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Faith and Medicine at the Bedside: Caring for the Patient - @drbrowncares

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Faith and Medicine at the bedside. Caring for the Patient. #faith #medicine #patient #health #healthcare @drbrowncares

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Faith and Medicine at the Bedside: Caring for the Patient - @drbrowncares

  1. 1. Faith & Medicine At The Bedside: Caring For The Patient SHERRY-ANN BROWN, MD, PHD NARDIA MCFARLANE, MD MARK NYMAN, MD Painting from www3.stcamilluscenter.org @drbrowncares drbrowncares@gmail.com brown.sherryann@mayo.edu
  2. 2. Outline  Faith in America  Faith and Culture  Need for a Spiritual component  Case: Supporting spiritual need  The Biopsychosociospiritual Model  Barriers to a Spiritual component  Tools for your Toolbox brown.sherryann@mayo.edu @drbrowncares drbrowncares@gmail.com
  3. 3. Faith in America  According to an online poll of 2,455 U.S. adults by Harris Interactive in November 2007:  82% of adult Americans believe in God.  79% of the public believe in miracles.  75% believe in the existence of heaven. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  4. 4. Faith and Culture  It is well known that spirituality, faith, and culture are intimately connected with each other.  In the Hispanic world, faith plays a significant role in day to day life.  Faith and spirituality are known to be very important to individuals of African and Caribbean descent.  “Religion is not only a way of life in the African-American community, it is a part of an identity that has been molded over centuries of experiences.” (http://home.wlu.edu/~connerm/AfAmStudies/Contemporary%20Culture%20Project/Religion&Culture/conclusion.html) brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  5. 5. Faith and Culture  Patients - particularly ethnic minorities - rely upon religion and spirituality as an important means to interpret and cope with illness…improve quality of life, and impact medical decision-making near death.  Patients largely desire medical caregivers to take an active role in providing spiritual care, and patients likewise frequently experience multiple spiritual needs arising in the face of life- threatening illness. El Nawawi et al, Curr Opin Support Palliat Care 2012 6(2):269-74 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  6. 6. The Need for a Spiritual Component  Medical illness can often trigger spiritual distress in patients and their family members:  Why is this happening to me?  Why is God allowing this?  Is it something I’ve done?  Spiritual distress may worsen the medical illness. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  7. 7. The Need for a Spiritual Component  Religious beliefs can affect decision making:  A patient believing God will heal them and not adhering to medication regiments  Jehovah Witnesses’ do not accept transfusions brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  8. 8. The Need for a Spiritual Component  According to Anandarajah et al up to 77% of patients would like spiritual issues considered as part of their medical care but only 10-20% of physicians discuss this issue with their patients. Anandarajah et al, Am Fam Physician 2001;63:81-89 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  9. 9. The Need for a Spiritual Component  A study by King et al found that:  94% of patients admitted to hospitals regarded spiritual health as important as physical health.  77% believed that physicians should consider their patient’s spiritual needs as part of their medical history.  70% reported physicians never or rarely discuss spiritual or religious issues with them. King et al, J Fam Pract. 1994 39(4):349-52. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  10. 10. The Need for a Spiritual Component  In patients at the Dana-Faber Cancer Institute:  68% felt religion was very important to them  89% felt religion was at least somewhat important  Spiritual support by medical team resulted in OR:  Better quality of life near death  3x times more likely - final days in hospice  3x times less likely - need for aggressive care  5x times less likely - death in the ICU In the last week of life. Balboni et al, JAMA Intern Med 2013 173(12):1109-17 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  11. 11. The Need for a Spiritual Component  In another study at the Dana-Faber Cancer Institute:  80% patients/nurses/physicians felt providing spiritual care was important AND appropriate  15% patients frequency of spiritual care provided  100% patients positive impact of spiritual care  Spiritual care training for physicians, OR:  7x more likely to provide spiritual care  14% had received prior training J Balboni et al, J Clin Oncol 2013 1;31(4):461-7 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  12. 12. Case Presentation  69 year old female with small cell lung cancer metastatic to the brain, bone, and liver  Presents with pain, nausea, vomiting, anorexia, constipation, generalized fatigue  PMH: Hypothyroidism, depression, hypertension; s/p radiation and chemotherapy  SH: Widowed, grandson recently moved in brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  13. 13. HOW WOULD YOU support this patient’s SPIRITUAL needs? 1. I would offer to call the patient’s spiritual leader 2. I would connect the patient with Chaplain Services 3. If I am part of the patient’s greater faith community, I would pray with the patient 4. Spiritual needs have no role in health care brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  14. 14. The Need for a Spiritual Component  The National Center for Complementary and Alternative Medicine report that prayer is by far the most popular alternative form of therapy in comparison with yoga, tai chi, gigong, and reiki.  Religious people are physically healthier, lead healthier lives and require fewer health services. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  15. 15. The Need for a Spiritual Component  Beneficial relationship with:  Recovery from illness.  Prevention of heart disease and high blood pressure.  Recovery from Cardiac surgery.  Adjustment to disability.  Substance abuse prevention and recovery.  Stress reduction.  Anxiety.  Depression.  Mitigation of Pain.  Sense of well-being. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  16. 16. The Need for a Spiritual Component  Random, national sample of 340 patients  Avanced illness  Ranked highest in importance:  Pain control  Being at peace with God Steinhauser et al, JAMA 2000 284(19):2476-82 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  17. 17. HOW WOULD YOU support this patient’s SPIRITUAL needs? 1. I would offer to call the patient’s spiritual leader 2. I would connect the patient with Chaplain Services 3. If I am part of the patient’s greater faith community, I would pray with the patient 4. Spiritual needs have no role in health care brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  18. 18. Case Resolution  Patient’s spiritual leader visited with her  Shared faith experience with patient  Provided songs, Scriptures, and quotes  Impacted:  Patient and her healthcare providers  “We need more like you…”  Developed need for pain meds escalation  Passed away 2 months later at home with hospice brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  19. 19. Easing Patient Suffering  “To cure sometimes, relieve often, comfort always”  Spiritual strength: strength which gives the ability to face difficulties & overcome adversities  Meaning of life: a sense of purpose to life or that life is part of a greater plan or mission O’Connor and Skevington, Br J Health Psychology 2005 10 (pt 3):379-398 Wessel MA ,Conn Med 1980 44(2):111-2 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  20. 20. The Biopsychosociospiritual Model  WHO definition of health: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”  Patients as whole persons with physical, emotional, social & spiritual needs brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  21. 21.  Towards the end of the 20th century  Shift from purely Biomedical view of health to a more holistic approach  Biopsychosocial Model of illness formulated in 1970’s by George Engel, professor of psychiatry & medicine at the University of Rochester NY brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com The Biopsychosociospiritual Model
  22. 22.  Biopsychosocial Model  Illness results from interaction of biological, psychological, & social causal factors  Biopsychosociospiritual Model  Religion and spirituality important to health  Onarecker and Sterling proposed revision to include spirituality Katerndahl, Ann Fam Med 2008 6(5):412-20 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com The Biopsychosociospiritual Model
  23. 23. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com The Biopsychosociospiritual Model
  24. 24. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com The Biopsychosociospiritual Model
  25. 25. #11 Spiritual Care - Offer biopsychosociospiritual support and Chaplain Services as needed #12 FEN #13 Prophylaxis #14 Disposition #15 Code status brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com The Biopsychosociospiritual Model
  26. 26. Mandate to incorporate a Spiritual Component  The Joint Council for Accreditation of Healthcare Organizations (JCAHO, 1999) has recognized the influence of spirituality on hospitalized patients and has mandated that a spiritual assessment should be performed on every patient. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  27. 27. Barriers to incorporating a Spiritual Component  Uncertainty about how to address spiritual needs.  Lack of experience or formal training.  Not wanting to offend anyone.  The belief that the role of a physician is separate and apart from that of a pastor/priest.  Inability to correctly identify patients who desire such discussions. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  28. 28. Tools  HOPE  Hope (sources of hope, meaning or comfort)  Organized religion (church attendance/commitment)  Personal spirituality and practice (prayer, meditation)  Effects of medical care and end-of-life issues  FAITH  Faith (importance of faith/religion)  Apply (how do beliefs apply to health)  Involvement (church, community etc)  Treatment (spiritual views affecting Tx)  Help (how can I help address your concerns) Anandarajah et al, Am Fam Physician 2001;63:81-89 King, Spirituality And medicine 2002 (pp. 651-669) brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  29. 29. Tools  FICA  Faith/Beliefs (Spiritual vs. religious)  Importance (emphasis placed on faith/belief)  Community (belonging to a church etc.)  Address needs (what concerns can the dr. address) Puchalski et al, J Of Palliative Medicine 2000 3(1):129-137 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  30. 30. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com The Biopsychosociospiritual Model
  31. 31. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com The Biopsychosociospiritual Model
  32. 32. Developing Your Toolbox 1. What are your sources of hope, strength and comfort? 2. Are you at peace? 3. What helps to get you through the difficult times in your life? 4. What practices do you find helpful when you are ill (example prayer, meditation, etc)? 5. Do you hold faith/religious beliefs that can affect your health care decisions? 6. Would you like someone to pray with you? brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  33. 33. High Yield Points  Patients desire integration of their faith in their care  Obtain a meaningful spiritual history: Develop toolbox  Interest in patient as a whole person  Patient care should reflect impact of spirituality  Caring respectable manner  Assess and meet patients’ spiritual needs  Ease patient suffering brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  34. 34. Quotes to consider  “To exclude God from a consultation with a patient is a form of malpractice. Spirituality is a wonder and joy and shouldn’t be left in the clinical closet.” Kornhaber (psychotherapist), Newsweek 1992 119:40 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  35. 35. Quotes to consider  “Science without religion is lame, but religion without science is blind.” (Albert Einstein) brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  36. 36. Addressing Spiritual/Religious Conflicts  Assessing Capacity  “I believe in Miracles”  Chaplain Services; Spiritual Leader  Treating Patients As Whole Persons  Ethics Consultation brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  37. 37. References  Anandarajah et al. Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. Am Fam Physician. 2001;63:81-89.  Balboni et al. Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. JAMA Intern Med. 2013 173(12):1109-17.  Balboni et al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. J Clin Oncol. 2013 1;31(4):461-7.  Borrell-Carrio et al. The Biopsychosocial Model 25 years later: Principles Practice and Scientific Inquiry. Ann Fam Med. 2004; 2:576-582.  El Nawawi et al. Palliative care and spiritual care: the crucial role of spiritual care in the care of patients with advanced illness. Curr Opin Support Palliat Care. 2012 Jun;6(2):269-74.  Katerndahl. Impact of spiritual symptoms and their interactions on health services and life satisfaction. Ann Fam Med. 2008 6(5):412-20.  King et al. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract. 1994 39(4):349-52.  King. Spirituality And medicine, In Fundamentals Of Clinical Practice: A Text Book On The Patient, Doctor, And Society. Mengel, M. B., Holleman, W. L., & Fields, S. A. (Eds.). New York, NY: Plenum. 2002 (pp. 651--669).  MacLean et al. Patient Preference for Physician Discussion and Practice of Spirituality. J Gen Inter Med. 2003; 18:38- 43.  McCord et al. Discussing Spirituality with Patients: A rational and Ethical Approach. Ann Fam Med. 2004; 2:356-361.  Phelps et al. Addressing spirituality within the care of patients at the end of life: perspectives of patients with advanced cancer, oncologists, and oncology nurses. J Clin Oncol. 2012 30(20):2538-44.  Post et al. Physician and Patient Spirituality: Professional Boundaries Competency and Ethics. Ann Intern Med. 2000;132: 578-583.  Puchalski et al. Taking Spiritual History Allows Clinicians To Understand Patients More Fully. Journal Of Palliative Medicine 2000 3(1):129-137.  Rumbold. A Review of Spiritual Assessment in health care practice. MJA. 2007;186:S60-62.  Steinhauser et al. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000 284(19):2476-82.  Wessel. To cure sometimes, to relieve often, to comfort always. Conn Med. 1980 44(2):111-2. brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  38. 38. Faith & Medicine At The Bedside: Caring For The Patient SHERRY-ANN BROWN, MD, PHD NARDIA MCFARLANE, MD MARK NYMAN, MD Painting from www3.stcamilluscenter.org brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  39. 39. Questions? brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  40. 40. Organized Religious Preferences in the Study Participants, 2013 Balboni et al, J Clin Oncol. 2013 1;31(4):461-7. Balboni et al, JAMA Intern Med 2013 173(12):1109-17 brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  41. 41. http://www.gallup.com Organized Religious Preferences in the United States, 2012 (Gallup poll) brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  42. 42. http://www.gallup.com Global Religiosity, 2012 (Gallup poll) brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  43. 43. Example of Spiritual Ethics Conflict/Uncertainty brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com@drbrowncares
  44. 44. Example of Spiritual Ethics Conflict/Uncertainty brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com@drbrowncares
  45. 45. Ethics Consultation brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com
  46. 46. Faith & Medicine At The Bedside: Caring For The Patient SHERRY-ANN BROWN, MD, PHD NARDIA MCFARLANE, MD MARK NYMAN, MD Painting from www3.stcamilluscenter.org brown.sherryann@mayo.edu@drbrowncares drbrowncares@gmail.com

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