A Survey on the Integration of Spiritual Care in Medical Schools from the German-Speaking Faculties

The current status of "spirituality and health" teaching in Brazilian medical schools: a nationwide survey

BACKGROUND

Recent data on the teaching of "spirituality and health" (S/H) in medical schools are needed. In this study, we aimed to investigate the current status of S/H teaching in Brazilian medical schools, the opinions of medical directors/deans on this topic and the factors associated with its incorporation into the curriculum.

METHODS

A nationwide cross-sectional survey was carried out in 2021. Information concerning the S/H content in the curricula of medical schools was obtained through medical school representatives and other sources. Medical school representatives were asked about their opinions of and barriers to S/H teaching. Regression models were used to evaluate the factors associated with the incorporation of such content into the curriculum.

RESULTS

Information on the incorporation of S/H content in medical curricula was retrieved from different sources for all 342 (100%) Brazilian medical schools. Among the representatives, 150 (43.9%) completed the online form. An increase in the S/H content in Brazilian medical schools was observed (from 40% to 2011 to 65.5% in 2021). Most medical school representatives agreed that this issue is important in medical training and that more space in the curriculum is needed. However, they also observed several barriers, such as a lack of knowledge of medical teachers/faculty, a lack of time, and the topic not being included in teaching plans. The most important factors that influenced the incorporation of S/H teaching in medical schools and representatives' opinions were a lack of time and knowledge, professor preparedness and standardized national competency requirements.

CONCLUSION

These results could help medical educators rethink the incorporation of S/H content into their curricula.

Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention

BACKGROUND

Spiritual needs gain importance in old age but are often ignored in health care. Within the 'Holistic care program for elderly patients to integrate spiritual needs, social activity and self-care into disease management in primary care (HoPES3)' a complex intervention was evaluated in a cluster-randomized trial. The aim of this study was to explore the acceptability, feasibility, benefits, and harms of a spiritual history taken by general practitioners (GPs) as part of the complex intervention.

METHODS

In this mixed-methods study telephone interviews with 11 German GPs and 12 medical assistants (MAs) of the HoPES3 intervention group were conducted and analysed using a content-analytical approach. Furthermore, GPs were asked to complete a questionnaire after each spiritual history. One hundred and forty-one questionnaires from 14 GPs were analysed descriptively.

RESULTS

GPs considered the spiritual history very/quite helpful for the patient in 27% (n= 38) and very/quite stressful in 2% (n = 3) of the cases. Interviews indicated that GPs found discussing spiritual history easier than anticipated. GPs and MAs saw a difficulty in that many patients associated spirituality with religion or church and reacted with surprise or rejection. Benefits for patients were seen in the opportunity to talk about non-medical topics, and increased awareness of their own resources. Benefits for GPs mainly related to information gain and an intensified patient-physician relationship.

CONCLUSIONS

A spiritual history in general practice has the potential to reveal important information about patients' lives and to improve the patient-physician relationship. Implementation barriers identified in this study have to be considered and addressed.

Indicators of Sensory and Intellectual Thinking Based on Clinical Psychology and Islamic Perspective and their Role in Psychotherapy and Spiritual Health: Introducing a New Model of Thinking

Today, the field of health is not limited to physical and mental health, but is related to all aspects of life, including spirituality. Spiritual health is so important that it is suggested as the fourth dimension of health, and in the near future, it will form part of the definition of health by the WHO. According to research in clinical psychology, in addition to spiritual health, another important issue in most psychotherapy theories is the issue of thinking. Given the importance of health and thinking, so far, no model has been presented in the field of the relationship between "thinking and health". So, the purpose of the present study is introducing a new model of healthy thinking based on human soul faculties. In this study, qualitative content analysis method has been used. Indicators of sensory and intellectual thinking have been noted within research results, which are the main components of the new model of thinking. In this type of thinking model, it is argued that all human beings have powers within them that can grow, which are referred to as the faculties of the soul. The level of thinking of individuals is determined by the level of each person's soul faculties. The lowest level is sensory perception and the highest level is intellectual perception. The more a person grows from the level of sensory thinking to the level of intellectual thinking, the sources of thought error decrease and the better the health of the thinking. Also, those who have a level of intellectual thinking have a higher level of spiritual health and the lifestyle of these people is health-oriented. This is a philosophical-psychological model in which indicators of sensory thinking and intellectual deviation have been extracted from theories and texts of psychology and philosophy. The results of this study can be used in psychotherapy because research has shown that thinking, especially healthy thinking, has a very effective role in mental health and a healthy lifestyle as well as treatment of disorders.

A training programme for medical students in providing spiritual care to people with advanced diseases and their loved ones: A case study from the Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland

Purpose

This article presents the first programme on spiritual care particularly for people with advanced life-limiting illness including heart failure, lung disease or cancer for medical students in Poland implemented at the Collegium Medicum in Bydgoszcz of the Nicolaus Copernicus University in Toruń.

Methods and materials

Several steps were identified for the development of the first programme on spirituality for medical students at the Collegium Medicum in Bydgoszcz including preliminary work on the content of the programme, agreement on key concepts, terms, and definitions; consultations with teachers and review of the literature.

Results

The first Polish spiritual curriculum for medical students was implemented. The spirituality curriculum will potentially contribute to better care for the people with advanced illnesses such as heart failure, chronic lung disease or cancer and improve the quality of relationships between professionals and patients.

Conclusion

The article presents the content of the program, the expected learning objectives and ascribed teaching methods, along with the preliminary evaluation made by students.

Indicators of Intellectual Thinking as Healthy Thinking and Its Relation with Health-Promoting Lifestyle: A New Perspective in Clinical Psychology and Public Health

BACKGROUND

Quality of life is determined by the lifestyle of individuals. If people have a healthy lifestyle, then they have a higher quality of life. What makes a person's lifestyle is the way he thinks. Therefore, if the thinking is healthy, the person's lifestyle will be healthy, and if the thinking is unhealthy, the person's lifestyle will also be damaged, which will reduce the quality of life.

METHODS

The research method was mixed method in two quantitative and qualitative phases. The research method in the qualitative phase was customary qualitative content analysis, in which the data analysis process was based on the approach of Granheim and Ladman. In the quantitative phase, the psychometric properties of the research scale were measured. This research was conducted from 2016 to 2021 in Iran. The statistical population in the qualitative section was all scientific texts in the form of articles, books and dissertations that were extracted from scientific databases such as ScienceDirect, PubMed, Elsevier, Ebsco, Sid, Magiran.

RESULTS

Indicators of intellectual thinking have been mentioned as research results, which are the main components of the new model of thinking. Moreover, the level of thinking was mentioned and Cognitive distortions, cognitive bias, and perceptual errors were mentioned as sources of harm and error.

CONCLUSION

Intellectual thinking has been mentioned as healthy thinking, which is the main factor of a health promotion lifestyle because healthy lifestyle improves the quality of life of people, which is one of the indicators of public health. Therefore, a higher quality of life can be achieved from the model of healthy thinking, which is a new perspective on promoting public health.

"My life became more meaningful": confronting one's own end of life and its effects on well-being-a qualitative study

Background

The perception of being closer to death can be experienced due to old age or life-limiting diseases, and can pose profound existential challenges. Actively confronting death-related issues and existential questions may increase psychosocial comfort and stimulate personal growth, whereas dysfunctional coping may lead to existential distress.

To date, research on individual and (semi-)professional approaches to confronting the own end of life and the effects on one’s well-being remain scarce. Therefore, the aim of this study was to explore individual strategies and wishes in order to derive ideas for appropriate support concepts.

Methods

Twenty semi-structured interviews were conducted with people over the age of 80 (n = 11) and with a life-limiting disease (n = 10). The interviews were transcribed verbatim and independently coded by two researchers according to Braun and Clarke's thematic analysis approach.

Results

While the use of (semi-)professional approaches (e.g., therapeutic support) to confronting existential questions in the shape of one’s impending death was rare, individual coping strategies did have a positive impact on psychosocial comfort. There were hardly any significant differences between the participants aged 80 and over and those with a life-limiting disease in terms of individual coping strategies or how they approached the ends of their lives. Both groups reported that theoretical education, preparing for the ends of their lives (e.g., funerals), talking about death-related topics, reflecting on death-related topics, and contemplating death in a spiritual sense had positive effects on their assurance, self-determination and relief. The necessity of confrontation and a desire for low-threshold, accessible and flexible services to meet their existential and spiritual needs were highlighted.

Conclusions

There is both a desire and a need for the addressing of existential questions. Outside of private contexts, however, the participants possessed little awareness of support services that focused on confronting end-of-life issues, and rarely used such services. Efforts to raise awareness for psychosocial and spiritual needs should be implemented within the care system, together with low-threshold support concepts, in order to increase psychosocial well-being. More research evaluating individual approaches to confronting the own end of life are needed to better understand this determinant of well-being and its mechanisms of action.

Trial registration

www.germanctr.de, DRKS-ID: DRKS00020577.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00950-3.

GPs´ Personal Spirituality, Their Attitude and Spiritual Competence: A Cross-Sectional Study in German General Practices

To understand if GPs' spiritual competence, their personal spirituality and attitude towards enquiring about spirituality in practice interrelate, we conducted a cross-sectional survey of 30 German GPs regarding issues of SC. We found correlations between GPs' personal spirituality, their spiritual competence and their attitudes towards SC. The ability to perceive spiritual needs of patients was the competence most strongly related to GPs' attitude towards SC. The competence with the strongest correlation to personal spirituality was Self-awareness and Proactive opening. No correlation was found between affiliation to a spiritual community and GPs' attitude towards SC. The results show that GPs' personal spirituality and spiritual competence are indeed related to addressing spirituality with their patients. To foster SC, training programmes should raise awareness for one's personal spirituality and encourage one to reflect on spiritual competence.

Hidden Curriculum in Medical Residency Programs: A Scoping Review

INTRODUCTION

Hidden curriculum is important in medical education and has numerous, long-lasting effects on medical residency. The present scoping review seeks to investigate, identify, and plot the main concepts relating to hidden curriculum and its dimensions, domains, impacts and factors in medical residency courses based on the main references and evidence.

METHODS

Scoping review methodology was used to guide a search of electronic databases for relevant papers. Of the 394 abstracts initially identified, after screening of both abstracts and full-text papers, 43 studies were selected for inclusion in this review. Following abstraction of key information from each study, a content analysis was undertaken.

RESULTS

Eleven themes were identified from the content analysis: 1) Organizational Issues (13.77%), 2) Socio-cultural Issues (10.5%), 3) Professional Issues (13.41%), 4) Communicational Factors (8.7%), 5) Educational Issues (22.83%), 6) Resident Personal Characteristics (21.01%), and 7) Resident Educational Characteristics (9.78%). Among the extracted effective hidden curriculum factors, the role modeling had the highest frequency and was emphasized in the studies.

CONCLUSIONS

Although this study explained and identified the components, elements and also the preparation of the initial format of the hidden curriculum framework of the medical residency program, its results can reduce the negative effects of the hidden curriculum on it. More extensive and in-depth studies with different qualitative methods or mixed methods related to the hidden curriculum in different contexts and disciplines of medical residency are recommended to define characteristics of a constructive hidden curriculum of medical residency programs.

Evaluation of a Spiritual History with Elderly Multi-Morbid Patients in General Practice-A Mixed-Methods Study within the Project HoPES3

Background: The “Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity and Self-Care into Disease Management in Primary Care” (HoPES3) examines the implementation of a spiritual history (SH) as part of a multifaceted intervention in German general practices. While the effectiveness of the interventions was evaluated in a cluster-randomized trial, this article investigates the patients’ views concerning the acceptability of the SH and its effects. Methods: A mixed-methods study was conducted in which 133 patients of the intervention group filled in a standardized questionnaire after the intervention. Later, 29 of these patients took part in qualitative semi-standardized interviews. Results: According to the survey, 63% (n = 77) of patients found the SH helpful. In the interviews, however, many indicated that they either kept the conversation brief or declined the offer to talk about spirituality. Contents of longer conversations referred to difficult life events, personal sources of strength, and experiences with religious institutions. Many patients who had a longer conversation about spirituality reported that their relationship with their general practitioner (GP) had improved. Almost all patients recommended integrating a personal conversation of this kind into primary care. Conclusions: The SH seems to be a possible ‘door opener’ for a trusting doctor-patient relationship, which can then be built upon.

The Process of Spiritual Care

The aim of this article is to illustrate and outline an understanding of spiritual care as a process involving a number of organically linked phases: (1) the identification of spiritual needs and resources, (2) understanding the patient's specific needs, (3) developing the individual spiritual care treatment plan, hereunder involving the relevant healthcare/spiritual care professionals, (4) the provision of spiritual care, and (5) evaluating the spiritual care provided. The focus on spiritual care in healthcare research has increased throughout the past decades, showing that existential, spiritual, and/or religious considerations and needs increase with life-threatening illness, that these needs intensify with the severity of disease and with the prospect of death. Furthermore, research has shown that spiritual care increases quality of life, but also that failing to provide spiritual care leads to increased chance of depression and lowered health conditions. The World Health Organization accordingly emphasizes that providing spiritual care is vital for enhancing quality-of-life. Looking at spiritual care as a process suggests that working within a defined conceptual framework for providing spiritual care, is a recommendable default position for any institution where spiritual care is part of the daily work and routines. This so, especially because looking at spiritual care as a process highlights that moving from identifying spiritual needs in a patient to the actual provision of spiritual care, involves deliberate and considered actions and interventions that take into account the specific cultural and ontological grounding of the patient as well as the appropriate persons to provide the spiritual care. By presenting spiritual care as a process, we hope to inspire and to contribute to the international development of spiritual care, by enabling sharing experiences and best-practices internationally and cross-culturally. This so to better approach the practical and daily dimensions of spiritual care, to better address and consider the individual patient's specific spiritual needs, be they secular, spiritual and/or religious. In the final instance, spiritual care has only one ambition; to help the individual human being through crisis.

Training General Practitioners and Medical Assistants Within the Framework of HoPES3, a Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity, and Self-Care into Disease Management in Primary Care

Background

This study presents a concept for training general practitioners (GPs) in taking a spiritual history. In the same workshop, medical assistants (MAs) were trained in counselling elderly, chronically ill patients on social activities and home remedies. After the training, GPs and MAs will apply the acquired skills in their practices within the scope of the HoPES3 intervention study, which aims at raising patients’ self-efficacy.

Methods

Sixteen GPs and 18 MAs were trained in a 5-hour workshop and completed an evaluation questionnaire.

Results

All participants reported great satisfaction. In particular, 85% of GPs (n=11) affirmed increased capacity to address patients’ spiritual needs. About 88% (n=15) of MAs were satisfied with the training, yet expressed difficulties in integrating theoretical knowledge into daily professional routine.

Discussion

While the evaluation of the workshop is promising, the results of the randomized-controlled trial evaluating the effectiveness of the complete HoPES3 intervention have to be awaited.

Conclusion

To our knowledge, this is the first interdisciplinary, holistic care training in primary care in Germany. It fosters GPs’ and MAs’ competency in providing a proactive support in spirituality, social activities, and home remedies to their patients. If the concept proves to be effective, it could be integrated into existing care models and curriculums and provide clear guidance on how to consider elderly patients’ spiritual needs and strengthen their self-efficacy in primary care settings.

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[Spiritual competence in psychiatry and psychotherapy-Barriers and success factors]

BACKGROUND

Just as the World Psychiatric Association (WPA) and other national psychiatric societies, the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) has published a position statement about religiosity and spirituality in psychiatry and psychotherapy, in which it demands patient orientation and spiritual competency in psychiatric professions. Previous research has shown that lack of competency is the major barrier against implementing spiritual care into clinical practice.

OBJECTIVE

The aim of this study was to examine spiritual care in psychiatry and psychotherapy. An evaluation of how health professionals in psychiatry gauge the spiritual care competency of their professional group and which variables influence this judgement.

MATERIAL AND METHODS

A total of 391 psychiatric nursing personnel, 75 psychiatrists, 119 therapists from diverse professions and 62 others, i.e. 647 working in German and Austrian hospitals completed the German version of the spiritual care competency questionnaire (SCCQ).

RESULTS

Nursing personnel, older and spiritually more experienced persons gauged the spiritual competency of their own professional group comparatively higher and judged less frequently that they have no responsibility in this field. Nursing personnel reported the lack of suitable rooms as a barrier against implementation of spiritual care more often than other professional groups. Judging the spiritual competency of one's own professional group higher is associated with higher values in the SCCQ factors self-experience and proactive opening up, team spirit, perception and documentation competency.

CONCLUSION

The responsibility of healthcare professions for spiritual care in psychiatry and psychotherapy is still a controversial issue among German-speaking psychiatric professional groups. This is partially due to a lack of competency in this domain.

[Increased attention of radiotherapy patients to religiousness and spirituality - a comparison with patients in a psychosomatic outpatient clinic]

Increased attention of radiotherapy patients to religiousness and spirituality - a comparison with patients in a psychosomatic outpatient clinic Objectives: The aim of this study is to prove both hypothesis, that patients of radiation therapy are different to patients of a psychosomatic outpatient unit in case of their spirituality and religiosity and that these attitudes have an influence of their own lives. Methods: In a cross-sectional study, a data set of the Department of Psychosomatic and Psychotherapy of the University Hospital Münster in 2013 (n = 1110) was compared to data from 2017 by the Department of Radiation Therapy - Radiation oncology of the University Münster (n = 275) in terms of their religiosity and spirituality. The survey was carried out by a questionnaire on religious attitudes (FRA-RE, Heuft 2016). An age- and gender-controlled statistical analysis has been made by means of partial correlations and mean comparisons. Results: The results are consistent with the hypothesis that patients of radiotherapy, in contrast to psychosomatic patients, are more religious, more spiritual, show more private, but also public religious/spiritual practice, have a stronger desire for more religiosity in their lives and belief that religiosity helps to overcome times of crisis. Conclusions: Thus, it is of particular importance to provide this burdened patient clientele spiritual/religious offers for coping with their disease.

The Catalogue of Spiritual Care Instruments: A Scoping Review

Spiritual care has been a growing focus in international healthcare research over the last decades. The approaches to spiritual care are many and derive from many different medical fields and different cultural contexts and often remain unknown across healthcare areas. This points to a potential knowledge gap between existing instruments and the knowledge and use of them cross-disciplinarily and cross-culturally, and thus best practice insights are not sufficiently shared. This article contributes to the growing field of spiritual care by providing an overview of the various approaches (henceforth instruments) to assess patients’ spiritual needs in view of improving spiritual care. This was done through a scoping review method. The results of the review were collected and catalogued and presented here as ‘The Catalogue of Spiritual Care Instruments’. The included instruments derive from a wide range of geographical contexts and healthcare areas and are aimed at patients and healthcare professionals alike, clearly showing that spiritual care is a focus in healthcare internationally. However, it also shows the difficulties of defining spiritual care, the importance of local contexts, and the difficulties of cross-cultural validity. The catalogue contains 182 entries and is available as an interactive platform for the further development of spiritual care internationally.