Spiritual management: issues and concerns
The international palliative care community makes a clear distinction between religious and spiritual care while acknowledging the need for both. There is considerable overlap between psychological and spiritual needs and these are best seen as a continuum of psychospiritual needs.
‘Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature and to the significant or sacred' (37).Spiritual care is ‘Care that is designed to offer a person an opportunity to explore values, ideals, meaning and purpose'. It addresses common human questions such as:
• Who am I?
• Where do I come from?
• Why am I here?
• Where is the meaning and purpose in my life?
In addition, it may also address the value of a transcendent ‘enduring reality' and ‘the non-material aspects of life' (38, 39).
Religious care addresses the same issues within the framework of organized religion, particular to that individual patient, and may include significant rituals, such as last rites or communion.
Both religious and spiritual care need to be acknowledged and incorporated at every stage of the illness. The basis of both is compassion.
At times spiritual, religious, and cultural beliefs may be in conflict with medical care being offered, causing conflict or impeding effective management. Fixed beliefs may block the open exploration of death and dying as this is taboo in many cultures and religions. Unrealistic beliefs in alternative therapies can seriously hamper effective palliative care. Sometimes beliefs are put forward as a reason for avoiding discussions and denying the status of disease even when the belief system may be misrepresented in doing so. Gently examining this with the patient or an influential family member or even a spiritual or religious guide can assist in dealing with the present and making plans for the future.
Denial can be both a protection and an impediment and cannot be forcefully confronted. The goal of counselling is to develop realistic hope, at the patient's pace. Unrealistic hopes and denial by the patient and/or the family may block treatment and lead to unnecessary suffering. Ask questions (40) in order to understand the individual. Being seen as a unique person and being treated with care and love brings true comfort and spiritual healing.
Bringing things back to practical realities allows hope to develop— being supported and being pain free, comfortable, and safe. Look for achievable goals and expectations in the conversation and plan
| F: Faith or belief | What is your faith or belief? What gives your life meaning? |
| I: Importance and Influence | What is important to you? What importance does your spirituality have in your life? Have your beliefs influenced your behaviour during this illness? What role do your beliefs play in your understanding of healing? |
| C: Community | Are you part of a faith community as a member of a group? Is this of support to you and how? Is there a person or group of people you really love or who are important to you? |
| A: Address | How would you like me to address these issues in your healthcare? |
Source data from Puchalski C, Ferrell BR, 2010. Making Health Care Whole: Integrating Spirituality into Patient Care. West Conshohocken, PA: Templeton Press.
ahead appropriately. Try to enable and empower in every way, to help people make the best of the possible in this impossible, irreversible situation.
Spiritual care includes counselling, non-verbal support, and complementary therapy. There are tools to help in assessing and discussing this area (Table 69.4). The aim is to help people express their fears and find meaning in their lives and in their illness. It allows people to come to a place of acceptance and peace by acknowledging what was and working through the fears of the present and future.