It seems to me only yesterday that we in spiritual care and chaplaincy in health care were bemoaning the fact that there was so little literature in our field, no research, no guidelines, and the whole issue was destined to stay, at best, on the periphery of health care. That day has clearly past. I recently had a conversation with George Fitchett in which he noted that it is now difficult to keep up with all of the quality publication that is being done in the field.
There are certainly multiple causes for this change. The rise of palliative care probably leads the list because spiritual care is so prominently featured but interest internationally in the integration of spiritual care is also a factor.
I prefer to leave the “whys” to others and focus on the “whats” and “so whats”. In most cases while we have to understand the “what”, it is the “so what” that is critical for the practice of spiritual care. In the last few weeks at least three very interesting pieces have appeared or been announced- all of which deserve the attention of the spiritual care community.
The recent article by Tracy and Michael Balboni and their team in Boston (Provision of Spiritual Support to Patients With Advanced Cancer by Religious Communities and Associations With Medical Care at the End of Life) published in JAMA Internal Medicine has understandably gotten a lot of press for its well-documented finding that the patients they surveyed who were religious and who were well supported by religious communities used more aggressive care at the end of life and spent less time in hospice. This result, if not counterintuitive, is certainly not what those of us who believe that religious community is a support to people would have hoped for. It appears that the medical teams have done a better job of meeting patient’s spiritual needs at the end of life than the religious community.
The authors speculate on what is happening here and probably every spiritual care provider will do the same. However, I think the “so what” here as Martin Montonye has helpfully pointed out on Linkedin is to see this as a research opportunity to be followed by a training opportunity. The research doesn’t have to be that involved. Most chaplains in acute care often see patients who are very religious and members of religious communities and who also are asking for aggressive care at the end of life. Starting to document these cases, especially the reasons behind the requests wouldn’t be that difficult. Then we need to find a way to aggregate our findings and start to discover some trends. In the mean time, it is important for chaplains to access and read the actual study- not the news reports of the study- so we can discuss it with our teams with full knowledge of what it actually says and does not say.
The other two pieces to pay attention to are the revised Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life which is available for pre-order and the new English translation of the Spiritual Care Guidelines from the Netherlands available free online at http://www.oncoline.nl/spiritual-care. The stellar reputation of the Hastings Center in this area of expertise is well known and well earned. The table of contents of the new guidelines alone is enough to convince me that this will be a must read for anyone in spiritual care especially at the end of life. These guidelines will be much discussed in palliative care and hospice teams and chaplains need to have firsthand comprehension of what they say in order to contribute knowledgably. The quality and relevance of the Dutch work might be a surprise to many in North America. Yes, there are some differences in context and language usage. However, in general, I think many of us in North America are missing out on a lot of excellent work being done in spiritual care and palliative care internationally. The work of the European Association for Palliative Care is a prime example. These guidelines are aimed at physicians and nurses and will be especially useful in contexts where members of the health care team are willing to deal with the spiritual and existential domains but don’t think they should have anything to do with religion.
So I haven’t answered George Fitchett’s implied question on how to keep up. Nor do I really have a good answer. I do know that finding ways to pay attention to the writing in spiritual care in health care is more and more critical to the practice of spiritual care and the ability to access and evaluate that literature is more and more critical to those of us who are spiritual care professionals as we seek to be increasingly integrated into the care our patients receive.