Spiritual care is an aspect of palliative care that is the focal point to healing. According to the Annals of Internal Medicine (2000; 132:578-583), clinical studies are clarifying how spirituality and religion can contribute to the coping strategies of many patients with severe, chronic, and terminal conditions. When patients feel that their spiritual needs are neglected in standard clinical environments, many of them can be driven away from effective medical treatments. More attention to patient spirituality in the clinical context of standard medical care could attract more patients to proven interventions. A patient's anxiety and hope can be factors in illness outcomes.
Spirituality pertains to the ultimate meaning and purpose in life. There are two clinically significant points to consider in understanding a dying patient's spirituality: (1) Patients are very often concerned directly with the relationship of their immediate suffering and debilitation versus their relationships, existential purpose, morals and value system. (2) Their resolution involves faith in a higher being in the universe. This faith is a source of comfort, hope and reassurance.
Having a pastoral care worker available as part of the palliative care team allows for the full integration of spirituality in the overall care plan. The pastoral worker on the palliative care team will be able to:
- Listen, elicit, identify and respond to individual
- Identify and articulate the pastoral worker's
own issues around death and dying;
- Complete a spiritual assessment;
- Identify and clarify ethical issues related to
end-of-life treatment/care in relation to religious/spiritual care plan;
- Work cooperatively with healthcare professionals;
- Provide appropriate bereavement care to family,
significant others and professional staff;
- Analyze the cultural contexts in which they serve and
create ways of raising public awareness of end-of-life concerns in their
- Incorporate the religious (Koran, Torah, Bible, etc.)
perspectives on what these traditions say about death and dying;
Adapted from: Christina M. Puchalski, MD, Rev. Laurel Arthur Burton, ThD, ThM, William Aiken, Rev. Natalia Beck, BA, MA, Rabbi Zahara Davidowitz-Farkas, Rev., Norman E. Dewire, Mdiv, DD, Dmin, Iman Yusef Hassan, BCC, Michelle Jacobs, MPH, J.
Thomas Koutsoumpas, Mary Meyer, Rev. Donald Byrd Oliver, PhD. MS, Mdiv. Learning Objectives for Curriculum in End-Of-Life for Seminary Training. Acad. Med. 1998; 73: 970-974.
The Spiritual Needs Assessment
Though the interdisciplinary team members should address a patient's spirituality in their initial assessments, it is important to refer a patient and/or family to a pastoral care worker/chaplain. Pastoral care provides direct support and heightened respect for the total patient's dying experience and not just the medical aspects of care. Allowing the patient to communicate about his or her spiritual concerns, with someone outside the medical model, may provide added comfort.
Generally spiritual screening tools include the following questions:
- Do you consider yourself spiritual or religious?
- What is your faith or belief?
- What things do you believe in that give meaning to
- How important are these beliefs to you?
- Do you belong to a spiritual community?
- Do you believe in God or an afterlife?
- How might healthcare providers best address any needs in this area?
1. Puchalski C. A Spiritual History. Supportive Voice 1999;5:12-13.
2. Sulmasy D. The Healer's Calling: Spirituality for Physicians and Other Health Care Professionals: Mahway, NJ, Paulist Press, 1997.
3. Kendrick SB, A report on new medical school courses relating to religious faith and medicine. Med Encounter 1998;13:14-17.
4. Puchalski CM, Larson DB. Developing curricula in spirituality and medicine. Acad Med 1998;73:970-974.
5. JS Levin, PL Schiller. "Is There a Religious Factor in Health?" Journal of Religion and Health 1987;26(1):9-36.
6. KI. Pargament, et al., "Religious Coping Efforts as Predictors of the Outcomes to Significant Negative Life Events," American Journal of Community Psychology 1990;18(6):793-824.
7. J. W. Yates, et al., "Religion in Patients with Advanced Cancer," Medical and Pediatric Oncology, 1981, 9: pp. 121-128.
8. Daaleman TP, VandeCreek L. Placing Religion and
Spirituality in End-of-Life Care. Journal of the American Medical
Association, 2000; 284: pp 2514.
9. Post SG, Puchalski CM, & Larson DB. Physicians and
Patient Spirituality: Professional Boundaries, Competency, and Ethics.
Annals of Internal Medicine, 2000; 132: pp 578-583.
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Spirituality -Grand Rounds Call
Douglas Miller, MD, Professor of Geriatric Medicine and John Chibnall, PhD, Associate Professor of Psychiatry at St. Louis University discuss the importance of spirituality in palliative care. This is a conference call.
Supportive-Affective Groups for Patients with Life-Threatening Medical Conditions:
A Spiritual-Emotional-Relational Approach to Helping Patients
Saint Louis University School of Medicine
Departments of Internal Medicine, Community & Family Medicine, Pastoral Care and Psychiatry
A Memorial Reading
Mount Sinai Hospital
New York City
A Day to Remember: Memorial Readings
The UCSF Comfort Care Team Ceremony Selections