Spiritual care rare at end of life

Excerpted from "Study finds spiritual care still rare at end of life," Chicago Tribune, by Kathleen Raven. December 26, 2012--Physicians and nurses at four Boston medical centers cited a lack of training to explain why they rarely provide spiritual care for terminally ill cancer patients - although most considered it an important part of treatment at the end of life. "I was quite surprised that it was really just lack of training that dominated the reasons why," senior author Dr. Tracy Balboni, a radiation oncologist at the Dana-Farber Cancer Institute in Boston, told Reuters Health. Current U.S. palliative care guidelines encourage medical practitioners to pay close attention to religious and spiritual needs that may arise during a patient's end-of-life care. However, the 204 physicians who participated in the study reported providing spiritual care to just 24 percent of their patients. Among 118 nurses, the figure was 31 percent. The 69 patients with advanced cancers who took the survey reported even lower rates, saying 14 percent of nurses and six percent of physicians had provided them some sort of spiritual care.

Past research has shown that spiritual care for seriously ill patients improves their quality of life, increases their overall satisfaction with hospital care and decreases aggressive medical treatment, which may in turn result in lower overall health spending. "I think we are realizing we can no longer ignore this aspect of care," said Ferrell, a professor of nursing who was not involved in the new study. Yet the reasons why spiritual care is rarely incorporated into patient treatment and dialogue have been poorly understood. To gain more insight, Balboni and her colleagues designed a survey - the first of its kind, to their knowledge - to compare attitudes toward spiritual care across randomly chosen patients, nurses and doctors in oncology departments at four hospitals. The questions were geared toward identifying barriers preventing healthcare professionals from delivering spiritual care, beginning with whether anyone felt it was inappropriate for them to be doing so. Full story can be found here.

Commentary

Director of Hematology/Oncology Fellowship and Past President of CMDA Al Weir, MD: “I have followed Dr. Balboni and Dr. Puchalski for a number of years and am grateful for their scientific effort.

"What have they taught us?

"It is clear from their work and the work of others that:

1. Religious practices such as regular prayer and church attendance are associated with improvement in many health outcomes.
   
   
2. The majority of patients in the United Sates would like for their doctors to address their spiritual needs.
   
   
3. A small minority of doctors actually does so.
   
   
4. The first step in addressing spiritual needs is to take a patient’s spiritual history.
   
   
5. Those who have been trained to address the spiritual needs of their patients are far more likely to do so.

"This information is well established and provides a rational motivation for addressing the spiritual needs of our patients.

"As Christian doctors, we also have a revelational motivation to bear witness for Christ with our patients. God has revealed to us through Scripture that we shall be His witnesses. So, whether we choose science or Scripture, we need to get about doing the work we have been assigned.

"A lack of training may be your concern, as in this study. If so, I’ve got good news for you. This year, Christian Medical & Dental Associations is introducing a new evangelism curriculum titled Grace Prescriptions. It is a major update on the popular Saline Solution curriculum introduced more than 10 years ago. The first Grace Prescriptions symposium will take place at CMDA’s headquarters in Bristol, Tennessee on February 9-10. For more information and to register, go to or call 888-230-2637."

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