A Valuable Resource for All Palliative Care Disciplines

Abstract

Drs. Puchalski and Ferrell have written a fine book on Integrating Spirituality Into Patient Care, which should be useful and accessible to palliative care clinicians of all disciplines. The authors, a physician and a nurse, are well known and respected in palliative care. As a hospice and palliative care chaplain, I found their perspectives on spirituality refreshing and informative. Works on spirituality can suffer from an excessive focus on lofty ideals at the expense of specific details, and the authors, to their great credit, avoid this mistake. This book presents specific and practical strategies for better integration of spiritual care into clinical work. In the chapter entitled “Spiritual History Taking and Assessment,” concrete instruction is provided on how best to perform a history and initial assessment. As a hospice chaplain, I found the clinical suggestions well informed, effective, and empowering for all members of the interdisciplinary team, to identify and explore spiritual issues facing patients. Suggestions for taking a history and doing an assessment are well summarized in a handy appendix. Although the advice offered is practical, the task at hand should not be taken lightly. As the authors stress, skilled spiritual assessment and care requires compassion and deep respect for the patient’s unique expression of his or her spirituality. It also takes a lot of practice. I was struck by the book’s handling of the difficult, but important, balance between the specific and the transcendental. The authors note that patients often want to address existential questions, whether there are “answers.” Some patients find answers to their questions, but many do not, and that is acceptable. Simply listening, hearing, and respecting their questions can bring comfort, even when there is no clear answer. This is particularly relevant for those of us working in palliative care. When faced with suffering, we tend to want to provide specific answers and fix things. The authors of this book remind us that this is not always optimal for honoring patients’ concerns. They also note that spiritual beliefs and concerns are expressed differently across cultures. Therefore, a deeper understanding of these cultural differences will inform our work in addressing and alleviating suffering. The book addresses a number of topics not commonly found in books on spirituality. For example, Chapter 9 presents an excellent discussion of the value of understanding the professional training and qualifications of other palliative care team members. Too often we do not know enough about each other’s backgrounds. Specific to chaplaincy, there are significant differences among chaplains in the nature of their training and different certification levels, which are of relevance to their work in palliative care and yet unfamiliar to other team members. Chapter 10 provides a useful reference on specific training programs for clergy, psychologists, physician assistants, and nurses that have been implemented and address spiritual care. In summary, this book provides a well-written practical discussion of how to improve the quality of spiritual care delivered by clinicians and palliative care teams. As the authors state, “All members of the palliative care team should be trained in spiritual care. This training should be part of continuing education for all clinicians.” I wholeheartedly agree and believe that this book will be a valuable asset and tool for others working toward that end. Penny V. Phillips, MA, MDiv, BCC, is a Hospice and Palliative Care Chaplain at the Palo Alto VA Hospice Care Center, Palo Alto, CA, USA.