Organization-level principles and practices to support spiritual care at the end of life

Holyoke, P. & Stephenson, B. BMC Palliative Care | Published online: 11 April 2017

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Background: Though most models of palliative care specifically include spiritual care as an essential element, secular health care organizations struggle with supporting spiritual care for people who are dying and their families. Organizations often leave responsibility for such care with individual care providers, some of whom are comfortable with this role and well supported, others who are not. This study looked to hospice programs founded and operated on specific spiritual foundations to identify, if possible, organizational-level practices that support high-quality spiritual care that then might be applied in secular healthcare organizations.

Conclusions: These Principles, and the practices underlying them, could increase the quality of spiritual care offered by secular health care organizations at the end of life.

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People who are dying should be asked about their spiritual beliefs

NICE has published new guidance calling on healthcare professionals to ask adults in the final days of life about their religious or spiritual beliefs.

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Cultural preferences and spiritual beliefs should be included in discussions about the care a person, and those close to them, want to receive, says NICE.

Knowing if someone holds a religious belief can be important for providing the care they desire. For example, someone who is Catholic may wish to receive the last prayers and ministrations.

The 2016 End of Life Care Audit reported nearly half of all deaths in England occurred in hospital. Spiritual wishes were only documented for one in 7 people who were able to communicate their desires.

Read the full overview here

Read the full guidance here

Spiritual care in palliative care influences patient-reported outcomes

van de Geer, J. et al. Palliative Medicine. Published online: November 9 2016

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Background: Spiritual care is reported to be important to palliative patients. There is an increasing need for education in spiritual care.

Aim: To measure the effects of a specific spiritual care training on patients’ reports of their perceived care and treatment.

Design: A pragmatic controlled trial conducted between February 2014 and March 2015.

Setting/participants: The intervention was a specific spiritual care training implemented by healthcare chaplains to eight multidisciplinary teams in six hospitals on regular wards in which patients resided in both curative and palliative trajectories. In total, 85 patients were included based on the Dutch translation of the Supportive and Palliative Care Indicators Tool. Data were collected in the intervention and control wards pre- and post-training using questionnaires on physical symptoms, spiritual distress, involvement and attitudes (Spiritual Attitude and Involvement List) and on the perceived focus of healthcare professionals on patients’ spiritual needs.

Results: All 85 patients had high scores on spiritual themes and involvement. Patients reported that attention to their spiritual needs was very important. We found a significant (p = 0.008) effect on healthcare professionals’ attention to patients’ spiritual and existential needs and a significant (p = 0.020) effect in favour of patients’ sleep. No effect on the spiritual distress of patients or their proxies was found.

Conclusion: The effects of spiritual care training can be measured using patient-reported outcomes and seemed to indicate a positive effect on the quality of care. Future research should focus on optimizing the spiritual care training to identify the most effective elements and developing strategies to ensure long-term positive effects.

Read the abstract here

culturally- and spiritually-sensitive end-of-life care

BMC Geriatrics

Background

Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool.

Methods

To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June–August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004–2014.

Results

The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making.

Conclusions

This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented.

Full reference Mei Lan Fang et.al.   A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review BMC Geriatrics (2016) 16:107

 

Faith at the end of life: public health approach resource for professionals

Public Health England (PHE)

This resource aims to help frontline professionals and providers working in community settings and commissioners maintain a holistic approach to the people dying, caring or bereaved. It provides information to help ensure that commissioning and delivery of services and practice takes account of spiritual needs of the six largest faith groups in England and remains appropriate to the community setting in which they work.

Embracing a broad spirituality in end-of-life discussions and advance care planning

Churchill, L. Embracing a Broad Spirituality in End of Life Discussions and Advance Care Planning. Journal of Religion and Health Online – 18 December 2014.


A broad view of spirituality is needed, one that may involve traditional religious beliefs, but also includes personal understandings of what is holy or sacred. Embracing this broad practice of spirituality will help both familial and professional caregivers honour an essential aspect of endof-life discussions and promote greater discernment of the deep meaning in advance care documents.