scholarly journals Spirituality Training as an Essential Element of Person-Centered Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 132-132
Author(s):  
Raya Kheirbek
Keyword(s):  
Spiritual Care ◽  
Cultural Sensitivity ◽  
Ethical Issues ◽  
Clinical Care ◽  
Critical Role ◽  
Essential Element ◽  
Spiritual Needs ◽  
Consensus Definition ◽  
Sensitivity Assessment

Abstract Palliative Medicine, built on the biopsychosocial-spiritual model of care, has long recognized the critical role of spirituality in the care of patients with complex, serious, and chronic illnesses. We conducted focus groups to arrive at a consensus definition of “spiritual care.” Additionally, we collected and compared frameworks and models that recognize that providers cannot be made compassionate simply through the imposition of rules; methods were needed to achieve behavior change. The created curricula covered the definitions of spiritual care, self-awareness, cultural sensitivity, assessment, and skills. As part of ongoing curriculum development processes, training included evaluation tools to accompany competency standards. Results demonstrated improvements in self- reported abilities to (a) establish appropriate boundaries with patients; (b) apply the concept of compassionate presence to clinical care; (c) understand the role of spirituality in professional life; (d) identify ethical issues in inter-professional spiritual care. Clinicians need to address patients’ spiritual needs.

scholarly journals Spirituality as an Essential Element of Person-Centered Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 885-886
Author(s):  
Rachel Nathan ◽  
Deborah Zuercher ◽  
Steven Eveland ◽  
Anjana Chacko ◽  
Raya Kheirbek
Keyword(s):  
Health Care ◽  
Chronic Illness ◽  
Health Care Providers ◽  
Spiritual Care ◽  
Ethical Issues ◽  
Critical Role ◽  
Essential Element ◽  
Care Providers ◽  
Sensitivity Assessment ◽  
Centered Care

Abstract Data demonstrate that the majority of patients with serious or chronic illness would like their clinicians to address their spirituality but that the majority of clinicians do not provide such care. Reasons cited include lack of training. Palliative Medicine, built on the biopsychosocial-spiritual model of care, has long recognized the critical role of spirituality in the care of patients with complex, serious, and chronic illness. There is mounting evidence that spiritual care is a fundamental component of all high-quality compassionate health care, and it is most effective when it is recognized and reflected in the attitudes and actions of both patients and health care providers. We conducted focus groups as a first step in the process to arrive at a consensus definition of “spiritual care.” A second step involved collecting and comparing frameworks and models that recognize that providers cannot be made compassionate simply through the imposition of rules; methods were needed to achieve behavior change. The study group developed and piloted curriculum to train health care providers. The created curricula covered the definitions of a spiritual care, self-awareness, cultural sensitivity, assessment, and skills. As part of ongoing curriculum development processes, training included evaluation tools to accompany skill development . Our work demonstrated the need for compassionate presence during encounters, for applying the spirituality in professional life; and for identifying ethical issues in inter-professional spiritual care. We concluded that it is feasible to train clinicians to address spirituality and provide holistic and patient-centered care in an effort to minimize suffering.

Death, taxes and uncertainty: Economic motivations in end-of-life decision making

2021 ◽  
pp. 147775092110114
Author(s):  
George Slade Mellgard ◽  
Jacob M Appel
Keyword(s):  
End Of Life ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Third Party ◽  
Ethical Conflicts ◽  
Financial Interests ◽  
End Of Life Decision ◽  
Death Taxes

Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests? Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.

scholarly journals The role of a clinician amid the rise of mobile health technology

2019 ◽  
Vol 26 (11) ◽  
pp. 1385-1388 ◽  
Author(s):  
William E Yang ◽  
Lochan M Shah ◽  
Erin M Spaulding ◽  
Jane Wang ◽  
Helen Xun ◽  
...  
Keyword(s):  
Mobile Health ◽  
Healthy Lifestyle ◽  
Clinical Care ◽  
Critical Role ◽  
Lifestyle Changes ◽  
Mhealth Intervention ◽  
Early Results ◽  
Modification Technique ◽  
Behavior Modification Technique

Abstract Mobile health (mHealth) interventions have demonstrated promise in improving outcomes by motivating patients to adopt and maintain healthy lifestyle changes as well as improve adherence to guideline-directed medical therapy. Early results combining behavioral economic strategies with mHealth delivery have demonstrated mixed results. In reviewing these studies, we propose that the success of a mHealth intervention links more strongly with how well it connects patients back to routine clinical care, rather than its behavior modification technique in isolation. This underscores the critical role of clinician-patient partnerships in the design and delivery of such interventions, while also raising important questions regarding long-term sustainability and scalability. Further exploration of our hypothesis may increase opportunities for multidisciplinary clinical teams to connect with and engage patients using mHealth technologies in unprecedented ways.

scholarly journals The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists for the Management of NAFLD

2021 ◽  
Author(s):  
Chandani Patel Chavez ◽  
Kenneth Cusi ◽  
Sushma Kadiyala
Keyword(s):  
Evidence Synthesis ◽  
Clinical Care ◽  
Treatment Options ◽  
Critical Role ◽  
Risk Groups ◽  
The United States ◽  
Multidisciplinary Teams ◽  
Consensus Statements ◽  
Meta Analyses

Abstract Context The burden of cirrhosis from NAFLD is reaching epidemic proportions in the United States. This calls for greater awareness among endocrinologists, who often see but may miss the diagnosis in adults with obesity or type 2 diabetes mellitus (T2D) who are at the highest risk. At the same time, recent studies suggest that GLP-1RAs are beneficial versus steatohepatitis (NASH) in this population. This minireview aims to assist endocrinologists to recognize the condition and recent work on the role of GLP-1RAs in NAFLD/NASH. Evidence acquisition Evidence from observational studies, randomized controlled trials, and meta-analyses. Evidence Synthesis Endocrinologists should lead multidisciplinary teams to implement recent consensus statements on NAFLD that call for screening and treatment of clinically significant fibrosis to prevent cirrhosis, especially in the high-risk groups (i.e., people with obesity, prediabetes or T2D). With no FDA-approved agents, weight loss is central to their successful management, with pharmacological treatment options limited today to vitamin E (in people without T2D) and diabetes medications that reverse steatohepatitis, such as pioglitazone or GLP-1RA. Recently the benefit of GLP-1RAs in NAFLD, suggested from earlier trials, has been confirmed in adults with biopsy-proven NASH. In 2021, the FDA also approved semaglutide for obesity management. Conclusion A paradigm change is developing between the endocrinologist’s greater awareness about their critical role to curve the epidemic of NAFLD and new clinical care pathways that include a broader use of GLP-1RAs in the management of these complex patients.

Palliative and Spiritual Care of Persons with HIV and AIDS

2010 ◽  
Author(s):  
Mary Ann Cohen ◽  
Joseph Z. Lux
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Cultural Sensitivity ◽  
Care Delivery ◽  
Clinical Care ◽  
Symptom Control ◽  
Hiv And Aids ◽  
Hiv Care ◽  
Hospice Movement ◽  
Health Organization

Palliative care of persons with HIV and AIDS has changed over the course of the first three decades of the pandemic. The most radical shifts occurred in the second decade with the introduction of combination antiretroviral therapy and other advances in HIV care. In the United States and throughout the world, progress in prevention of HIV transmission has not kept pace with progress in treatment, thus the population of persons living with AIDS continues to grow. Furthermore, economic, psychiatric, social, and political barriers leave many persons without access to adequate HIV care. As a result, persons who lack access to care may need palliative care for late-stage AIDS while persons with access to AIDS treatments are more likely to need palliative care for multimorbid medical illnesses such as cardiovascular disease, cancer, pulmonary disease, and renal disease. Palliative care of persons with HIV and AIDS cannot be confined to the end of life. We present palliative care on a continuum as part of an effort to alleviate suffering and attend to pain, emotional distress, and existential anxiety during the course of the illness. We will provide guidelines for psychiatric and palliative care and pain management to help persons with AIDS cope better with their illnesses and live their lives to the fullest extent, and minimize pain and suffering for them and their loved ones. This chapter reviews basic concepts and definitions of palliative and spiritual care, as well as the distinct challenges facing clinicians involved in HIV palliative care. Finally, issues such as bereavement, cultural sensitivity, communication, and psychiatric contributions to common physical symptom control are reviewed. The terms palliative care and palliative medicine are often used interchangeably. Modern palliative care has evolved from the hospice movement into a more expansive network of clinical care delivery systems with components of home care and hospital-based services (Butler et al., 1996; Stjernsward and Papallona, 1998). Palliative care must meet the needs of the “whole person,” including the physical, psychological, social, and spiritual aspects of suffering (World Health Organization, 1990).

Reducing overuse by recognising the unintended harms of good intentions

2019 ◽  
pp. bmjebm-2019-111247
Author(s):  
David Slawson ◽  
Allen F Shaughnessy
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Clinical Care ◽  
Critical Role ◽  
Medical Decision ◽  
Wide Acceptance ◽  
Hierarchy Of Evidence ◽  
Healthcare Interventions

Overdiagnosis and overtreatment—overuse—is gaining wide acceptance as a leading nosocomial intervention in medicine. Not only does overuse create anxiety and diminish patients’ quality of life, in some cases it causes harm to both patients and others not directly involved in clinical care. Reducing overuse begins with the recognition and acceptance of the potential for unintended harm of our best intentions. In this paper, we introduce five cases to illustrate where harm can occur as the result of well-intended healthcare interventions. With this insight, clinicians can learn to appreciate the critical role of probability-based, evidence-informed decision-making in medicine and the need to consider the outcomes for all who may be affected by their actions. Likewise, educators need to evolve medical education and medical decision-making so that it focuses on the hierarchy of evidence and that what ‘ought to work’, based on traditional pathophysiological, disease-focused reasoning, should be subordinate to what ‘does work’.

scholarly journals How to Be Savvy About Gender Disparities in Academic Stroke Medicine

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Aleksandra Pikula ◽  
Luciana Catanese ◽  
Cheryl D. Bushnell ◽  
Valeria Caso ◽  
Julie K. Silver
Keyword(s):  
Clinical Care ◽  
Critical Role ◽  
Women's Leadership ◽  
Gender Disparities ◽  
Early Career ◽  
Diagnostic Tools ◽  
Career Stage ◽  
Clinical Practices ◽  
New Treatments

In the past decade, stroke medicine has evolved from discovery of innovative diagnostic tools to implementation of new treatments. These advances are projected to increase the demand for stroke neurologists in academic and clinical practices, but hopefully with equitable opportunities for everyone across the gender spectrum. Academic medicine provides opportunities to participate in clinical care, teaching, research, and administration. The early career stage is short-focused on finding an academic niche and developing new skills that will help you navigate the academic environment. A recent InterSECT article emphasized the critical role of women’s leadership in stroke medicine. In this article, we reflect on workforce gender disparities and provide 5 practical strategies that may help women overcome barriers and advance their work mission.

scholarly journals The Effect of Hierarchy on Moral Silence in Healthcare: What Can the Holocaust Teach Us?

Conatus ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 21
Author(s):  
Ashley K Fernandes ◽  
DiAnn Ecret
Keyword(s):  
Medical Education ◽  
Nursing Education ◽  
National Socialism ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Clinical Care ◽  
Negative Effects ◽  
Professional Students ◽  
Parallel Features

Physicians, nurses, and healthcare professional students openly (and in many cases, eagerly) participated in the medical atrocities of the Shoah. In this paper, a physician-bioethicist and nurse-bioethicist examine the role of hierarchical power imbalances in medical education, which often occur because trainees are instructed ‘to do so’ by their superiors during medical education and clinical care. We will first examine the nature of medical and nursing education under National Socialism: were there cultural, educational, moral and legal pressures which entrenched professional hierarchies and thereby commanded obedience in the face of an ever-diminishing individual and collective conscience? We will then outline relevant parallel features in modern medical education, including the effects of hierarchy in shaping ethical decision making and conscience formation. We then propose several solutions for the prevention of the negative effects of hierarchical power imbalances in medical education: (1) universal Holocaust education in medical and nursing schools; (2) formative and experiential ethics instruction, which teaches students to ‘speak up’ when ethical issues arise; (3) acceptance of, and adherence to, a personalistic philosophical anthropology in healthcare; (4) support for rigorous conscience protection laws for minority ethical views that respect the role of integrity without compromising patient care.

Medicine, Spirituality, Religion, and Psychology

2017 ◽  
Author(s):  
Kelly M. Trevino ◽  
Kenneth I. Pargament
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Clinical Care ◽  
Large Body ◽  
Spiritual Needs ◽  
Care Providers ◽  
Religion And Psychology ◽  
And Coping ◽  
The Relationship

The current chapter examines the relationship between religion/spirituality (R/S) and medicine through the psychological lens of a religious coping framework. This relationship is considered at the theoretical, patient, caregiver, and care team levels. The R/S beliefs, practices, and coping strategies of patients, informal caregivers, and health care providers in the context of illness is then discussed. A large body of research demonstrates the important role of R/S in how patients and caregivers understand and cope with illness. Similarly, many health care providers view illness and their clinical care through a R/S lens and believe that attending to patients’ spiritual needs is part of their professional role. The chapter concludes with a brief review of psycho-spiritual interventions in medical populations.

scholarly journals Interprofessional spiritual care in oncology: a literature review

ESMO Open ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. e000465 ◽  
Author(s):  
Christina M Puchalski ◽  
Andrea Sbrana ◽  
Betty Ferrell ◽  
Najmeh Jafari ◽  
Stephen King ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Literature Review ◽  
Health Outcomes ◽  
Clinical Setting ◽  
Spiritual Care ◽  
Essential Element ◽  
Spiritual Needs ◽  
Serious Illness ◽  
American Society

Spiritual care is recognised as an essential element of the care of patients with serious illness such as cancer. Spiritual distress can result in poorer health outcomes including quality of life. The American Society of Clinical Oncology and other organisations recommend addressing spiritual needs in the clinical setting. This paper reviews the literature findings and proposes recommendations for interprofessional spiritual care.

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