Monday, March 26, 2012
Thursday, February 16, 2012
What do the Super Bowl & professional health care chaplaincy have in common? Lots!
By Marian Betancourt
So, did you win or lose the Super Bowl pool? And once the euphoria or heartbreak subsided, what kind of Monday morning quarterbacking did you do? If only Patriots receiver Wes Welker hadn’t dropped that pass from Tom Brady! Or, what if Giants’ Mario Manningham’s footwork had been a tad less precise? And what if Ahmad Bradshaw didn’t sit down in the end zone?
During the Super Bowl madness team sports is on everybody’s mind. We admire the players, the coaches, and more than anything, the splendid teamwork. As Dan Hawkins, former coach at Boise State and Colorado, told a New York Times reporter, “This isn’t Football 101. This is like doctorate-level stuff.”In a recent KevinMD blog, Davis Liu, MD, a New England Patriots fan wrote, “There is much to be learned by doctors and others involved in health care from the successful teams and the way they are coached and the way they practice, and the results that become obvious in the way they win.” Liu continued, “Providing complex medical care is like leading a football team of 53 players of which only 11 are on the field at any given time to play offense, defense, or special teams. For success, each individual must do his job consistently and reliably every time.”
So, we asked some sports-loving board certified chaplains to talk with us about team leadership.
From Martial Arts to Trauma Team
This is a condensed version of a more comprehensive article that originally ran in HealthCare Chaplaincy’s PlainViews, the online professional journal for chaplains and other spiritual care providers. To read the entire article, go to http://plainviews.healthcarechaplaincy.org.
Marian Betancourt is the associate editor of PlainViews and the author of Playing Like a Girl: Transforming Our Lives with Team Sports published by McGraw-Hill in 2001 and brought back into print by iUniverse.
So, did you win or lose the Super Bowl pool? And once the euphoria or heartbreak subsided, what kind of Monday morning quarterbacking did you do? If only Patriots receiver Wes Welker hadn’t dropped that pass from Tom Brady! Or, what if Giants’ Mario Manningham’s footwork had been a tad less precise? And what if Ahmad Bradshaw didn’t sit down in the end zone?
During the Super Bowl madness team sports is on everybody’s mind. We admire the players, the coaches, and more than anything, the splendid teamwork. As Dan Hawkins, former coach at Boise State and Colorado, told a New York Times reporter, “This isn’t Football 101. This is like doctorate-level stuff.”In a recent KevinMD blog, Davis Liu, MD, a New England Patriots fan wrote, “There is much to be learned by doctors and others involved in health care from the successful teams and the way they are coached and the way they practice, and the results that become obvious in the way they win.” Liu continued, “Providing complex medical care is like leading a football team of 53 players of which only 11 are on the field at any given time to play offense, defense, or special teams. For success, each individual must do his job consistently and reliably every time.”
So, we asked some sports-loving board certified chaplains to talk with us about team leadership.
Chaplains as Team Players
The Rev. George Handzo, sports fan and senior consultant, chaplaincy care leadership and practice at HealthCare Chaplaincy, said chaplains are trained to be solo practitioners, but that in a code team, “Good chaplains will learn their ‘position’ on these teams including when to get involved and when and how to stay out of the way. Sometimes we get in the game from the beginning like when a family is viewing the code. We have to know our role and be ready to get in the game as needed.”
From Martial Arts to Trauma Team
Chaplain Fran Pultro, who holds Black Belts in all the martial arts, is a one-person pastoral care department and part of the multi-person level one trauma team at St. Christopher’s Children’s Hospital in North Philadelphia. A few weeks ago, he was paged at home late at night and rushed to the hospital when a shooting that began over an altercation on Facebook, took the lives of three 14-year-olds and a 16-year-old, two already dead when he arrived. “It’s my job to do pastoral intervention for the families,” said Pultro, describing the chaotic scene. The medical staff didn’t know about the families, as they were working to save the life of the third teen. There was information coming from every different angle,” he said, and as a result a great deal of misinformation. “I began making phone calls,” he said and making course corrections as he worked. “I became the clearing house for information.” Pultro also still teaches martial arts and said he still gets on the mat with his students, because “if they don’t think you can do it yourself, they won’t listen to you.”
From Quarter Back to ER Team
Chaplain Malcolm Marler directs a 20-person pastoral care department at the University of Alabama Medical Center in Birmingham. Born in Selma, Marler learned about teamwork as a defensive quarter back (corner back) for Clemson University and was team captain in his senior year. “I grew up wanting to play with Bear Bryant, like every kid in Alabama did,” he said about the legendary coach. But they didn’t give scholarships then to poor kids like me.” When he took over as director of the pastoral care department at UAB in 2009, Marler applied this kind of team training. Previously chaplains worked either the day or the night shift and those shifts never met. Marler changed it so that everybody worked some of both shifts. “This is a big place with 1,000 plus patients,” he said. “The ER is a huge operation and we have 12 ICUs.” His department includes eight staff chaplains and one CPE supervisor along with support staff.
From Swim Team to Pastoral Care Team
Chaplain Sara Hester, who works with Marler, and is assigned to several services including ED, Trauma, and Trauma Burns, said it was her years of experience on a swim team that taught her the importance of teamwork. She was the breast stroke person but you had to watch for the back stroker, and know when to dive in or get out of the way. “It’s important to have that good hand off.” Hester said her trauma team in ED has excellent doctors and nurses. “I go around and introduce myself; I make regular rounds.” She illustrated the effectiveness of the team with an incident involving the chief trauma doctor who is “a bit gruff” and had upset the patient’s family. That physician immediately called Hest er and asked her to go and appease them. “She knew she needed me,” Hester said. “It was a good handoff.”
This is a condensed version of a more comprehensive article that originally ran in HealthCare Chaplaincy’s PlainViews, the online professional journal for chaplains and other spiritual care providers. To read the entire article, go to http://plainviews.healthcarechaplaincy.org.
Marian Betancourt is the associate editor of PlainViews and the author of Playing Like a Girl: Transforming Our Lives with Team Sports published by McGraw-Hill in 2001 and brought back into print by iUniverse.
Saturday, February 4, 2012
Helping Grandparents to Be There for Their Twin Granddaughters
Helping Grandparents to Be There for Their Twin Granddaughters
Afterwards Grandpa wrote to me, “The words were read by one of our sons and through these words everyone at the celebration felt our presence and love for our granddaughters. The words were beautiful and very moving. You had finalized our thoughts so perfectly. Thank you for what you helped us say and for our ‘being there with everyone,’ especially our girls. It touched us and gave us the comfort we needed so very much at that time.”Grandpa’s letter was such a gift to me, to hear that I could bring him and Grandma closer to their family, to ease their burdens in difficult times, and to add to the joy of this milestone event for their family.
Orthodox Rabbi Nathan Goldberg, an Association for Clinical Pastoral Education Supervisor, is a member of the Clinical Faculty at HealthCare Chaplaincy.
By Rabbi Nathan Goldberg
At a local hospital the daughter of a patient undergoing acute dialysis came to me and said that her father was feeling down, and asked that I speak with him, which I did.I learned that his twin granddaughters were soon to become bat mitzvah, and the grandfather was distressed that neither grandparent could attend, because he was in the hospital and Grandmother was home-bound. We together composed a blessing for each granddaughter on the lines of the blessing that Jacob gave to his grandsons in the book of Genesis:
At a local hospital the daughter of a patient undergoing acute dialysis came to me and said that her father was feeling down, and asked that I speak with him, which I did.I learned that his twin granddaughters were soon to become bat mitzvah, and the grandfather was distressed that neither grandparent could attend, because he was in the hospital and Grandmother was home-bound. We together composed a blessing for each granddaughter on the lines of the blessing that Jacob gave to his grandsons in the book of Genesis:
BLESSING!
Jewish Tradition provides the perspective that healing is not merely about the physical body. Healing incorporates body and soul. June and Joan, (note: names changed to respect privacy) please allow me to thank you for allowing me the privilege to be part of your lives and to share this blessing.
The mere act of writing this has provided healing for Grandma’s and my spirits.
Please know that even though Grandma and I cannot be here with you with our physical presence, we are certainly with you in spirit. On that note, we would like to share our gratitude to your parents, our children. They loved and cared for you long before you could recognize them. Their vigilant and tender care for one-and-a-half pound “premie” twins began years ago. The fruits of their love are beginning to be experienced now as you begin your journey as young women.
Joan, I shall start with you. Your Hebrew name is Miriam. Like Miriam the prophetess, your kind, considerate creativity endears you to your family and friends. I am blessed by you and pray that you will continue to grow into the wonderful woman you are already becoming.
June, your Hebrew name is Devora. You, like Devora the judge, can see things clearly and achieve your goals. Your intensity is energizing and I cannot wait to see where you will go in the future.We are particularly proud that our two granddaughters are wonderful individuals who are not afraid to express who they are. At the same time, they are considerate of others- each of them emanates kindness. In this way, they are following in the footsteps of their family- in particular their mother and father who are dedicated to Tikun Olam, fixing the world, on a personal and professional basis.
I leave you with the blessing of Jacob for his children and grandchildren as well as the Aaronic blessing, traditionally given to children as well. In these blessings, I also include (other granddaughter, grandson Jesse, and great grandson.)May the angel who redeemed me from all evil bless the children in the name of the parents…May G-d bless you, and watch over you. May G-d make his face shine upon you, and be gracious unto you.May The L-RD lift up his presence to you, and give you peace.
Afterwards Grandpa wrote to me, “The words were read by one of our sons and through these words everyone at the celebration felt our presence and love for our granddaughters. The words were beautiful and very moving. You had finalized our thoughts so perfectly. Thank you for what you helped us say and for our ‘being there with everyone,’ especially our girls. It touched us and gave us the comfort we needed so very much at that time.”Grandpa’s letter was such a gift to me, to hear that I could bring him and Grandma closer to their family, to ease their burdens in difficult times, and to add to the joy of this milestone event for their family.
Orthodox Rabbi Nathan Goldberg, an Association for Clinical Pastoral Education Supervisor, is a member of the Clinical Faculty at HealthCare Chaplaincy.
Global Perspectives on Palliative Care
By Kathleen M. Foley, M.D., attending neurologist in the Pain & Palliative Care Service at Memorial Sloan-Kettering Cancer Center & HealthCare Chaplaincy Trustee
Five million people die of cancer or AIDS each year with untreated pain, most of them in low and middle-income countries. The Open Society Foundations’ International Palliative Care Initiative has been working since1995 to change this. The Initiative is funded at three million dollars a year to work globally to advance palliative care in regions where the Open Society, founded and chaired by George Soros, has supportive foundations, such as Central and Eastern Europe, Central Asia and Africa.
I had the pleasure of co-moderating a seminar on Global Perspectives on Palliative Care with my colleague at Memorial Sloan-Kettering Cancer Center (MSKCC), Dr. Paul Glare, Chief of Pain and Palliative Care, held at MSKCC.
Palliative Care Advances Around the World
We heard firsthand accounts from four international experts on efforts to advance palliative care globally. Professor Judith Hill, the chief executive officer of the Northern Ireland Hospice told us of her organization’s efforts in Belfast, Ireland, as well as internationally. With her colleague, Professor Max Watson of both Ulster University and the medical consultant to the Northern Ireland Hospice, they described palliative care educational efforts in India and Nepal including the development of an international diploma program and publication of a handbook on palliative care.
Dr. Joe Hartford, director of the Office of International Affairs of the U.S. National Cancer Institute (NCI) described the key elements of his strategy to make palliative care integral to cancer care in resource-limited countries, and he discussed NCI efforts in the Middle East and Ireland. The Middle East Cancer Consortium (MECC) was started in 1996 during one of President Clinton’s peace initiatives. The vision was to try to form partnerships and collaborative efforts on cancer care in the region. For example, Egypt has 10 times the population of Israel, but Israel has 10 times as many services in palliative care. By sharing experiences and educational efforts, the Consortium is working to improve cancer care and palliative care in eight countries.
Similarly, The All Ireland Cancer Consortium , started in 1999 directly out of George Mitchell’s negotiation of the Good Friday Peace Accords, began with cancer and cross border ambulance services as the areas of cooperation in health in these two regions of Ireland. This Consortium has also supported cross border efforts to improve palliative care.
The fourth speaker, Dr. Nessa Coyle, an advanced practice palliative care nurse at MSKCC, and co-author of the leading textbook in palliative care nursing, described her role as an educator in international programs to advance nurse training in palliative care in Central and Eastern Europe, Africa and Asia. As one of the international faculty of the End of Life Nursing Education Consortium (ELNEC) which is administered by the American Association of Colleges of Nursing in Washington, D.C. and the City of Hope in Los Angeles, this initiative has trained more than 14,000 American nurses as well as international nurses in more than 30 countries.
The good news is that palliative care initiatives are rapidly expanding around the world. As Dr. Hartford described the World Health Organization’s (WHO) guide on palliative care, it outlines a model approach for how countries can create palliative care cancer services in their countries. The WHO model to advance palliative care calls for a three-pronged approach: availability of essential medicines for palliative care; the education of health care professionals and the public; and policy change that integrates palliative care into national health strategies. The WHO has recognized that access to pain relief and palliative care are human rights issues.
Palliative Care and Human Rights
Using a human rights-based approach, there is an increase in advocacy efforts by several groups. Human Rights Watch has published a series of reports on the needless suffering of patients and families in countries that lack access to pain treatment and palliative care such as India, Kenya and Ukraine. These reports, coupled with new advocacy campaigns, call for improved access to pain relief and palliative care for dying patients. Stop Torture in Healthcare is an Open Society Foundation campaign to call attention to the under-treatment of pain and features the story of a young Ukrainian patient with terminal brain cancer whose treatment for pain is severely limited by Ukraine’s strict laws regulation the availability of pain-relieving medicines like morphine. A Treat the Pain campaign is supported by the International Union Against Cancer. Using short powerful videos of real patients to document the problem of lack access to pain relief and palliative care in resource-poor countries, these are very useful educational and advocacy narratives. In fact, Dr. Watson used these videos in his opening talk to describe the barriers to palliative care internationally.
Make it Political
Siddhartha Mukherjee in his Pulitzer Prize winning book, The Emperor of all Maladies, pointed out that the big change in cancer care in America came only when the politicians were mobilized to really make the difference. Is there lack of political will? You can say a dying person cannot vote, but their families sure can. Access to pain relief should be a human right for everyone.As we ended our seminar, Judith Hill reminded us of these lines from Clearances, a poem by Nobel Laureate Seamus Heaney, about his mother’s death:
Kathleen M. Foley, M.D., is one of the world’s leading authorities in cancer pain management and palliative care. She is an attending neurologist in the Pain & Palliative Care Service at Memorial Sloan-Kettering Cancer Center and holds the chair of the Society of Memorial Sloan-Kettering Cancer Center in Pain Research. Dr. Foley is professor of neurology, neuroscience, and clinical pharmacology at Weill Medical College of Cornell University. She was the founding director of Death In America, which funded initiatives to improve the care of the dying. Dr. Foley is the medical director of the international palliative care initiative of the public health program of the Open Society Institute, working to advance palliative care worldwide. She consults to the World Health Organization Cancer and Palliative Care Unit. Dr. Foley was elected to the Institute of Medicine of the National Academy of Sciences for her national and international efforts in the treatment of patients with cancer pain. She earned her medical degree at Cornell University Medical College and is a trustee of HealthCare Chaplaincy.
Five million people die of cancer or AIDS each year with untreated pain, most of them in low and middle-income countries. The Open Society Foundations’ International Palliative Care Initiative has been working since1995 to change this. The Initiative is funded at three million dollars a year to work globally to advance palliative care in regions where the Open Society, founded and chaired by George Soros, has supportive foundations, such as Central and Eastern Europe, Central Asia and Africa.
I had the pleasure of co-moderating a seminar on Global Perspectives on Palliative Care with my colleague at Memorial Sloan-Kettering Cancer Center (MSKCC), Dr. Paul Glare, Chief of Pain and Palliative Care, held at MSKCC.
Palliative Care Advances Around the World
We heard firsthand accounts from four international experts on efforts to advance palliative care globally. Professor Judith Hill, the chief executive officer of the Northern Ireland Hospice told us of her organization’s efforts in Belfast, Ireland, as well as internationally. With her colleague, Professor Max Watson of both Ulster University and the medical consultant to the Northern Ireland Hospice, they described palliative care educational efforts in India and Nepal including the development of an international diploma program and publication of a handbook on palliative care.
Dr. Joe Hartford, director of the Office of International Affairs of the U.S. National Cancer Institute (NCI) described the key elements of his strategy to make palliative care integral to cancer care in resource-limited countries, and he discussed NCI efforts in the Middle East and Ireland. The Middle East Cancer Consortium (MECC) was started in 1996 during one of President Clinton’s peace initiatives. The vision was to try to form partnerships and collaborative efforts on cancer care in the region. For example, Egypt has 10 times the population of Israel, but Israel has 10 times as many services in palliative care. By sharing experiences and educational efforts, the Consortium is working to improve cancer care and palliative care in eight countries.
Similarly, The All Ireland Cancer Consortium , started in 1999 directly out of George Mitchell’s negotiation of the Good Friday Peace Accords, began with cancer and cross border ambulance services as the areas of cooperation in health in these two regions of Ireland. This Consortium has also supported cross border efforts to improve palliative care.
The fourth speaker, Dr. Nessa Coyle, an advanced practice palliative care nurse at MSKCC, and co-author of the leading textbook in palliative care nursing, described her role as an educator in international programs to advance nurse training in palliative care in Central and Eastern Europe, Africa and Asia. As one of the international faculty of the End of Life Nursing Education Consortium (ELNEC) which is administered by the American Association of Colleges of Nursing in Washington, D.C. and the City of Hope in Los Angeles, this initiative has trained more than 14,000 American nurses as well as international nurses in more than 30 countries.
The good news is that palliative care initiatives are rapidly expanding around the world. As Dr. Hartford described the World Health Organization’s (WHO) guide on palliative care, it outlines a model approach for how countries can create palliative care cancer services in their countries. The WHO model to advance palliative care calls for a three-pronged approach: availability of essential medicines for palliative care; the education of health care professionals and the public; and policy change that integrates palliative care into national health strategies. The WHO has recognized that access to pain relief and palliative care are human rights issues.
Palliative Care and Human Rights
Using a human rights-based approach, there is an increase in advocacy efforts by several groups. Human Rights Watch has published a series of reports on the needless suffering of patients and families in countries that lack access to pain treatment and palliative care such as India, Kenya and Ukraine. These reports, coupled with new advocacy campaigns, call for improved access to pain relief and palliative care for dying patients. Stop Torture in Healthcare is an Open Society Foundation campaign to call attention to the under-treatment of pain and features the story of a young Ukrainian patient with terminal brain cancer whose treatment for pain is severely limited by Ukraine’s strict laws regulation the availability of pain-relieving medicines like morphine. A Treat the Pain campaign is supported by the International Union Against Cancer. Using short powerful videos of real patients to document the problem of lack access to pain relief and palliative care in resource-poor countries, these are very useful educational and advocacy narratives. In fact, Dr. Watson used these videos in his opening talk to describe the barriers to palliative care internationally.
Make it Political
Siddhartha Mukherjee in his Pulitzer Prize winning book, The Emperor of all Maladies, pointed out that the big change in cancer care in America came only when the politicians were mobilized to really make the difference. Is there lack of political will? You can say a dying person cannot vote, but their families sure can. Access to pain relief should be a human right for everyone.As we ended our seminar, Judith Hill reminded us of these lines from Clearances, a poem by Nobel Laureate Seamus Heaney, about his mother’s death:
In the last minutes he said more to her
almost than in their whole life together.“You’ll be in New Row on Monday night
And I’ll come up for you and you’ll be glad
When I walk in the door…Isn’t that right?”
His head was bent down to her propped-up head.
She could not hear but we were overjoyed.
He called her good and girl.
Then she was dead,
The searching for a pulse beat was abandoned
And we all knew one thing by being there.
The space we stood around had been emptied
Into us to keep, it penetrated
Clearances that suddenly stood open.
High cries were felled and a pure change happened.
Kathleen M. Foley, M.D., is one of the world’s leading authorities in cancer pain management and palliative care. She is an attending neurologist in the Pain & Palliative Care Service at Memorial Sloan-Kettering Cancer Center and holds the chair of the Society of Memorial Sloan-Kettering Cancer Center in Pain Research. Dr. Foley is professor of neurology, neuroscience, and clinical pharmacology at Weill Medical College of Cornell University. She was the founding director of Death In America, which funded initiatives to improve the care of the dying. Dr. Foley is the medical director of the international palliative care initiative of the public health program of the Open Society Institute, working to advance palliative care worldwide. She consults to the World Health Organization Cancer and Palliative Care Unit. Dr. Foley was elected to the Institute of Medicine of the National Academy of Sciences for her national and international efforts in the treatment of patients with cancer pain. She earned her medical degree at Cornell University Medical College and is a trustee of HealthCare Chaplaincy.
“Just Healing the Body is Not Enough"
“Just Healing the Body is Not Enough,” says HealthCare Chaplaincy in Top Magazine Modern Healthcare
A recent issue of Modern Healthcare, the top-ranked magazine in readership among health care executives, featured an article about the important topic of how to measure quality care in the clinical setting.
HealthCare Chaplaincy’s the Rev. George Handzo responded with a letter to the editor which was published.
He wrote:“(The article) makes some valuable points in defense of patient satisfaction as a quality indicator. There is no argument about whether everyone ought to be held to best practices in clinical care. That said, many of us have seen patients whose diseases are cured but who leave the health care system so dissatisfied that they hesitate to interact with the system the next time they really need to and/or leave with actual social, emotional or spiritual wounds that negatively impact their quality of life.Just healing the body is not enough. Patient satisfaction speaks to the concept that the system needs to attend to all dimensions of the patient’s experience.”
A recent issue of Modern Healthcare, the top-ranked magazine in readership among health care executives, featured an article about the important topic of how to measure quality care in the clinical setting.
HealthCare Chaplaincy’s the Rev. George Handzo responded with a letter to the editor which was published.
He wrote:“(The article) makes some valuable points in defense of patient satisfaction as a quality indicator. There is no argument about whether everyone ought to be held to best practices in clinical care. That said, many of us have seen patients whose diseases are cured but who leave the health care system so dissatisfied that they hesitate to interact with the system the next time they really need to and/or leave with actual social, emotional or spiritual wounds that negatively impact their quality of life.Just healing the body is not enough. Patient satisfaction speaks to the concept that the system needs to attend to all dimensions of the patient’s experience.”
HealthCare Chaplaincy CEO Awarded National Ministry Network’s Highest Honor
At its annual convocation in January in Alexandria, Virginia, The Network on Ministry in Specialized Settings (the COMISS Network) honored HealthCare Chaplaincy’s president and CEO, the Rev. Dr. Walter J. Smith, S.J., with its highest honor—the 2012 COMISS Medal—in recognition of his contributions to the profession and to the international field of chaplaincy care.
COMISS is a national organization of chaplaincy, pastoral care and pastoral counseling professionals, and their religious endorsing officials. Its multifaith network includes organizations that provide, certify, accredit and endorse chaplaincy and other pastoral services to persons in health care facilities, correctional institutions, mental health settings, the armed forces, business settings and the Department of Veterans Affairs.
The COMISS Medal has been given only 6 times since its inception. Some previous recipients have included the noted Dutch writer and lecturer, the late Henri Nouwen, and the celebrated developmental psychologist and Pulitzer Prize winner, the late Professor Erik Erikson.
Fr. Smith’s address to the COMISS delegates will be published in late March issue of the Journal of Pastoral Care and Counseling and will be available on HealthCare Chaplaincy's website in April.
COMISS is a national organization of chaplaincy, pastoral care and pastoral counseling professionals, and their religious endorsing officials. Its multifaith network includes organizations that provide, certify, accredit and endorse chaplaincy and other pastoral services to persons in health care facilities, correctional institutions, mental health settings, the armed forces, business settings and the Department of Veterans Affairs.
The COMISS Medal has been given only 6 times since its inception. Some previous recipients have included the noted Dutch writer and lecturer, the late Henri Nouwen, and the celebrated developmental psychologist and Pulitzer Prize winner, the late Professor Erik Erikson.
Fr. Smith’s address to the COMISS delegates will be published in late March issue of the Journal of Pastoral Care and Counseling and will be available on HealthCare Chaplaincy's website in April.
Making the case for palliative care
HealthCare Chaplaincy’s the Rev. George Handzo was a workshop presenter in November at the annual conference of the Center to Advance Palliative Care (CAPC) which attracts palliative care professionals from around the country. Most of the 650 people registered at this educational event were doctors and nurses, followed by administrators, social workers and chaplains.George’s topic was “Improving the Quality of Spiritual Care as a Dimension of Palliative Care,” emphasizing the important role that a professional chaplain plays on the palliative care team.A recurring theme that ran through the presentations was the need to educate and advocate for the value of palliative care to the public, policy makers, and the health care profession itself.
CAPC Director Diane Meier, MD emphasized these grim facts:
CAPC Director Diane Meier, MD emphasized these grim facts:
- 5% of all insured patients account for two-thirds of insurance company costs
- 10% of Medicare patients account for two-thirds of Medicare costs
- 10% of patients in hospitals account for two-thirds of a hospital’s costs
Important Article on Chaplaincy Research Is Now Available to Read
“Testing the Efficacy of Chaplaincy Care,” in the current issue of the Journal of Health Care Chaplaincy, is the latest and most comprehensive narrative on the importance of research in professional chaplaincy.Its authors are HealthCare Chaplaincy’s Katherine R. B. Jankowski, George F. Handzo and Kevin J. Flannelly. You can download and read the article here.
To highlight the key points:
Research to date supports the importance of spiritual and religious needs of patients and their families, and that patients, family of patients, and hospital staff recognize the need for chaplaincy and are satisfied with chaplaincy care.
But this research is inconclusive on what chaplains do that is unique to chaplaincy practice, how what they do relates directly to patient health outcomes, and which practices are best for which kinds of patients in what patient settings.
More research is needed to describe the unique contributions of chaplains to spiritual care and identify best chaplaincy practices to optimize patient and family health outcomes.
The authors gratefully acknowledge the John Templeton Foundation which funded this work. Last month HealthCare Chaplaincy announced Calls for Proposals for the major research initiative “Growing the Field of Chaplaincy Research in Palliative Care,” also funded by the John Templeton Foundation. This will award six to ten grants of up to $250,000 each to build capacity in the field of chaplaincy research in palliative care by creating an interdisciplinary network of experienced researchers and board-certified chaplains, promoting career development of participants, and supporting field-advancing research projects to better understand chaplaincy care in palliative care. For more information, click here.
To highlight the key points:
Research to date supports the importance of spiritual and religious needs of patients and their families, and that patients, family of patients, and hospital staff recognize the need for chaplaincy and are satisfied with chaplaincy care.
But this research is inconclusive on what chaplains do that is unique to chaplaincy practice, how what they do relates directly to patient health outcomes, and which practices are best for which kinds of patients in what patient settings.
More research is needed to describe the unique contributions of chaplains to spiritual care and identify best chaplaincy practices to optimize patient and family health outcomes.
The authors gratefully acknowledge the John Templeton Foundation which funded this work. Last month HealthCare Chaplaincy announced Calls for Proposals for the major research initiative “Growing the Field of Chaplaincy Research in Palliative Care,” also funded by the John Templeton Foundation. This will award six to ten grants of up to $250,000 each to build capacity in the field of chaplaincy research in palliative care by creating an interdisciplinary network of experienced researchers and board-certified chaplains, promoting career development of participants, and supporting field-advancing research projects to better understand chaplaincy care in palliative care. For more information, click here.
Important Oncologist & Chaplain Conversation
A Conversation with Palliative Care Researcher Tracy Balboni on the Importance of Spirituality and Chaplains as Members of the Health Care Team
“The neglect of religion and spirituality as a key aspect of someone’s experience at the end of life results in a medical system that overly focuses on technology and aims for cure. This focus appears to lead to greater aggressive care, which has been shown to be associated with decreased patient quality of life near death and increased psychological issues among family members troubled by a medicalized death.”
When the spiritual needs of cancer patients are not well supported by the health care team the end-of-life (EOL) costs are higher. These findings are part of a study by Tracy Balboni, MD, MPH, an Assistant Professor in the Department of Radiation Oncology at Harvard Medical School and practicing radiation oncologist at Dana-Farber Cancer Institute and Brigham and Women’s Hospital. She also is the director of the Supportive and Palliative Radiation Oncology service that provides dedicated clinical care to patients with advanced cancers.
At Dana Farber, Dr. Balboni has been mentored by Holly Prigerson, Ph.D., an internationally-recognized palliative care researcher and director of the Center for Psychosocial Oncology and Palliative Care Research. Other research colleagues she credits for their collaboration include Michael Balboni, PhD, ThM, Andrea Phelps, MD, Alexi Wright, MD, John Peteet, MD, Chris Lathan, MD, and Tyler VanderWeele, PhD.
Dr. Balboni’s research examines how specific religious/spiritual beliefs and attitudes of advanced cancer patients influence quality of life in the anticipation of death and medical care received near the end of life. As part of the NIH-funded Coping with Cancer study, she is currently examining the elements of spiritual care from both the medical team and religious communities that impact patient well being and the intensity of medical care received at the end of life. This research will inform the development of spiritual care interventions aiming to improve patient well-being and to assist patients in avoiding futile, aggressive therapies near death.
The Rev. George Handzo, BCC, HealthCare Chaplaincy’s Vice President for Chaplaincy Care Leadership and Practice, first spoke with Dr. Balboni at last summer’s annual conference of the American Association of Hospice and Palliative Medicine in Vancouver. They established that HCC and her research group have much in common and agreed to follow up by phone about her study and its implications for the future of palliative care. Here are highlights of their conversation.
Handzo: The subject of spiritual needs and spiritual issues is not the normal course of research for radiation oncologists.
Balboni: Palliative care is at least 40 percent of what radiation oncologists do for symptomatic management of patients who have advanced cancers, so we’re frequently interacting with people who are near the end of life. Spirituality is a way that many patients cope with and find meaning within their illness. On the clinical side within radiation oncology, the importance of spirituality is not taught as part of the curriculum, but I imagine that it may be in the future with increasing focus on palliative care as part of a comprehensive approach to patients.Concerning my own personal career path, my initial interest was in caring for patients with advanced cancer. In the backdrop of that my husband, Michael, received his PhD in practical theology looking specifically at the intersection of spirituality in the practice of medicine. His interest area is on the side of practitioners, so that has been his focus, and I had these patient experiences. I couldn’t help but see the lack of real awareness of spirituality within my everyday practice. My training and clinical practice included very little interaction with chaplaincy--even knowing simply when to refer to a chaplain--let alone learning from chaplains about what issues to be looking out for or how do to things like a spiritual screening. It was actually during my internship year that my career came to a key turning point. I had a one month elective and--because of these interests--I asked if I could create my own elective of shadowing chaplaincy while doing a project examining the religion and health literature. It was an amazing experience to be immersed in chaplaincy. Seeing what chaplains do really opened my eyes to how important these issues are for patients. Then at the same time as I was reviewing the literature, I realized that there was a real need for a better understanding of the role of religion and spirituality within illness and of patients’ spiritual needs. That elective month with chaplaincy was the tipping point in my own realization that this is a very important area where a lot of research needs to be done. I also recognized that there needs to be better inroads created between chaplains, physicians, nurses, and religious communities. As I was going through my radiation oncology training I asked to make a research transition by focusing on spirituality and medicine--prior to that I was planning on being a translational researcher. I was fortunate enough to have a very supportive radiation oncology training program, and palliative care leaders as tremendous mentors, including Susan Block as a career mentor and Holly Prigerson as a research mentor.
Handzo: It’s interesting how the kind of chance encounters and the things we put ourselves in the way of make our story. It was not only your internship, but then you had mentors in Susan Block and Holly Prigerson who are among the leading researchers in palliative care.I have read what your group has done. Out of all that data, if you had to name the two or three salient findings, especially with regard to clinical practice, what would you say it was—the ones that made you say-- “Wow! This is important!”
Balboni: A few things immediately come to mind. First, it is remarkable how infrequently spiritual needs are addressed by the medical system. There is a sizable gap between what patients want and need in the realm of religion and spirituality and what the medical system offers to patients with advanced illness. Second is the finding within subsequent data showing that support of patients’ spiritual needs is associated with better quality of life, increased hospice use, and less intensive care at the end of life. Even after considering all the limitations in descriptive research and our current measurement tools, these associations are both remarkable and troubling. The neglect of religion and spirituality as a key aspect of someone’s experience at the end of life appears to lead to greater aggressive medical interventions which have been shown to be associated with decreased patient quality of life near death and increased psychological issues among family members troubled by a medicalized death. The real issue, at least as I see it, is that by neglecting a fundamental aspect of the illness experience, there is a cascading impact upon patient well-being, their medical decisions and hence costs. A key response to this neglect is that we need greater integration between the practice of chaplaincy and medical practice at the end of life. We also need nurses and physicians who are trained to be attuned to patients’ spirituality so that spiritual care becomes routinely addressed as part of patient care. This research suggests that this would provide a better balance to our approach to end-of-life care: one that is not solely guided by a technologically-driven mentality which tends to simply offer more technology, which is often futile and costly.
Handzo: It’s certainly costly - and, it depends on one’s definition of futile.
Balboni: Yes, it certainly does.
Handzo: Is two more days of aggressive treatment futile or not? Balboni: It’s always much clearer in retrospect, but not always so clear at the time. Our patients can help to guide us in this regard--for many an additional two days made possible by receiving aggressive medical care would be futile, but for others it would be essential to their preparation for death. Regardless, this preparation should be simultaneously addressed throughout the treatment plan.
Handzo: I know exactly what you’re talking about. In some cancer centers, there is a mentality among the treatment team which pushes to continue treatment on the assumption that another new drug will be along at any moment that could be helpful.
Balboni: Yes. This technological mentality has its benefits, but can also be problematic.
Handzo: One of the findings I can’t explain, and I’d love you to explain it to me, is that religious people disproportionally use aggressive care at the end of life. Is that right?
Balboni: Yes.
Handzo: What do you make of that?
Balboni: I only have some possible hypotheses as to why. One possibility is that religious people are holding onto miracles and equating continuing medical therapy with leaving things in God’s hands. Perhaps in many cases, that approach is most consistent with that person’s beliefs. But I think it can also be a misunderstanding--for some it might also be a realistic belief that God can heal with or without medical technology and that miraculous healing might not always mean healing in a physical form.
Other possibilities might be that these are patients who have spiritual needs that are not being addressed, and they’re not reaching that place of real peace to be able to let go.
Handzo: Yes, that makes sense. They’ve got to resolve the religious question, because that’s what’s important to them. And your data suggest that if they had someone to help them with those questions, it would be extremely helpful.
Balboni: Yes. In our research, we found that it is among these high religious coping patients that you see most of the benefits of spiritual care. When these patients’ spiritual needs are well-supported, they become markedly less likely to receive aggressive interventions at the end of life.
Handzo: So the challenge for us now is to discover what the active ingredient is in that spiritual care.
Balboni: Yes, that’s a big question.
Handzo: If only we could figure that out. Experts like Ken Pargament have been trying for years to figure out why some high religious copers decompensate, and some of them are resilient.
Balboni: There is a lack of information to indicate what that is. The current measures for spiritual care have been broad and not well-characterized. One thing that we did find--which was not surprising--is that patients reporting high support of their spiritual needs are also more likely to have received chaplaincy visits. But what actually happens within those chaplain encounters? What is the interaction between chaplaincy and the rest of the medical team? Clearly, even when and how someone gets referred to a chaplain is an interesting question.
Handzo: We do have answers to how that should happen. That’s what we do--strategic positioning. There are models and triggers, and that’s what we’ve been working on here is some protocols to hard wire that referral in. Part of it, as you can guess, is that a referral to palliative care should trigger a referral to chaplaincy.
Balboni: Palliative care teams really should be staffed with chaplains.
Handzo: Yes, The Joint Commission’s new standards have said that. So that’s an easy one: goals and care discussions that have the chaplain as an integral and required member of the interdisciplinary team. I think there’s more, for example when there's a conversation about DNR (do not resuscitate), or withdrawal of treatment, the family should at the very least have the opportunity to have a chaplain in the room. The next question is, given what we know, what you all found and what you know from others, what are the big questions still out there?
Balboni: We named one of them which is what are the key elements of spiritual care? We know chaplaincy is a key participant. What does the integrated medical team look like in providing spiritual care? And then ultimately the next step would be actually implementing a spiritual care intervention; putting that into practice and testing it in the setting of people who are facing advanced illness.
Handzo: So we need some pilot studies and somebody to try a few interventions--probably in oncology where the evidence is best for the work you and the others are doing.
Balboni: Yes. Within advanced cancer care I’m working with Holly Prigerson, who is the principal investigator of Coping with Cancer II--a multi-site, prospective cohort study of advanced cancer patients that examines communication between patients and physicians. The study also examines this question of why religious coping is associated with more aggressive medical care. It also attempts to better define the key elements of spiritual care by using a combination of qualitative and quantitative survey questions. We are hoping that this data will lead to hypothesis-generating conceptual models that can eventually be turned into a testable spiritual care intervention. The hope is that this research will help in providing some data to help fill in these missing pieces. Another major area of study that we have recently published focuses on patients’ spiritual needs and concerns. That’s a whole other area requiring further research in order to better characterize those needs and understand how they might relate to key spiritual and medical outcomes. Future spiritual care interventions need to be adapted to what patients’ needs are.
Handzo: It’s hard to know what the intervention should be if you don’t know what the diagnosis is.
Balboni: Yes, and its important to have flexibility so that spiritual care addresses the particular situation and needs of each patient. For example, Jennifer Temel’s study on patients with advanced lung cancer showed that palliative care improved issues including quality of life and depressive symptoms. The way the palliative care intervention was approached was to allow a degree of flexibility based on palliative care guidelines and on the expertise of the palliative care practitioners as they interfaced with each particular patient--though this is also a limitation of Dr. Temel’s very important study because it’s not clear what specific elements of palliative care resulted in these outcomes. Ideally, to be both flexible to the needs of patients and to identify what elements of spiritual care impact outcomes, there would be a defined, but flexible structure to the intervention and mixed qualitative-quantitative research methods would be used clearly to identify the key elements of spiritual care.
Handzo: What was remarkable to me was that despite the looseness, to put it one way, of the design, they still got a salient finding in that the patients who received aggressive care plus early palliative care lived longer than those who received aggressive care only. Less surprising was the finding that those who received palliative care had better quality of life and less depression. The point is, even if there was a chaplain, and as you said, we can’t isolate the salient variables anyway, so it wouldn’t have mattered.
Balboni: It may or may not have mattered. The study design does not allow us to definitively know.
Handzo: Yes, we couldn’t have been able to parse anything out. One last question: what advice might you give to chaplains to be effective members of the hospital community?
Balboni: I would think that most of the correction probably needs to be on the rest of medical team’s part. My vision would be that chaplains would play a key role in the training of medical practitioners in specialties that frequently care for patients facing advanced illness. Chaplaincy should be integrated into medical education, and we would all benefit from the inclusion of chaplaincy in multi-disciplinary teams, lectures, and case-based learning in order to better understand the role of chaplaincy and the provision of spiritual care. Better integration is needed in medical schools and continued throughout medical practice. We need chaplains to help do the educating about the intersection of illness, medical care, and spirituality. This is a needed correction that I hope we see in the years ahead.
Handzo: Tracy, thanks so much for the conversation.
KEY POINTS:
“The neglect of religion and spirituality as a key aspect of someone’s experience at the end of life results in a medical system that overly focuses on technology and aims for cure. This focus appears to lead to greater aggressive care, which has been shown to be associated with decreased patient quality of life near death and increased psychological issues among family members troubled by a medicalized death.”
When the spiritual needs of cancer patients are not well supported by the health care team the end-of-life (EOL) costs are higher. These findings are part of a study by Tracy Balboni, MD, MPH, an Assistant Professor in the Department of Radiation Oncology at Harvard Medical School and practicing radiation oncologist at Dana-Farber Cancer Institute and Brigham and Women’s Hospital. She also is the director of the Supportive and Palliative Radiation Oncology service that provides dedicated clinical care to patients with advanced cancers.
At Dana Farber, Dr. Balboni has been mentored by Holly Prigerson, Ph.D., an internationally-recognized palliative care researcher and director of the Center for Psychosocial Oncology and Palliative Care Research. Other research colleagues she credits for their collaboration include Michael Balboni, PhD, ThM, Andrea Phelps, MD, Alexi Wright, MD, John Peteet, MD, Chris Lathan, MD, and Tyler VanderWeele, PhD.
Dr. Balboni’s research examines how specific religious/spiritual beliefs and attitudes of advanced cancer patients influence quality of life in the anticipation of death and medical care received near the end of life. As part of the NIH-funded Coping with Cancer study, she is currently examining the elements of spiritual care from both the medical team and religious communities that impact patient well being and the intensity of medical care received at the end of life. This research will inform the development of spiritual care interventions aiming to improve patient well-being and to assist patients in avoiding futile, aggressive therapies near death.
The Rev. George Handzo, BCC, HealthCare Chaplaincy’s Vice President for Chaplaincy Care Leadership and Practice, first spoke with Dr. Balboni at last summer’s annual conference of the American Association of Hospice and Palliative Medicine in Vancouver. They established that HCC and her research group have much in common and agreed to follow up by phone about her study and its implications for the future of palliative care. Here are highlights of their conversation.
Handzo: The subject of spiritual needs and spiritual issues is not the normal course of research for radiation oncologists.
Balboni: Palliative care is at least 40 percent of what radiation oncologists do for symptomatic management of patients who have advanced cancers, so we’re frequently interacting with people who are near the end of life. Spirituality is a way that many patients cope with and find meaning within their illness. On the clinical side within radiation oncology, the importance of spirituality is not taught as part of the curriculum, but I imagine that it may be in the future with increasing focus on palliative care as part of a comprehensive approach to patients.Concerning my own personal career path, my initial interest was in caring for patients with advanced cancer. In the backdrop of that my husband, Michael, received his PhD in practical theology looking specifically at the intersection of spirituality in the practice of medicine. His interest area is on the side of practitioners, so that has been his focus, and I had these patient experiences. I couldn’t help but see the lack of real awareness of spirituality within my everyday practice. My training and clinical practice included very little interaction with chaplaincy--even knowing simply when to refer to a chaplain--let alone learning from chaplains about what issues to be looking out for or how do to things like a spiritual screening. It was actually during my internship year that my career came to a key turning point. I had a one month elective and--because of these interests--I asked if I could create my own elective of shadowing chaplaincy while doing a project examining the religion and health literature. It was an amazing experience to be immersed in chaplaincy. Seeing what chaplains do really opened my eyes to how important these issues are for patients. Then at the same time as I was reviewing the literature, I realized that there was a real need for a better understanding of the role of religion and spirituality within illness and of patients’ spiritual needs. That elective month with chaplaincy was the tipping point in my own realization that this is a very important area where a lot of research needs to be done. I also recognized that there needs to be better inroads created between chaplains, physicians, nurses, and religious communities. As I was going through my radiation oncology training I asked to make a research transition by focusing on spirituality and medicine--prior to that I was planning on being a translational researcher. I was fortunate enough to have a very supportive radiation oncology training program, and palliative care leaders as tremendous mentors, including Susan Block as a career mentor and Holly Prigerson as a research mentor.
Handzo: It’s interesting how the kind of chance encounters and the things we put ourselves in the way of make our story. It was not only your internship, but then you had mentors in Susan Block and Holly Prigerson who are among the leading researchers in palliative care.I have read what your group has done. Out of all that data, if you had to name the two or three salient findings, especially with regard to clinical practice, what would you say it was—the ones that made you say-- “Wow! This is important!”
Balboni: A few things immediately come to mind. First, it is remarkable how infrequently spiritual needs are addressed by the medical system. There is a sizable gap between what patients want and need in the realm of religion and spirituality and what the medical system offers to patients with advanced illness. Second is the finding within subsequent data showing that support of patients’ spiritual needs is associated with better quality of life, increased hospice use, and less intensive care at the end of life. Even after considering all the limitations in descriptive research and our current measurement tools, these associations are both remarkable and troubling. The neglect of religion and spirituality as a key aspect of someone’s experience at the end of life appears to lead to greater aggressive medical interventions which have been shown to be associated with decreased patient quality of life near death and increased psychological issues among family members troubled by a medicalized death. The real issue, at least as I see it, is that by neglecting a fundamental aspect of the illness experience, there is a cascading impact upon patient well-being, their medical decisions and hence costs. A key response to this neglect is that we need greater integration between the practice of chaplaincy and medical practice at the end of life. We also need nurses and physicians who are trained to be attuned to patients’ spirituality so that spiritual care becomes routinely addressed as part of patient care. This research suggests that this would provide a better balance to our approach to end-of-life care: one that is not solely guided by a technologically-driven mentality which tends to simply offer more technology, which is often futile and costly.
Handzo: It’s certainly costly - and, it depends on one’s definition of futile.
Balboni: Yes, it certainly does.
Handzo: Is two more days of aggressive treatment futile or not? Balboni: It’s always much clearer in retrospect, but not always so clear at the time. Our patients can help to guide us in this regard--for many an additional two days made possible by receiving aggressive medical care would be futile, but for others it would be essential to their preparation for death. Regardless, this preparation should be simultaneously addressed throughout the treatment plan.
Handzo: I know exactly what you’re talking about. In some cancer centers, there is a mentality among the treatment team which pushes to continue treatment on the assumption that another new drug will be along at any moment that could be helpful.
Balboni: Yes. This technological mentality has its benefits, but can also be problematic.
Handzo: One of the findings I can’t explain, and I’d love you to explain it to me, is that religious people disproportionally use aggressive care at the end of life. Is that right?
Balboni: Yes.
Handzo: What do you make of that?
Balboni: I only have some possible hypotheses as to why. One possibility is that religious people are holding onto miracles and equating continuing medical therapy with leaving things in God’s hands. Perhaps in many cases, that approach is most consistent with that person’s beliefs. But I think it can also be a misunderstanding--for some it might also be a realistic belief that God can heal with or without medical technology and that miraculous healing might not always mean healing in a physical form.
Other possibilities might be that these are patients who have spiritual needs that are not being addressed, and they’re not reaching that place of real peace to be able to let go.
Handzo: Yes, that makes sense. They’ve got to resolve the religious question, because that’s what’s important to them. And your data suggest that if they had someone to help them with those questions, it would be extremely helpful.
Balboni: Yes. In our research, we found that it is among these high religious coping patients that you see most of the benefits of spiritual care. When these patients’ spiritual needs are well-supported, they become markedly less likely to receive aggressive interventions at the end of life.
Handzo: So the challenge for us now is to discover what the active ingredient is in that spiritual care.
Balboni: Yes, that’s a big question.
Handzo: If only we could figure that out. Experts like Ken Pargament have been trying for years to figure out why some high religious copers decompensate, and some of them are resilient.
Balboni: There is a lack of information to indicate what that is. The current measures for spiritual care have been broad and not well-characterized. One thing that we did find--which was not surprising--is that patients reporting high support of their spiritual needs are also more likely to have received chaplaincy visits. But what actually happens within those chaplain encounters? What is the interaction between chaplaincy and the rest of the medical team? Clearly, even when and how someone gets referred to a chaplain is an interesting question.
Handzo: We do have answers to how that should happen. That’s what we do--strategic positioning. There are models and triggers, and that’s what we’ve been working on here is some protocols to hard wire that referral in. Part of it, as you can guess, is that a referral to palliative care should trigger a referral to chaplaincy.
Balboni: Palliative care teams really should be staffed with chaplains.
Handzo: Yes, The Joint Commission’s new standards have said that. So that’s an easy one: goals and care discussions that have the chaplain as an integral and required member of the interdisciplinary team. I think there’s more, for example when there's a conversation about DNR (do not resuscitate), or withdrawal of treatment, the family should at the very least have the opportunity to have a chaplain in the room. The next question is, given what we know, what you all found and what you know from others, what are the big questions still out there?
Balboni: We named one of them which is what are the key elements of spiritual care? We know chaplaincy is a key participant. What does the integrated medical team look like in providing spiritual care? And then ultimately the next step would be actually implementing a spiritual care intervention; putting that into practice and testing it in the setting of people who are facing advanced illness.
Handzo: So we need some pilot studies and somebody to try a few interventions--probably in oncology where the evidence is best for the work you and the others are doing.
Balboni: Yes. Within advanced cancer care I’m working with Holly Prigerson, who is the principal investigator of Coping with Cancer II--a multi-site, prospective cohort study of advanced cancer patients that examines communication between patients and physicians. The study also examines this question of why religious coping is associated with more aggressive medical care. It also attempts to better define the key elements of spiritual care by using a combination of qualitative and quantitative survey questions. We are hoping that this data will lead to hypothesis-generating conceptual models that can eventually be turned into a testable spiritual care intervention. The hope is that this research will help in providing some data to help fill in these missing pieces. Another major area of study that we have recently published focuses on patients’ spiritual needs and concerns. That’s a whole other area requiring further research in order to better characterize those needs and understand how they might relate to key spiritual and medical outcomes. Future spiritual care interventions need to be adapted to what patients’ needs are.
Handzo: It’s hard to know what the intervention should be if you don’t know what the diagnosis is.
Balboni: Yes, and its important to have flexibility so that spiritual care addresses the particular situation and needs of each patient. For example, Jennifer Temel’s study on patients with advanced lung cancer showed that palliative care improved issues including quality of life and depressive symptoms. The way the palliative care intervention was approached was to allow a degree of flexibility based on palliative care guidelines and on the expertise of the palliative care practitioners as they interfaced with each particular patient--though this is also a limitation of Dr. Temel’s very important study because it’s not clear what specific elements of palliative care resulted in these outcomes. Ideally, to be both flexible to the needs of patients and to identify what elements of spiritual care impact outcomes, there would be a defined, but flexible structure to the intervention and mixed qualitative-quantitative research methods would be used clearly to identify the key elements of spiritual care.
Handzo: What was remarkable to me was that despite the looseness, to put it one way, of the design, they still got a salient finding in that the patients who received aggressive care plus early palliative care lived longer than those who received aggressive care only. Less surprising was the finding that those who received palliative care had better quality of life and less depression. The point is, even if there was a chaplain, and as you said, we can’t isolate the salient variables anyway, so it wouldn’t have mattered.
Balboni: It may or may not have mattered. The study design does not allow us to definitively know.
Handzo: Yes, we couldn’t have been able to parse anything out. One last question: what advice might you give to chaplains to be effective members of the hospital community?
Balboni: I would think that most of the correction probably needs to be on the rest of medical team’s part. My vision would be that chaplains would play a key role in the training of medical practitioners in specialties that frequently care for patients facing advanced illness. Chaplaincy should be integrated into medical education, and we would all benefit from the inclusion of chaplaincy in multi-disciplinary teams, lectures, and case-based learning in order to better understand the role of chaplaincy and the provision of spiritual care. Better integration is needed in medical schools and continued throughout medical practice. We need chaplains to help do the educating about the intersection of illness, medical care, and spirituality. This is a needed correction that I hope we see in the years ahead.
Handzo: Tracy, thanks so much for the conversation.
KEY POINTS:
- Data show that support of patients’ spiritual needs is associated with better quality of life, increased hospice use, and less intensive care at the end of life.
- There is a sizable gap between what patients want and need in the realm of religion and spirituality and what the medical system offers to patients with advanced illness.
- The neglect of religion and spirituality as a key aspect of someone’s end of life experience appears to lead to greater aggressive medical interventions, which are shown to be associated with higher costs, decreased patient quality of life near death and increased psychological issues among family members.
- Greater integration is needed between the practice of chaplains and medical practice including chaplains being the expert trainers of physicians, nurses, and other members of the team so that spiritual issues are routinely addressed as part of the ongoing plan of care.
SIGNIFICANT CHALLENGES AND OPPORTUNITIES
- Identify and name what the active ingredients/key elements are in spiritual care, including professional chaplaincy’s unique contributions and
- Articulate and demonstrate what an integrated interdisciplinary team providing spiritual care would look like..
- Chaplains must engage in research, both independently and in collaboration with other disciplines in oncology or other settings where persons are facing advanced illness so that spiritual care interventions can be clearly identified, described, implemented, compared, and standardized.
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