Your question indicates sensitivity and recognition of the important role the patient’s religion plays in her illness experience ― an essential component of spiritual care at the end of life, in and of itself. Your sense of inadequacy in addressing spiritual and religious issues is common among health care professionals, even among spiritual care specialists.

Professional caregivers can greatly help patients draw on their spiritual and religious resources. However, they may feel uncertain about how to do this when a patient’s religion is unfamiliar. A good place to begin is by gathering appropriate information about the patient’s spiritual needs.

Supporting a patient’s religious faith or spirituality begins with spiritual screening, which allows you to quickly determine the patient’s spiritual health. Look for signs of spiritual crisis or distress and the strength of the patient’s spiritual resources. Spiritual screening can be included in a patient’s routine care with a few simple questions such as:

• “Where do you find the strength to carry on?”
• “Are spirituality and/or religion important in your life?”
• “How well are these resources working for you at this time?”
  

The first question allows you to gauge the extent of your patient’s spirituality. The second question allows her to express the importance of religion in her life and confirm what you have already sensed. The third question gives her an opportunity to identify her spiritual needs. She may also tell you that she has questions or doubts about her religion as a result of her illness.

Once you have confirmed that religion is important to her, you might arrange for someone, such a spiritual care provider on your team, to take a spiritual history. This is especially important if your patient shows signs of spiritual distress or expresses specific religious needs she would like met while receiving care. However, if you do not have a spiritual care provider, you could expand your spiritual screening to a spiritual history by asking questions like the following[1]:

• “What spiritual and religious beliefs are especially important to you?”
  
• “What gives you meaning and hope?” “How has your illness affected these beliefs?”
  
• “What spiritual practices or perspectives give you inner strength?”
  
• “Do your beliefs affect the kind of care or treatment you want?”
  
• “What community or group supports you spiritually?” “Are you in contact with them?”
  

Consider these questions as guidelines rather than as formal interview questions. They work best as conversation openers about the importance of religion to the patient and to identify her spiritual needs. The goal of such conversations is to determine what you, the team, and perhaps her faith community can do to support her.

Needs or concerns determined through a spiritual screening or spiritual history can be included in the patient’s care or treatment plan. They should be documented in the patient’s record and communicated to other team members in interdisciplinary rounds.

A spiritual screening or spiritual history may reveal spiritual distress. Signs of distress may also be observed by any team member who has regular interaction with the patient. A sense of meaninglessness, hopelessness, isolation, guilt, inability to forgive and conflicts between beliefs and experience are aspects of spiritual distress. Spiritual distress may have a strong impact on your patient’s emotional, social and physical well being and needs to be addressed. All team members should be sensitive to it and be able to recognize it.

Patients who show signs of spiritual distress should be referred to a certified spiritual care provider for an in-depth spiritual assessment. If none is available, the assessment could be performed by a team member who has sensitivity and skill in addressing spiritual and emotional issues. The spiritual assessment tool, FICA (© 1999 Christina Puchalski), provides clinicians with an efficient and useful way of taking a spiritual history.[2] Use the spiritual assessment to determine spiritual care goals and interventions that can be integrated into the patient’s care or treatment plan.

Respect and a readiness to learn from the patient are essential for effectively responding to a patient’s spiritual and religious needs. When these are present, you can help ensure that the patient’s spirituality has a significant place in her care and be able to detect spiritual distress quickly.

Reference

1,2. Puchalski CM, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000;3:129-137.