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IAHPC Hospice and Palliative Care Newsletter


2005; Volume 6, No 5, May


Article of the Month

Carla Ripamonti, MD

Many ways to help support palliative care.

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Effects of spiritual care training for palliative care professionals

Author(s): Wasner M, Longaker C, Fegg MJ, Borasio GD
Abstract:  Palliative Medicine 2005; 19:99-104

Much has been written in literature regarding the spiritual needs of patients with cancer in its various phases. Palliative Care has a holistic approach because it considers all aspects regarding the patient, but are the professionals working in palliative medicine prepared or trained to respond to patients who need help to find hope, peace of mind and spiritual resources?

In this prospective study, the Authors studied the effects of spiritual training for Palliative Care professionals over a six-month period. The course “Wisdom and Compassion in Care for the Dying” took place in Munich from the 7 th to the 10 th of October 2002 . The course, designed by Christine Longaker was expressly intended for professionals and volunteers of the medical and social fields, coming from various cultures and religion. The aim is to teach participants how to recognize the various aspects of the suffering both of the dying patient and his family, how to be of help and how to provide the necessary support. Only those persons who are willing to question themselves and reflect on the fear of their own death as well as understand what are the needs of the dying and how to satisfy them are accepted for this course. This involves technical methods of active and compassionate listening as well as means of recognition of the spiritual and emotional suffering in patients with cognitive problems in addition to support to those going through a bereavement process. Participants were furthermore encouraged to practice contemplation and meditation as a technique of mental relaxation.

All participants were asked to fill out three questionnaires: before and just after the training and then six months later. In addition to demographic data, the questionnaires included

1. numeric rating scales about general attitudes towards the work in palliative care (QoL, compassion with severely ill and dying persons, compassion with oneself, attitude towards one’s family, fear of the dying process and of death, attitude towards colleagues, perception of work-related stress),

2. the spiritual subscale of the Functional Assessment of Chronic Illness Therapy (FACIT-Sp) (Ref. Ann Behav Med 2002; 24: 49-58),

3. the Self-Transcendence Scale (STS) (Ref. Nurs Res 1991; 40: 5-11) and

4. the Idler Index of Religiosity (IIR) (Ref. Soc Forces 1987; 66: 226-38).

The participants were also asked to name their main problems in dealing with death and dying, to report the changes as a result of the course and to evaluate the single course contents on a 4 point scale (0= unhelpful to 3= very helpful).

For the IIR the assessments were performed only at baseline and six months after the course.

Of the 63 persons who took part in this course, 51% of them were nurses, 14% hospice volunteers, 14% physicians, 5% social workers, 5% pastoral counselors. As far as the religious affiliation of the participant was concerned: 71% of them were Christians and 10% Buddhists. The regular spiritual practice was prayer in 56%, meditation in 54%, reading sacred texts 27%, and contemplation 22%. Moreover, of the 63 participants, 6% were severely ill, 35% had a family member or friend severely ill and 25% were in a bereavement process.

With respect to baseline, 77% of the responders showed an improvement in coping with their emotions, their uncertainties, problems of communication and coping with problematic families. Sixmonths after end of course, participants who had a patient in the family reported a significant increase in their ability to accept the situation (p=0.03) and towards the end of training those who were in a bereavement process were capable of accepting the process better than before (p<0.01). Six months later this improvement was not maintained (p=0.26). Significant improvement and support were reported as far as a single aptitude towards working in a palliative care environment. As far as changes noted through use of validating instruments, the FACIT-Sp increased immediately after training and increased again after 6 months. The STS also significantly increased after training, but not after 6 months. IIR did not show any important changes with time. Results of FACIT-Sp and STS were strongly correlated at all times whereas the IIR was correlated to FACIT-Sp just before and right after training. Aptitude scores correlated with the FACIT-Sp and the STS during all of the evaluation period.

Why I chose this article

This is one of the very few articles published on the spiritual training of professionals in palliative care. The results are an encouragement to participate in courses of spiritual care training because of the benefits derived by those working in the medical field (and a great aim) and consequently their patients and families.

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC

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