Abstract
At a recent symposium around death and dying I was pushed into deep and profound thought while consumed by existential reflections. What is death? And what is life? Arguably, we are all terminally ill and must use what time we have left for our fulfilment or purpose, whatever that may be. I have heard anecdotally that referring patients to the care of a palliative care team early prolongs life expectancy. This is explained by patients using what limited energy they have to focus on life rather than aggressive and sometimes unpleasant treatment. I am duly informed that palliative care is about life, not death; supporting patients to live that short and precious period of time as comfortably as possible, with exploration and support around spiritual health and wellbeing.
The concept of spiritual health is closely linked to end-of-life care and we may feel at ease or even obliged to explore this aspect of wellbeing when consulting with the dying. Do we do this often enough with those who are not terminally ill?
The General Medical Council’s good medical practice guide states we should ‘adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values’. Furthermore, the RCGP curriculum states that our approach should extend ‘beyond a disease-based focus of biomedical science to incorporate the physical, emotional, social, spiritual, cultural and economic aspects of well-being, in order to successfully achieve “whole person care”’.
Would patients, and perhaps even doctors, feel enriched by more frequent exploration of spiritual health and wellbeing? And how does one enquire about spiritual health without the fear of sounding evangelical or bringing ‘God’ into the consultation? We know spiritual health is not solely about religion or belief in a supreme being.
The University of Minnesota's Earl E. Bakken Centre for Spirituality and Healing (2019) describes spiritual health as a ‘sense of connection to something bigger than ourselves, and it typically involves a search for meaning in life’, with some achieving this through organised religion and others through their connections to nature or art. They describe spirituality as being connected to large questions about life and identity (spiritual questions), such as:
Am I a good person? What is the meaning of my suffering? What is my connection to the world around me? Do things happen for a reason? How can I live my life in the best way possible?
But how can we adapt such questions to have meaning and relevance in a consultation? And why is there such hesitation in doing this for patients who are not at the end of their lives? Would this aid a consultation where the patient is presenting with ringworm? There are arguably many situations where such a discussion might bring useful information to the forefront and a sense of comfort to the patient, and perhaps even the doctor.
Anadarajah and Hight (2001) explore the use of the HOPE questionnaire to assess spirituality in patients:
This spiritual assessment tool may aid us to fulfil our roles as holistic and ‘whole person’ clinicians.
How often do you explore the spiritual health of your patients? What are the barriers and could or should you be doing this more frequently?