BARRIERS TO THE DELIVERY OF SPIRITUAL CARE

There are multiple complex barriers to adequately addressing patient’s spiritual needs during oncology care. These include spiritual and religious differences between patients and providers; the true uncertainty of the impact of spirituality and religion on each patient; a lack of understanding of spirituality; and a fear of sacrificing scientific integrity in providing spiritual care.3 The combined effect of these barriers may be attributed to a professional silence about spiritual and religious concerns that dehumanize health care providers and patients.

Stranahan found that health care providers infrequently identify and address spiritual needs among their patients.13 A study performed by Hubbell, Woodard, and Barksdale-Brown demonstrated that despite professing a belief that spiritual care is an important component of health care, health care providers do not routinely and consistently provide spiritual care to their patients.7 More than 50% of health care providers surveyed listed such factors as time, lack of training in taking a spiritual history, and a concern about projecting their own beliefs onto patients as barriers to discussing spiritual issues.12 Ethical barriers related to degree of expertise for spiritual interventions, nonmedical agendas, spiritual issues being perceived as inappropriate objects of interventions, and the potential to do harm to patients by linking health status and spirituality were also barriers to the delivery of spiritual care.12


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Previous research suggests that overall, the largest hindrance to the delivery of spiritual care by oncology clinicians is that ways to deliver such care are poorly integrated into clinical practice and barely form part of the professional competence of health care providers. Academic and medical training pays very little attention to spirituality.3 Assessments of spirituality can be time-intensive and require an assessment tool that is easy to remember and concisely comprehensive.3

INTEGRATING SPIRITUAL CARE PRACTICES

Spiritual assessment of cancer patients is a delicate and intimate task for both the patient and the health care professional performing the assessment. For this reason, an assessment method is needed to help clinicians adequately assess spiritual strengths and weaknesses as well as to build or bolster patients’ sense of self.3 Various methods and techniques related to spiritual assessments and the delivery of spiritual care are provided in the oncology literature. However, the basics of providing spiritual care start with the understanding that spiritual care in the health care setting is not about the religious or spiritual beliefs of the provider. Spiritual care should be about what matters to the patient.

The patient-centered model of care should start with a detailed assessment of the spiritual needs of patients who demonstrate that they are experiencing spiritual distress or crisis. Spiritual care interventions can be simple, such as helping patients learn to meditate, write in a journal, attend support groups, or participate in bibliotherapy (reading of motivational and encouraging literature), and referring them to the appropriate professional resource (eg, chaplain or psychologist) when supportive interventions are beyond what the clinician is capable of effectively delivering. A framework for spiritual assessment provides a foundation to guide the clinician-patient interaction. Clinicians can initiate spiritual care by performing a spiritual assessment that begins with three simple questions (Table 1).

CONCLUSION

The importance of providing spiritual care to patients has become increasingly more apparent. Cancer patients cannot afford for their spiritual care needs to go unmet. They need this aspect of care because it helps to restore hope amidst the threats to hope and life that come with a cancer diagnosis. Nurses must be educated to meet these spiritual needs through assessment, planning, and intervention. They should be familiar with aspects of spirituality in order to properly deliver such care and should understand that lack of knowledge about these issues can worsen patient outcomes and hinder professional growth. The barriers to providing spiritual care must be overcome so that comprehensive care can be given without compromise. Spiritual assessments and care must become consistent in oncology practice from the time of diagnosis, throughout treatment, and into survivorship and end-of life care.

Clinician education focusing on defining spiritual care practices, spirituality, and spiritual well-being is essential to successfully integrate this component into oncology care. This type of education can diminish apprehension and uneasiness about providing spiritual care and foster a sense of security and openness in the patient-provider relationship. Integration of consistent spiritual care practices can increase the oncology nurse’s sense of competence about the overall care provided. And the delivery of spiritual care to patients allows them to feel that all aspects of their health are being appropriately addressed. ■


Jiajoyce Conway is an oncology nurse practitioner at Cancer Care Associates of York in York, Pennsylvania, and a member of the Oncology Nurse Advisor editorial board..


REFERENCES

1. Williams DR, Sternthal MJ. Spirituality, religion and health: evidence and research directions. Med J Aust. 2007;186(10 Suppl):S47-S50.

2. MacDonald BH. Quality of life in cancer care: patients’ experiences and nurses’ contribution. Eur J Oncol Nurs. 2001;5(1):32-41.

3. Skalla KA, McCoy JP. Spiritual assessment of patients with cancer: the moral authority, vocational, aesthetic, social, and transcendent model. Oncol Nurs Forum. 2006;33(4):745-751.

4. Anandarajah G, Hight E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician. 2001;63(1):81-89.

5. Manning-Walsh JK. Psychospiritual well-being and symptom distress in women with breast cancer. Oncol Nurs Forum. 2005;32(3):543.

6. Astrow AB. Approaching the spiritual and religious concerns of the patient with cancer: creating an environment for dialogue regarding spiritual concerns. J Clin Oncol. 2009;26:183-185.

7. Hubbell SL, Woodard EK, Barksdale-Brown DJ, Parker JS. Spiritual care practices of nurse practitioners in federally designated nonmetropolitan areas of North Carolina. J Am Acad Nurse Pract. 2006;18(8):379-385.

8. Laubmeier KK, Zakowski SG, Bair JP. The role of spirituality in the psychological adjustment to cancer: a test of the transactional model of stress and coping. Int J Behav Med. 2004;11(1):48-55.

9. Taylor EJ. Caring for the spirit. In: Burke CC, ed. Psychosocial Dimensions of Oncology Nursing Care. 2nd ed. Pittsburgh: Oncology Nursing Society; 2009:59-74.

10. Meraviglia M. Effects of spirituality in breast cancer survivors. Oncol Nurs Forum. 2006;33(1):E1-E7.

11. Nolan MT, Hodgin MB, Olsen SJ, et al. Spiritual issues of family members in a pancreatic cancer chat room. Oncol Nurse Forum. 2006;33(2):239-244.

12. Kliewer S. Allowing spirituality into the healing process. J Fam Pract. 2004;53(8):616-624.

13. Stranahan S. Spiritual perception, attitudes about spiritual care, and spiritual care practices among nurse practitioners. West J Nurs Res. 2001;23(1):90-104.