Dated: July 13, 2010
Thanks to Growth House, you can now download the entire spiritual care training module for palliative and end of life care. The URL for downloads is http://www.growthhouse.org/spirit.
You may download the educational training module, the pre-tests and post-tests, as well as the spirituality questionnaires/exercises for clergy and for health care professionals. You should feel free to use these materials yourselves and to send these materials to your colleagues as long as you and your colleagues provide appropriate attribution. Here's what you can get:
- Spirituality Boost article (PDF) Overview of the project
- Consensus Report Puchalski, C., et al., Consensus report on spirituality in palliative care, Journal of Palliative Medicine, 2009, Vol. 12, No. 10 (Distributed with permission of Mary Ann Liebert, Inc., Publishers)
- Spiritual care module (Powerpoint presentation)
- Spiritual care module (PDF version)
- Spirituality questionnaire for clergy (PDF)
- Spirituality questionnaire for healthcare professionals (PDF)
- Spirituality module pre and post test (PDF)
- Spirituality module pre and post answer key (PDF)
- All spirituality files (zip file)
If you are interested in having training for your staff in doing spiritual assessments and dealing with spiritual issues/concerns/crises, you may contact me at firstname.lastname@example.org. I hope to train 150 community clergy, seminarians and chaplains by June 2011 and another 150 by June 2012.
In 2010, as we celebrate the birthday of Dame Cicely Saunders who would have been 92 years old this week (July 22, 1918 - July 14, 2005) it is fitting to focus a on a core concept of palliative care, that of Total Pain, particularly spiritual pain. Although the bio-psycho-social approach in medicine traces back to the 1950's, when George Engel, M.D. who was later on the faculty of the University of Rochester School of Medicine, began to develop and refine that concept, it was Dame Cicely Saunders who, in 1948, had added the spiritual domain of suffering to this mix which she referred to as Total Pain. As Dame Cicely recounted, "My story in this field goes right back to 1948 when I was a social worker… meeting a young Polish Jew who had an inoperable cancer.... I became very fond of him. [David Tasma had escaped the Warsaw ghetto and was dying in a London hospital.... Tasma's pain, loneliness and anguish had a profound affect on Saunders. She visited Tasma frequently in the last two months of his life. As Saunders and Tasma spoke of his looming death, Saunders had a revelation,] I realized that we needed not only better pain control but better overall care. People needed the space to be themselves. I coined the term 'total pain,' from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated. I have been working on that ever since."
With increasing interest in palliative care during the 1990's the importance of spiritual issues and concerns in end-of-life care led to increased attention to spiritual issues and the role of clergy in palliative care. A consensus conference sponsored by the Archstone Foundation was held February 17–18, 2009. The result of the conference was a report titled, "Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference", which was published in the Journal of Palliative Medicine as a special report in the October, 2009 issue and made it clear that spiritual care is a fundamental component of quality palliative care. This Conference Report came on the heals of the of the October 2007 Institute of Medicine report about the need for psychosocial services to cancer patients and their families, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, which led to increased attention to the psychosocial needs of patients who have life limiting illnesses and their families, using the context of cancer. You may download the Report of the Consensus Conference from the Growth House website.
I am a participant in the ACE Project (Advocating for Clinical Excellence - Transdisciplinary Palliative Care Education) which is a palliative care educational experience funded by a major 5-year National Cancer Institute R-25 Grant Award to the City of Hope Medical Center in Duarte, California, for development and implementation of this program to enhance the advocacy, leadership and support skills of competitively selected psycho-oncology professionals throughout the United States. As part of the ACE program, each participant has to do a project which will help further palliative care in their institution or community.
The project I chose is to further the ability of palliative care patients and their families to receive quality spiritual care. The major part of that project is to train members of the clergy in palliative care. Although there are chaplains in institutions (most of whom have training in chaplaincy) the chaplains are limited to working with patients and families when the patient is in their institution (except in hospice where they may provide bereavement services after the death of the patient).
The largest need for palliative care trained clergy is in the communities. The community clergy who are working in congregations and parishes are the first line in providing spiritual care, as congregants/parishioners often seek assistance from their clergy in relation to spiritual concerns that arise in the context of end-of-life and/or serious illnesses or injuries which are life altering. These parishioners/congregants have indicated they want to have their clergy come to the hospitals rather than have a chaplain they do not know and who may not be from their faith group to attend to them in the hospital. In this regard, as the elderly population increases dramatically, as more terminally ill patients are being cared for at home, and as the number of people who suffer from chronic (and at time debilitating) illnesses who remain in the community rather than in hospitals, there will be an increasing demand for community clergy to provide spiritual care to these people and their families.
The second portion of this project is to facilitate, using a transdisciplinary model, the ability of physicians, nurses, social workers, psychologists and clergy who work in palliative care, to perform spiritual assessments and provide interventions to address spiritual issues/concerns/crises in the absence of chaplains trained in palliative care. To this end I have I have updated an educational module which I developed in 2003 when I first trained chaplains (some of who were also community clergy) in palliative care. In response to a posting on the Social Work Palliative Care Listserv over the past eight weeks, I have sent out over one hundred e-mails of this educational training module, Spirituality in Palliative & End-of-Life Care, the accompanying pre-tests and post-tests, along with a spirituality questionnaire/exercise for clergy as well as a spirituality questionnaire/exercise for health care professionals.
Third, it is imperative to seize the moment of the issuance of the consensus report on spiritual care as a critical domain of palliative care, along with the physical, psychological and social domains. If the palliative care and faith/religious communities as a group do not seize upon this important moment in the history of palliative care to energize a nationwide movement to bring spiritual care services into the fabric of palliative care as a co-equal services along with those services which address physical and psychosocial suffering, we may well miss out on the potential momentum that can be generated from this consensus report, thereby squandering the opportunity the report presents to bring spiritual care to its rightful, critically important place in palliative care's core mission to treat total pain. To this end I have reached out to seminaries, various religious denominations, and health care organizations.