Editorial
Advocating for a Bio-Psycho-Social-Spiritual Approach to Hospice and Palliative Care
Powers JS*
Department of Medicine Vanderbilt University School of Medicine and Department of Veterans Affairs Tennessee
Valley Geriatric Research Education and Clinical Center, USA
*Corresponding author: James S. Powers, Vanderbilt University School of Medicine and Department of Veterans Affairs Tennessee Valley Geriatric Research Education and Clinical Center, Nashville, Tennessee 37232, USA
Published: 27 May, 2016
Cite this article as: James S. Powers. Advocating for a Bio-Psycho-Social-Spiritual Approach to Hospice and Palliative Care. Ann Clin Case Rep. 2016; 1: 1006.
Editorial
Spirituality is an important dimension of hospice and palliative care treatment. Patients often
report that religious beliefs and practices are powerful sources of comfort, hope, and meaning,
particularly in coping with illness. Addressing the human spirit is part of the person-centric
continuum of care. Practitioners are reminded to support and utilize the patient's own spiritual
resources to enhance care in advanced illness and end of life care.
Regrettably not all hospice and palliative care teams address the spiritual dimension of patient
care. This is the unfortunate reality of many busy hospitals, trauma services, and intensive care units.
All too commonly patients at the end of their life are confronted with many new providers with
whom they have no prior relationship and are forced to make critical, intermediate, and irreversible
decisions about their lives. We urgently plea to all clinicians to address spirituality to enhance the
patient's experience of care. To neglect spirituality seriously hampers the patient's ability to cope
with advanced or critical illness at the end of life.
Spirituality equates to the patient's belief system and personal values. Even in the absence of
specific religious denomination affiliation, patients report that religious beliefs and practices are
powerful sources of comfort, hope, and meaning. It also realizes the unique experience of death for
every individual and for their loved ones.
The inter-professional team caring for seriously ill patients assumes the care of many overlapping
spheres including the biological, the psychological, the social, and the spiritual dimensions. Caring
for the human spirit is all the more important to address as the patient approaches the end of life.
Team members including the psychologist, the nurse, social worker, the chaplain, and the physician
will find their roles support and enhance each other, in providing comprehensive care and also
caring for the human spirit [1]. Clinicians should routinely inquire about spiritual beliefs, and help
arrange visits by hospital or service chaplains or the patient's own spiritual advisor or clergy. They
should encourage the patient to express their beliefs and associated existential questions including
the meaning of illness and suffering as they reflect on their life experiences. Contacting the patient's
primary care physician additionally can enhance care and bring comfort to the patient and family
at the end of life
Sensitivity to the needs of the chronically ill and dying, including the spiritual component, is part
of an over 1000 year faith-based tradition at the origins of hospice and palliative care [2]. Spirituality
is an important component of end of life care which complements the inter-professional team's
pain and symptom management [3]. Person-centered care supports the patient's values, goals, and
preferences, guides all aspects of their care and respects the patient's family relationships.
Care the dying also includes care for the patient's family and loved ones. The inter-professional
team can enhance relationships and promote emotional healing at this important time surrounding
the end of life. Sensitivity to spiritual issues helps address concerns common to all and helps the
patient say, as well expressed by Byock [4]: 1) Please forgive me, 2) I forgive you, 3) Thank you, and
4) I love you.
The benefits of spiritual care include acceptance, trust, enhanced relationships, and increased
hope. Spiritual care supports the patient and family and acknowledges the inner spiritual resources
of the patient. Spiritual care also enhances dignity and peace which are the hallmarks of care at the
end of life [5,6].
References
- Wolff JA, Palmer S, Handzo G. The Critical Role of Spirituality in Patient Experience. 2015.
- Crislip AT. From monastery to hospital-Christian Monasticism & the transformation of health care in late antiquity. Ann Arbor: Minchang University. Minchigan Press. 2005.
- Bainbridge D, Seow H Sussman J. Common Components of Efficacious In-Home End-of-Life Care Programs: A Review of Systematic Reviews. J Am Geriatr Soc. 2016; 64: 632-639.
- Byock I. The Things That Matter Most: A Book About Living, Free Press NY. 2004.
- Anandarajah G, Hight E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician. 2001; 63: 81-89.
- Koenig HG, George LK, Titus P. Religion, spirituality, and health in medically ill hospitalized older patients. J Am Geriatr Soc. 2004; 52: 554-562.