HealthCare Chaplaincy - Meaning. Comfort.

What do the Super Bowl & professional health care chaplaincy have in common? Lots!

2012-02-16T14:08:00.003-05:00

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.

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.

Helping Grandparents to Be There for Their Twin Granddaughters

2012-02-04T14:26:00.001-05:00

Helping Grandparents to Be There for Their Twin Granddaughters

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:

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

2012-02-04T14:16:00.002-05:00

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:

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"

2012-02-04T14:14:00.000-05:00

“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.”

HealthCare Chaplaincy CEO Awarded National Ministry Network’s Highest Honor

2012-02-04T14:12:00.000-05:00

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.

Making the case for palliative care

2012-02-04T14:10:00.001-05:00

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:

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

Dr. Meier said that palliative care can reduce costs while improving patient outcomes, that key to effective palliative care is listening to the patient and family members, and that chaplains are experts at this. Dr. Meier made special mention of the fact that professional chaplaincy will have a certification process in palliative care within the year. This effort, which creates the first subspecialty certification for chaplains, is a result of a joint initiative of HealthCare Chaplaincy and the Association of Professional Chaplains, and is supported by grants from the Arthur Vining Davis Foundations and the Retirement Research Foundation.HCC began the pilot of the educational curriculum with a small group of chaplains on January 23rd, and will open the program to all interested chaplains in September.

Important Article on Chaplaincy Research Is Now Available to Read

2012-02-04T14:08:00.001-05:00

“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.

Important Oncologist & Chaplain Conversation

2012-02-04T09:08:00.005-05:00

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:

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.

2011-12-13T07:28:00.001-05:00

Don Berwick: US health care delivery system is broken http://bit.ly/viYvt5 palliative hpm

2011-09-16T07:28:00.001-04:00

Wry and true commentary about American health care system http://bit.ly/nvpISz palliative hpm

2011-06-24T11:05:00.001-04:00

June 28: free, important webinar from CAPC on unprecedented public opinion research on pallative care http://bit.ly/k9RJNN hpm

New health care chaplaincy webinars from experts on palliative care for chaplains and other spiritual care providers

2011-04-29T14:23:00.003-04:00

Details at www.healthcarechaplaincy.org/learn or https://secure.healthcarechaplaincy.org/cart/productsubcats.aspx?SubCategory=7

Each webinar is 90-minutes long, includes time for discussion/question and answers, and costs $35. If you purchase the webinar but cannot attend for any reason, you will still be able to view the webinar recording for six months after the event.

All of the webinars run 2-3:30 pm Eastern Time.

May 3rd, 2011

Advanced Care Planning for Aging, Illness, and Incapacity

Who should attend: Anyone interested in this vital topic, chaplains, other religious professionals, and other spiritual care providers.

Become familiar with the concepts, vocabulary and tools that are necessary for preparing for the legal and spiritual needs that arise as people age, become incapacitated, or face life-limiting illness.

Expert presenters:

Robert Wolf, Esq. – Senior Vice President, Innovation and Development, HealthCare Chaplaincy
Martin Montonye, DMin, BCC -- Vice President, Academic Affairs, HealthCare Chaplaincy

May 9th, 2011

Caring in the Presence of Loss:

Who should attend: Anyone interested in this vital topic, chaplains, other religious professionals, and other spiritual care providers.

Learn to identify the needs of people grieving, explore the experience of grief and bereavement, and discuss the various interventions to provide supportive care.

Learn the contribution of Kubler-Ross' stage theory of grief; be able to define the terms anticipatory grief, bereavement, grief and mourning; and identify the skills necessary to engender trust and openness in a relationship with someone who is dying.

Expert presenter:

Martin Montonye, DMin, BCC -- Vice President, Academic Affairs, HealthCare Chaplaincy

June 14th, 2011

The Role of Chaplaincy within a Changing Culture

Who should attend: Professional and volunteer chaplains

Cultural competence is an increasingly important issue in health care and one where chaplains can have a major impact. Learn the current salient issues in making a health care institution culture-friendly for patients, families, and staff, and include new Joint Commission standards and assessment issues. Emphasis will be placed on the role that chaplains can have in being the “culture broker” for the institution.

Expert presenters:

George Handzo, BCC, CSSBB -- Vice President, Chaplaincy Care and Leadership Practice, HealthCare Chaplaincy
Sue Wintz, MDiv, BCC -- Managing Editor, PlainViews® e-newsletter for spiritual care providers, HealthCare Chaplaincy

June 28th, 2011

Spiritual Screening, History Taking, and Assessment

Who should attend: Professional and volunteer chaplains

Based on the work of the National Consensus Conference on Spiritual Care in Palliative Care, learn a system for integrating spiritual screening, history taking, assessment and care planning into the palliative care team. Emphasis will be placed on the role of the chaplain within the overall spiritual care function of the palliative care team

Expert presenter:

George Handzo, BCC, CSSBB -- Vice President, Chaplaincy Care and Leadership Practice, HealthCare Chaplaincy

September 13th, 2011

Palliative Care: Creating an Effective Transdisciplinary Team

Who should attend: Chaplains, other spiritual care providers, and other health care professionals

Teamwork is essential in providing quality care to patients receiving palliative care. This program is designed to enhance the clinical skills and effectiveness of healthcare professionals caring for palliative patients and their families. The content will include developing a team, defining roles, care and collaboration, leadership and communication skills, conflict resolution and finding meaning. In addition, a physician, nurse, social worker and chaplain will demonstrate teamwork by providing a case review
Expert presenter:

Martin Montonye, DMin, BCC -- Vice President, Academic Affairs, HealthCare Chaplaincy

October 11th, 2011

Organ Donation: Important Religious, Spiritual and Practical Aspects

Who should attend: Anyone interested in this vital topic, chaplains, other religious professionals, and other spiritual care providers.

Learn the facts about the organ donation and referral process; the ethical, religious and cultural considerations that families may have when deciding about donation and the role that each faith leader plays in saving lives.

Expert presenter:

Karen Cummings, New York Organ Donor Network

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Improve your practice with these online courses

HealthCare Chaplaincy introduces a new approach in continuing education for chaplains, clergy, counselors, educators, health care professionals and others with online courses that:

•Bring up-to-date subject matter to you at your convenience
•Add to, or refresh, your professional skills
•Provide opportunity for dialogue with peers

What Chaplains and Clergy Need to Know About Cultural Self-Awareness” created by the Rev. Dagmar Grefe, PhD, Manager of Spiritual Care Services/ACPE Supervisor, Childrens Hospital, Los Angeles; Templeton Visiting Scholar, HealthCare Chaplaincy

This course contains up-to-date, relevant information for chaplains, clergy, and other professionals on developing cultural self-awareness. Cultural self-awareness is awareness of interactions of cultural groups, and awareness of the psychological processes that occur automatically and impact on our social behaviors. Social psychology provides a framework for understanding why human beings categorize others, develop stereotypes, and respond to others in automatic ways. Included in this online course are methods to improve cultural self-awareness. The information is based in psychological research and theory.

--------------------------------------------------------------------------------

"What Chaplains and Clergy Need to Know About The Confused Patient: Delirium and Dementia” created by David A Harrison, MD, PhD, Department of Psychiatry & Behavioral Sciences, University of Washington; Templeton Visiting Scholar, HealthCare Chaplaincy

This course contains up-to-date, relevant information for chaplains, clergy, and other professionals on the often overlooked and under-diagnosed disorder of delirium. It also contains information about, and useful clarifying comparisons with, dementia, because delirium and dementia are often confused one for the other. Case studies provide examples of the risk factors, signs, and potentially life-long negative impacts for patients with delirium, as well as the progression of dementia on patient and family members. Recommended intervention strategies for patients and families of patients with delirium and dementia are included in this course.
Price: $40 per course.

To purchase, click here.

Each of these courses:

•Contains an online, self-directed learning module that you can access as often as you like, at your convenience, for up to one year.
•Contains bookmarks, so that you can close the course and resume your learning later from that place.
•Allows for repeated course completions to reinforce learning.
•Includes an invitation to participate in a facilitated, online, community of practice for peer to peer learning.
•Provides a certificate of completion, accessible and printable after the learner completes the course at least once

2011-04-29T14:13:00.005-04:00

2011-04-29T14:07:00.001-04:00

Those involved in spiritual care/palliative care can find helpful new webinars from experts starting May 3. http://bit.ly/iWtabA hpm

Untreated pain is a huge global problem. But a problem that is solvable.

2011-04-14T13:07:00.001-04:00

Palliative care pioneers such as HealthCare Chaplaincy trustee Dr. Kathy Foley, Mary Calloway, Dr. Bal Mount, Dr. Betty Ferrell and others have not only worked to help eradicate physical pain in the lives of people around the world but have sought to keep in front of the world how pervasive and devastating pain is in the lives of so many people.
Clearly, solving this problem is far from simple.

No one denies that the diversion and abuse of legal pain medicines is also a huge problem.
Yet the abuse is not a legitimate excuse to keep people in pain when a remedy is available.

What so many of us fail to appreciate is how huge a public health problem pain is. It not only takes away quality of life from so many but costs economies untold real money.

Even though I know about this problem in my head, I admit that I often find it so difficult to get my hands around it because of its enormity.

Thus I would commend to you this posting on the prominent palliative care blog Pallimed (http://bit.ly/g2ju64) which links to two new short videos at http://bit.ly/fqeAis and http://bit.ly/dLRLWH.

These videos are grim, but are not even close to the experience of those suffering in intractable pain.

They remind us of what an unnecessary scourge pain is.

Share This Now With Your Hospital Administrator and Risk Manager

2011-04-07T15:05:00.010-04:00

A recent issue of Modern Healthcare, the weekly health news magazine that virtually all hospital administrators read, recently published an article on new strategies for dealing with patients and families after medical error (“Going beyond saying you’re sorry: More hospitals using quick remediation strategies following medical error”, March 28, 2011, pp. 32-33).

The article highlights a program at the University of Michigan Health System which replaces the traditional approach run by the hospital attorneys to an approach based on transparency and “remediation” which generally seems to involve a quick payment offer or at least not changing the patient for the procedure which resulted in the error.

This approach is clearly a big step forward in compassionate patient care and did reduce the lawsuits at this hospital.

However, something is missing.

It overlooks the potential contribution of the chaplain.

Many of us who are professional chaplains have long claimed that we can help reduce hospital lawsuits, though of course we cannot prove it. The lack of evidence notwithstanding, this article which many hospital administrators and risk managers will read, gives chaplains an opportunity to remind their management how they could make any program of this kind even better.

Chaplains are not there to defend the hospital or make any offers, but to help patients and families express and process the sometimes intense feelings that these events evoke and be a caring presence. Often it can be the unique expertise of the chaplain that reduces conflict and facilitates communication.

The chaplain’s active involvement sends a message that the hospital is truly interested in the person’s welfare and not just in protecting the hospital’s interests. In cases like this, chaplains are an essential and valuable resource to bridge the often divergent interests of risk management and patient-centered care.

I suggest that you share this now with your hospital administrator and risk manager, and talk with them about establishing a protocol where “exceptional” cases automatically trigger a chaplain referral and response as a member of the professional healthcare team.

Good dialogue about how to explain palliative care

2011-03-08T08:40:00.001-05:00

From Pallimed blog: http://bit.ly/hYK14G

Jim Siegel said...
Christian -- Thanks much for this post and raising the question about the term "non-hospice palliative care.” From my marketing & communications perspective, I shy away from saying what something is not, because it reminds people more of “the not" and thus can be counterproductive. However, since so many health care professionals think palliative care and hospice care are synonymous, and almost everyone in the general public that I speak to about it thinks that as well, the directness of the expression is intriguing, because it attacks the misperception head on. Since superb communicator Diane uses the term, that sure is an endorsement. Also, you mention the palliative care elevator pitch, and in case this is useful for Pallimed readers, here’s the elevator pitch that we’ve adopted here at HealthCare Chaplaincy: “Palliative care matches patient wishes to treatment goals and reduces suffering.” PS. The cloud is one cool visual and thanks for the link to Wordle.

March 07, 2011
Larry Boggeln, MD said...
I like "non-hospice palliative care" for the same reason..attacking misperception directly. Nice succinct elevator pitch. I personally would amend it slightly, such as "Palliative Care is a medical specialty that reduces suffering through an interdisciplinary team, focusing on patient-identified treatment goals."

March 07, 2011
Lisa Morgan said...
Thanks for raising the language issue. The term non-hospice palliative care is a term that CAPC effectively used early on with clinical audiences (not patient/family) that didn't know palliative care could be provided upstream. I would not necessarily recommend that the term be used with patients/families/general public. Jim is correct to point out the problematic nature of defining something by what it is not. The palliative care field faces a communications challenge in this respect. Upstream patients and families who confuse palliative care and hospice do respond to being told bluntly that the two are different. This is because the explanation addresses a direct question already in their minds. Referring clinicians have told us that this directness is very helpful. However, people who don't know what palliative care is at all can become confused. CAPC is currently in the process of conducting major public opinion and messaging research that will help guide our definitions and messages now and into the future. Stay tuned later this spring!

March 07, 2011
Jim Siegel said...
Lisa and Larry -- Thanks for the helpful feedback. That CAPC is conducting major public opinion and messaging research to help develop definitions and messages is hugely valuable and another instance where CAPC is taking the lead in a vital area. I like the amended elevator pitch, but I think that works more for the professional audience than the public audience. I recognize that I was not clear that the general public is the target of the elevator pitch that I cited. A second talking point that we do make is that palliative care is delivered by a transdisciplinary team that includes physicians, nurses, professional chaplains, social workers, and others. Your thoughts?

March 07, 2011
Drew Rosielle MD said...
Lisa thanks for the history of the phrase - yes it makes sense as a short-cut way of talking with other clinicians/health professionals/hospital administrators, but not families.

I've said on the blog before, and won't pass up this opportunity again, that I think we suffer as a community due to lack of any sort of accurate, non-euphemistic (you start throwing around 'quality of life' and people start thinking about support groups and wigs for cancer survivors...not that there's anything wrong with that), and very succinct (one sentence) way of describing to lay people what we do in palliative care. And in a way that wouldn't lead my mother to respond 'Isn't that what all doctors do?'

Christian, you didn't exactly say this, but I wonder if you are concerned the phrase stigmatizes hospice. While we need to, absolutely de-link ourselves from being connected solely to EOL care, it's also true that hospice care, as a whole, provides immaculate care which promotes quality of life, alleviates suffering, supports patients & families emotionally, and is aligned with care goals (usually, b/c if it wasn't then they'd likely not be in hospice). The only problem, you know, is that hospice is, b/c Medicare made it so, for people at life's end. It's like 'we're not for dying people - hospice is - not that there's anything wrong with that.'

Anyway, despite my longing for a non-euphemistic sentence I have found that, at the bed side, you can usually help people understand in a few sentences, tailored to what the consult reason is, and that from a practical standpoint I have a MUCH more difficult time helping patients understand the difference between an hospital-based palliative consult service which also runs clinics and home based palliative care programs. Eats up a lot of time at times.

I'll also say that I usually tell patients I see as a consultant, straight up, b/c I figure many of them are worried about it, that we do take care of a lot of people who are dying, make sure they're comfortable and in the place they want to be, help them figure out when it's time for hospice care, etc., and that's a role we play in the institution, although that's not why Dr. XYZ asked us to see you today. I may be oblivious to the effects of this, but I haven't noticed any major problems, and even for patients who completely aren't ready to 'go there,' I've signalled to them, from the beginning, that we're a team who is comfortable going there and it's a safe topic in our presence. I think it helps down the road, and half the time anyway patients are so terrified of this, to have the door opened to talk about it, in a safe and less threatening manner (ie framed as this is something our team does for some patients so we can talk about it hypothetically here, not this is something that your pulmonologist thought was so urgent that she wanted us to talk with you, NOW, about your death), allows them to begin to discuss what they worry the most about. So, for the most part, I think it helps us to foreground, a little, our expertise and confidence in providing excellent EOL care, not hide from it. Of course these are already patients who have agreed to see us, referred to us by people who understand what we do....

March 07, 2011
Earl Quijada said...
I’m not a fan of the phrase “non-hospice palliative care”. I first heard it used at AAHPM 2010 Boston by Diane Meier in context of “improving optics” on Capitol Hill as anything with “death”, “end of life” etc...immediately produces a lightening rod for controversy. I don’t remember the phrase being discussed in context of describing palliative care to colleagues or patients and families. I don’t imagine that if “non-hospice palliative care” were used that it would be contained in whatever intended silo. So that said, it will get to the patient and it does stigmatize hospice. In my opinion, it minimizes what we do best, end of life care. I don’t think Balfour Mount coined palliative care to “cloak” the death part.

That being said, of course I don’t think we should be passing out death cards. Our expertise lies in knowing how to handle this part of life in the context of each individual’s narrative. I don’t think there is a non-euphemistic phrase to describe what we do. Do we clinically need one and do all specialties have one? I don’t think we need one clinically and if we’re trying to create a phrase for someone other than patients/families it’s almost as if we’re trying to justify something.

If we were to use a phrase, I prefer something morally neutral like Advance Illness Management (AIM) that Brad Stuart uses. Phrases with “quality”, “relieve suffering”, and even “matching preferences” to me can sometimes create a tone that we’re doing something that someone ought to be doing but isn’t (bad bad).

More Palliative Care Could Save Hospitals, Medicaid Millions: Study

2011-03-08T07:02:00.001-05:00

More Palliative Care Could Save Hospitals, Medicaid Millions: Study
WNYC Radio
Tuesday, March 08, 2011
By Fred Mogul

Dr. Sean Morrison said bringing together doctors, nurses, chaplains and social workers to talk through treatment options with patients and their families makes sense not only for the patient with end-stage pancreatic cancer but also for the one in the early stages of a relatively curable leukemia.

And now, Dr. Morrison said, data suggests not only improved outcomes for patients, but potentially thousands of dollars' worth of savings per hospital visit and tens or hundreds of millions of dollars' worth of potential savings state-wide.

His study in the journal Health Affairs compared the treatment of hundreds of patients at four hospitals across New York State. The main savings come from shortening hospital stays and keeping people out of the Intensive Care Units.

"What we found is that when patients received palliative care plus usual care, it resulted in somewhere between $4,000 and $7,500 per admission to the hospital," said Morrison, an internist, geriatrician and palliative care specialist at Mt. Sinai Medical Center.

He estimated that could save the New York Medicaid program up to $250 million, if applied to all hospitals with 150 beds or more.

Morrison said about 80 percent of hospitals already have palliative care teams, but that doesn’t mean widespread savings would be easy to come by because there’s a wide variation in how effective these teams are.

He also said there's much resistance to expanding palliative care because hospitals can’t always bill Medicaid or insurers for it, and many doctors associate it with giving up on patients.

I posted this comment:

Dr. Morrison is right about palliative care’s benefits to patients, families and hospitals. Simply put, palliative care matches patient wishes to treatment goals, and reduces suffering. Palliative care may be right for someone who suffers from pain or other symptoms due to a serious illness such as cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s, AIDS, Amyotrophic Lateral Sclerosis (ALS) and multiple sclerosis. Palliative care can be provided at any stage of illness and along with treatment meant to cure. Good information sites for the general public are getpalliativecare.org and healthcarechaplaincy.org and for health care professionals capc.org.
http://bit.ly/fyb43W

The truth about end-of-life planning

2011-03-04T06:50:00.001-05:00

From The Huffington Post: http://huff.to/gyMTtA

Joseph Nowinski, Ph.D..Clinical psychologist; coauthor, 'Saying Goodbye: How Families Can Find Renewal through Loss'
Posted: March 3, 2011

Congress is debating the merits of the Affordable Care Act, and the usual suspects are leading the charge against it. They've already scored one victory. A few weeks ago, the news broke that the Obama administration was prepared to move ahead with the "end-of-life planning" provision of the Affordable Care Act, both of which have been the target of so much misinformation. Shortly thereafter, it was announced that end-of-life planning would not be authorized after all. It seems that this humane practice has fallen victim to yet another slanderous salvo. How did this happen?

First of all, it's vital that people understand exactly what end-of-life planning is, and what it is not. In an effort that would undermine badly needed health care reform in this country, demagogues like Sarah Palin created a fantasy called "death panels" and insinuated that health care reform would result in some government agency deciding when to "pull the plug" on terminally ill Americans. This tactic, outrageous as it was, did succeed, in that it scared many people and turned them against health care reform. It also reveals, however, how little many people understand about our health care system as well as how impotent they feel in the face of it. No populace that felt empowered about their health care system could possibly be stampeded in this way.

So what is end-of-life planning? It is, for one thing, not a death panel. On the contrary, the health care system that has existed in America prior to health care reform could be said to have been dominated by the equivalent of "death panels." They take the form of millions of denials, exclusions and outrageous premium increases that Americans with serious or terminal illnesses have received each and every year when they turned to their health insurers expecting help. I know of no one who does not know someone who has been the victim of such practices. In fact, in a survey just released by the Department of Health and Human Services, as many as half of Americans under the age of 65 have medical conditions that qualify them to either be denied coverage or else subjected to prohibitively high premiums. Naturally, the insurance industry insists that this number is inflated. But what if it is only a third of Americans? No matter what the percentages, do these practices not amount to de facto death panels? After all, where is one to turn if you are diagnosed with a terminal illness and then denied coverage or asked to pay a premium you can't possibly afford?

What end-of-life planning is, in the context of the Affordable Care Act, is for a patient with a terminal diagnosis to be able to meet with his or her primary care physician once a year to review the overall treatment program, consider various options and make rational decisions. There is no reason why close family members cannot be part of this process.

Not every man or woman who is facing impending death is open to end-of-life planning. Many individuals have shared with us their frustration in this regard -- often with unfortunate results. As an example, consider the woman whose father, suffering from severe dementia as well as kidney failure requiring dialysis, underwent cardiac bypass surgery. He died a week later from an infection of unknown origin. Why did this happen? Because, the daughter explained, her father had stubbornly refused to discuss such end-of-life decisions. "He didn't even know who I was," this woman said, "but I said yes to the surgery because the doctors wanted to do it and I didn't know what he would want." Such reports only serve to underscore the fact that there are many decisions that the terminally ill are well advised to make (preferably in consultation with loved ones) while they are lucid and capable of making them. Too many people die every year in hospitals and intensive care units simply because they did not have an opportunity to consider alternatives such as hospice or home care combined with palliative care, as opposed to heroic interventions when the chances for improvement are nil. Resources for end-of-life planning can be found on www.NewGrief.com.

Contrast the above scenario with recent research which shows that making palliative care available to the terminally ill -- including pain management, along with regular opportunities to talk with counselors and doctors -- results in patients reporting less depression, improved energy levels and a better quality of life in general. Hardly the image of a death panel.

Those of us who would prefer to offer the above alternative to Americans who are battling terminal illness need to stand up in any way we can in order to challenge misinformation and advocate for the humanity of end-of-life planning. We need to say it, loudly, clearly and often: The Affordable Care Act includes no death panels! There will be no death panels in America!

What Makes Us Unique, What Makes Us Similar

2011-03-04T06:34:00.001-05:00

"Our uniqueness is what gives us value and meaning. Yet in the telling of stories we also learn what makes us similar, what connects us all, what helps us transcend the isolation that separates us from each other and from ourselves." -- Dean Ornish, MD

About the power of laughter

2011-03-03T07:00:00.001-05:00

“The ultimate weapon,” he wrote, “in the face of evil or sorrow, sadness or death, is not stoic virtue and the stiff upper lip but laughter, for where laughter is, God cannot be far away.”
-- The Rev. Peter Gomes

Something so true about everyone that I read just this morning

2011-03-03T06:40:00.001-05:00

"That every one of us matters. And that we have the power to befriend and strengthen the life in one another to change the world, one heart at a time." -- from the preface to the book "Kitchen Table Wisdom" by Rachel Naomi Remen, MD.

Tribute to the Rev. Peter J. Gomes

2011-03-02T09:34:00.001-05:00

The Rev. Peter J. Gomes, a Harvard minister, theologian and author died recently at age 68. He was a highly visible presence on campus whose reach was much wider.

I found his writings instructive and inspirational to me, who is not a Christian.

Yesterday’s New York Times obituary (http://ping.fm/w2SpK) reminded me of that:

In his 1996 best seller, “The Good Book: Reading the Bible with Mind and Heart,” Mr. Gomes urged believers to grasp the spirit, not the letter, of scriptural passages that he said had been misused to defend racism, anti-Semitism and sexism, and to attack homosexuality and abortion. He offered interpretations that he said transcended the narrow context of modern prejudices.

“The Bible alone is the most dangerous thing I can think of,” he told The Los Angeles Times. “You need an ongoing context and a community of interpretation to keep the Bible current and to keep yourself honest. Forget the thought that the Bible is an absolute pronouncement.”

But Mr. Gomes also defended the Bible from critics on the left who called it corrupt because passages had been used to oppress people. “The Bible isn’t a single book, it isn’t a single historical or philosophical or theological treatise,” he told The Seattle Gay News in 1996. “It has 66 books in it. It is a library.”

In 1991 he announced that he was gay. He then said:

“I now have an unambiguous vocation — a mission — to address the religious causes and roots of homophobia,” he told The Washington Post months later. “I will devote the rest of my life to addressing the ‘religious case’ against gays.”

I never met him. I wish I had.

May his memory be a blessing.

Chaplaincy Testifies at Medicaid Redesign Hearing

2011-02-21T10:13:00.001-05:00

To curb the projected $9 billion New York State budget gap created in part by enormous expenditures in state health care, Governor Andrew Cuomo has created a new task force named the “Medicaid Redesign Team” to assess the reform possibilities in the New York State Medicaid system.

Medicaid accounts for about one-third of all state spending, making it a key target area for cost-cutting and deficit reduction.

Established by executive order by the governor, the 27-member team is made up of a variety of health care professionals and members of advocacy organizations. Leading the team are Michael Dowling, president and chief executive officer of the North Shore-LIJ Health System, and Dennis Rivera, president of the labor union SEIU Healthcare. The team’s role in the reform process is two-fold: 1) to provide good ideas for how to lower costs and improve quality in New York’s Medicaid Program; 2) to evaluate ideas generated through stakeholder and staff engagement.

A total of 3,000 ideas were submitted to the New York State Health Department, both at public hearings and on the department’s website. These were narrowed down to 49 of the most promising items and submitted by the Health Department to the governor’s Medicaid Redesign Team.

Claire Altman, HealthCare Chaplaincy’s executive vice president and chief operating officer, testified at the February 22nd hearing and those suggestions are reflected in one of the recommended proposals covering long-term care. To read Claire’s full testimony, click here

2011-02-19T12:19:00.001-05:00

Study Finds Early Palliative Care Extends Life and Improves Quality of Life for Cancer Patients. Video: http://bit.ly/c2bVwH

2011-02-19T09:35:00.001-05:00

U.S. State Department Profiles
HealthCare Chaplaincy’s Imam Yusuf Hasan http://bit.ly/aKmsTP spirituality

2011-02-19T09:32:00.001-05:00

Hear what Anderson Cooper says about HealthCare Chaplaincy http://bit.ly/9vve0H
#hpm

2011-02-18T18:32:00.001-05:00

Read the latest news on spirit-centered palliative care http://bit.ly/ebAJoP hpm

HealthCare Chaplaincy - Meaning. Comfort.

What do the Super Bowl & profession​al health care chaplaincy have in common? Lots!

Helping Grandparents to Be There for Their Twin Granddaughters

Global Perspectives on Palliative Care

“Just Healing the Body is Not Enough"

HealthCare Chaplaincy CEO Awarded National Ministry Network’s Highest Honor

Making the case for palliative care

Important Article on Chaplaincy Research Is Now Available to Read

Important Oncologist & Chaplain Conversation

New health care chaplaincy webinars from experts on palliative care for chaplains and other spiritual care providers

Untreated pain is a huge global problem. But a problem that is solvable.

Share This Now With Your Hospital Administrator and Risk Manager

Good dialogue about how to explain palliative care

More Palliative Care Could Save Hospitals, Medicaid Millions: Study

The truth about end-of-life planning

What Makes Us Unique, What Makes Us Similar

About the power of laughter

Something so true about everyone that I read just this morning

Tribute to the Rev. Peter J. Gomes

Chaplaincy Testifies at Medicaid Redesign Hearing

What do the Super Bowl & professional health care chaplaincy have in common? Lots!