The Role of Spirituality in Patient-Centered Care

The Role of Spirituality in Patient-Centered Care Melissa M. Carbajal, MD Assistant Professor Baylor College of Medicine Department of Pediatrics Section of Neonatology

Disclosure No Relevant Financial Relationships with any Commercial Interests I have nothing to disclose. Page 1 xxx00.#####.ppt 9/10/2013 4:00:26 PM

Video Clip Page 2 xxx00.#####.ppt 9/10/2013 4:00:27 PM

Goals Attempt to provide a functional definition for Spirituality and Religion To introduce a body of literature highlighting the benefits of integrated spirituality/religion in clinical practice To introduce a variety of Spiritual Assessment Tools and Spiritual History Taking Techniques Page 3 xxx00.#####.ppt 9/10/2013 4:00:27 PM

Objectives To have an increase awareness of patients spirituality and their desire to have it addressed by their physician To become familiar with the current literature demonstrating the benefits of integrating spirituality/religion in clinical practice To formulate a respectful response to your patient s (or family s) spirituality or belief in God To identify and overcome barriers to integrating spirituality/religion in clinical practice To begin using spiritual assessment tools in a clinical setting as a way to integrate spirituality/religion into your clinical practice. Page 4 xxx00.#####.ppt 9/10/2013 4:00:28 PM

Why do I care? A conversation between a parent and a neonatologist Page 5 xxx00.#####.ppt 9/10/2013 4:00:28 PM

Why should YOU care? Gallup Poll Report 2011 more than 9 in 10 Americans continue to believe in God or a Universal Spirit CBS Poll in 2009 80% of Americans believed in the healing power of prayer 63% felt that physicians should pray with patients who requested it Page 6 xxx00.#####.ppt 9/10/2013 4:00:29 PM

Why should YOU care? Self-Rated Religious Coping* 40% use religion as their most important source of coping While 90% reported religion between most to moderately important source Religious Coping on a Scale from 1 to 10 23% 5% 27% 5% 40% Most Improtant Factor (10) Large Extent (9.9 to 7.5) Moderate to Large Extent (7.4 to 5 ) Small to Moderate (4.9 to 0.1) None (0) *Responses by 337 consecutively admitted patients to Duke Hospital (Koenig 1998) Page 7 xxx00.#####.ppt 9/10/2013 4:00:29 PM

Why should YOU care? A national survey of stress reactions after the September 11, 2001, terrorist attacks Schuster MA, Stein BD, Jaycox L, Collins RL, Marshall GN, Elliott MN, Zhou AJ, Kanouse DE, Morrison JL, Berry SH. NEJM 2001; 345;1507-1512 Page 8 xxx00.#####.ppt 9/10/2013 4:00:30 PM

Why should YOU care? Do Patients Want Physicians to Inquire About Their Spiritual or Religious Beliefs If They Become Gravely Ill? JW Ehman, BB Ott, TH Short, RC Ciampa, J Hansen-Flaschen Page 9 xxx00.#####.ppt 9/10/2013 4:00:31 PM

Let s Ask ourselves What is a physician? noun - a person skilled in the art of healing What is Healing? verb - to restore to health What is Health? noun - the condition of being sound in body, mind, or spirit Page 10 xxx00.#####.ppt 9/10/2013 4:00:31 PM

What did we learn? Materialism Only physical things truly exist Naturalism All phenomena can be explained in terms of natural causes and laws Theism Doctrine concerning the nature of a deity The study of a deity s relationship to the universe A search for the Sacred Page 11 xxx00.#####.ppt 9/10/2013 4:00:32 PM

Medical Training Over the Last 30 Years Then Now MD = Boss Family Centered Care Freudian Theory Cultural Competency Marxian Theory Spiritual Awareness Page 12 xxx00.#####.ppt 9/10/2013 4:00:32 PM

Medical Training Over the Last 30 Years Association of American Medical Colleges Part III of the Medical School Objectives Project Report Communication in Medicine The ability to elicit a spiritual history An understanding that the spiritual dimension of people s lives is an avenue for compassionate care giving An understanding of the student s own spirituality and how it can be nurtured as part of their professional growth, promotion of their well being and the basis of their calling as a physician. Page 13 xxx00.#####.ppt 9/10/2013 4:00:33 PM

Medical Training Over the Last 30 Years Medical School and Residency Toward a Person-centered Medicine: Religious Studies in the Medical Curriculum: 1995 Journal of Academic Medicine The Development of Professionalism: Curriculum Matters: 2000 Journal of Academic Medicine The Role of Spirituality in Patient Care: Incorporating Spirituality Training into Medical School Curriculum: 2002 Journal of Academic Medicine Implementing a Medicine Spirituality Curriculum in a Community-based Internal Medicine Residency Program: 2002 Academic Medicine Spirituality and Medicine: A workshop for Medical Students and Residents: 2006 Journal of General Internal Medicine Page 14 xxx00.#####.ppt 9/10/2013 4:00:33 PM

Medical Training Over the Last 30 Years The intensivist in a spiritual care training program adapted for clinicians Page 15 xxx00.#####.ppt 9/10/2013 4:00:34 PM

Medical Training Over the Last 30 Years Spirituality Institutes GW School of Medicine and Health Sciences Duke University School of Medicine Texas Medical Center Page 16 xxx00.#####.ppt 9/10/2013 4:00:34 PM

Spirituality or Religion? Spirituality Individually oriented inward experience Awe and wonder Mystery-sensing Value-sensing Hope Reflection Purpose Sacred Love Religion Community oriented outward experience Doctrines and Creeds Rituals and Routines Learned stories and prayers Page 17 xxx00.#####.ppt 9/10/2013 4:00:35 PM

Spirituality Page 18 xxx00.#####.ppt 9/10/2013 4:00:35 PM

Religion Page 19 xxx00.#####.ppt 9/10/2013 4:00:36 PM

How do we come to think about Spirituality/Religion? Piaget s Stages of Cognitive Development The Sensorimotor Stage: (birth to 2 yrs) The Preoperational Stage: (2 to 6 yrs) The Concrete Operational Stage: (7 to 11 yrs) The Formal Operational Stage: (12yrs to adulthood) Joyce Eady Myers, B. A. (2009). "CHILDREN S SPIRITUAL DEVELOPMENT" Dissertation. Page 20 xxx00.#####.ppt 9/10/2013 4:00:36 PM

How do we come to think about Spirituality/Religion? Erikson Faith Correlates Joyce Eady Myers, B. A. (2009). "CHILDREN S SPIRITUAL DEVELOPMENT" Dissertation. Page 21 xxx00.#####.ppt 9/10/2013 4:00:37 PM

How do we come to think about Spirituality/Religion? Fowler s Stages of Faith Spiritual Assessment and Care PowerPoint with the Touro Institute at the University of Minnesota Page 22 xxx00.#####.ppt 9/10/2013 4:00:38 PM

How do we come to think about Spirituality/Religion? Comparing the Theories Joyce Eady Myers, B. A. (2009). "CHILDREN S SPIRITUAL DEVELOPMENT" Dissertation. Page 29 xxx00.#####.ppt 9/10/2013 4:00:42 PM

How do we come to think about Spirituality/Religion? The Golden Rule Christianity So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets (Matthew 7:12). Confucianism - Do not do to others what you would not like yourself. Then there will be no resentment against you, either in the family or in the state (Analects 12:2). Buddhism -- Hurt not others in ways that you yourself would find hurtful (Udana- Varga 5, 1). Hinduism -- This is the sum of duty; do naught onto others what you would not have them do unto you (Mahabharata 5, 1517). Islam -- No one of you is a believer until he desires for his brother that which he desires for himself (Sunnah). Judaism -- What is hateful to you, do not do to your fellowman. This is the entire Law; all the rest is commentary (Talmud, Shabbat 3id). Taoism -- Regard your neighbor s gain as your gain, and your neighbor s loss as your own loss (Tai Shang Kan Yin P ien). Page 30 xxx00.#####.ppt 9/10/2013 4:00:42 PM

Could it be social support, sacred rituals, prayer, and other manifestations of spirituality are significant dimensions in faith and healing. the ability to recognize and mobilize these resources on a patient s behalf is thus a vital and largely untapped part of the physician s healing role. Page 31 xxx00.#####.ppt 9/10/2013 4:00:43 PM

Compassionate Care Christina Puchalski, MD, MS Compassion means to suffer with Victor Frankl says, Man is not destroyed by suffering; he is destroyed by suffering without meaning PUCHALSKI (2001). BUMC Proceedings 2001;14:352-357 Page 32 xxx00.#####.ppt 9/10/2013 4:00:43 PM

Spirituality, Religion, and Clinical Care Daniel Sulmasy, MD, PhD Why not leave spirituality to families, clergy, and chaplains? Patients are frightened by their condition and its meaning Spiritual issues may be interfering with treatment Treatment of the whole person Sulmasy, D. P. (2009). CHEST Journal 135(6): 1634-1642. Page 33 xxx00.#####.ppt 9/10/2013 4:00:44 PM

Spiritual and Religious Components of Patient Care in the Neonatal Intensive Care Unit: Sacred Themes in a Secular Setting Catlin, Elizabeth A., Guillemin, Jeanne H., Thiel, Mary Martha, Hammond, Sheila, Wang, Marvin L., O'Donnell, James Catlin, E. A., et al. (2001). Journal of Perinatology 21(7): 426. Page 34 xxx00.#####.ppt 9/10/2013 4:00:44 PM

Religious Struggle as a Predictor of Mortality Kenneth I. Pargament, PhD; Harold G. Koenig, MD; Nalini Tarakeshwar, MA; June Hahn, PhD 444 hospitalized medical patients followed for 2 years Each one of the 7 statements was rated on a 0-3 scale based on agreement Religious Struggle Scale Wondered whether God had abandoned me Feel punished by God for my lack of devotion Wondered what I did for God to punish me For every 1 point increase on the religious struggle scale (0-21), there was a 6% INCREASE IN MORTALITY. Questioned God s love for me Wondered whether my church had abandoned me Increased mortality was INDEPENDENT of physical and mental health Decided the Devil made this happen Questioned the power of God Arch Intern Med, 2001;161: 1881-1885 Page 35 xxx00.#####.ppt 9/10/2013 4:00:45 PM

Religious coping and use of intensive lifeprolonging care near death in patients with advanced cancer Phelps AC, Maciejewski PK, Nilsson M, Balboni TA, Wright AA, Paulk ME, Trice E, Schrag D, Peteet JR, Block SD, Prigerson HG Multi-site prospective study 345 patients with advanced cancer followed to death Intensive, futile life-prolonging care was significantly more common among those with high levels of religious coping Phelps et al, 2009, JAMA Page 36 xxx00.#####.ppt 9/10/2013 4:00:45 PM

Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. Balboni TA, Paulk ME, Balboni MJ, Phelps AC, Loggers ET, Wright AA, Block SD, Lewis EF, Peteet JR, Prigerson HG. If addressed, likelihood of receiving hospice INCREASED FIVE-FOLD Likelihood of receiving aggressive care near EOL DECREASED by 72% Balboni et al, 2010, J Clin Onc Page 37 xxx00.#####.ppt 9/10/2013 4:00:46 PM

What is Spiritual Care? Taking a spiritual history/assessment/screening Identifying spiritual needs Ensuring that spiritual needs are met by someone Providing healthcare in a spiritual way Page 38 xxx00.#####.ppt 9/10/2013 4:00:46 PM

Focus on spiritual well-being: harmonious interconnectedness of mind-body-spirit--use of the JAREL spiritual well-being scale Prayer is an important part of my life. I believe I have spiritual well-being. As I grow older, I find myself more tolerant of others beliefs. I find meaning and purpose in my life. I feel there is a close relationship between my spiritual beliefs and what I do. I believe in an afterlife. When I am sick, I have less spiritual well-being. I believe in a supreme being. I am able to receive and give love to others. God has little meaning in my life. I am satisfied with the way I am using my abilities. Prayer does not help me in making decisions. I am able to appreciate differences in others. I am pretty well put together. I prefer that others make decisions for me. I find it hard to forgive others. I accept my life situations. Belief in a supreme being has no part in my life. I cannot accept change in my life. I am satisfied with my life. I set goals for myself. Hungelmann J, Kenkel-Rossi E, Klassen L, Stollenwerk R. Geriatr Nurs. 1996 Nov-Dec;17(6):262-6. Page 39 xxx00.#####.ppt 9/10/2013 4:00:47 PM

Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment GOWRI ANANDARAJAH, M.D., and ELLEN HIGHT, M.D., M.P.H, Brown University School of Medicine, Providence, Rhode Island. Anandarajah, G. and E. Hight (2001). Am Fam Physician 63(1): 81-89. Page 40 xxx00.#####.ppt 9/10/2013 4:00:47 PM

Evaluation of the FICA Tool for Spiritual Assessment Borneman T, Ferrell B, Puchalski CM. F: Faith or Beliefs I: Importance and Influence C: Community A: Address Borneman, T., et al. (2010). Journal of Pain and Symptom Management 40(2): 163-173. Page 41 xxx00.#####.ppt 9/10/2013 4:00:48 PM

To the doctor, the child is a typhoid patient; to the playground supervisor, a first baseman; to the teacher, a learner of arithmetic. At times, he may be different things to each of these specialists, but too rarely he is a whole child to any of them. White House Conference on Children and Youth, 1930 Page 42 xxx00.#####.ppt 9/10/2013 4:00:48 PM