By Austine Duru
Research in spiritual care can no longer be ignored in the provision of comprehensive healthcare, especially as healthcare moves into a new and exciting era.
Speaking at the 2014 annual conference of the NACC, Dr. Tracy Balboni, associate professor of radiation oncology at Harvard Medical School and a nationally recognized researcher on spirituality and medicine, stressed the importance of integrating religion and spirituality into medical practice in the healing of the whole person.
Dr. Balboni identified the chasm between the “care of the body and the care of the soul” as one major problem in western medicine. This problem, she said, has deep historical roots in the “intersection of religion, spirituality and the practice of medicine.” Research therefore has become a tool at the service of spirituality and medicine to address the divide. She alluded to the narrative powers of research to capture the untold stories of the individual patients hidden within the data.
Dr. Balboni drew attention to ancient and medieval medicine and the rituals of healing that often revolved around the whole person, when there were no technological means to alleviate pain. In those times, the practice of Hippocratic medicine was integrated with spiritual rituals of healing in the Judeo-Christian tradition.
She explained that medicine and spirituality began to separate in the Renaissance, with its focus on the empirical data, materialism and scientific discoveries, and the rejection of non-empirical or spiritual dimension. The result is a rupture in the balance between the body and the soul, the segregation of the human being and a dehumanization of the individual. She observed that research may now offer some opportunity to reclaim some of the lost dynamics of holding the same person both spiritually and materially in their care.
Research, she says, is the primary language in the practice of medicine; however, it is a limited tool. It “allows us to study the ordered universe and to discern important truths about the universe,” although limited in their scope. Most importantly it allows caregivers the opportunity to “speak into the world of medicine about the spiritual aspects of what it means to be a human person, to tell these patients’ stories.” It helps answer such questions as, “is religion or spirituality important to patients when they face illness, if so, what types of roles does it play in the context of the illness?” “What role does religion play in patients’ well-being as they encounter advanced illness?” “Does illness raise patients’ spiritual struggles, if so, what are they?” A large national study of advanced cancer patients sponsored by NIH showed that 90% of the participants in that study reported that religion/spirituality is important to them in dealing with their illness.
This report was significant particularly for the black and Hispanic communities. Balboni shared several studies that suggest the significance of patients’ faith and spiritual beliefs, even as they and their families consider medical decisions. This is a reality that, according to some studies, clinicians do not often acknowledge. The data suggests, therefore, that religion and spirituality are important to most people in coping with illness, especially among minority groups. Religion appears to be playing multiple roles and to affect patients’ medical decision-making. Other reports show that when patients draw on their spirituality and religion in the context of illness, their quality of life is preserved better, helping patients to absorb the stress of the physical symptoms. Dr. Balboni adds, “Feelings of anger at God, punishment and abandonment by God, doubting one’s belief in God, very frequently, are forms of spiritual struggle in the context of illness.”
It is therefore not surprising that patients with terminal illness clearly desire their care to include attention to their spirit. Interestingly, Dr. Balboni says, studies have shown that the quality-of-life outcomes of patients receiving spiritual support at the end of life are markedly higher than those who do not. The research also unearthed a perplexing finding which suggests that patients who report spiritual support from their religious community are more likely to receive aggressive treatment at the end of life. Subsequent research led to a conclusion that specific beliefs about end of life, such as miracles, cure, etc, encouraged patients to choose more aggressive treatment.
Research has helped in developing current spiritual care guidelines. Also, spiritual care is included as one of the eight domains of palliative care, and it is also included as a Joint Commission guideline. In spite of these gains, Dr. Balboni laments the general lack of pastoral care training for clinicians. She shared her own experience of taking clinical pastoral education, and suggests that clinicians will greatly benefit from the CPE model.
Dr. Balboni suggested some next steps, including chaplain-led training in spiritual care and clinical pastoral care for nurses, social workers, and physicians, to recognize when to refer patients to chaplains. Also, we need improved and tested models of care integrated with chaplaincy, and continued research that tells the patients’ stories within the medical culture. We must learn to embrace people not only in their material being, but also who they are as spiritual beings.
Austine Duru, BCC, is director of mission and pastoral care at St. Elizabeth Regional Medical Center and Nebraska Heart Health in Lincoln, NE.
