The effectiveness of spiritual care training on medical students' self-reported competencies: A quasi-experimental study

OBJECTIVES

To evaluate the effectiveness of spiritual care training on medical students' self-reported competencies.

METHODS

This is a quasi-experimental (controlled and non-randomized) study including 115 Brazilian medical students. Participants were enrolled into 2 groups: fourth-year students (n = 64) who received spiritual care training and sixth-year students (n = 51) who did not receive this training - control group (i.e., usual teaching). Participants answered a self-reported Spiritual Care Competence Scale. Comparisons between groups were performed and effect sizes were reported.

RESULTS

Providing a spiritual care training resulted in significantly higher self-reported scores for the dimensions of "Assessment" (d = 0.99), "Improvement of care" (d = 0.69), "Counseling (d = 0.88)," "Referral" (d = 0.75), and "Total Spiritual Care" (d = 1.044) as compared to the control group. Likewise, 21 out of 27 items of the Spiritual Care Competence Scale were significantly higher for the intervention group, presenting effect sizes (d) ranging between 0.428 and 1.032.

SIGNIFICANCE OF RESULTS

Medical students receiving spiritual care training showed greater self-reported competencies as compared to those in the usual teaching. These results reinforce the importance of promoting spirituality teaching in medical schools.

Nursing and Medical Students' Responses About End-of-Life Communication Reveal Educational Opportunities for Spiritual Care

BACKGROUND

The need for improved spiritual care education is a national directive, prompting many nursing and medical education programs to respond with spiritual curriculum. This article reports on research that tested an educational intervention to enhance nursing and medical students' understanding of end-of-life communication with families.

METHOD

This mixed-methods study included three reflection questions to ascertain students' attitudes about their own death and dying.

RESULTS

Many of the students' responses were spiritual in nature. Findings revealed two important misconceptions about death and one educational strategy that can be used to help students identify potential sources of spiritual discomfort in clinical situations.

CONCLUSION

The findings offer a glimpse into the attitudes and beliefs of nursing and medical students that could influence how they view and deliver spiritual care, contributing to the evidence base for spiritual care education and curriculum. [J Nurs Educ. 2023;62(11):601-605.].

Neuroeconomics of decision-making during COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic reveals the decision-making challenges faced by communities, governments, and international organizations, globally. Policymakers are much concerned about protecting the population from the deadly virus while lacking reliable information on the virus and its spread mechanisms and the effectiveness of possible measures and their (direct and indirect) health and socioeconomic costs. This review aims to highlight the various balanced policy decision that would combine the best obtainable scientific evidence characteristically provided by expert opinions and modeling studies. This article's main goal is to summarize the main significant progress in the understanding of neuroeconomics of decision-making and discuss the anatomy of decision making in the light of COVID-19 pandemic.

Significado del duelo frente al COVID en estudiantes y profesores de enfermería

Objetivo: La pandemia ocasionada por el COVID- 19 y sus consecuencias por el alto índice de mortalidad, afectó a la población mundial a nivel de salud mental, psicológica y emocional. La comunidad académica de la enfermería no fue la excepción; por tanto, el objetivo de este estudio fue describir el significado del duelo frente al COVID - 19 en estudiantes y profesores de enfermería de una institución universitaria. Materiales y métodos: Estudio cualitativo descriptivo con enfoque fenomenológico, a partir de la experiencia de 12 personas que enfrentaron duelo ante la pérdida de un ser querido por COVID -19. La información se obtuvo de septiembre de 2021 a febrero de 2022 mediante entrevistas en profundidad grabadas y transcritas literalmente; posteriormente se identificaron las palabras clave para categorizarla. Resultados: Emergieron cuatro categorías: El último adiós por lo que el COVID nos quitó; seguir viviendo en medio de un duelo por COVID; búsqueda de apoyo para sobrellevar el duelo COVID; lo que cambió después de perder a un ser querido por COVID. Los datos anteriores  indican que se debe pensar en el cuidado sobre este tipo de actitudes frente al duelo sobre la desaparición de seres queridos y cercanos por el COVID-19 desde la academia de manera particular. Conclusiones: El estudio concluye que estudiantes y profesores de un programa de enfermería enfrentaron un proceso complejo y diverso, con matices sociales, culturales y que las categorías develadas dan luz a posibles acciones de cuidado orientadas a la población de estudio.

Healthcare Providers' Perceptions about the Role of Spiritual Care and Chaplaincy Services in Substance Use Outpatient Treatment

Addressing patients' religion and spirituality (R/S) needs has been associated with positive health outcomes. However, despite receiving extensive training in spiritual assessment and care, chaplaincy services are primarily confined to inpatient settings, with few studies occurring in outpatient settings. The study sought to understand mental health providers' views about what shaped provider and patient motivation to engage in R/S discussions and seek referrals to chaplaincy services. We conducted five one-hour focus group sessions with a total of 38 staff members and thematically analyzed the resulting session and field notes. We identified four themes concerning provider knowledge and attitudes about R/S and chaplaincy services: Staff Information Needs, Staff Motivation to Discuss R/S and Refer, Patient Motivation to Use Chaplaincy Services, and Chaplain Accessibility. The study findings suggest that providers in outpatient substance use treatment clinics in the Veterans Health Administration are receptive to learning about R/S care and the possibility of expanding chaplaincy services. However, staff have misconceptions about the roles and responsibilities of chaplains. Attitudes about and experiences with R/S discussions varied. Trust and confidence in the benefits of chaplaincy services may be improved among both providers and patients by increasing chaplains' accessibility and visibility within these outpatient settings.

Spiritual Support During COVID-19 in England: A Scoping Study of Online Sources

Spiritual support is a key element of holistic care, and better healthcare professionals training and stronger strategic guidelines become urgent in light of health disasters and emergencies, such as the COVID-19 pandemic. To this end, the aim of this study was to explore spiritual support provision within mass and social media and the websites of spiritual leaders, institutions and NHS chaplaincy units during COVID-19 in England, between March and May 2020. A scoping review design informed by Levac and colleagues' five-staged framework was adopted, and adapted with a multi-strategy search to scope the different domains of online sources. Results revealed that spiritual support for dying patients, their families, health care staff, spiritual leaders and chaplains, had to be drastically reduced, both in quality and quantity, as well as being provided via different technological devices or domestic symbolic actions. No mention was found of a central strategy for the provision of spiritual support. This study points to the importance of developing centralized strategies to prepare healthcare systems and professionals in relation to spiritual support provision, both routinely and during health disasters and emergencies. Further research will have to explore innovative practices, in particular the role of digital technologies, in spiritual support provision.

Systematic Review of Medical Education on Spirituality

BACKGROUND

Spirituality is a fundamental dimension of our human nature that impacts on medical care and yet is relatively neglected by medical education courses in Australia.

AIM

This systematic review was conducted to assess the curriculum content currently used to develop medical student understanding of, and engagement with, spirituality in the context of patient care.

METHODS

Studies published in English from 2010 to the review date were included in order to focus on the most recent curricula. Studies included medical students in undergraduate or postgraduate programs, doctors in resident training programs, and registrars. Interventions considered for inclusion were curriculum modules on communication skills in spirituality, spiritual needs assessments and holistic care planning. Six databases including PubMed, Scopus, PsycINFO, Embase, Medline, and CINAHL were searched electronically using the following keywords and MeSH search terms:- 'medical students', 'doctor', 'physician', 'spirituality', 'spiritual care', 'religion', 'education', 'history taking' and 'communication skills training' from 2010 to 2020.

RESULTS

For 342 articles, three researchers screened the titles and abstracts; disagreements were resolved by discussion. Full-text articles were assessed for eligibility based on study and report characteristics: 17 papers were included in the analysis. Curriculum content of each study was reviewed. The following key features were employed frequently: chaplain shadowing, communications skills training, self-reflection, examining evidence and relationship building.

CONCLUSION

This review has determined the core content, aims and objectives to guide construction of spirituality curricula in Australian medical education. This article is protected by copyright. All rights reserved.

Spirituality and religion in residents and inter-relationships with clinical practice and residency training: a scoping review

OBJECTIVES

With the increased emphasis on personalised, patient-centred care, there is now greater acceptance and expectation for the physician to address issues related to spirituality and religion (SR) during clinical consultations with patients. In light of the clinical need to improve SR-related training in residency, this review sought to examine the extant literature on the attitudes of residents regarding SR during residency training, impact on clinical care and psychological well-being of residents and SR-related curriculum implemented within various residency programmes.

DESIGN

A scoping review was conducted on studies examining the topic of SR within residency training up until July 2020 on PubMed/Medline and Web of Science databases. Keywords for the literature search included: (Spirituality OR Religion) AND (Residen* OR "Postgraduate Medicine" OR "Post-graduate Medicine" OR "Graduate Medical Education").

RESULTS

Overall, 44 studies were included. The majority were conducted in North America (95.5%) predominantly within family medicine (29.5%), psychiatry (29.5%) and internal medicine (25%) residency programmes. While residents held positive attitudes about the role of SR and impact on patient care (such as better therapeutic relationship, treatment adherence and coping with illness), they often lacked the knowledge and skills to address these issues. Better spiritual well-being of residents was associated with greater sense of work accomplishment, overall self-rated health, decreased burnout and depressive symptoms. SR-related curricula varied from standalone workshops to continuous modules across the training years.

CONCLUSIONS

These findings suggest a need to better integrate appropriate SR-related education within residency training. Better engagement of the residents through different pedagogical strategies with supervision, feedback, reflective practice and ongoing faculty and peer support can enhance learning about SR in clinical care. Future studies should identify barriers to SR-related training and evaluate the outcomes of these SR-related curriculum including how they impact the well-being of patients and residents over time.

The CASH assessment tool: A window into existential suffering

Spiritual beliefs and practices have long served as a critical component of treating or managing serious illness. There is evidence to suggest that patients would like healthcare professionals to address their existential and spiritual needs. The CASH Assessment Tool focuses on four key areas of spiritual concern: Care, Assistance/Help, Stress, and Hopes/Fears. In this QI Project, a palliative care team within an urban, safety net, tertiary-care, and academic healthcare setting sought to elicit themes from the CASH assessment used by chaplains caring for patients with serious illnesses. Thirty patients were included in the pilot. Themes identified included knowing the patient as a person, concern about loved ones, concern about pain, and fear of death. We found that the CASH Assessment Tool was able to demonstrate the existential concerns of patients and serve as a framework for discussion about concerns and hopes of patients with serious illness.

Religiosity and Spirituality of Resident Physicians and Implications for Clinical Practice-the SBRAMER Multicenter Study

OBJECTIVES

To assess the attitudes, knowledge, and experiences of Brazilian resident physicians regarding religiosity/spirituality (R/S), factors associated with addressing this issue, and its influence on clinical practice.

METHODS

We report results of the multicenter "Spirituality in Brazilian Medical Residents" (SBRAMER) study involving 7 Brazilian university centers. The Network for Research Spirituality and Health (NERSH) scale (collecting sociodemographic data, opinions about the R/S-health interface, and respondents' R/S characteristics) and the Duke Religion Index were self-administered. Logistic regression models were constructed to determine those factors associated with residents' opinions on spirituality in clinical practice.

RESULTS

The sample comprised 879 resident physicians (53.5% of total) from all years of residency with 71.6% from clinical specialties. In general, the residents considered themselves spiritual and religious, despite not regularly attending religious services. Most participants believed R/S had an important influence on patient health (75.2%) and that it was appropriate to discuss these beliefs in clinical encounters with patients (77.1%), although this was not done in routine clinical practice (14.4%). The main barriers to discussing R/S were maintaining professional neutrality (31.4%), concern about offending patients (29.1%), and insufficient time (26.2%). Factors including female gender, clinical specialty (e.g., internal medicine, family medicine, psychiatry) as opposed to surgical specialty (e.g., surgery, obstetrics/gynecology, orthopedics), having had formal training on R/S, and higher levels of R/S were associated with greater discussion of and more positive opinions about R/S.

CONCLUSION

Brazilian resident physicians held that religious and spiritual beliefs can influence health, and deemed it appropriate for physicians to discuss this issue. However, lack of training was one of the main obstacles to addressing R/S issues in clinical practice. Educators should draw on these data to conduct interventions and produce content on the subject in residency programs.

Primary Palliative Care Education for Trainees in U.S. Medical Residencies and Fellowships: A Scoping Review

Background: The medical profession increasingly recognizes the growing need to educate nonpalliative physicians in palliative care. Objective: This study aims to provide a scoping review of the primary palliative care (PPC) education currently available to graduate medical trainees in primary and specialty tracks. Design: Studies of PPC interventions in U.S. residency or fellowship programs of all subspecialties published in English and listed on MEDLINE, CINAHL, and EMBASE through January 2020 were included. To meet admission criteria, studies had to describe the content, delivery methods, and evaluation instruments of a PPC educational intervention. Results: Of 233 eligible full texts, 85 studies were included for assessment, of which 66 were novel PPC educational interventions and 19 were standard education. Total number of publications evaluating PPC education increased from 8 (2000-2004) to 36 (2015-2019), across 11 residency and 10 fellowship specialties. Residency specialties representing the majority of publications were emergency medicine, general surgery, internal medicine, and pediatric/medicine-pediatrics. PPC content domains most taught in residencies were communication and symptom management; the primary delivery method was didactics, and the outcome assessed was attitudes. Fellowship specialties representing the majority of publications were pediatric subspecialties, nephrology, and oncology. The PPC content domain most taught in fellowships was communication; the primary delivery method was didactics and the outcome evaluated was attitudes. Conclusions: While PPC education has increased, it remains varied in content, delivery method, and intervention evaluations. Future studies should include more widespread evaluation of behavioral outcomes, longitudinal persistence of use, and clinical impact.