Religion and spirituality in palliative care

1. Religion and Spirituality in
Palliative Care
Su Sundee Myint
Jenny Story
Wenbo Li
Sharon Lau
1

2. Outline
• Su Sundee
2
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

3. Outlines
• Jenny
3
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

4. Outline (continued)
• Wenbo
• Sharon
4
Religious needs of family in palliative care
Fears of patients’ family
Caregiver team
 Important practice points in religious
palliative care
Benefits and limitations of spirituality and
religion in palliative care
Important roles of pharmacist
Summary of presentation

5. Religion and Spirituality in
Palliative Care
5
Su Sundee

6. Law of Nature
• Human condition is bound by the law of nature –
life and death
6
Image from (josephjohnmcgovern.wordpress.com)

7. Religion
• Associated with various connotations:
- the totality of belief systems
-an inner piety or disposition
-an abstract system of ideas
- ritual practices
7Image from (www.hfa.ucsb.edu)

8. 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
8

9. Different perspectives of religion in
palliative care
• There are many types of religion in the world which
people believe in
9Image from (500questions.wordpress.com)

10. 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
10
Imagefrom (www.tumblr.com)

11. 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
11Image from (samingersoll.com)

12. 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
12Image from (detailsofindia.blogspot.com)

13. 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
13
Image from (www.religious-symbols.net)

14. Spirituality
• Relate to the vital life essence of an individual
• Considerable importance when our physical existence
is threatened by disease and death
14Image from (www.zengardner.com)

15. 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
15

16. Relationship between religion and
spirituality in palliative care
• Play important roles hand- in- hand in palliative care
16
Image from (www.med.navy.mil)

17. 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
17
Image from (www.thecamreport.com)

18. Spiritual and Religious Care of the
Palliative Care Patient
18
Jenny Story

19. 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.
19

20. 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)
20

21. 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)
21http://www.simplyhe.co.uk/comedy/130605-Ladies-Who-Do-1963-
5060082512155.html

22. 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
22
http://www.columban.org.au/Archives/mary-
mackillop/blessed-mary-mackillop/

23. 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)
23
http://rocksolid.gibraltarsoftware.com/developme
nt/logging/first-do-no-harm-designing-robust-
infrastructure

24. 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.
24

25. 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.
25

26. 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)
26
http://jsri.jp/English/ojo/2009/i
ijima.html

27. 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)
27

28. 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.
28

29. 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).
29

30. Music
thanatologist is
Peter Roberts.
30
http://www.robertsmusic.net/NEW/music-
than.html

31. Religion in palliative care
•Religious needs of family in palliative care
•Fears of patients’ family
•Caregiver team
•Important practice points in religious palliative care
31
Wenbo Li

32. religious needs in palliative care
http://msa.maryland.gov/msa/speccol/sc5500/sc5590/html/religious_toleration.html
32

33. Common religious needs
• Access to clergy of their faith
http://www.srkilsyth.catholic.edu.au/curricul
um/3/religious-education/15405/
33

34. Common religious needs
• Prayer and reading of sacred writings
http://zenmirror.blogspot.com.au/2010/09/diamond-sutra-worlds-
earliest-dated.html
34

35. Common religious needs
• Religious rituals
e.g. faith healing
35

36. "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
36

37. Common religious needs
• Dietary requirement
http://myauraiya.wordpress.com/tag/meaning-of-the-
words-hindu-and-hinduism/
37

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 problems
http://talkislam.com.au/
38

39. Fears of patients’ family
Afterlife concerns: fear of dead patients
Fear of the end of a relationship
Fear of death
39

40. Palliative care team
http://kathmurray.blogspot.com.au/2011/07/are-we-
preparing-our-health-care.html 40

41. Religious carer team
• Social workers
• Pastoral care staff
• Social workers
• Volunteers
• Community groups
http://www.essorstrategies.com/e
n/team.php
41

42. Important practice points in religious care
• Recipients’ preference
• Confidentiality
• A missionary rather than a carer?
• Carer qualifications
42
http://www.people-
results.com/admiring-problem/

43. Religion and Spirituality in
Palliative Care
•Benefits and Limitations
•Role of pharmacists
•Summary
43
Sharon Lau

44. 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
44

45. • 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
45
www.lifehealthpro.com

46. 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
46
www.iwantcovers.com

47. Roles of pharmacist
• Advise on drug therapy
• Supply medications
• Proficiency in drug discontinuation
• Education
• Counselling
• Drug management
• Help to reduce cost
47
www.diabetesmine.com

48. Roles of pharmacist
• medicines reconciliation
• investigation of errors
• development of evidence-based guidelines
• local formularies
• participation in audit
48farmaceuticacuriosa.blogspot.com

49. 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
49

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 death
50

51. Conclusion
• Religion in palliative care
– Vary form spirituality
– Common needs
– Each religion varies in the need of care
– Fears
– Palliative care team members
– Issues
51

52. Conclusion
52
Benefits Limitations
can be provided regardless of the staff
member’s own faith or lack of it Not worked on “unchurched”
provide by anyone for anyone
Carers with strong beliefs like to force
patients
increase an individual’s control and planning
over their future Abuse use
empowerment in situations
Patients 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

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 audit
53

54. References
Su Sundee
• Beuken, G. 2003, “The Spiritual Dimension of Palliative Care in the Local Christian Community”, Scottish Journal of
Healthcare 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 in
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• Mohammad, Z. and Abdullah, K. 2005, “Palliative Care for Muslim Patients”, The Journal of Supportive
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55. Reference
Jenny Story
• Astrow, A, Puchalski, CM & Sulmasy, DP 2001, 'Religion, spirituality, and health care: Social, ethical, and practical
considerations', 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 May
2012, <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 29
May 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’, Annals
of 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 Mary
MacKillop, 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, viewed
17 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 heart
failure: 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 spiritual
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III, pp. 24-33.
• Taylor, A & Box, M 1999, Multicultural Palliative Care Guidelines, Palliative Care Australia, Eastwood South Australia.
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56. References
Wenbo Li
• Broeckaertm, B 2011, ‘Spirituality and palliative care’, Interdisciplinary Centre for the Study of Religion and
Worldview, vol. 17, p:s39-s41.
• Dana, EK & Bushwick B 1994, ‘Beliefs and attitudes of hospital inpatients about faith healing and prayer’, The
Journal of Family Practice, vol. 39, no. 4, pp. 349-352.
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1999’, Journal of Palliative Care. vol. 20, pp. 50-57.
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Publishers, New York.
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Melbourne.
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excellence, Oxford University Press, Oxford. pp. 90-106.
• Rajagopal, MR & Lipman AG 2003, ‘Commentary: Spirituality and religion in palliative care– potential benefits and
risks’, Journal of Pain and Palliative Care Pharmacotherapy, vol. 17, pp. 167-169.
• Rumbold, B 2002, Spirituality and Palliative care : Social and Pastoral Perspectives, Oxford University
Press, Melbourne.
• Taylor, A & Box, M 1999, Multicultural Palliative Care Guidelines, Palliative Care Australia, Eastwood South
Australia.
• Thorson, J, Horacek, B & Harrington, S 2008, Efficacy of Religious Rituals for Person in Late Life Maintaining
Spiritual Well-being, UMI Dissertation Omaha Nebraska.
• Wiener, L, et al. 2013,Cultural and Religious Considerations in Pediatric Palliative Care, Palliative Support Care, NIH
Public Access.
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57. Questions?
57
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