf. Thn thr will b no rsntmnt against you, ithr in th family or in th stat (Analcts 12:2). Buddhism -- Hurt not othrs in ways that you yourslf would find hurtful (Udana- Varga 5, 1). Hinduism -- is th sum of duty; do naught onto othrs what you would not hav thm do unto you (Mahabharata 5, 1517). Islam -- No on of you is a blivr until h dsirs for his brothr that which h dsirs for himslf (Sunnah). Judaism -- What is hatful to you, do not do to your fllowman. is th ntir Law; all th rst is commntary (Talmud, Shabbat 3id). Taoism -- Rgard your nighbor s gain as your gain, and your nighbor s loss as your own loss (Tai Shang Kan Yin P in). Could it b social support, sacrd rituals, prayr, and othr manifstations of spirituality ar significant dimnsions in faith and haling. th ability to rcogniz and mobiliz ths rsourcs on a patint s bhalf is thus a vital and largly untappd part of th physician s haling rol. Pag 30 Pag 31 Compassionat Car Christina Puchalski, MD, MS Spirituality, Rligion, and Clinical Car Danil Sulmasy, MD, PhD Compassion mans to suffr with Victor Frankl says, Man is not dstroyd by suffring; h is dstroyd by suffring without maning Why not lav spirituality to familis, clrgy, and chaplains? Patints ar frightnd by thir condition and its maning Spiritual issus may b intrfring with tratmnt Tratmnt of th whol prson PUCHALSKI (2001). BUMC Procdings 2001;14: Sulmasy, D. P. (2009). CHEST Journal 135(6): Pag 32 Pag 33 Spiritual and Rligious Componnts of Patint Car in th Nonatal Intnsiv Car Unit: Sacrd Thms in a Scular Stting Catlin, Elizabth A., Guillmin, Jann H., Thil, Mary Martha, Hammond, Shila, Wang, Marvin L., O'Donnll, Jams Rligious Struggl as a Prdictor of Mortality Knnth I. Pargamnt, PhD; Harold G. Konig, MD; Nalini Tarakshwar, MA; Jun Hahn, PhD 444 hospitalizd mdical patints followd for 2 yars Each on of th 7 statmnts was ratd on a 0-3 scal basd on agrmnt For vry 1 point incras on th rligious struggl scal (0-21), thr was a 6% INCREASE IN MORTALITY. Incrasd mortality was INDEPENDENT of physical and mntal halth Rligious Struggl Scal Wondrd whthr God had abandond m Fl punishd by God for my lack of dvotion Wondrd what I did for God to punish m Qustiond God s lov for m Wondrd whthr my church had abandond m Dcidd th Dvil mad this happn Qustiond th powr of God Catlin, E. A., t al. (2001). Journal of Prinatology 21(7): 426. Arch Intrn Md, 2001;161: Pag 34 Pag 35 6

7 Th Rol of Spirituality in Patint Cntrd Car 4.3 Rligious coping and us of intnsiv lifprolonging car nar dath in patints with advancd cancr Phlps AC, Macijwski PK, Nilsson M, Balboni TA, Wright AA, Paulk ME, Tric E, Schrag D, Ptt JR, Block SD, Prigrson HG Multi-sit prospctiv study 345 patints with advancd cancr followd to dath Intnsiv, futil lif-prolonging car was significantly mor common among thos with high lvls of rligious coping Provision of spiritual car to patints with advancd cancr: associations with mdical car and quality of lif nar dath. Balboni TA, Paulk ME, Balboni MJ, Phlps AC, Loggrs ET, Wright AA, Block SD, Lwis EF, Ptt JR, Prigrson HG. If addrssd, liklihood of rciving hospic INCREASED FIVE-FOLD Liklihood of rciving aggrssiv car nar EOL DECREASED by 72% Phlps t al, 2009, JAMA Balboni t al, 2010, J Clin Onc Pag 36 Pag 37 What is Spiritual Car? Focus on spiritual wll-bing: harmonious intrconnctdnss of mind-body-spirit--us of th JAREL spiritual wll-bing scal Taking a spiritual history/assssmnt/scrning Idntifying spiritual nds Ensuring that spiritual nds ar mt by somon Providing halthcar in a spiritual way Prayr is an important part of my lif. I bliv I hav spiritual wll-bing. As I grow oldr, I find myslf mor tolrant of othrs blifs. I find maning and purpos in my lif. I fl thr is a clos rlationship btwn my spiritual blifs and what I do. I bliv in an aftrlif. Whn I am sick, I hav lss spiritual wll-bing. I bliv in a suprm bing. I am abl to rciv and giv lov to othrs. I am satisfid with my lif. God has littl maning in my lif. I am satisfid with th way I am using my abilitis. Prayr dos not hlp m in making dcisions. I am abl to apprciat diffrncs in othrs. I am prtty wll put togthr. I prfr that othrs mak dcisions for m. I find it hard to forgiv othrs. I accpt my lif situations. Blif in a suprm bing has no part in my lif. I cannot accpt chang in my lif. I st goals for myslf. Hunglmann J, Knkl Rossi E, Klassn L, Stollnwrk R. Griatr Nurs Nov Dc;17(6): Pag 38 Pag 39 Spirituality and Mdical Practic: Using th HOPE Qustions as a Practical Tool for Spiritual Assssmnt GOWRI ANANDARAJAH, M.D., and ELLEN HIGHT, M.D., M.P.H, Brown Univrsity School of Mdicin, Providnc, Rhod Island. Evaluation of th FICA Tool for Spiritual Assssmnt Bornman T, Frrll B, Puchalski CM. F: Faith or Blifs I: Importanc and Influnc C: Community A: Addrss Anandarajah, G. and E. Hight (2001). Am Fam Physician 63(1): Bornman, T., t al. (2010). Journal of Pain and Symptom Managmnt 40(2): Pag 40 Pag 41 7

8 Th Rol of Spirituality in Patint Cntrd Car 4.3 To th doctor, th child is a typhoid patint; to th playground suprvisor, a first basman; to th tachr, a larnr of arithmtic. At tims, h may b diffrnt things to ach of ths spcialists, but too rarly h is a whol child to any of thm. Whit Hous Confrnc on Childrn and Youth, 1930 Pag 42 8