Top Ten Tips Palliative Care Clinicians Should Know About Caring for Pentecostal Patients

Abstract

People of the Pentecostal faith are a grouping of Protestant Christians. Pentecostals are a growing group not only in the United States, but also worldwide. This article focuses on the Pentecostal beliefs and spiritual practices in North America and their implications in the clinical environment. As the population of this faith group continues to grow, palliative care clinicians will need a basic understanding of the values and practices of Pentecostal spirituality and its potential impact on goals-of-care discussions. This article offers 10 recommendations for clinicians to better understand and support Pentecostal patients and families. These overarching concepts of Pentecostal faith and practices are presented as a point of initiation for further exploration of the support that may be needed, and not as a comprehensive guide.

Introduction

People of the Pentecostal Faith (PPF) are a grouping of Christians. Practitioners of this faith tradition continue to grow worldwide. One of the core beliefs of the PPF is the importance of the power of the Holy Spirit, traditionally considered the third person of Christianity's Holy Trinity (Father, Son, and the Holy Spirit). PPF believe that the Holy Spirit's power and presence are available daily, including when facing illness, when hopes for supernatural healing may be expressed. PPF receive spiritual gifts from the Holy Spirit that are practiced in daily life.

Although the population of PPF is expanding, there is a lack of knowledge within the health care system about how to best support Pentecostal patients and their families. It is imperative that clinicians, particularly in palliative care (PC), have a basic understanding of this faith tradition to offer the best support to help alleviate suffering. Without the knowledge of Pentecostal spiritual practices, conflicts can arise between health care providers and PPF when facing and discussing serious medical illnesses.

The intent of this article is to serve as a beginning point for PC clinicians to understand and address the spiritual needs of PPF in coping with serious illness. We hope that this discussion will allow for value-aligned care for PPF. Although this article discusses 10 prominent topics to assist in communication with PPF, there is great diversity even within the Pentecostal faith, and so, special attention must be paid to meet individual care needs.

Tip 1: Understanding the Background and Theological Underpinnings of the Pentecostal Faith Can Improve Clinicians' Ability to Support PPF

Pentecostals, a grouping of Protestant Christians, include many denominations. PPF attend Assemblies of God, Church of God, Church of God in Christ, Holiness, Apostolic, Full Gospel, Vineyard, churches that consider themselves “charismatic” or “Spirit-filled” and many more, including nondenominational churches that espouse tenets of Pentecostal theology in their preaching and teaching. The term “Pentecostal” derives from a passage in the book of Acts in the Bible, where followers of Jesus were given the gift of the Holy Spirit on the Day of Pentecost, a Jewish festival. PPF believe that a central feature of the Christian life is receiving the empowerment of the Holy Spirit for daily life and decision making and as a witness to others of God's power.¹

As one Pentecostal theologian writes, “We confess a radical openness to the invasion and intervention of God's Spirit in our daily lives.”² Even after one has been baptized with water, many PPF believe that there is also a need for a “baptism in the Holy Spirit.” Receiving this “second baptism”—a new empowerment of the Holy Spirit—will allow God, through the Spirit, to work in supernatural ways in everyday life.³

Compared with other Christian denominations, there are two distinctive aspects of the Pentecostal faith. First, physical healing is possible for all believers through the atoning sacrifice of Jesus (an often quoted Scripture is, “By his wounds we are healed.” Isaiah 53:5–6).⁴ Second, all believers receive spiritual gifts such as speaking in tongues, which are manifested in daily life.^5,6_.

Tip 2: The Supernatural Can Be Seen as Natural; Miracles, Prophecies, and the Daily Engagement with the Power of the Holy Spirit Are to Be Expected in the Pentecostal Faith

Many PPF believe that the Holy Spirit has filled them to be a conduit of God's grace and gifts, including possible healing, and therefore, the supernatural may be considered a natural part of life. One way to conceive of Pentecostal spirituality is to “mediate divinity with humanity by experiencing the presence of God,” through the power of the Holy Spirit.⁶ Receiving a second baptism in the Holy Spirit “opens believers eyes to a dimension of reality that is a-rational and supra-empirical,” empowering them for service to God.⁵

Gifts of the Holy Spirit, which are named in the Bible (in 1 Corinthians 12, for example) may include speaking or interpretation of utterances in tongues (glossolalia), strong faith, healing, prophecy, discernment of spirits, and words of knowledge (insightful/truthful words offered to another outside the speaker's human knowledge or understanding, which must be divine in origin). Features of Pentecostal worship services may include times of “waiting on the Lord” to come with a fresh infusion of the Holy Spirit, as evidenced by the gifts of the Holy Spirit listed above. Families may share with providers their testimonies of God's supernatural actions in daily life, including healings. Unlike some other Christian denominations, PPF believe that miracles, special gifts of the Holy Spirit, and other supernatural events that are described in the Bible still happen today and should be asked for or expected in prayer.

Tip 3: Some Aspects of the Pentecostal Faith May Support a Dichotomy Between Good/Evil and Science/God; the Medical System's Scientific Approach Can Sometimes Be Viewed as in Contrast to God

Given the importance of the Holy Spirit's actions and supernatural possibilities for PPF, they may emphasize having a “spiritual” outlook on the world that supersedes what can be observed by the medical team's science-driven data. When a serious prognosis is being discussed, people may wish to dissociate from the information or begin praying, quoting Scripture, or speaking in tongues so as not to align themselves with negativity or evil spirits that could get in the way of healing. Patients and families may also make statements such as, “I hear what you're saying, but we believe God is bigger.”

PPF may want to create an environment of positivity where “bad news” is not discussed because to discuss it may actually cause it to happen. To ease tensions, it may be best to ask for permission to disclose difficult information or inquire who a patient would want this information discussed with or be present when information is shared. Some PPF see their need for faith in complete healing as a “necessary precondition for God's healing to be made manifest in the believers' life. Thus, those who do not believe enough may not be healed.”⁷

PPF may also use the term “spiritual warfare” or mention having “prayer warriors.” These two concepts reinforce the “battle” between good and evil, which is being processed by PPF as they cope with illness and death. Illness and death may be seen as an aberration from God's plan for good in the world, which needs to be confronted, or even as a demon to be exorcised. PPF may view the sacrifice of Jesus as “the means to be freed from everything that disempowers: darkness, sin, the demonic, and human oppression.”⁸ Therefore, PPF may have a spiritual need for prayer for protection from evil forces that cause sickness, for example.

Tip 4: Chaplains Are an Essential Source of Support for Hospitalized Pentecostal Patients and Their Families

Chaplains are specially trained to be able to complete a thorough spiritual assessment and address a patient's spiritual concerns.⁹ They also can help a patient and family tap into their unique sources of spiritual strength. They can have more in-depth theological discussions about a patient's beliefs and hopes without fear of judgment. Chaplains can also help all health care team members understand how to best support and interpret the spiritual content raised by the patient and family. This understanding can assist providers with improved communication and eliciting of patient/family's values in light of medical decision making.

Chaplains can also advocate for or help accomplish specific spiritual rituals for PPF, such as reciting specific “healing Scriptures,” anointing with holy oil, praying, utilizing imagery of theological resonance to PPF in conversation and prayer (such as divine protection or the protection and salvation of the blood of Christ), and inviting the patient's pastor to the next family meeting (by patient or family's request). If a PPF's pastor cannot come to the hospital, a chaplain can advocate for a virtual visit by phone or video at bedside for prayer or on speaker phone during a goals-of-care meeting. Receiving prayer and counsel from one's own pastor from the same theological tradition can bring a great deal of peace and a sense that everything that can be done spiritually to promote healing for the patient is being done.

Tip 5: Allow Time and Space for Prayer

PPF will likely appreciate and feel supported by the encouragement to offer prayer themselves or have a hospital chaplain or their pastor offer prayer at bedside. Prayer for healing is a regular feature of many Pentecostal worship services and there will likely be a desire for this tradition to continue at bedside.⁵ The PPF or chaplain may use anointing oil as a symbol of God's healing presence, power, or protection. Make sure there is ample time for prayer at bedside before and after palliative extubation, for example, so that the patient, family, and pastor feel that they have been able to enact their faith and adequately petition God for healing. Pentecostal worship styles often tend to be oral and narrative in style, so some of the expressions of prayer and worship may be vocal or animated, and include activities such crying, dancing, or falling down.⁶

Pentecostal worship styles tend to be less formal or structured with the assumption that “God can, and will, do exactly what he wants exactly as he wants, and reject[s] formal liturgical structure to provide him that opportunity.”¹⁰ Families may even pray for a physical resurrection of the deceased patient after death.

Tip 6: Utilize NURSE Statements to Provide Empathetic Support and, More Importantly, Garner Better Understanding

Use VitalTalk's NURSE statements¹¹ to help build connection and better understand the spiritual needs present. Table 1 offers some examples of statements that may be helpful in exploring statements made by PPF.

Table 1.

NURSE Examples to Enhance Communication with People of the Pentecostal Faith

	Example	Notes from VitalTalk
Naming	“It sounds like you believe God's power is bigger than what we see as doctors.”	In general, turn down the intensity a notch when you name the emotion
Understanding	“This helps me to understand your beliefs about staying positive.”	Think of this as another kind of acknowledgment but stop short of suggesting you understand everything as you likely don't.
Respecting	“You're doing a wonderful job in advocating for what your loved one would want.”	Remember that praise also fits in here, for example, “I think you have done a great job with this.”
Supporting	“You mentioned that you'd like to pray before we take the breathing tube out and I want to make sure you and your pastor have plenty of time for this beforehand.”	Making this kind of commitment is a powerful statement.
Exploring	“Could you share more about what you mean when you said that you received a word from the Lord about this?”	Asking a focused question prevents this from seeming too obvious.

Tip 7: Explore the Patient/Family's Hope for a Miracle and Its Significance to Them

It can be difficult for providers to feel comfortable in addressing the hope for a miracle and what this means to families. Each situation is unique and so it is important to have a respectful approach to each individual's faith during these conversations. Although the immediate reaction in the medical community may be to react with medical information to show how a miracle cannot be achieved, it is important to first listen to the significance behind the miracle.¹²

Miracles can at times be used to express one's thoughts for hope, anger, frustration, or disappointment.¹³ Some helpful thoughts for navigating this conversation to best support the patients and their wishes can be found in the AMEN mnemonic.¹⁴ This is summarized as: Affirm the belief; Meet the patient/family where they are; Educate from your role as a medical provider; No matter what the outcome, assure the patient and family that you will be there to support them. Clinicians must note that “little will be gained by trying to directly challenge the family about its belief. In arguing the validity of the family's belief, the physician is only likely to alienate them.”¹² It is also important to remain humble in these conversations by acknowledging that there is a lot of uncertainty in the medical system, which may be leaned on by those hoping for a miracle.

Tip 8: It Is Common to Require Multiple Family Meetings to Allow Patients and Their Family Time to Process Information; Plan Regular Follow-Up

Having continuity in regular follow-up with PPF can be essential to establishing the trust to build relationships for medical care moving forward. Patients and their families will likely need time to discuss among themselves and perhaps with their spiritual leaders about the medical information that they have received about the patient's care and prognosis. Allowing time to process between meetings can create space for emotions and questions to be processed. When discussions are had, seek compromise while upholding the practices of good medicine. In addition, while practicing good medicine, boundaries may need to be set, although these can be difficult for providers to all agree upon and for families to hear.

Such boundaries may include a compromise to continue the current level of care while not escalating if the situation should further deteriorate, parameters to look for that would show a patient's improvement or worsening, and so on. At times a provider may need to name the fact that a disagreement is present to focus on the idea that care should be patient centered to seek a compromise.¹²

Tip 9: Clinicians Should Be Mindful of the Emotional Toll That Sickness Can Have on PPF

Life-threatening illnesses with very poor prognosis can create what is called a “crisis of faith” with PPF. Questions such as, “Why is God doing this to me?” or “Why isn't my faith strong enough?” are often articulated in emotionally distressed PPF. Guilt and fear can often accompany feelings of grief and sorrow. PPF need clear and simple diagnostic information to aid them in their strategy of prayer and petitioning God. This information can be the catalyst to allow them to see the acuity of the situation.

Another intervention to address emotional distress is to affirm a universal tenet of Pentecostal theology—that it is God who determines the timing of healing. “God heals in three different ways—instantly, gradually or ultimately in the resurrection.”¹⁵ Reinforcing this tenet can help patients and families move to a place of accepting that not everyone is cured but all people can experience some level of emotional and spiritual healing.

Tip 10: Include the Chaplain to Probe Ways by Which to Expand PPF's Experience of the Spirit and Be Alert to the Potential Presence of False Guilt

Where appropriate, the chaplain can speak to how the Spirit is present in both joy and sorrow, in both healing and times of pain, suffering and loss.¹⁶ Most PPF assume that the presence and power of the Spirit necessitate an expectation of healing, but many are open to seeing how the Spirit is also a source of comfort and strength even when there is no healing. For example, the chaplain may appeal to a Scripture found in Romans 8:26–27: that the Spirit is present to the Christian and to the world as one who groans with sighs too deep for words. That is, gently raise the possibility that the patient might find that the Spirit is indeed very present, just not in the way that they had originally anticipated. If they are open and receptive, they might find that this is a source of encouragement and comfort.

This source of comfort may be very important as many PPF assume that the Spirit will heal and if they are not experiencing this healing, it is their fault—due to, perhaps, a lack of faith. The clinician or chaplain might get a sense of this in conversations and thus needs to find a way to assure PPF that there is nothing wrong with their faith—that this is a false guilt. PPF may raise the question about whether a lack of faith meant that the Spirit did not do a miraculous work. In such situations, PPF may only need assurance that they do trust in God but that, in this case, the Spirit did not choose to act.

Footnotes

Conclusion

Meeting the multifaceted needs of patients and families (including physical, psychosocial, cultural, and spiritual needs) is central to holistic PC. Pentecostal beliefs and practices are often unknown or misunderstood and clinicians may miss important cultural cues that could better inform goals of care, or even help prevent escalation of cases to complicated ethical quandaries. PPF have a specific worldview—one which celebrates the miraculous and welcomes, through prayer, spiritual gifts, and faith—the intervention of the Holy Spirit in everyday life. Listening to the lived experience of PPF and acknowledging the hope for divine healing can help align clinicians with PPF and build more trusting relationships between PPF with serious illness and the health care system.

Funding Information

No funding was received for this article.

Author Disclosure Statement

No competing financial interests exist.

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