Clinical psychology in palliative care

Clinical psychologists with specialist knowledge and skills in palliative care can be described as palliative psychologists. Whether as core members of a palliative care team or as consultants, palliative psychologists can become involved soon after a diagnosis of serious illness and continue to provide care during treatment, transitions of care, during the dying process, and in bereavement. The distress patients and family caregivers may experience is on a continuum and may involve both psychological and spiritual factors. When the patient and family coping strategies become depleted or are inadequate to face the challenges imposed by illness, suffering can ensue. The palliative psychologist may offer assessment and management of anxiety, depression, and other types of psychological distress. Grief reactions should always receive special and ongoing attention to determine whether the distress is manageable or whether psychological or psychiatric intervention is warranted. Because of the ongoing interplay of psychological and spiritual concerns, palliative psychologists can effectively use spiritual screening and the spiritual history to understand spiritual and existential needs, and help integrate spiritual care into the psychotherapy session. This offers the opportunity to collaborate with spiritual care providers in the psychospiritual care of the patient and the family. Maintaining professional self-care is also a mandate for palliative psychologists and includes the timely recognition of risk factors for professional distress, protective factors, and meaningful interventions.

The accuracy of measures in screening adults for spiritual suffering in health care settings: A systematic review

ObjectiveGuidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence of the accuracy of measures used to screen adults for spiritual suffering.MethodsA systematic review of the literature. We searched five scientific databases to identify relevant articles. Two independent reviewers screened, extracted data, and assessed study methodological quality.ResultsWe identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the two-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82–87%), and the revised Rush protocol had the highest specificity (81–90%). The methodological quality of all included studies was low.Significance of ResultsWhile most of the identified spiritual screening measures are brief (comprised 1 to 12 items), few had sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.

Spiritual Screening, History, and Assessment

Spiritual care is integral to palliative care. Palliative care patients and their family members often use spiritual coping strategies, and spiritual well-being is a commonly high-ranked pursuit for those at the end of life. Appropriate spiritual care, however, must reflect the spiritual needs and preferences of the care recipient. Thus, numerous approaches to spiritual screening, history-taking, and assessment exist. Whereas the spiritual screening is proposed as a skill and expectation that nurses and others can be trained to complete, the spiritual assessment is the domain of the spiritual care expert—typically, a skilled chaplain. These diverse approaches are described here along with some additional observations that can guide the process.

The Fifth Domain of Palliative Care

This chapter presents palliative psychology competencies in the fifth domain of palliative care, which addresses the existential and spiritual needs of the patient and the family. The constructs of spiritual screening, spiritual history, and spiritual assessment are discussed with attention to their application to the palliative care setting. Through clinical case vignettes and discussions, the chapter discusses how psychologists can effectively use spiritual screening and spiritual history to fully understand spiritual and existential needs. Ways of integrating spiritual concerns and needs during the therapy session are highlighted in this chapter. The interplay of psychological and spiritual concerns offers the opportunity for palliative psychologists and spiritual care providers to collaborate in the psychospiritual care of the patient and the family. Because interdisciplinary collaboration is a hallmark of palliative care, the chapter also describes examples of effective collaboration between psychologists and spiritual care providers, from assessment to treatment planning.

Capturing religious identity during hospital admission: a valid practice in our increasingly secular society?

Objective Most major Victorian hospitals include religious identity in routine admission demographic questions. However, approximately 20% of admissions do not have their religious identity recorded. At the Royal Melbourne Hospital this missing 20% was surveyed throughout 2014–15 for two reasons: (1) to enable patient care; and (2) to provide an insight into the significance of religious identity for patients. There is scarce literature on this subject, so the present mixed-methods study, including a qualitative component, will start to bridge the gap. Methods Mixed methods, cross-sectional survey. Results The quantitative component of the study found that religious identity was important for a significant proportion of our diverse population and that, in general, demographics were congruent with Australian Bureau of Statistics (ABS) census figures. The qualitative component also revealed significant complexity behind religious identity labels, which the census is unable to capture, providing an insight into the requirements of our growing multicultural population. Conclusions This study illustrates that religious identity is important for a majority of Royal Melbourne’s culturally diverse inpatients. This data would seem to give the practice of collecting religious identity data on admission new credence, especially as our culturally and linguistically diverse populations increase. In order to understand these nuances and provide appropriate care, skilled spiritual screening and assessment would appear to be not optional, but rather necessary in our increasingly complex healthcare future. What is known about the topic? A search of the literature using related terms (religious, religion, spiritual identity, care) revealed that there is scarce literature on the subject of religious identity and its importance and meaning to patients. What does this paper add? This mixed methods study approaches the issue of the importance of religious identity from the patient perspective via a spiritual screening survey that included a qualitative component, so will begin to bridge a gap in knowledge. What are the implications for practitioners? Improved understanding of the complexity of the spiritual needs of our Victorian multicultural population and commensurate emphasis on the need for individual spiritual screening and assessment.

Advocating and Educating for Spiritual Screening Assessment and Referrals to Chaplains

This article presents attempts to improve the quality of spiritual care offered to palliative care patients by educating nursing and other staff about spiritual screening with the goal of increasing referrals to a board certified chaplain. Attention to patients' spiritual identity and spiritual needs upon admission and throughout a hospitalization through either a formalized screening tool or provider awareness and sensitivity can assist patients in naming their needs, thus triggering a referral to a board certified chaplain or other spiritual counselor. Along with a spiritual care plan based upon assessment of spiritual needs and resources facilitates the healing process.