Religion and spirituality in palliative care

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Religion and spirituality in palliative care

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Religion and spirituality in palliative care

  1. 1. Religion and Spirituality inPalliative CareSu Sundee MyintJenny StoryWenbo LiSharon Lau1
  2. 2. Outline• Su Sundee2Religion in the context of palliative careDifferent perspectives of religion from differentreligious backgroundsSpirituality in the context of palliative careRelationship between religion and spiritualityImportance of religion and spirituality in palliativecare
  3. 3. Outlines• Jenny3Key characteristics of quality spiritual care ofthe patient in palliative careAssessment of the spiritual and religious needsof late-life patientsPrinciples underlying spiritual carePractice points in spiritual careMusic thanatology as spiritual care
  4. 4. Outline (continued)• Wenbo• Sharon4Religious needs of family in palliative careFears of patients’ familyCaregiver team Important practice points in religiouspalliative careBenefits and limitations of spirituality andreligion in palliative careImportant roles of pharmacistSummary of presentation
  5. 5. Religion and Spirituality inPalliative Care5Su Sundee
  6. 6. Law of Nature• Human condition is bound by the law of nature –life and death6Image from (josephjohnmcgovern.wordpress.com)
  7. 7. Religion• Associated with various connotations:- the totality of belief systems-an inner piety or disposition-an abstract system of ideas- ritual practices7Image from (www.hfa.ucsb.edu)
  8. 8. Religion in palliative care• In end-of-life care, religion and religious traditionsserve two primary functions:1. the provision of a set of core belief about lifeevents2. the establishment of an ethical foundation forclinical decision-making8
  9. 9. Different perspectives of religion inpalliative care• There are many types of religion in the world whichpeople believe in9Image from (500questions.wordpress.com)
  10. 10. Different perspectives of religion inpalliative care• Buddhism- Life is one of an infinite series- If we die well with a peaceful mind, it willbeneficially influence our next life10Imagefrom (www.tumblr.com)
  11. 11. Different perspectives of religion inpalliative care• Christianity- Assurance of spiritual security is vitally importantto Christian patients facing death- A ‘good death’ can be achieved when the dyingpatient is relieved from both physical pain andemotional pain11Image from (samingersoll.com)
  12. 12. Different perspectives of religion inpalliative care• Hinduism- Beliefs and practices vary considerably- Most Hindus require time for meditation andprayer when small idols or pictures of gods may bekept under the pillow of the patient12Image from (detailsofindia.blogspot.com)
  13. 13. Different perspectives of religion inpalliative care• Islam- Life is viewed as a time of preparation for hereafter-Death is viewed as the beginning of a different formof life13Image from (www.religious-symbols.net)
  14. 14. Spirituality• Relate to the vital life essence of an individual• Considerable importance when our physical existenceis threatened by disease and death14Image from (www.zengardner.com)
  15. 15. Spirituality in palliative care• Spiritual beliefs have been shown to affect the waysin which palliative care patient deals with illness• Spirituality forms the context in which patientsrespond to care, choose treatment options and facedeath15
  16. 16. Relationship between religion andspirituality in palliative care• Play important roles hand- in- hand in palliative care16Image from (www.med.navy.mil)
  17. 17. Importance of religion and spiritualityin palliative care• Important connection to mental health• Buffer against depression and fear• Initiate the search for the meaning in life• Prepare one for death17Image from (www.thecamreport.com)
  18. 18. Spiritual and Religious Care of thePalliative Care Patient18Jenny Story
  19. 19. Spiritual and Religious Care of thePalliative Care Patient• What is spiritual care?• Operational principles.• Conducting needs assessment.• Common spiritual needs.• Music thanatology as spiritual care.19
  20. 20. Key Characteristics of Quality SpiritualCare 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 approachingend.(Daaleman et al. 2008)20
  21. 21. Operational Principles UnderlyingSpiritual and Religious Care of thePalliative Care Patient1. Any member of the palliative care team can give spiritual care.(Daaleman et al. 2008)21http://www.simplyhe.co.uk/comedy/130605-Ladies-Who-Do-1963-5060082512155.html
  22. 22. St Mary of the Cross, motto for life: “Neversee a need without doing something about it.”(Goodwin & Prats 2010)Operational Principles Underlying Spiritualand Religious Care of the Palliative CarePatient22http://www.columban.org.au/Archives/mary-mackillop/blessed-mary-mackillop/
  23. 23. Operational Principles UnderlyingSpiritual and Religious Care of thePalliative Care Patient2. “Primum non nocere.” (Hippocrates)Care team members can undermine thepatient’s identity and self-worth.(Murray et al. 2004)23http://rocksolid.gibraltarsoftware.com/development/logging/first-do-no-harm-designing-robust-infrastructure
  24. 24. Operational Principles UnderlyingSpiritual and Religious Care of thePalliative Care Patient3. The patient should receive religious carewhich is culturally appropriate.• Conduct a late life spiritual and religious needassessment.24
  25. 25. How to conduct a late life patient spiritualand religious care needs assessment• Open questions. (Astrow, Pulchalski & Sulmasy 2001).• Ask for clarification if necessary.• Observation.• Admission interview notes.25
  26. 26. Call clergy if indicated• Do this early, so they can address late lifereligious needs and• Provide a funeralrespecting the uniquenarrative of the patient’slife. (Rev. Keido Iijima, Soto Zen Nun& Palliative Care Nurse, 2009)26http://jsri.jp/English/ojo/2009/iijima.html
  27. 27. Late life spiritual needs of thepatient 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 anddeath. (Sulmasy 2002)27
  28. 28. Summary: Spiritual and religious carea palliative care team member can offerto the patient• Assessment allowing interface with clergy forprovision of religious needs• Physical and emotional presence (spiritual care), as acontext in which:- the patient’s fears can be allayed,- forgiveness undertaken and accepted, and- the meaning of the patient’s experiencesestablished.28
  29. 29. Music Thanatology• The use of music in late life to allay fear, to bring peaceand to help establish a narrative meaning to life.• It reduces depression,• Supplements pain control methods, and• Enhances communication between the patient andfamily, and the patient and the clinical and pastoral careteams(Bailey1983,1984,1985).• The sensation of pain is experienced as reduced(Zimmerman et al. 1989).29
  30. 30. Musicthanatologist isPeter Roberts.30http://www.robertsmusic.net/NEW/music-than.html
  31. 31. Religion in palliative care•Religious needs of family in palliative care•Fears of patients’ family•Caregiver team•Important practice points in religious palliative care31Wenbo Li
  32. 32. religious needs in palliative carehttp://msa.maryland.gov/msa/speccol/sc5500/sc5590/html/religious_toleration.html32
  33. 33. Common religious needs• Access to clergy of their faithhttp://www.srkilsyth.catholic.edu.au/curriculum/3/religious-education/15405/33
  34. 34. Common religious needs• Prayer and reading of sacred writingshttp://zenmirror.blogspot.com.au/2010/09/diamond-sutra-worlds-earliest-dated.html34
  35. 35. Common religious needs• Religious ritualse.g. faith healing35
  36. 36. "available scientific evidence does not supportclaims that faith healing can actually curephysical ailments.”……."Death, disability, andother unwanted outcomes have occurred whenfaith healing was elected instead of medical carefor serious injuries or illnesses."American Cancer Society36
  37. 37. Common religious needs• Dietary requirementhttp://myauraiya.wordpress.com/tag/meaning-of-the-words-hindu-and-hinduism/37
  38. 38. 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 problemshttp://talkislam.com.au/38
  39. 39. Fears of patients’ familyAfterlife concerns: fear of dead patientsFear of the end of a relationshipFear of death39
  40. 40. Palliative care teamhttp://kathmurray.blogspot.com.au/2011/07/are-we-preparing-our-health-care.html 40
  41. 41. Religious carer team• Social workers• Pastoral care staff• Social workers• Volunteers• Community groupshttp://www.essorstrategies.com/en/team.php41
  42. 42. Important practice points in religious care• Recipients’ preference• Confidentiality• A missionary rather than a carer?• Carer qualifications42http://www.people-results.com/admiring-problem/
  43. 43. Religion and Spirituality inPalliative Care•Benefits and Limitations•Role of pharmacists•Summary43Sharon Lau
  44. 44. Benefits• can be provided regardless of the staff member’sown faith or lack of it• provided by anyone for anyone• increase an individual’s control and planning overtheir future• empowerment in situations44
  45. 45. • relieve the discomfort• Improve the quality of life• well-being improvements• drug is not likely to achieve much in a personwho is deprived of all hope45www.lifehealthpro.com
  46. 46. Limitations• Not worked on “unchurched”• Carers with strong beliefs like to force patientsaccept their beliefs• Abuse use• Patients may have terrible feelings if not work• Burden46www.iwantcovers.com
  47. 47. Roles of pharmacist• Advise on drug therapy• Supply medications• Proficiency in drug discontinuation• Education• Counselling• Drug management• Help to reduce cost47www.diabetesmine.com
  48. 48. Roles of pharmacist• medicines reconciliation• investigation of errors• development of evidence-based guidelines• local formularies• participation in audit48farmaceuticacuriosa.blogspot.com
  49. 49. Conclusion• End-of-life care– provision of a set of core belief about life events– establishment of an ethical foundation for clinicaldecision making– different perspectives of religion in palliative care49
  50. 50. 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 death50
  51. 51. Conclusion• Religion in palliative care– Vary form spirituality– Common needs– Each religion varies in the need of care– Fears– Palliative care team members– Issues51
  52. 52. Conclusion52Benefits Limitationscan be provided regardless of the staffmember’s own faith or lack of it Not worked on “unchurched”provide by anyone for anyoneCarers with strong beliefs like to forcepatientsincrease an individual’s control and planningover their future Abuse useempowerment in situationsPatients may have terrible feelings if notworkrelieve the discomfort BurdenImprove the quality of lifewell-being improvementsdrug is not likely to achieve much in a personwho is deprived of all hope
  53. 53. 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 audit53
  54. 54. ReferencesSu Sundee• Beuken, G. 2003, “The Spiritual Dimension of Palliative Care in the Local Christian Community”, Scottish Journal ofHealthcare Chaplaincy, vol. 6, no. 1, pp. 44-46.• Benzein , E., Norberg, A., and Saveman, BI. 2001, “The meaning of the lived experience of hope in patients with cancer inpalliative home care”, Palliative Medicine, vol. 15, pp. 117-126.• Coleman, P., McKiernan, F., Mills, M., and Speck, P. 2002, “Spiritual beliefs and quality of life: experience of older bereavedspouses”, Quality in Ageing – Policy practice and research, vol. 3, no. 1, pp. 20-26.• Cousens, D. 2006, “Providing Culturally Sensitive End-of-Life Care – Cultural Perspectives on Death and Dying”, Palliative Careand Buddhist Cultural Sensitivity, pp. 1-7.• Dein S, Stygall J. 1997, “Does being religious help or hinder coping with chronic illness? A critical literature review”, PalliativeMedicine, vol. 11, pp- 291-298.• Ersek M, Ferrell BR. 1994, “Providing relief from cancer pain by assisting in the search for meaning”, Journal of PalliativeCare, vol. 10, pp. 15-22.• Hegarty, M. 2001, “The dynamics of hope: Hoping in the face of death”, Progress Palliative Care, vol. 9, no. x, p.10.• King, M., Speck, P., and Thomas, A. 1999, The effect of spiritual beliefs on outcome from illness, vol. 48, pp. 1291-1299.• Mohammad, Z. and Abdullah, K. 2005, “Palliative Care for Muslim Patients”, The Journal of SupportiveOncology, vol.3, no.6, pp.432-435.• Sarhill, N., LeGrand, S., and Islambouli, R. 2001, “ The terminally ill Muslim: Death and dying from the Muslimperspective”, American Journal of Hospital Palliative Care, vol. 18, pp. 251-255.• Sharman, K. 2000, “A question of faith for the Hindu patient”, European Journal of Palliative Care, vol. 7, pp. 99-101.• Timothy, P. D. and Larry, VC. 2000, “Placing Religion and Spirituality in End-of-Life-Care”, Journal of American MedicalAssociations, vol. 284, no. 19, pp. 2514-2517.• White, G. 2000, “An inquiry into the concepts of spirituality and spiritual care”, International Journal of Palliative Nurses, vol.6, no. 10, pp. 479-484.54
  55. 55. ReferenceJenny Story• Astrow, A, Puchalski, CM & Sulmasy, DP 2001, Religion, spirituality, and health care: Social, ethical, and practicalconsiderations, American Journal of Medicine, vol. 110, pp. 283-287.• Bailey, L 1983, “The effects of live music versus tape recorded music on hospitalised cancer patients’, Music Therapy, vol. 3, no.1, pp.17-28• Bailey, L 1984, ‘The use of songs with cancer patients and their families’, Music Therapy, vol. 4, no. 1, pp. 5-17.• Bailey, L 1985, ‘Music’s soothing charms’, American Journal of Nursing, vol. 85, no. 11, p. 1280.• Cerddeu, S 2009, ‘Music thanatology as narrative practice’, Journal of the Music Thanatology Association International, viewed 16 May2012, <http://www.journal.mtai.org/index.php/feature/music_thanatology_as_a_narrative_practice/>• Cox, H 2005, ‘Relief of Suffering at the End of Life: Report to Deakin University, St John of God Hospital & Kings Australia’, viewed 29May 2013, <http://helencox.com.au/Music_into_Silence.pdf>• Cox, H & Roberts, P 2013, The Harp and the Ferryman, Michelle Anderson Publishing, Melbourne.• Daaleman, TP, Usher, BM, Williams, SW, Rawlings, J & Hanson, LC 2008, ‘An Exploratory study of spiritual care at the end of life’, Annalsof Family Medicine, vol. 6, iss. 5, pp. 406-411.• Goodwin, J & Prats, K 2010, Never See a Need Without Doing Something about It: Inspirational Stories from the Life of MaryMacKillop, St Pauls Publications, Strathfield, NSW, Australia.• Iijima, K 2009, ‘Amans: A Buddhist Nun’s Efforts to Unite the Medical and Religious Worlds in Death, Jodo Shu Research Institute, viewed17 May 2013, <http://jsri.jp/English/ojo/2009/iijima.html>• Leming, M & Dickinson, G 1994, Understanding Dying, Death and Bereavement, 3rd edn, New York: Harcourt Brace College Publishers.• Murray, S, Kendall, M, Boyd, K, Worth, A & Benton, TF 2004, ‘Exploring the spiritual needs of people dying of lung cancer or heartfailure: a prospective qualitative interview study of patients and their carers’, Palliative Medicine, vol. 18, iss. 1, pp. 39-45.• Roberts, P 2009, ‘The Sanctuary. A Collection of Harp Music played to bring Comfort, Peace and Restoration’, Peter Roberts, Geelong.• Steinhauser, KE, Voils, CI, Clipp, EC, Bosworth, HB, Christakis, NA, & Tulsky, JA 2006, ‘ “Are you at peace?” One item to probe spiritualconcerns at the end of life’, Archives of Internal Medicine, vol. 166, pp. 101-105.• Sulmasy, D P 2002, ‘A biopsychosocial-spiritual model for care of patients at the end of life’, The Gerontologist, vol. 42, special issueIII, pp. 24-33.• Taylor, A & Box, M 1999, Multicultural Palliative Care Guidelines, Palliative Care Australia, Eastwood South Australia.55
  56. 56. ReferencesWenbo Li• Broeckaertm, B 2011, ‘Spirituality and palliative care’, Interdisciplinary Centre for the Study of Religion andWorldview, vol. 17, p:s39-s41.• Dana, EK & Bushwick B 1994, ‘Beliefs and attitudes of hospital inpatients about faith healing and prayer’, TheJournal of Family Practice, vol. 39, no. 4, pp. 349-352.• Flannelly, KJ, et al., 2004, ‘A Systematic review of religion and spirituality in three palliative care journals, 1990-1999’, Journal of Palliative Care. vol. 20, pp. 50-57.• Gatrad, R, Choudhury, PP, Brown, E, & Sheikh, A 2003, ‘Palliative care for Hindus, International Journal of PalliativeNursing, vol. 9, pp. 442-448.• Gatrad, R, Panesar, SS,.Brown E, Notta, H & Sheikh, A 2003, ‘Palliative care for Sikhs’, International Journal ofPalliative Nursing, vol. 9, pp. 496-498.• Leming, M & Dickinson, G 1994, Understanding Dying, Death and Bereavement, 3rd edn, Harcourt Brace CollegePublishers, New York.• Maaike, AH & Henk, AMJ 2004, ‘Pastoral care, spirituality, and religion in palliative care journals’, AmericanJournal. of Hospice and Palliative Medicine, vol. 21, pp. 353-357.• Palliative Care Expert Group 2010, Therapeutic guidelines. Palliative care. Therapeutic Guidelines Ltd, NorthMelbourne.• Speck, P 2003, ‘Spiritual/Religious Issues in Care of the Dying’, in Care of the dying: A pathway toexcellence, Oxford University Press, Oxford. pp. 90-106.• Rajagopal, MR & Lipman AG 2003, ‘Commentary: Spirituality and religion in palliative care– potential benefits andrisks’, Journal of Pain and Palliative Care Pharmacotherapy, vol. 17, pp. 167-169.• Rumbold, B 2002, Spirituality and Palliative care : Social and Pastoral Perspectives, Oxford UniversityPress, Melbourne.• Taylor, A & Box, M 1999, Multicultural Palliative Care Guidelines, Palliative Care Australia, Eastwood SouthAustralia.• Thorson, J, Horacek, B & Harrington, S 2008, Efficacy of Religious Rituals for Person in Late Life MaintainingSpiritual Well-being, UMI Dissertation Omaha Nebraska.• Wiener, L, et al. 2013,Cultural and Religious Considerations in Pediatric Palliative Care, Palliative Support Care, NIHPublic Access.56
  57. 57. Questions?57http://www.simplyhe.co.uk/comedy/130605-Ladies-Who-Do-1963-5060082512155.html

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