'I think you just learnt as you went along' - community clergy's experiences of and attitudes towards caring for dying people: A pilot study

Improving access to palliative care clinical pastoral education

Palliative care is interprofessional care for seriously ill people. Many clergy, religious leaders, and hospice and palliative care chaplains of color and minority religious backgrounds desire clinical palliative care education. This manuscript presents findings from a three-year quality improvement project which included the development of a palliative care specialty ACPE: The Standard for Spiritual Care and Education (ACPE) accredited program at an academic medical center. The program was designed to improve spiritual care provision in palliative care at the institution and to facilitate the participation of clergy and spiritual leaders of color and minority religious groups. Forty-six students participated in 53 400-h clinical pastoral education units. Strategies from medical education literature were employed to address obstacles to CPE participation including a racially and religiously diverse CPE advisory group, financial assistance, flexible learning (e.g. hybrid, asynchronous), and clinical placement agreements at places of employment. Upon completion of the program students provided written feedback, participated in a structured exit interview and completed a survey. Data were reviewed for common themes and results report student perceptions about the strategies utilized.

Identifying Core Domains to Assess the "Quality of Death": A Scoping Review

CONTEXT

There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines.

OBJECTIVES

Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems.

METHODS

PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles.

RESULTS

A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication.

CONCLUSION

The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.

Espiritualidad en el contexto de cuidados paliativos oncológicos dirigidos a personas mayores

La última década ha estudiado la faceta “espiritualidad” en el contexto de cuidados paliativos oncológicos en personas mayores desde perspectivas cuantitativas, cualitativas y mixtas. El estudio busca develar –en este contexto– el significado de espiritualidad. Se revisa literatura indexada en buscador PubMed vía Medline entre los años 2009 y 2019, con acceso on line, a texto completo, en forma anónima, en idiomas inglés-español y, análogamente, con búsqueda manual en la Revista Medicina Paliativa. Los resultados arrojan 50 artículos de pertinencia temática y cuatro categorías. Se concluye que existen desafíos relacionados con el significado de espiritualidad y calidad de vida, formación y perspectivas de invetigación.

Spiritual Care in Palliative Care: A Systematic Review of the Recent European Literature

Many studies on spiritual care in palliative care are performed in the US, leaving other continents unexplored. The objective of this systematic review is to map the recent studies on spiritual care in palliative care in Europe. PubMed, CINAHL, ATLA, PsycINFO, ERIC, IBSS, Web of Science, EMBASE, and other databases were searched. Included were European studies published in a peer-reviewed journal in 2015, 2016, or 2017. The characteristics of the included studies were analyzed and a narrative synthesis of the extracted data was performed. 53 articles were included. Spiritual care was seen as attention for spirituality, presence, empowerment, and bringing peace. It implied creative, narrative, and ritual work. Though several studies reported positive effects of spiritual care, like the easing of discomfort, the evidence for spiritual care is low. Requirements for implementation of spiritual care in (palliative) care were: Developing spiritual competency, including self-reflection, and visibility of spirituality and spiritual care, which are required from spiritual counselors that they participated in existing organizational structures. This study has provided insight into spiritual care in palliative care in Europe. Future studies are necessary to develop appropriate patient outcomes and to investigate the effects of spiritual care more fully.