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Religion and Spirituality in Palliative Care

Su Sundee MyintJenny StoryWenbo Li

Sharon Lau

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Outline

• Su Sundee

Religion in the context of palliative care

Different perspectives of religion from different

religious backgrounds

Spirituality in the context of palliative care

Relationship between religion and spirituality

Importance of religion and spirituality in palliative

care

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Outlines

• Jenny

Key characteristics of quality spiritual care of

the patient in palliative care

Assessment of the spiritual and religious needs

of late-life patients

Principles underlying spiritual care

Practice points in spiritual care

Music thanatology as spiritual care

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Outline (continued)

• Wenbo

• Sharon

Religious needs of family in palliative careFears of patients’ familyCaregiver team Important practice points in religious palliative care

Benefits and limitations of spirituality and religion in palliative careImportant roles of pharmacistSummary of presentation

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Religion and Spirituality in Palliative Care

Su Sundee

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Law of Nature

• Human condition is bound by the law of nature – life and death

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Religion

• Associated with various connotations:- the totality of belief systems-an inner piety or disposition-an abstract system of ideas- ritual practices

Image from (www.hfa.ucsb.edu)

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Religion in palliative care

• In end-of-life care, religion and religious traditions serve two primary functions:

1. the provision of a set of core belief about life events 2. the establishment of an ethical foundation for clinical decision-making

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Different perspectives of religion in palliative care

• There are many types of religion in the world which people believe in

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Different perspectives of religion in palliative care

• Buddhism- Life is one of an infinite series

- If we die well with a peaceful mind, it will beneficially influence our next life

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Different perspectives of religion in palliative care

• Christianity - Assurance of spiritual security is vitally important

to Christian patients facing death

- A ‘good death’ can be achieved when the dying patient is relieved from both physical pain and emotional pain

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Different perspectives of religion in palliative care

• Hinduism- Beliefs and practices vary considerably

- Most Hindus require time for meditation and prayer when small idols or pictures of gods may be kept under the pillow of the patient

Image from (detailsofindia.blogspot.com)

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Different perspectives of religion in palliative care

• Islam- Life is viewed as a time of preparation for

hereafter-Death is viewed as the beginning of a different

form of life

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Spirituality

• Relate to the vital life essence of an individual • Considerable importance when our physical existence

is threatened by disease and death

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Spirituality in palliative care

• Spiritual beliefs have been shown to affect the ways in which palliative care patient deals with illness

• Spirituality forms the context in which patients respond to care, choose treatment options and face death

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Relationship between religion and spirituality in palliative care

• Play important roles hand- in- hand in palliative care

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Importance of religion and spirituality in palliative care

• Important connection to mental health• Buffer against depression and fear• Initiate the search for the meaning in life • Prepare one for death

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Spiritual and Religious Care of the

Palliative Care Patient

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Jenny Story

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Spiritual and Religious Care of the Palliative Care Patient

• What is spiritual care?

• Operational principles.

• Conducting needs assessment.

• Common spiritual needs.

• Music thanatology as spiritual care.

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Key Characteristics of Quality Spiritual Care of the Patient in Palliative Care

• Physical and emotional presence– Physical closeness– Compassionate actions

• Caregiver awareness– Taking time to learn about the patient’s life and– The patient’s experience of the approaching

end.

(Daaleman et al. 2008)

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Operational Principles Underlying Spiritual and Religious Care of the

Palliative Care Patient

1. Any member of the palliative care team can give spiritual

care. (Daaleman et al. 2008)

http://www.simplyhe.co.uk/comedy/130605-Ladies-Who-Do-1963-5060082512155.html

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St Mary of the Cross, motto for life: “Never see a need without doing something about it.” (Goodwin & Prats 2010)

Operational Principles Underlying Spiritual and Religious Care of the Palliative Care

Patient

http://www.columban.org.au/Archives/mary-mackillop/blessed-mary-mackillop/

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Operational Principles Underlying Spiritual and Religious Care of the

Palliative Care Patient

2. “Primum non nocere.” (Hippocrates)

Care team members can undermine the

patient’s identity and self-worth. (Murray et al. 2004)

http://rocksolid.gibraltarsoftware.com/development/logging/first-do-no-harm-designing-robust-infrastructure

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Operational Principles Underlying Spiritual and Religious Care of the Palliative Care Patient

3. The patient should receive religious care

which is culturally appropriate.

• Conduct a late life spiritual and religious need

assessment.

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How to conduct a late life patient spiritual and religious care needs assessment

• Open questions. (Astrow, Pulchalski & Sulmasy 2001).

• Ask for clarification if necessary.

• Observation.

• Admission interview notes.

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Call clergy if indicated

• Do this early, so they can address late life religious needs and

• Provide a funeral

respecting the unique

narrative of the patient’s

life. (Rev. Keido Iijima, Soto Zen Nun

& Palliative Care Nurse, 2009)

http://jsri.jp/English/ojo/2009/iijima.html

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Late life spiritual needs of the

patient and how to address them• Coping with fear of dying - Don’t deny the fear or suggest courage

- Let the patient express fear. Stick with them. (Leming & Dickinson 1994)

• Forgiving and accepting forgiveness

- “Are you at peace?” (Steinhauser et al. 2006)

• Finding meaning in one’s life, suffering and death. (Sulmasy 2002)

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Summary: Spiritual and religious care a palliative care team member can offer to the patient

• Assessment allowing interface with clergy for provision of religious needs

• Physical and emotional presence (spiritual care), as a context in which:

- the patient’s fears can be allayed, - forgiveness undertaken and accepted, and - the meaning of the patient’s experiences

established.

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Music Thanatology

• The use of music in late life to allay fear, to bring peace and to help establish a narrative meaning to life.

• It reduces depression,• Supplements pain control methods, and• Enhances communication between the patient and

family, and the patient and the clinical and pastoral care teams(Bailey1983,1984,1985).

• The sensation of pain is experienced as reduced (Zimmerman et al. 1989).

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Music thanatologist is Peter Roberts.

http://www.robertsmusic.net/NEW/music-than.html

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Religion in palliative care

•Religious needs of family in palliative care•Fears of patients’ family•Caregiver team•Important practice points in religious palliative care

Wenbo Li

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religious needs in palliative care

http://msa.maryland.gov/msa/speccol/sc5500/sc5590/html/religious_toleration.html

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Common religious needs

• Access to clergy of their faith

http://www.srkilsyth.catholic.edu.au/curriculum/3/religious-education/15405/

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Common religious needs

• Prayer and reading of sacred writings

http://zenmirror.blogspot.com.au/2010/09/diamond-sutra-worlds-earliest-dated.html

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Common religious needs

• Religious rituals e.g. faith healing

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"available scientific evidence does not support

claims that faith healing can actually cure physical

ailments.”……."Death, disability, and other

unwanted outcomes have occurred when faith

healing was elected instead of medical care for

serious injuries or illnesses."

American Cancer Society

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Common religious needs

• Dietary requirement

http://myauraiya.wordpress.com/tag/meaning-of-the-words-hindu-and-hinduism/

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Fears of patients’ family

Fear of financial burdens

Fear of losing loved ones

Fear of being unable to cope with patients’

physical problems

Fear of being unable to cope with patients’

emotional problems

http://talkislam.com.au/

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Fears of patients’ family

Afterlife concerns: fear of dead patients

Fear of the end of a relationship

Fear of death

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Palliative care team

http://kathmurray.blogspot.com.au/2011/07/are-we-preparing-our-health-care.html

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Religious carer team

• Social workers

• Pastoral care staff

• Social workers

• Volunteers

• Community groupshttp://www.essorstrategies.com/en/team.php

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Important practice points in religious care

• Recipients’ preference

• Confidentiality

• A missionary rather than a carer?

• Carer qualificationshttp://www.people-results.com/admiring-problem/

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Religion and Spirituality in Palliative Care

•Benefits and Limitations•Role of pharmacists•Summary

Sharon Lau

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Benefits

• can be provided regardless of the staff member’s own faith or lack of it

• provided by anyone for anyone

• increase an individual’s control and planning over their future

• empowerment in situations

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• relieve the discomfort

• Improve the quality of life

• well-being improvements

• drug is not likely to achieve much in a person who is deprived of all hope

www.lifehealthpro.com

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Limitations

• Not worked on “unchurched”• Carers with strong beliefs like to force patients

accept their beliefs• Abuse use• Patients may have terrible feelings if not work• Burden

www.iwantcovers.com

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Roles of pharmacist

• Advise on drug therapy • Supply medications• Proficiency in drug discontinuation• Education• Counselling• Drug management• Help to reduce cost

www.diabetesmine.com

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Roles of pharmacist

• medicines reconciliation• investigation of errors• development of evidence-based guidelines• local formularies • participation in audit

farmaceuticacuriosa.blogspot.com

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Conclusion

• End-of-life care– provision of a set of core belief about life events

– establishment of an ethical foundation for clinical decision making

– different perspectives of religion in palliative care

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Conclusion

• Spirituality in palliative care– minimise depression and fear– to prepare one for death– operational principles – assessment – coping with fear of dying– forgiving and accepting forgiveness – finding meaning in one’s life, suffering and death

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Conclusion

• Religion in palliative care– Vary form spirituality– Common needs– Each religion varies in the need of care– Fears– Palliative care team members – Issues

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Conclusion

Benefits Limitationscan be provided regardless of the staff member’s own faith or lack of it Not worked on “unchurched”

provide by anyone for anyoneCarers with strong beliefs like to force patients

increase an individual’s control and planning over their future Abuse use

empowerment in situationsPatients may have terrible feelings if not work

relieve the discomfort Burden

Improve the quality of life

well-being improvements

drug is not likely to achieve much in a person who is deprived of all hope

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Conclusion

• Role of pharmacists– Advise on drug therapy – Supply medications– Proficiency in drug discontinuation– Education– Counselling– Drug management– medicines reconciliation– investigation of errors– participation in audit

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Questions?

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