Pain control and chaplaincy in Australia

The Spiritual Aspect of Pain: An Integrative Review

Pain is an unpleasant sensory and emotional experience that affects individuals in various ways involving biological, psychological, social, and spiritual aspects. There is currently no comprehensive treatment that effectively addresses all aspects of pain. This integrative review aimed to analyze the spiritual aspect of pain relief. Following the specified methodological criteria, a total of 20 articles were selected. There evidenced a lack of spiritual care provided by healthcare professionals, even though its correlation with pain and its potential benefits have been widely demonstrated in the literature. Fortunately, some patients put into practice existential and religious tools to self-control and cope with their pain, although not always with a successful response.

Spiritual Pain: A Symptom in Search of a Clinical Definition

We conducted a literature search to identify and compare definitions of the experiential dimension of spiritual pain. Key databases were searched, up to the year 2021 inclusive, for papers with a definition of "spiritual" or "existential" pain/distress in a clinical setting. Of 144 hits, seven papers provided theoretical definitions/descriptions; none incorporated clinical observations or underlying pathophysiological constructs. Based on these findings, we propose a new definition for "spiritual pain" as a "self-identified experience of personal discomfort, or actual or potential harm, triggered by a threat to a person's relationship with God or a higher power." Our updated definition can inform future studies in pain assessment and management.

Benefits of Spiritual and Religious Support in the Pain Management of Cancer Patients: A Literature Scoping Review

Pain is one of the main symptoms of cancer and the most difficult to control due to its complexity as it can involve physical, psychological, social, and spiritual aspects. We proposed to summarize the scientific knowledge already published related to the influence of spirituality on pain therapy in cancer patients. Articles were searched in PubMed, SciELO, SciFinder, PsycInfo, and ScienceDirect databases using the following descriptors: "Spirituality," "Religion," "Religion," "Chronic Pain," "Pain Management" and "Cancer." A total of 68 articles were included and discussed. Most articles dealt with the influence of spirituality in palliative care, focussed on patient quality, and highlighted the importance of integrative oncology. Although few studies associated spirituality with chronic pain, most articles reported that spirituality could confer greater pain control.

Music Therapy for Pain in Black and White Cancer Patients: A Retrospective Study

CONTEXT

Racial pain disparities present challenges to cancer symptom management. Music therapy has demonstrated benefits for pain and is a promising treatment option for diverse populations due to music's multicultural presence. However, Black cancer patients are under-represented in music therapy trials.

OBJECTIVES

This study compared pain severity, treatment approaches, and responses to music therapy between Black and white cancer patients. The findings will be used to generate hypotheses for future music therapy research to address racial disparities in pain management.

METHODS

We conducted a retrospective program evaluation of Black and white patients who received music therapy at an NCI-Designated Comprehensive Cancer Center. We used the Edmonton Symptom Assessment Scale (ESAS) to assess pain. We abstracted opioid use, music therapy referral reasons, and treatment approaches from the electronic health record.

RESULTS

Among 358 patients, 18% were Black, 42% reported moderate-to-severe pain, and 47% received opioids. Black patients reported higher baseline pain than white patients, but similar proportions of Black and white patients received opioids. Greater proportions of Black patients received music therapy referrals for pain (73% vs. 56%, P = 0.04) and engaged in active techniques (92% vs. 82%, P = 0.04). Black and white patients reported clinically meaningful pain reduction of similar magnitude after music therapy. Black patients discussed spirituality more commonly during music therapy, whereas white patients focused on family bonds.

CONCLUSION

Black and white patients reported clinically meaningful pain reduction through varying music therapy approaches. Our findings may help inform cultural adaptations of music therapy to address racial pain disparities in oncology.

Complementary, Traditional and Spiritual Practices Used by Cancer Patients in Turkey When Coping with Pain: An Exploratory Case Study

This study was conducted to determine the complementary and traditional-spiritual practices applied by individuals diagnosed with cancer when experiencing significant pain. This descriptive and cross-sectional study was conducted with 110 patients who were receiving chemotherapy treatment in a university hospital outpatient treatment unit (Chemotherapy Unit) between 1st March and 30th June 2019. The study sample size was calculated using the 'unknown-population sample selection formula' (n = t²·p·q·/d²). Study data were collected using a patient information form comprising 13 questions about the participants' sociodemographic characteristics, diseases, and complementary practices. The data were analyzed using descriptive percentage tests and the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) software. The study found that 45.5% of the cancer patients took a walk, 38.2% listened to music, 27.3% watched movies, 24.5% received massages, 20.0% read newspapers or books, 20.0% did sports, and 10.9% dreamed in painful situations. Spiritual practices used by the patients were determined as praying (46.4%), engaging in salat (the daily ritual prayers of Islam) (30.9%) and reading religious books (23.6%). The herbal practices applied by the patients include the use of garlic, mulberry molasses, pomegranate, green tea; furthermore, herbs such as honey, sage, lime, black cumin, ginger, centaury, thyme, nettle, flaxseeds, and rosehip were also used. Most of the patients learned complementary practices from television programs (62.7%); only 8.2% learned these practices from healthcare professionals. Nurses should investigate patients' use of complementary practices and provide them with the necessary evidence-based information to prevent unconscious use of these practices. Considering that determining patients' spiritual needs and practices is seen as the first step in the holistic care of patients, it is important to satisfy cancer patients by providing necessary healthcare services and help them improve their physical and mental health.

Pastoral care in hospitals: A literature review

Aims and background

This literature review investigates the potential contribution of the pastoral care provided in hospitals by hospital chaplains, as part of an integrated view of patient care, particularly in institutions dealing with severe disease.

Methods and study design

A search was conducted in the Medline database covering the last 10 years.

Results

Ninety-eight articles were considered concerning the modern hospital chaplains' relationships and the principal procedures and practices associated with their roles, i.e., their relations with the scientific world, with other religious figures in the community, with other faiths and religious confessions, with other public health professionals and operators, with colleagues in professional associations and training activities, and with the hospital organization as a whole, as well as their patient assessment activities and the spiritual-religious support they provide, also for the patients' families.

Conclusions

Improvements are needed on several fronts to professionalize the pastoral care provided in hospitals and modernize the figure of the hospital chaplain. These improvements include better relations between modern chaplains and the hospital organization and scientific world; more focus on a scientific approach to their activities and on evaluating the efficacy of pastoral care activities; greater clarity in the definition of the goals, methods and procedures; the design of protocols and a stance on important ethical issues; respect for the various faiths, different cultures and both religious and nonreligious or secularized customs; greater involvement in the multidisciplinary patient care teams, of which the hospital chaplains are an integral part; stronger integration with public health operators and cooperation with the psychosocial professions; specific training on pastoral care and professional certification of chaplains; and the development of shared ethical codes for the profession.

The Place of Faith for Consultant Obstetricians Following Stillbirth: A Qualitative Exploratory Study

Stillbirth remains among the most challenging areas in obstetric practice. The objectives of this study were to explore the impact of stillbirth on the faith of obstetricians. Semi-structured in-depth qualitative interviews were conducted with obstetricians focusing on the impact of stillbirth on their faith. Data were analyzed using interpretative phenomenological analysis. Stillbirth was identified as one of the most difficult experiences, and most consultants were unable to engage with their personal beliefs when dealing with death at work. The major study themes were conflict of personal faith and incongruence between personal faith and professional practice. This study highlights a gap in how obstetricians see their own faith and feeling able to respond to the faith needs of bereaved parents. Participating obstetricians did not demonstrate that spirituality was an integrated part of their professional life.

"The Patient Is Dying, Please Call the Chaplain": The Activities of Chaplains in One Medical Center's Intensive Care Units

CONTEXT

Patients and families commonly experience spiritual stress during an intensive care unit (ICU) admission. Although most patients report that they want spiritual support, little is known about how these issues are addressed by hospital chaplains.

OBJECTIVES

To describe the prevalence, timing, and nature of hospital chaplain encounters in ICUs.

METHODS

This was a retrospective cross-sectional study of adult ICUs at an academic medical center. Measures included days from ICU admission to initial chaplain visit, days from chaplain visit to ICU death or discharge, hospital and ICU lengths of stay, severity of illness at ICU admission and chaplain visit, and chart documentation of chaplain communication with the ICU team.

RESULTS

Of a total of 4169 ICU admissions over six months, 248 (5.9%) patients were seen by chaplains. Of the 246 patients who died in an ICU, 197 (80%) were seen by a chaplain. There was a median of two days from ICU admission to chaplain encounter and a median of one day from chaplain encounter to ICU discharge or death. Chaplains communicated with nurses after 141 encounters (56.9%) but with physicians after only 14 encounters (5.6%); there was no documented communication in 55 encounters (22%).

CONCLUSION

In the ICUs at this tertiary medical center, chaplain visits are uncommon and generally occur just before death among ICU patients. Communication between chaplains and physicians is rare. Chaplaincy service is primarily reserved for dying patients and their family members rather than providing proactive spiritual support. These observations highlight the need to better understand challenges and barriers to optimal chaplain involvement in ICU patient care.

The Utility of the WHO ICD-10-AM Pastoral Intervention Codings Within Religious, Pastoral and Spiritual Care Research

The World Health Organization (WHO) 'Pastoral Intervention Codings' were first released in 2002 as part of the 'International Statistical Classification of Diseases and Related Health Problems' (WHO 2002). The purpose of the WHO pastoral intervention codings (colloquially abbreviated as 'WHO-PICs') was to record and account for the religious, pastoral and/or spiritual interventions of chaplains and volunteers providing care to patients and other clients experiencing religious and/or spiritual health and well-being issues. The intent of such WHO codings was to provide information in five areas: statistical, research, clinical, education and policy. The purpose of this paper predominantly accounts for research although it does intersect and relate to other WHO priorities. Over the past 10 years, research by the current and associated authors to test the efficacy of the WHO-PICs has been implemented in a number of different health and welfare contexts that have engaged chaplaincy personnel. In summary, while the WHO-PICs are yet to be more widely utilized internationally, the codings have largely proven to be valuable indices appropriate to a variety of contexts. Research utilizing the WHO-PICs, however, has also revealed the necessity for a number of changes and inclusions to be implemented. Recommendations concerning the future utilisation of the WHO-PICs are made, as are recommendations for these codings to be further developed and promoted by the WHO, so as to more accurately record religious, pastoral and spiritual interventions.

Pain control and chaplaincy in Aotearoa New Zealand

This paper summarizes the results of 100 New Zealand health care chaplains with regard to their involvement in issues concerning pain control within the New Zealand health care context. Both quantitative (via survey) and qualitative methods (in-depth interviewing) were utilized. The findings of this study indicated that approximately 52 % of surveyed hospital chaplains had provided some form of pastoral intervention directly to patients and/or their families dealing with issues concerning pain and that approximately 30 % of hospital chaplains had assisted clinical staff with issues concerning pain. NZ chaplaincy personnel involved in pain-related issues utilized a number of pastoral interventions to assist patients, their families and clinical staff. Differences of involvement between professionally stipended hospital chaplains and their volunteer chaplaincy assistants are noted, as are the perspectives of interviewed chaplains about their pastoral interventions with issues relating to pain. Some implications of this study with respect to chaplaincy utility, training and collaboration with clinical staff are noted, as are comparisons with international findings.

A national study of chaplaincy services and end-of-life outcomes

BACKGROUND

Medicine has long acknowledged the role of chaplains in healthcare, but there is little research on the relationship between chaplaincy care and health outcomes. The present study examines the association between chaplaincy services and end-of-life care service choices.

METHODS

HealthCare Chaplaincy purchased the AHA survey database from the American Hospital Association. The Dartmouth Atlas of Health Care database was provided to HealthCare Chaplaincy by The Dartmouth Institute for Health Policy & Clinical Practice, with the permission of Dartmouth Atlas Co-Principal Investigator Elliot S. Fisher, M.D., M.P.H. The Dartmouth Atlas of Health Care is available interactively on-line at http://www.dartmouthatlas.org/. Patient data are aggregated at the hospital level in the Dartmouth Atlas of Health Care. IRB approval was not sought for the project because the data are available to the public through one means or another, and neither database contains data about individual patients, i.e. all the variables are measures of hospital characteristics. We combined and analyzed data from the American Hospital Association's Annual Survey and outcome data from The Dartmouth Atlas of Health Care in a cross-sectional study of 3,585 hospitals. Two outcomes were examined: the percent of patients who (1) died in the hospital, and (2) were enrolled in hospice. Ordinary least squares regression was used to measure the association between the provision of chaplaincy services and each of the outcomes, controlling for six factors associated with hospital death rates.

RESULTS AND DISCUSSION

The analyses found significantly lower rates of hospital deaths (β = .04, p < .05) and higher rates of hospice enrollment (β = .06, p < .001) for patients cared for in hospitals that provided chaplaincy services compared to hospitals that did not.

CONCLUSIONS

The findings suggest that chaplaincy services may play a role in increasing hospice enrollment. This may be attributable to chaplains' assistance to patients and families in making decisions about care at the end-of-life, perhaps by aligning their values and wishes with actual treatment plans. Additional research is warranted.

Bioethical issues and health care chaplaincy in aotearoa New Zealand

This paper summarizes survey and interview results from a cross-sectional study of New Zealand health care chaplaincy personnel concerning their involvement in multiple bioethical issues encountered by patients, families and clinical staff within the health care context. Some implications of this study concerning health care chaplaincy, ecclesiastical institutions, health care institutions and government responsibilities are discussed and recommendations presented.

Organ procurement and health care chaplaincy in Australia

As part of an Australian national project, quantitative data via a survey were retrospectively obtained from 327 Australian health care chaplains (staff and volunteer chaplains) to initially identify chaplaincy participation in various bioethical issues-including organ procurement. Over a third of surveyed staff chaplains (38%) and almost a fifth of volunteer chaplains (19.2%) indicted that they had, in some way, been involved in organ procurement issues with patients and/or their families. Nearly one-fifth of staff chaplains (19%) and 12% of volunteer chaplains had also assisted clinical staff concerning various organ procurement issues. One hundred of the surveyed chaplains volunteered to an interview. Qualitative data were subsequently coded from 42 of the chaplains who had been involved in organ procurement requests. These data were thematically coded using the World Health Organization 'Pastoral Intervention Codings' (WHO-PICs). The qualitative data revealed that through a variety of pastoral interventions a number of chaplains (the majority being staff chaplains) were engaged in the critical and sensitive issues of organ procurement. It is argued that while such involvement can help to ensure a holistic and ethically appropriate practice, it is suggested that chaplains could be better utilized not only in the organ procurement process but also for the training of other chaplains and clinicians.

Health care chaplains and their role on institutional ethics committees: an Australia study

This paper presents the results of the largest Australian pastoral study concerning the perceptions of health care chaplains about their involvement on hospital research ethics committees (also known in some contexts as institutional ethics committees). Survey results from over 300 Australian health care chaplains indicated that nearly 90% of chaplains believed there was merit in chaplains serving on hospital research ethics committees, yet only a minority (22.7%) had ever participated on such committees. Data from in-depth interviews is also presented exploring the reasons for the lack of participation and the varying opinions regarding the role, appropriateness, and value of chaplains on ethics committees. Some implications of this study with respect to chaplaincy, hospital research ethics committees, health care institutions, ecclesiastical institutions, and government responsibilities are discussed.

Chaplain-physician consultancy: when chaplains and doctors meet in the clinical context

This paper summarizes the perspectives of 327 Australian health care chaplains concerning their interaction with physicians within the clinical context. In general terms the findings indicated that nearly 90% of chaplains believed that it was part of their professional role to consult with physicians regarding patient/family issues. Differences of involvement between volunteer and staff chaplains, Catholic and Protestant, male and female chaplains and the type of chaplaincy training are noted, as are the perspectives of chaplaincy informants regarding their role in relation to physicians. Some implications of this study with respect to chaplaincy utility and training are noted.

Chaplaincy and resuscitation

This paper summarises the results of 327 Australian health care chaplains with regard to their involvement in issues concerning Not For Resuscitation (NFR)/Do Not Attempt Resuscitate (DNAR) decisions within the health care context. The findings indicate that 24% of the chaplains surveyed had provided some form of pastoral intervention directly to patients and/or their families dealing with issues concerning NFR/DNAR and that approximately 18% of chaplains had assisted clinical staff with issues concerning NFR/DNAR decisions. Differences of involvement between volunteer and staff chaplains are noted, as are the perspectives of chaplaincy informants regarding their role in relation to NFR/DNAR decisions. Some implications of this study with respect to chaplaincy training and practice are noted.