Abstract
The George Washington University Institute for Spirituality & Health (GWish), Washington, DC, has built its foundation on the premise that the way to provide more compassionate care is to recognize the spiritual dimension of health and suffering and provide professionals with tools to address such issues in medicine. Leading efforts to bring spirituality to the forefront of clinical care, GWish has made tremendous advancements in equipping health care clinicians and other professionals with specific tools to offer more integrative and compassionate care to their patients. Today, GWish is recognized as an international leader in the quest to bridge spirituality and health.
Christina M. Puchalski, MD, the founder and executive director of GWish (established in 2001) and professor, School of Medicine and Health Sciences, The George Washington University Medical Center, Washington, DC, commented in an interview that it was a personal experience that ignited her initial efforts to emphasize spirituality in medicine. Puchalski stated, “Years ago, my fiancé died of cancer, and at the time this happened, the health care system wasn't addressing issues around spirituality. I wondered why no one was talking about spirituality and health in order to help ease suffering. The focus was on medication. In fact, bereavement was considered pathological.” Puchalski noted, however, that bereavement and suffering are pervasive in the medical community, and spirituality is an important part of the integrative approach in patients dealing with these conditions.
As a result of her experience, Puchalski took on an assigned project for an ethics course in medical school that would eventually lead to her role in the internationally reaching organization that GWish is today. Puchalski said, “As a medical student, I proposed an elective on spirituality and health, which eventually became a required course that was integrated into the curriculum at The George Washington University. I thought the need for such a course was obvious.” As Puchalski's and her colleagues' efforts to integrate spirituality into clinical care expanded, she said she knew there would be interest, but never anticipated how popular or far reaching her initial endeavors would become.
In contrast, Puchalski also never anticipated that her endeavors around spirituality and health would be so controversial. She reported, “At the beginning of our efforts toward integrating spirituality in medicine, spirituality equaled religion to many people, so we had to untangle that for professionals and teach people that spirituality could include religion, but also point out that may only be a piece of it. We also had to spend a lot of time through the years working on the definition of spirituality.” The GWish website offers a definition of spirituality as written in an Association of American Medical Colleges report, which reads as follows: “Spirituality is recognized as a factor that contributes to health in many persons. The concept of spirituality is found in all cultures and societies. It is expressed in an individual's search for ultimate meaning through participation in religion and/or belief in God, family, naturalism, rationalism, humanism and the arts. All these factors can influence how patients and health care professionals perceive health and illness and how they interact with one another.” 1
Today, GWish provides an extensive array of offerings to help clinicians, pastors, educators, and other professionals acquire tools to help integrate spirituality into their care programs. Specifically, the mission of GWish is to develop educational programs supported by scholarly and research-based initiatives, which train physicians and other health care professionals to more fully integrate spirituality in their professional work with patients.
Tools to Integrate Spirituality into Clinical Care
Surveys have suggested that >75% of patients would like to have their spiritual issues discussed as a part of their medical care; however, a much smaller percentage of physicians actually discuss spiritual issues with their patients. 2 This may be due to clinicians feeling uncomfortable addressing such issues as well as clinicians not being equipped with specific training and tools. GWish is in the business of helping clinicians to become more comfortable and fully equipped to address spirituality with their patients and clients.
Specifically, GWish offers a wide range of educational tools and programs, often in collaboration with other organizations, including spirituality and health curriculum and competencies for medical students and residents; tools for taking a spiritual history; a summer institute that teaches health care professionals how to holistically integrate spirituality into their care plans; an Interprofessional Spiritual Care Education Curriculum (ISPEC), which includes an online training program and train-the-trainer component; a global network for spirituality and health; an online spirituality and health education and resource center called SOERCE and much more.
GWish recently received a $500,000 gift from the Kanarek Family Foundation to support its ISPEC endeavors. According to the GWish website: “ISPEC is a national and international multiyear, outcomes-based, education initiative whose mission is to improve spiritual care for patients with serious and chronic illness. Since the first ISPEC training in July 2018, hundreds of health professionals have learned to recognize, address, and attend to the spiritual needs and suffering of patients with chronic and serious illness. This gives patients (and their families) the ability to find their own capacity for healing and whole health. ISPEC is also focused on outcomes that lead to culture change where dignity, respect, and compassionate presence form the foundation of all care.” 3
GWish hosts regular local and international events. Upcoming events include the 15th Annual Art of Presence conference—Healthcare Renewal Retreat in Assisi, Italy, on July 22–28, 2021 and ISPEC training in Washington, DC, July 6–7, 2020.
The Importance of Addressing Spirituality in Health Care
Today, the health care system has come a long way in realizing the need to utilize tools for integrating spirituality into patient care, according to Puchalski, who said that many patients desire and need spirituality tools as part of their care plan. However, clinicians also benefit from the integration of spirituality into health care, and Puchalski commented, “The interest in mindfulness and the epidemic of burnout have both contributed to the growing interest in incorporating spirituality into health care. Burnout really is about spiritual distress, and clinicians are losing their sense of what gives them value and purpose. Today, at a hospice meeting we were talking about the sacredness of our work, and this is such an important topic and discussion today.”
Puchalski stated that there are still many challenges/obstacles we face today in terms of engaging clinicians in the process of addressing spirituality with their patients. She stated, “If we, as clinicians, are stressed and distracted and we have 20 patients to see, then the goal is to simply get through the day. This can be a significant obstacle to bringing spirituality into the discussion. If a clinician is tired or burned out, it is difficult for them to be present with their patients. But also, and perhaps most importantly, many clinicians are simply not trained to integrate spirituality into their care plan. So the easier thing to do is simply address the concrete issues.”
Puchalski continued, “Taking a spiritual history can take just a few minutes, and GWish has online modules about how to address this. We need interdisciplinary teams in hospital systems that are trained about spiritual care and trained that asking about spiritual distress is similar to asking a patient about their pain level. But I also want to point out that integrating spirituality into healthcare is not just about taking a spiritual history, this is about learning to make a deeper connection with patients, which then creates a sacred space where compassion can occur.”
If spirituality were always a part of providing health care, patients would feel cared for and clinicians would feel better about their work, according to Puchalski. She said that integrating spiritual inventories into the electronic record could help. She also said that one of the GWish trainings is Reflection Rounds, which facilitates the medical conversation in a spiritual direction. She said, “It is not about therapy, but rather taking more of a contemplative approach when addressing patients' suffering and not trying to fix the patient's story, but listening and asking questions in a different way.”
Fortunately, Puchalski said there is growing interest in the field of spirituality and health and the realization that patients are not just about an electronic note, but that they want to be listened to and talked with. Research is also increasing in this area demonstrating how spiritual endeavors impact body, mind, and spirit. Puchalski commented, “Most clinicians appreciate being able to engage their patients in a meaningful encounter, and those values are being talked about much more as a part of offering compassionate care. We want to help people thrive in whatever ways that we can, which requires taking care of medical issues, but also requires deep presence and facing things that are difficult to talk about.”
Conclusion
GWish is on the frontlines training clinicians to be prepared to address spirituality with their patients and, therefore, be able to be more present and provide more compassionate care. Through online modules, educational curricula, at the bedside, in-person trainings, and conferences, GWish fervently seeks to help clinicians integrate spirituality into patient care. In terms of the future, Puchalski stated that there is tremendous suffering throughout the world, and she envisions GWish working with countries around the globe to provide culturally appropriate programming and trainings around spirituality and health. She noted that 50% of the hospitals in the United States have had ISPEC training and have implemented this training in some way, and that now, she and her colleagues are working with, for example, Africa and Australia and other countries to provide such trainings. Puchalski stated that she would also like to see training programs for hospital systems. She said, “If we can train hospital systems to truly provide compassionate care both for the patients and the clinicians (in terms of relief from burnout and help with self-care) then we will be able to provide the best that we can for our patients. Integrating spirituality and providing compassionate care is truly about interdisciplinary care and teamwork.” ■