SU4 - Spiritual Assessment In Palliative Medicine And End .

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Spiritual Assessment in PalliativeMedicine and End-of-Life CareKaren Pugliese, MA, BCCAoife Lee, D.Min, BCCGeorge Fitchett, D.Min, PhD, BCCPresentedto: Insert relevant presenter information Calibri 16ptMay 30, 2017Presented on: Month day, YearPresented by: Insert relevant presenter information here1

Workshop Objectives1. Describe the limitations of current approaches to spiritualassessment.2. Utilize a new model to quantitatively assess the unmet spiritualneeds of a Palliative Medicine patient.3. Evaluate the strengths and limitations of a quantifiable model forassessing unmet spiritual needs in patients receiving palliative care.2

Current Approaches to Spiritual Assessment33

Limitations of Current Practice in Spiritual AssessmentCurrent PracticeRevised PracticeRationaleOne-size fits allMultiple conditionspecific assessmentsRecent research about R/S needs in specific clinical populationssupports condition-specific assessmentCommunication with colleagues is thwarted by narrative modelswhose assessments are too long and use chaplain jargonNarrativeQuantifiableIdentify degrees of R/S distress and R/S resources in order to informcare planDescribe change in R/S distress or other sx in response tochaplain/spiritual careAcceptable to patientsInefficientUsefulAcceptable to chaplains: helpful guide to spiritual care; consistentwith identity and educationProvides information valued by other cliniciansLocalUniversalThe same model is used by all chaplains working with patientswith this condition44

SDAT: Needs, Interview Questions & ScoringPatient InterviewSpiritual Needs ModelMEANINGNEED FOR LIFE BALANCETRANSCENDENCENEED FOR CONNECTIONSet of Questions for patient interviewScoringAre you having difficulty with what is happening toyou now (hospitalization, illness)?Score 0No evidence of unmetIs your religion/spirituality/faith challenged by what need for life balanceis happening to you now?Does what is happening to you now change ordisturb the way you live or express yourfaith/spirituality/religion?VALUESNEED FOR VALUESACKNOWLEDGEMENTDo you think that the health professionals caringfor you know you well enough?NEED TO MAINTAINCONTROLDo you feel you are participating in the decisionsmade about your care?PSYCHO-SOCIAL IDENTITYNEED TO MAINTAINIDENTITYDo you have any worries or difficulties regardingyour family or other persons close to you?Do you feel lonely?Could you tell me about the image you have ofyourself in your current situation (illness,hospitalization)?Score 1Some evidence ofunmet need for lifebalanceScore 2Substantial evidenceof unmet need for lifebalanceScore 3Evidence of severeunmet need for lifebalance55

Spiritual Distress in Older Medical Rehab Patients65% some distress27% some distressin all 5 dimensions22% severedistress in at leastone dimension60% of severeunmet needswere forLife BalanceFrom Monod et al., 2012; n 203 geriatric patients in medical rehabilitation,Switzerland66

Advancing EB Screening & AssessmentReliability & Validity of SDAT1. Factor Analysis & Reliability(internal consistency and item correlations)2b3. ValidityCriterion(correlation with related measures)*FACIT-SP*“Are you at peace?”2.2aConcurrentcorrelation with:*Geriatric Depression Scale*Need for family d/c meetingPredictive(association with rehab outcomes)*LOS*D/C to NHMonod et al 20127

Developing Palliative Care Spiritual AssessmentOutgrowth of Coleman Palliative Education Project Used SDAT framework Spiritual Concerns from* Steinhauser et al QUAL-E (preparation & completion)* Pargament – R/s Struggles Revisions based on monthly case discussions88

Spiritual Concerns in Palliative CareThemeDescriptionsScore The patient is having difficulty coming to terms with changes in things that gaveNeed formeaning to life (e.g., grief related to key relationships, illness, frailty,meaning in thedependency.)2face of (The focus here is on coming to terms with illness, loss, diminishment. If thesufferingissue is about the meaning of their life then score under Legacy.) The patient questions the meaning of their life; whether the life they have livedhas meaning. Patient has painful regret about some or all of life they have lived (If the regret isabout a relationship where reconciliation is possible it is OK to score thisconcern here as well as under Concerns about Family and/or Significant Others.)Need for The patient questions whether they have made a positive contribution to lovedIntegrity, aones, others, or society.Legacy, The patient has tasks they must complete before they are ready to die (If tasksGenerativity1are interpersonal score under Concerns about Family and/or Significant Others.) Reminiscing about their life is painful for the patient. Patient is distressed about having lived an imperfect life. (If the regret, conflictor discomfort focuses on current illness, code under Need for Meaning in theFace of Suffering.) The patient has unfinished business with significant others (e.g., need toovercome estrangement, need to express forgiveness, need for reconciliation;Concernsunfulfilled expectations of others).about familyand/or(Regrets about relationships where reconciliation is unlikely should only bescored under Legacy).significant The patient has concerns about their family’s ability to cope without them.others The patient has concern that they are a burden to their family. The patient expresses unwanted isolation, loneliness.9

Spiritual Concerns in Palliative CareThemeDescriptionsScore The patient has concerns about dying: unready for death, impatient for death. The patient is concerned to participate in important events before death; thepatient is concerned illness or death will prevent participation in importantConcern orevents.Fear about The patient is torn between letting go and fighting on.Dying or Death The patient has uncertainty or fear about life after death (afraid of damnation;concerned about reunion with loved ones.) The patient has fear of pain or of pain in dying.Issues Related The patient needs assistance with values-based advance care planning.to Making The patient is confused or distressed about end-of-life treatment.Decisions The patient has not expressed wishes about end-of-life treatment.AboutTreatment The patient wonders whether they are being abandoned or punished by God. The patient is concerned about God’s judgment, forgiveness, and/or love. The patient questions God’s love for them.Religious/ The patient feel God is not answering their prayers (e.g. asking to die soon.)SpiritualStruggle The patient expresses anger with God. The patient is alienated from formerly meaningful connections with religiousinstitutions or leaders. The patient identifies a need for assistance to perform important rituals,Otherreligious or otherwise.Dimensions Other spiritual concerns.Scoring spiritual concerns: 0 no evidence of spiritual concern; 0* no evidence of spiritual concern, furtherassessment to be sure; 1 some evidence of spiritual concern; 2 substantial evidence of spiritual concern;3 evidence of severe spiritual concerns10

Spiritual Concerns in Palliative CareThis assessment focuses on the patient as an individual and is not meant to:* aid in assessment of a family or* to be a comprehensive assessment of interpersonal issues that aresometimes the focus of attention for chaplains working in palliative careThis assessment is meant to:* assess explicit spiritual concern; and can note areas for future inquiry* focus on unmet spiritual need; need minus resources11

Spiritual Concerns in Palliative CareScoring spiritual concerns:0 no evidence of spiritual concern;0* no evidence of spiritual concern, further assessment to be sure;1 some evidence of spiritual concern;2 substantial evidence of spiritual concern;3 evidence of severe spiritual concerns.12

Case Study ProcessHear the case: Patient “Barb” Chaplain “Lee”Use the template to assess (score) the caseReport out on each of the 7 categories of spiritual concerns by a show of handsDiscuss:Consensus on ScoringAbsence of consensus on scoringRationale for differences in scoring13

Next Steps?Test validity, reliability & clinical usefulness of this palliative care assessmentForm teams to develop similar assessment templates for other clinical contexts14

The patient needs assistance with values-based advance care planning. The patient is confused or distressed about end-of-life treatment. The patient has not expressed wishes about end-of-life treatment. Religious/ Spiritual Struggle The patient wonders whether they are being abandoned or punished by God.

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