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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 14: Table of Contents
    Part I: How to Assess Spirituality

    When to Ask
    What to be Prepared for When You Ask
    How to Ask
    When and How to Refer to Professional Spiritual Caregiver/Chaplain
    When and How to Refer to Professional Spiritual Caregiver/Chaplain

    When to Refer to a Professional Spiritual Caregiver/Chaplain

    • When a professional spiritual caregiver/chaplain is available:
      • Palliative care programs in most major hospitals should have access to their own specially trained spiritual care professional/chaplain and/or to the staff chaplains that serve the hospital at large

      • Hospice programs are even more likely to have a person filling the role of chaplain, though at times this need may be met through a network of volunteer community clergy

      • In spite of the increased request for attention to the spiritual dimension of people’s lives and care in the medical setting, staffing with professionally trained spiritual care providers remains inadequate

      • Caseloads of chaplains often exceed their ability to do more than respond to crisis cases and/or to serve as a liaison to community religious resources
    • When the time, training, or comfort level of the non-chaplain palliative care provider is not sufficient to meet the religious or spiritual needs of the patient and family:
        Ask yourself...

      • Do I have time to explore in further depth the impact of this person’s religious beliefs upon their treatment decisions?

      • Do I know how to assess whether this patient’s “pain” is physical or spiritual in origin?

      • Am I comfortable talking with this family about their religious beliefs and practices?

      • Am I likely to impose my own set of values or beliefs upon them in the process of assessing their needs?

      • Will I be comfortable in the face of strong emotions that may arise in the process of a more in-depth assessment of spiritual suffering?

      • Will I have the time and skills to provide comfort if my questions evoke great sadness or distress?

      • Who could best meet the needs of this patient and family at this time?

    • When the dominant worldview or language of the patient and family is spiritual or religious
    • When your brief assessment indicates:
      • Significant unmet spiritual or religious needs
      • Interest in spiritual care
      • The presence of spiritual suffering
      • Conflict between religious belief/practices and the medical plan of care
    • When “bad news” has been delivered regarding
      • Terminal diagnosis
      • Failure of radiation or chemotherapy to halt the progress of the disease
      • When palliative care is introduced as a treatment option in lieu of curative therapies
    • When difficult treatment decisions are to be implemented, such as:
      • Removal of life support
      • Starting “terminal sedation”
      • Cessation of artificial nutrition
      • Surgery that may result in radical changes in the patient’s physical or cognitive status, or even end in death
    • When the patient is actively dying

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    Potential Obstacles to Referral

    • There are several obstacles you may encounter in attempting to refer or “bridge” to the chaplain
      • You may need to educate your patients and families about the person and role of the chaplain in order to get this team member “in the door”

      • You may also need to use language that describes or explains the chaplain’s role rather than use their official title
    • Click here for sample questions to determine preferred spiritual care provider and identify interest in the chaplain

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    Addressing Common Misperceptions

    • Misperception #1:
      The chaplain is Christian, only serves Christian patients, and will attempt to “convert” persons from other faith traditions
    • The Truth:
      • Hospital and hospice chaplains are trained to serve persons from all religious traditions
      • Their job is to identify, respect, and integrate the patient’s and family’s own religious beliefs and practices into the medical plan of care, NOT to impose their own beliefs
      • In some settings, one may request a Jewish, Muslim, Catholic, or Protestant chaplain who does represent their own religious denomination
    • Misperception #2:
      “I’m not religious, why would I want to see the chaplain?” In other words, the chaplain only provides religious or pastoral care. Many persons equate the chaplain with the only experience they have of religious leaders, a priest or rabbi
    • The Truth:
      The chaplain’s area of expertise includes attention to the “spiritual” dimension of life which may include:
      • Questions of meaning, purpose and hope
      • Sources of comfort, relaxation, and strength
      • Ethical considerations
      • Core values that impact medical care
      • Grief and loss issues
      • The need for non-religious rituals of healing and closure, etc.
    • Misperception #3:
      Chaplain visit = time of death. Contact with the chaplain means the patient is dying NOW. Calling or referring to the chaplain will somehow bring about the patient’s death
    • The Truth:
      The chaplain is a person on the team who can:
      • Help sustain the person’s “spirit”
      • Help persons live as fully as possible
      • Help persons cope with the many challenges of being ill
      • Provide support to the family
      • Help persons draw upon their faith for strength, hope, and meaning during this difficult time

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    Strategies for Successful Referral

    • Referral Strategy #1:
      Use your own rapport or trust with the patient and family:
      • “I know this chaplain well and have found her to be extremely helpful to other patients in my care”
    • Referral Strategy #2:
      Offer to set up a meeting time or joint visit with the chaplain:
      • “May I invite her to our next appointment?”
      • “Is it ok if I bring her with me this afternoon on rounds?”
    • Referral Strategy #3:
      Explain your reasons for suggesting the chaplain and/or indicate your level of concern for the patient/family well-being
      • “Given how important your religious faith is to you, I think it would be helpful if we asked our chaplain to meet with you before you decide ____”.
      • “I am really concerned about how much suffering you are in and want to be sure you see the person on our staff best equipped to help you. In my opinion that person is _______, our chaplain. S/he can help you much better than I with these important questions you are asking”
    • Referral Strategy #4:
      Introduce the chaplain using a description of his or her role rather than the title, if you suspect resistance based upon common misperceptions
    • Referral Strategy #5:
      Consult directly with the chaplain about the needs identified and request s/he stop by the room of the patient or call them directly at home. Address confidentiality issues with the patient and family ahead of time so they are prepared to have someone else contacting them who is aware of their condition and needs
      • "I will be making other members of our palliative care team aware of your admission into our program and aware you are considering palliative rather than curative treatment, so they can offer you their assistance directly."
      • "Our team members include our chaplain, our social worker, and others who will be stopping by to introduce themselves and their services."
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