Overview of spirituality in palliative care
- Christina M Puchalski, MD, MS, FACP, FAAHPM
Christina M Puchalski, MD, MS, FACP, FAAHPM
- Director and Professor
- George Washington Institute for Spirituality and Health, School of Medicine and Health Sciences
- The George Washington University, Washington, DC
- Betty Ferrell, PhD, MA, FAAN, FPCN
Betty Ferrell, PhD, MA, FAAN, FPCN
- Director and Professor, Division of Nursing Research and Education
- City of Hope Medical Center
- Shirley Otis-Green, MSW, MA, LCSW, ACSW, OSW-C
Shirley Otis-Green, MSW, MA, LCSW, ACSW, OSW-C
- Collaborative Caring
- George Handzo, BCC, CSSBB
George Handzo, BCC, CSSBB
- Director of Health Services Research & Quality
- HealthCare Chaplaincy, New York, NY
Spirituality is a fundamental element of human experience. It encompasses the individual’s search for meaning and purpose in life and the experience of the transcendent . Spirituality also encompasses the connections one makes with others, his or herself, nature, and to the sacred realms, inside as well as outside of traditional religion . Viewed in this way, spirituality is an important component of quality of life (QOL) and may be a key factor in how people cope with illness, experience healing, and achieve a sense of coherence .
The diagnosis of chronic or life-threatening illness can lead to spiritual struggles for patients. The turmoil may be short for some patients and protracted for others as individuals attempt to make sense of the reality of their diagnosis with what gives them value and meaning in life. The journey may result in growth and transformation for some people, distress and despair for others, and both for many people .
Spiritual care is an essential domain of palliative care . This topic will provide an overview of key spiritual issues in palliative care, describe approaches to spiritual assessment in the clinical setting, and propose a way to integrate treatment of spiritual distress into a palliative care treatment or care plan. Specific discussions on the incorporation of palliative care with regard to various religious traditions (eg, Catholicism, Christianity, Judaism, Buddhism, or Islam, among others ) are beyond the scope of this topic. For more information regarding their role in clinical care, the clinician is advised to seek input from their local and institutionally based chaplaincy services.
A discussion about the influence of spirituality and religiousness on outcomes (ie, health care decision-making, QOL) in palliative care patients is provided separately. (See "Influence of spirituality and religiousness on outcomes in palliative care patients".)
For purposes of this discussion, the following definitions will apply:
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- INFLUENCE OF SPIRITUALITY IN PALLIATIVE CARE
- Spiritual needs
- Spirituality and health care decision-making
- Spiritual coping and support
- Spiritual wellbeing and quality of life
- Spiritual distress and existential suffering
- - Differentiating spiritual, existential, and psychological suffering
- SPIRITUAL STRENGTH
- INTEGRATING SPIRITUALITY INTO PALLIATIVE CARE
- Spiritual screening
- Spiritual history
- - The FICA spiritual history tool
- Spiritual assessment
- APPROACHING SPIRITUAL DISTRESS
- The biopsychosocial and spiritual assessment and treatment plan
- Interprofessional collaboration
- Importance of the patient’s community
- ADDRESSING SPIRITUALITY WITH PATIENTS
- SPIRITUALITY AT THE END OF LIFE
- SUMMARY AND RECOMMENDATIONS