Beruflich Dokumente
Kultur Dokumente
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TABLE 2. (Continued)
Internet Resources
Spirituality and Existential Care
Ersek M. The meaning of hope in dying. In: Ferrell BR, Coyle N, eds. Oxford Textbook of Palliative Nursing. New York: Oxford
University Press; 2006:513Y529.
Guenther MB. Healing: the power of presence. a reection. J Pain Symptom Manage 2011;41(3):650Y654.
Otis-Green S. The transitions program: existential care in action. J Cancer Educ 2006;21(1):23Y25.
Strang P, Strang S, Hultborn R, et al. Existential painVan entity, a provocation, or a challenge? J Pain Symptom Manage
2004;27(3):241Y250.
Spirituality in Palliative Care and Oncology Practice
Baird P. Spiritual care interventions. In: Ferrell B, Coyle N, eds. Oxford Textbook of Palliative Nursing. New York: Oxford University
Press; 2010:663Y672.
Balboni TAP, Balboni MJ, Phelps AC, et al. Provision of spiritual care to patients with advanced cancer: associations with medical care
and quality of life near death. J Clin Oncol 2010;28(3):445Y452.
Block SD. Perspectives on care at the close of life. Psychological considerations, growth, and transcendence at the end of life:
the art of the possible. JAMA 2001;285(22):2898Y2905.
Byock IR. To Life! Reections on spirituality, palliative practice, and politics. Am J Hosp Palliat Med 2007;23(6):436Y438.
Chochinov H, Hack T, Hassard T, et al. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life.
J Clin Oncol 2005;23(24):5520Y5525.
Ellis J, Lloyd-Williams M. Palliative care. In: Cobb M, Puchalski CM, Rumbold B, eds. Oxford Textbook of Spirituality in Healthcare.
New York: Oxford University Press; 2012.
Ferrell B, Borneman T, Otis-Green S, et al. Consensus project and pilot demonstration projects to improve the quality of spiritual care
in palliative care (abstract). J Support Oncol. 2010;8(5):A11.
Mattison D. The forgotten spirit: integrating spirituality in oncology health care. Hematol Oncol News Issues 2005:21Y23.
Otis-Green S, Ferrell B, Borneman T, et al. Integrating spiritual care into palliative care: an overview of nine demonstration projects.
J Palliat Med 2012;15(2):154Y162.
Puchalski C, Kilpatrick S, McCullough M, et al. A systematic review of spiritual and religious variables in Palliative Medicine,
American Journal of Hospice and Palliative Care, Hospice Journal. Journal of Palliative Care and Journal of Pain Symptom and
Management. Palliat Support Care 2003;1(1):7Y13.
Puchalski C. Time for listening and caring: Spirituality and the care of the chronically ill and dying. New York: Oxford University
Press; 2006.
Puchalski CM, Norris L, Walseman K. Communicating about spiritual issues with cancer patients. In: Surbone A, Zwitter M, Rajer M,
et al. New Challenges in Communication With Cancer Patients. New York: Springer; 2012:91Y104.
Puchalski CM, Ferrell B, ODonnell E. Spiritual issues in palliative care. In: Bruera E, Yennurajalingam S, eds. Oxford American
Handbook of Hospice and Palliative Medicine. New York: Oxford University Press; 2011:253Y268.
Reese DJ. Spirituality and social work practice in palliative care. In: Alitilio T, Otis-Green S, eds. Oxford Textbook of Palliative Social
Work. Oxford University Press; 2011:201Y213.
Selman L, Siegert R, Harding R, et al. A psychometric evaluation of measures of spirituality validated in culturally diverse palliative
care populations. J Pain Symptom Manage 2011;42(4):604Y622.
Soltura DL, Piotrowski LF. Teamwork in palliative care: social work role with spiritual care professionals. In: Alitilio T, Otis-Green S, eds.
Oxford Textbook of Palliative Social Work. Oxford University Press; 2011;495Y501.
Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist 2002;42 spec(3):24Y33.
Sulmasy DP. The Rebirth of the Clinic: An Introduction to Spirituality in Health Care. Washington, DC: Georgetown University Press; 2006.
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NCP GUIDELINES
One of the major advances in the eld of palliative care
has been the development of clinical practice guidelines to ensure the quality of care. The NCP Clinical Practice Guidelines
for Quality Palliative Care is a collaborative project of the key
organizations in the eld of palliative care. This includes the
FIGURE 1. Completing a spiritual history using the FICA* Spiritual History Tool. FICA is an acronym to guide health care professionals
in completing a spiritual history. The questions were developed to guide an interview to obtain critical information so that a
patients spiritual, religious, and existential concerns could be integrated into a comprehensive plan of care. F = faith, belief, values:
What beliefs and values give your life meaning? I = importance, inuence: How do these belief or values help you to cope with stress or
inuence your health care decision making? C = community: Do you receive support from a community of people who share your beliefs and
values? A = address, actions: In what ways can we (your health care team) address any spiritual, religious, or existential concerns that you
may encounter as you cope with your illness? *Adapted from Puchalski CM with permission. Restorative medicine. In: Cobb M, Puchalski
CM, Rumbold B, eds). Oxford Textbook of Spirituality in Healthcare. Oxford, Great Britain: Oxford University Press; 2012:197Y210.
Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both
from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.
* 2013 Lippincott Williams & Wilkins
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Ferrell et al
National Quality Forum, the Joint Commission, and other quality monitoring organizations. The NCP guidelines can also be
a valuable resource for cancer care settings as they seek to develop palliative care programs. There is signicant effort in the
oncology community including work by the American Society
of Clinical Oncology to integrate palliative care into routine
oncology care.25a
RESOURCES
Despite widespread organizational support for the inclusion
of spiritual care into palliative care, few professionals have been
adequately prepared for this role. Even health care chaplains
have only recently had access to a palliative care competencybased curriculum and specialty certication.26 In 2013, the
Health-Care Chaplaincy organization will launch the rst certication for chaplaincy in palliative care. In recognition that
oncology professionals may lack adequate preparation for their
role in addressing spiritual concerns of patients and families,
there has been increased effort to consolidate resources into
more centrally accessible sites. The George Washington Institute for Spirituality and Health (www.gwish.org) and the City of
Hope Pain and Palliative Care Resource Center (http://prc.coh.org)
house resources that are readily accessible, regardless of discipline or faith tradition. Table 2 highlights numerous resources
helpful for oncology professionals. Materials in Table 2 include
Web sites with information on screening, assessment and spiritual interventions, resources related to existential exploration,
and research that has been conducted in spirituality in the context
of oncology and palliative care. Although few validated clinical
instruments exist, instruments such as the Functional Assessment of Chronic Illness TherapyVSpiritual Well-being Scale,
(FACIT-Sp),27 FACT, (an acronym for Faith, Active, Coping,
Treatment),28 FICA (an acronym for Faith, Importance, Community and Address),29,30 HOPE (an acronym for Hope, Organized religion, Personal spirituality and practices, and Effects
of spirituality on medical care and end-of-life issues),31 SPIRIT
(an acronym for Spiritual belief system, Personal spirituality,
Integration with a spiritual community, Ritualized practices and
restrictions, Implications for medical care, and Terminal events
planning),32 and the Spiritual Well-Being Scale (SWBS)33 have
been developed for research and clinical use. Previous research
attention has focused primarily on measuring religiosity, and
only recently has the broader construct of spirituality been explored.34 These tools can be incorporated into clinical practice
so that patients spiritual, religious, and existential needs are
identied. Figure 1 offers an example of how the FICA Spiritual
History Tool can be used by health care professionals to guide
an interview that collects information that can be integrated into
a comprehensive plan of care.
SUMMARY
Facing a diagnosis of cancer raises spiritual and existential concerns for patients, families, and the professionals involved in their care. Beliefs regarding meaning and purpose
evolve over time and are culturally inuenced. Unattended
spiritual distress is an important source of suffering. Leading
organizations recognize the urgent need to prepare oncology
professionals for their responsibility to address these issues. The
NCP guidelines highlight the importance of integrating spiritual, religious, and existential care into the provision of quality
palliative care. Failure to address these issues leaves staff vulnerable to moral distress.
As illness progresses, these concerns become magnied.
Failure to address them can heighten the risk for complicated
bereavement. Spirituality is also of great concern for cancer
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survivors who often struggle to nd meaning in their cancer diagnosis and their survival. Cancer survivors face tremendous
existential impact of a cancer diagnosis and live with uncertainty and many long-lasting impacts of survivorship. Oncology
professionals can benet from a range of resources that provide guidance to address the spiritual, religious, and existential
concerns associated with cancer.
REFERENCES
1. Ferrell B, Munevar C. Domain of spiritual care. Prog Palliat Care.
2012;20:66Y71.
2. Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol. 2012;
23:49Y55.
3. Amoah CF. The central importance of spirituality in palliative care
[review]. Int J Palliat Nurs. 2011;17:353Y358.
4. Puchalski C, Ferrell B, Handzo G, et al. Improving spiritual care as a
domain of palliative care (P6). J Pain Symptom Manage. 2010;39:323.
5. Taylor EJ. Spiritual assessment. In: Ferrell BR, Coyle N, eds. Oxford Textbook of Palliative Nursing. New York, NY: Oxford University Press;
2010:647Y662.
6. El Nawawi NM, Balboni MJ, Balboni TA. Palliative care and spiritual
care: the crucial role of spiritual care in the care of patients with advanced illness. Curr Opin Support Palliat Care. 2012;6:269.
7. Dennis K, Duncan G. Spiritual care in a multicultural oncology environment. Curr Opin Support Palliat Care. 2012;6:247.
8. Balboni MJ, Sullivan A, Amobi A, et al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients,
nurses, and physicians and the role of training. J Clin Oncol. 2013;31:
461Y467.
9. Steinhauser AE, Christakis NA, Clipp EC, et al. Factors considered
important at the end of life by patients, family, physicians, and other
care providers. JAMA. 2000;284:2476Y2482.
10. Steinhauser KE, Voils CI, Clipp EC, et al. Are you at peace?VOne
item to probe spiritual concerns at the end of life. Arch Intern Med.
2006;166;101Y105.
11. Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual
care as a dimension of palliative care: the report of the Consensus
Conference. J Palliat Med. 2009;12:885Y904.
12. Balducci L. Suffering and spirituality: analysis of living experiences.
J Pain Symptom Manage. 2011;42:479Y486.
13. Kalish N. Evidence-based spiritual care: a literature review. Curr Opin
Support Palliat Care. 2012;6:242.
14. Pearce MJ, Coan AD, Herndon JE II, et al. Unmet spiritual care needs
impact emotional and spiritual well-being in advanced cancer patients.
Support Care Cancer. 2012;20:2269Y2276.
15. Johnson ME, Piderman KM, Sloan JA, et al. Measuring spiritual quality
of life in patients with cancer. J Support Oncol. 2007;5:437Y442.
16. Vallurupalli M, Lauderdale K, Balboni MJ, et al. The role of spirituality and religious coping in the quality of life of patients with advanced
cancer receiving palliative radiation therapy. J Support Oncol. 2012;
10:81Y87.
17. Winkelman WD, Lauderdale K, Balboni MJ, et al. The relationship of
spiritual concerns to the quality of life of advanced cancer patients:
preliminary ndings. J Palliat Med. 2011;14:1022Y1028.
18. Levit L, Balogh E, Ganz P, eds. Delivering High Quality Cancer Care:
Charting a New Course for a System in Crisis. Washington DC: National Academies Press; 2013.
19. Ferrell BR, Coyle N. The Nature of Suffering and the Goals of Nursing.
New York, NY: Oxford University Press; 2008.
20. National Comprehensive Cancer Network (NCCN). Distress management clinical practice guidelines, version 2.2013VChaplaincy Services
DIS-21. Available at: http://www.nccn.org/professionals/physician_gls/
pdf/distress.pdf. Accessed August 15, 2013.
21. Borneman T, Brown-Saltzman K. Meaning in illness. In: Ferrell BR,
Coyle N, eds. Oxford Textbook of Palliative Nursing. New York, NY:
Oxford University Press; 2010:673Y685.
Copyright 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
&
22. Moadel A, Morgan C, Fatone A, et al. Seeking meaning and hope: selfreported spiritual and existential needs among an ethnically-diverse
cancer patient population. Psychooncology. 1999;8:378Y385.
23. Alcorn SR, Balboni MJ, Prigerson HG, et al. If God wanted me yesterday, I wouldnt be here today: religious and spiritual themes in patients
experiences of advanced cancer. J Palliat Med. 2010;13:581Y588.
24. National Consensus Project for Quality Palliative Care (2013). Clinical
Practice Guidelines for Quality Palliative Care, Third Edition. Pittsburgh,
PA. Available at http://www.nationalconsensusproject.org. Accessed
August 15, 2013.
25. Wright AA, Zhang B, Ray A, et al. Associations between end-of-life
discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300:1665Y1673.
25a. Smith TJ, Temin S, Alesi ER, et al. American Society of Clinical Oncology Provisional Clinical Opinion: The integration of palliative care
into standard oncology care. J Clin Oncol. 2012;30:880Y887.
26. California State University San Marcos. Palliative Care Chaplaincy
Specialty Certicate. CSU Institute for Palliative Care, 2013. Retrieved
March 26, 2013. Available at: http://www.csusm.edu/el/palliativecare/
chaplaincy/index.html. Accessed August 15, 2013.
27. Peterman AH, Fitchett G, Brady MJ, et al. Measuring spiritual wellbeing in people with cancer: The functional assessment of chronic illness therapyVspiritual well-being scale (FACIT-Sp). Ann Behav Med.
2002;24:49Y58.
28. LaRocca-Pitts M. In FACT, chaplains have a spiritual assessment tool.
Aust J Pastoral Care Health. 2009;3:8Y15.
29. Puchalski C, Romer AL. Taking a spiritual history allows clinicians to
understand patients more fully. J Palliat Med. 2000;3:129Y137.
30. Borneman T, Ferrell B, Puchalski CM. Evaluation of the FICA tool for
spiritual assessment. J Pain Symptom Manage. 2010;40:163Y173.
31. Anandarajah G, Hight E. Spirituality and medical practice: using the
HOPE questions as a practical tool for spiritual assessment. Am Fam
Physician. 2001;63:81Y89.
32. Maugans TA. The SPIRITual history. Arch Fam Med. 1996;5:11Y16.
33. Ellison CW. Spiritual well-being: conceptualization and measurement.
J Psychol Theol. 1983;11:330Y340.
34. Doka KJ. Religion and spirituality: assessment and intervention. J Soc
Work End Life Palliat Care. 2011;7:99Y109.
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Copyright 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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