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SPIRITUAL ISSUES IN PALLIATIVE CARE

SPIRITUAL ISSUES IN PALLIATIVE CARE Jim Rawlings, Jr., D.Min. Director, Pastoral Care UNC Hospitals Introduction Definition of Spiritual(ity) “Contemporary spirituality is eclectic and individualistic, situated on a sacred-secular continuum.” Murray, 2004

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SPIRITUAL ISSUES IN PALLIATIVE CARE

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  1. SPIRITUAL ISSUES IN PALLIATIVE CARE Jim Rawlings, Jr., D.Min. Director, Pastoral Care UNC Hospitals

  2. Introduction • Definition of Spiritual(ity) “Contemporary spirituality is eclectic and individualistic, situated on a sacred-secular continuum.” Murray, 2004 “Our search for that which gives meaning, purpose, and value to our life.”

  3. The Spiritual Issues… • What does Morrie Schwartz have to say about this? Let’s listen to some of his thoughts about dying in a piece taped with Ted Koppel on the television program Nightline just weeks before Morrie died.

  4. What Is the Meaning of My Illness? • What will happen to me? • How will the illness proceed? • What will happen to my wife/husband, child(ren)? • How will I die? • Where will I die? • Will I be a burden?

  5. What Is the Meaning of My Life? • A search for meaning or purpose • Loss of a sense of connection • Feelings of guilt and/or unworthiness • Questioning of faith/beliefs • Desire for forgiveness • Sense of being abandoned by God

  6. Spiritual Needs of Person • Need for Companionship • To be with spouse/partner • To be with children • To be with friends • To talk with others • To help care for others

  7. Need for Involvement and Control • To have input into one’s life • To have information about one’s care • To stay as independent as possible • To have things in life stay constant • To be involved with family activities • To be helped by others

  8. Need for Positive Outlook • To see the smiles of others • To laugh • To think happy thoughts • To take one day at a time

  9. The Need to Experience Nature • To look outside • To be outside • To have flowers in the room • To have a pet nearby

  10. The Need for Religion/Spirituality • To pray • To read holy scriptures • To read inspirational material • To use inspirational material • To go to their house of worship • To sing/listen to sacred/secular music • To experience the rituals of their faith

  11. The Need to Finish Business • To do a life review • To finish life tasks • To come to terms with present situation • To resolve bitter feelings • To reconcile with loved ones

  12. The Physician’s Role • Be aware of the potential of spiritual distress when your patient is facing a life-threatening situation. • Listen to the patient’s concerns and their broader implications. • Be aware of your own attitudes, values, and assumptions regarding the spiritual dimension. • Consider utilizing a spiritual assessment: FICA. • Encourage advance care planning.

  13. References • EPEC (Educating Physicians on End-of-Life Care), Feinberg School of Medicine, Northwestern University. Module 3: Whole Patient Assessment.Email: info@epec.net. • Herman, CP. Spiritual Needs of Dying Patients. Oncology Nursing Forum.2001: Jan-Feb;28(1): 67–72. • Lo, Bernard and et al. Discussing Religious and Spiritual Issues at the End of Life. JAMA. 2002; Vol. 287, No. 6: 749–754. • Mueller PS, Plevak DJ, and Rummans TA. Religious Involvement, Spirituality, and Medicine: Implications for Clinical Practice. Mayo Clinic Proceedings. 2001;76:1225–1235. • Tolstoy, Leo. The Death of Ivan Ilych. New York: Bantam Book, 1981.

  14. Resources: • Project Compassion: Local group providing end-of-life education for the community. http://www.project-compassion.org/resource.htm • EPEC: Educating Physicians on End-Of-Life Care. http://epeconline.net/epec/webpages/index.cfm • Last Acts: A historical view of the campaign to improve end-of-life care by a coalition of professional and consumer organizations. http://www.rwjf.org/newsroom/featureDetail.jsp?featureID=886&type=3 • EPERC: End of life/palliative care resource center. http://www.eperc.mcw.edu/ • Innovations in End-of-Life Care: an international journal of leaders in end-of-life care. http://www2.edc.org/lastacts/ • The Carolinas Center for Hospice and End-of-Life Care. http://www.carolinasendoflifecare.org

  15. Journals • The Hastings Center Reporthttp://www.thehastingcenter.org • The Journal of Palliative Medicinehttp://www.liebertpub.com/publication.aspx?pub_id=41 • Palliative Medicinehttp://pmj.sagepub.com/

  16. Video Resources: • PBS Video: On Our Own Terms: Moyers on Dying in America • ABC News Videos: Morrie Schwartz: Lessons on Living

  17. Books: • Bartlow, Bruce G. MD, Johnson Books, 2000. Medical Care for the Soul. • Callanan, Maggie and Patricia Kelley. Poseidon, 1992. Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. • Levine, Stephen, Anchor Books, 1982. Who Dies? An Investigation of Conscious Living and Conscious Dying. • National Academy Press, 1997. Approaching Death: Improving Care at the End of Life. • Rando, Therese A., Research Press, 1984. Grief, Dying and Death. • Sulmasy, Daniel P., O.F.M., M.D. Paulist Press, 1997. The Healer’s Calling: A Spirituality for Physicians and Other Health Care Professionals. • Vaux, Kenneth L. and Sara A. Vaux, Abingdon Press, 1996. Dying Well.

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