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Higgins E, Coyne HL, Rogers CKM, Infanzon J, Velez N, Coyne P. The CASH assessment tool: A window into existential suffering. J Health Care Chaplain 2021; 28:482-496. [PMID: 34011243 DOI: 10.1080/08854726.2021.1922980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Spiritual beliefs and practices have long served as a critical component of treating or managing serious illness. There is evidence to suggest that patients would like healthcare professionals to address their existential and spiritual needs. The CASH Assessment Tool focuses on four key areas of spiritual concern: Care, Assistance/Help, Stress, and Hopes/Fears. In this QI Project, a palliative care team within an urban, safety net, tertiary-care, and academic healthcare setting sought to elicit themes from the CASH assessment used by chaplains caring for patients with serious illnesses. Thirty patients were included in the pilot. Themes identified included knowing the patient as a person, concern about loved ones, concern about pain, and fear of death. We found that the CASH Assessment Tool was able to demonstrate the existential concerns of patients and serve as a framework for discussion about concerns and hopes of patients with serious illness.
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Affiliation(s)
- Elizabeth Higgins
- Internal Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Hannah L Coyne
- Internal Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - James Infanzon
- Medical School, Medical University of South Carolina, Charleston, SC, USA
| | - Nicholas Velez
- Undergraduate, College of Charleston, Charleston, SC, USA
| | - Patrick Coyne
- Internal Medicine, Medical University of South Carolina, Charleston, SC, USA
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Pan CX, Costa BA, Yushuvayev EK, Gross L, Kawai F. Can Orthodox Jewish Patients Undergo Palliative Extubation? A Challenging Ethics Case Study. J Pain Symptom Manage 2020; 60:1260-1265. [PMID: 32882359 DOI: 10.1016/j.jpainsymman.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022]
Abstract
According to Jewish law/ethics, continuous life-sustaining therapy may not be withdrawn after its introduction, unless the patient has improved and no longer has a medical indication for the treatment. We report the case of an 88-year-old Orthodox Jewish patient, on invasive mechanical ventilation, with severe anoxic brain injury after multiple cardiac arrests. Although the patient's son informed the palliative care team that his father did not want to be in pain or to linger in a vegetative state when terminally ill, the mechanical ventilation was keeping him alive with a poor neurological prognosis. Additionally, the patient had previously stated his wish to observe Orthodox Jewish principles regarding end-of-life care. After extensive discussion, the family Rabbi clarified that it would be acceptable to withdraw mechanical ventilation if there were a "reasonable expectation" he would breathe on his own for a "reasonable amount of time." Thus, if the patient's death were to occur, it would not be an immediate consequence the normal ventilator weaning process. Following intermediation by the hospital Rabbi, the definition of what would be a "reasonable expectation" and "reasonable amount of time" was established by the family Rabbi as "over 50%" and "on the order of hours," respectively. Following pulmonary consultation, the patient underwent palliative extubation and, 12 hours after the procedure, died comfortably surrounded by the family. In conclusion, the collaborative and interdisciplinary work among the family Rabbi, hospital Rabbi, and the various medical teams allowed the development of a plan that met all of the patient's personal and religious wishes and beliefs.
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Affiliation(s)
- Cynthia X Pan
- Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens, Flushing, New York, USA.
| | - Bruno Almeida Costa
- Department of Internal Medicine, Walter Cantidio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Elina K Yushuvayev
- Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens, Flushing, New York, USA
| | - Liam Gross
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, NewYork-Presbyterian Brooklyn Methodist, Brooklyn, New York, USA
| | - Fernando Kawai
- Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens, Flushing, New York, USA
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Stilos KK, Ford B, Chakraborty A. Quality improvement of the end of life care experience through bereavement calls made by spiritual care. J Health Care Chaplain 2020; 28:13-20. [PMID: 32031494 DOI: 10.1080/08854726.2020.1724460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Improving the end of life care experience of people dying in acute care has become a priority for our organization since 2016 with the launch of the "Quality Living and Dying Initiative." This initiative has three distinct foci. The first two areas of focus, advance care planning and standardized comfort measures, are well established while the third focus bereavement program remains in its early stages. Bereavement is recognized as an essential component along the continuum of palliative care. Despite this recognition, bereavement care is often lacking in hospital settings. This paper will describe a telephone bereavement initiative spearheaded by the Spiritual Care Team at our organization.
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Affiliation(s)
- Kalli Kalliopi Stilos
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Adjunct Clinical Appointment Department of Nursing, Faculty of Nursing University of Toronto, Toronto, Canada
| | - Bill Ford
- Spiritual Care Department, Unity Health Toronto, Toronto, Canada
| | - Anita Chakraborty
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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Memaryan N, Ghaempanah Z, Aghababaei N, Koenig HG. Integration of Spiritual Care in Hospital Care System in Iran. JOURNAL OF RELIGION AND HEALTH 2020; 59:82-95. [PMID: 31227979 DOI: 10.1007/s10943-019-00864-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is a growing body of evidence on the positive effects of religion and spirituality on recovery from cancer and the ability to cope with it. Most spiritual interventions carried out in Iranian research are based on care and support models that have been developed in the West. With the unique cultural and religious features of the Iranian context, a more refined look at spiritual care in the hospital care system of Iran is called for. This paper examines how to implement the spiritual care of cancer patients in hospitals and oncology wards in Iran. A consensus panel of experts was used to develop guidelines for spiritually integrated care consisting of 18 primary areas, which are described in detail in this report. Health care policy makers and managers of health care in Iran and possibly other areas of the Middle East should consider implementing these guidelines. Using indigenous models and programs specific to the religion and the cultural of a region should be considered when providing spiritual care for cancer patients.
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Affiliation(s)
- Nadereh Memaryan
- Spiritual Health Research Center, Mental Health Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghaempanah
- Spiritual Health Research Center, Iran University of Medical Sciences, Shahid Mansouri Street, Niyayesh Street, Satarkhan Avenue, Tehran, 1445613111, Iran.
- Office of Islamic Studies in Mental Health, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Naser Aghababaei
- Department of Behavioral Sciences, The Institute for Research and Development in the Humanities (SAMT), Tehran, Iran
| | - Harold G Koenig
- Center for Spirituality, Theology and Health Duke University Medical Center, Durham, NC, USA
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Ningxia Medical University, Yinchuan, People's Republic of China
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Stilos K, Ford B, Lilien T, Moore J. The Role of Spiritual Care with the Introduction of an End of Life Order Set. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2019; 73:41-48. [PMID: 30895857 DOI: 10.1177/1542305018822283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Delivering comprehensive end-of-life care to dying patients must involve addressing physical symptoms and psychosocial concerns. Care pathways have been introduced to support health care teams in delivering this care. This retrospective chart review explores the contributions of the Spiritual Care Team in the care of dying patients. They offer a range of interventions which include supportive care, religious and spiritual support. This study was one step towards appreciating the contributions of the Spiritual Care Team.
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Affiliation(s)
- Kalli Stilos
- Sunnybrook Health Science Centre, Canada; Adjunct Clinical Faculty, University of Toronto, Lawrence Bloomberg Faculty of Nursing, Canada
| | - Bill Ford
- Sunnybrook Health Sciences Centre, Canada
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Kearney G, Fischer L, Groninger H. Integrating Spiritual Care into Palliative Consultation: A Case Study in Expanded Practice. JOURNAL OF RELIGION AND HEALTH 2017; 56:2308-2316. [PMID: 28550510 DOI: 10.1007/s10943-017-0419-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recognizing and addressing spiritual needs has long been identified as a key component of palliative care (PC). More often than not, the provision of spiritual care involves referral to a hospital chaplain. In this study, we aim to describe the role of a PC chaplain embedded within the interdisciplinary PC team and demonstrate how this palliative chaplain role differs from that of a traditional hospital chaplain. We postulate that integrating spiritual care provision into a PC team may offer a broader spiritual care experience for patients receiving PC and begin to delineate expanded clinical roles for the palliative chaplain.
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Affiliation(s)
- Grace Kearney
- Palliative Medicine, MedStar Health, 10980 Grantchester Way, Columbia, MD, 21044, USA
| | - Linda Fischer
- Section of Palliative Care, MedStar Washington Hospital Center, 110 Irving Street NW, Room 2A68, Washington, DC, 20010, USA
| | - Hunter Groninger
- Section of Palliative Care, MedStar Washington Hospital Center, 110 Irving Street NW, Room 2A68, Washington, DC, 20010, USA.
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Abstract
With an increasing number of terminal patients in the United States dying in the context of hospice, the role that hospice chaplains play in providing spiritual care for patients and their families is important to examine. The hospice chaplain role requires careful navigation of the development of relationships that may end abruptly, the expectations of hospice organizations, and the needs of both patients and families. The current study uses the concept of competing role dialectics to further our understanding of the challenges chaplains face as they enact this crucial role. Data from 45 current and former hospice chaplains reveal four major role tensions hospice chaplains must develop strategies to handle: fostering relationships versus fostering autonomy, acting as team members versus acting as individuals, serving the family unit as a whole versus serving particular family members, and following the agendas of patients and families versus following one's own agenda.
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Bowman T. Spirituality and countertransference: Individual and systemic considerations. DEATH STUDIES 2017; 41:154-161. [PMID: 27849452 DOI: 10.1080/07481187.2016.1236851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Spirituality is now routinely included in the arc of palliative or holistic care. In spite of this recognition, its importance can be compromised unless countertransference in its many forms gains more attention. In this article, individual and systemic considerations related to the intersection of spiritualty and countertransference in hospice and palliative care will be addressed, with particular emphasis on practitioner implications. A framework, developed by Kenneth Pargament will be extended to highlight perceptions that can exacerbate countertransference and spirituality. Practitioner questions useful in eliciting spiritual matters are included.
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Affiliation(s)
- Ted Bowman
- a School of Social Work , University of Saint Thomas , Saint Paul , Minnesota , USA
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The spiritual domain of palliative care: Who should be “spiritual care professionals”? Palliat Support Care 2009; 7:139-41. [DOI: 10.1017/s1478951509000182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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