Andrew Taylor Still, MD, DO, included in his founding postulates of osteopathy the concept that a patient's health includes the health of a patient's spirit. In the recent past, medicine as a whole, and osteopathic medicine specifically, has neglected this postulate. Recent research has confirmed the validity of Still's postulate, and many medical training institutions have received grants and established programs to incorporate spirituality into their curriculum. As with any patient evaluation, the history and physical examination is the starting platform. This article describes several tools that can be easily incorporated into the history and physical examination, along with some of the obstacles in evaluating the health of the patient's spirit. (+info)
General practitioners and their possible role in providing spiritual care: a qualitative study.
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We interviewed the general practitioners (GPs) of 40 patients with life-threatening illnesses over the course of the last year of life. We asked them to identify their patients' holistic needs, and to discuss whether they considered that they had a role in providing 'spiritual care'. The GPs varied greatly in their understanding of their patients' experiences and needs. Most said that they had a role in providing spiritual care, but hesitated to raise spiritual issues with patients, mentioning lack of time, a feeling that they should wait for a cue, or being unprepared or unskilled. (+info)
Addressing spiritual concerns in family medicine: a team approach.
(3/28)
Spiritual conflicts and concerns often accompany serious illness, but many family physicians are slow to recognize these concerns or unsure how to address them. The case of a patient with spinal cord injury and who later developed an astrocytoma is used to illustrate a team approach that involved a family physician, a spiritual counselor, and a psychologist. Narrative writing exercises in which the patient was encouraged to tell his own story also played a role in treatment. The case report includes the patient's own description of his experience with spirituality and spiritual counseling, as well as the perspectives of the spiritual counselor. (+info)
Privacy and patient-clergy access: perspectives of patients admitted to hospital.
(4/28)
BACKGROUND: For patients admitted to hospital both pastoral care and privacy or confidentiality are important. Rules related to each have come into conflict recently in the US. Federal laws and other rules protect confidentiality in ways that countermand hospitals' methods for facilitating access to pastoral care. This leads to conflicts and poses an unusual type of dilemma-one of conflicting values and rights. As interests are elements necessary for establishing rights, it is important to explore patients' interests in privacy compared with their desire for attention from a cleric. AIM: To assess the willingness of patients to have their names and rooms included on a list by religion, having that information given to clergy without their consent, their sense of privacy violation if that were done and their views about patients' privacy rights. METHODS AND PARTICIPANTS: 179 patients, aged 18-92 years, admitted to hospital in an acute care setting, were interviewed and asked about their preferences for confidentiality and pastoral support. RESULTS: Most (57%) patients did not want to be listed by religion; 58% did not think hospitals should give lists to clergy without their consent and 84% welcomed a visit by their own clergy even if triggered from a hospital list. CONCLUSIONS: Values related to confidentiality or privacy and pastoral care were found to be inconsistent and more complicated than expected. Balancing the right to privacy and the value of religious support continue to present a challenge for hospitals. Patients' preferences support the importance of providing balance in a way that protects rights while offering comprehensive services. (+info)
Matters of spirituality at the end of life in the pediatric intensive care unit.
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OBJECTIVE: Our objective with this study was to identify the nature and the role of spirituality from the parents' perspective at the end of life in the PICU and to discern clinical implications. METHODS: A qualitative study based on parental responses to open-ended questions on anonymous, self-administered questionnaires was conducted at 3 PICUs in Boston, Massachusetts. Fifty-six parents whose children had died in PICUs after the withdrawal of life-sustaining therapies participated. RESULTS: Overall, spiritual/religious themes were included in the responses of 73% (41 of 56) of parents to questions about what had been most helpful to them and what advice they would offer to others at the end of life. Four explicitly spiritual/religious themes emerged: prayer, faith, access to and care from clergy, and belief in the transcendent quality of the parent-child relationship that endures beyond death. Parents also identified several implicitly spiritual/religious themes, including insight and wisdom; reliance on values; and virtues such as hope, trust, and love. CONCLUSIONS: Many parents drew on and relied on their spirituality to guide them in end-of-life decision-making, to make meaning of the loss, and to sustain them emotionally. Despite the dominance of technology and medical discourse in the ICU, many parents experienced their child's end of life as a spiritual journey. Staff members, hospital chaplains, and community clergy are encouraged to be explicit in their hospitality to parents' spirituality and religious faith, to foster a culture of acceptance and integration of spiritual perspectives, and to work collaboratively to deliver spiritual care. (+info)
Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life.
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PURPOSE: Religion and spirituality play a role in coping with illness for many cancer patients. This study examined religiousness and spiritual support in advanced cancer patients of diverse racial/ethnic backgrounds and associations with quality of life (QOL), treatment preferences, and advance care planning. METHODS: The Coping With Cancer study is a federally funded, multi-institutional investigation examining factors associated with advanced cancer patient and caregiver well-being. Patients with an advanced cancer diagnosis and failure of first-line chemotherapy were interviewed at baseline regarding religiousness, spiritual support, QOL, treatment preferences, and advance care planning. RESULTS: Most (88%) of the study population (N = 230) considered religion to be at least somewhat important. Nearly half (47%) reported that their spiritual needs were minimally or not at all supported by a religious community, and 72% reported that their spiritual needs were supported minimally or not at all by the medical system. Spiritual support by religious communities or the medical system was significantly associated with patient QOL (P = .0003). Religiousness was significantly associated with wanting all measures to extend life (odds ratio, 1.96; 95% CI, 1.08 to 3.57). CONCLUSION: Many advanced cancer patients' spiritual needs are not supported by religious communities or the medical system, and spiritual support is associated with better QOL. Religious individuals more frequently want aggressive measures to extend life. (+info)
Examining differential treatment effects for depression in racial and ethnic minority women: a qualitative systematic review.
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OBJECTIVE: To examine effectiveness of depression treatment in racial and ethnic minority women. REVIEW METHODS: INCLUSION CRITERIA: 1) the study examined treatment of depression among racial and ethnic minority women age > 17, 2) data analysis was separated by race and ethnicity, and 3) the study was conducted in the United States. Interventions considered were: psychotropic medications, psychotherapy (including cognitive-behavioral, interpersonal therapy and any type of psychotherapy adapted for minority populations) and any type of psychotherapy combined with case management or a religious focus. Individual and group psychotherapy were eligible. Each study was critically reviewed to identify treatment effectiveness specific to racial and ethnic minority women. RESULTS: Ten published studies met the inclusion criteria (racial and ethnic minority participants n = 2,136). Seven of these were randomized clinical trials, one was a retrospective cohort study, one was a case series, and the remaining one had an indeterminate study design. Participants' age ranged from 18-74 years, with a higher proportion > 40 years. Most were low income. Differences in treatment responses between African-American, Latino and white women were found. Adapted models of care, including quality improvement and collaborative care, were found to be more effective than usual care and community referral in treating depression. Although medication and psychotherapy were both effective in treating depression, low-income women generally needed case management to address other social issues. CONCLUSION: Adapted models that allow patients to select the treatment of their choice (medication or psychotherapy or a combination) while providing outreach and other supportive services (case management, childcare and transportation) appear to result in optimal clinical benefits. (+info)
Healthcare and the hospital chaplain.
(8/28)
Many chaplains and most chaplaincy programs in the United States--with encouragement from their accrediting organization, the Association for Clinical Pastoral Education (ACPE)--have begun to assume a more proactive stance toward patients, healthcare professionals, and healthcare facilities. Some chaplains and chaplaincy programs have begun to engage in activities that have ranged from initiating conversations with and perusing the medical records of patients who have not requested their services to proposing that they be permitted to do "spiritual assessments" on patients--in some instances whether these patients have been explicitly informed and have agreed to this beforehand. Moreover, many chaplains and chaplaincy programs have begun to assume that chaplains are full-fledged members of the healthcare team, complete with access to patients' medical records both to gather information and to make notations of their own. It would appear that such novel activities are being justified by a questionable set of claims and assumptions that includes: (1) the claim that chaplains have a spiritual--as opposed to purely religious--expertise that entitles them to interact with patients and/or significant others (even those who have not requested a chaplain)--presumably without in the least compromising patient autonomy or the confidentiality of the patient/healthcare professional relationship; (2) the assumption that the terms "spirituality" and "religiosity" mutually entail one another; (3) the claim that the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) mandates "spiritual assessments" (which it does not); (4) the assumption that chaplains are full-fledged members of the healthcare team; and (5) the claim that chaplains must, therefore, be permitted access to patients and patients' medical records both to gather information and to make notations of their own. We consider such claims and assumptions disquieting, and suggest that it is high time we revisit the terms "chaplaincy," "healthcare professional," and "member of the healthcare team" in reassessing what our professional commitments to respect and protect the bio-psycho-social integrity of patients require. (+info)