Study finds spiritual care still rare at end of life

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"There are some basic models, but a rigorously developed spiritual care training model has not been established," she said.

Ferrell, who leads End-of-Life Nursing Education Consortium workshops, said such small-scale organized training opportunities are drops in the bucket of a huge unmet training need.

"We can't practice what we don't know," she said. "Physicians and nurses have never been taught to access and respond to spiritual need."

In addition to training, the field of spiritual care needs a clear definition, said Dr. Christina Puchalski, director of the George Washington Institute for Spirituality and Health in Washington, D.C.

"There is quite a bit of controversy about asking only about religion," Puchalski said. "But previous studies have shown that it's not a patient's particular religious denomination that matters, but what gives meaning and purpose in peoples' lives -things such as family, arts, work, nature, yoga and other values."

Puchalski, who invented a basic spiritual assessment questionnaire that is in wide use, added that the study could have benefitted by asking patients if nurses and doctors acted compassionately toward them, which is another example of spiritual care.

In a country full of diverse cultures, spiritual care may be intimidating to medical workers, but training can help with that, Ferrell said.

"For example, if we have a patient who says, 'I'm very devout in my faith and I never make decisions without consulting my rabbi,' then we immediately take that into account - perhaps by giving the patient extra time between procedures," she noted.

"Patients are telling us spiritual care has to be done with greater intention," Ferrell said.

SOURCE: Journal of Clinical Oncology, online December 17, 2012