pastoral care in palliative care russell armstrong barwon health palliative care program 6 june 2013

Pastoral Care in palliative carePastoral Care in palliative care

Russell ArmstrongRussell Armstrong

Barwon Health Palliative Care ProgramBarwon Health Palliative Care Program6 June 20136 June 2013

Expected length of life at birth, Australia, 1901-10 to 2004-06

Sources: ABS Cat No. 3302.0; ABS Cat. No. 3105.0.65.001

From an Australian ‘prophet’…From an Australian ‘prophet’…

In 2010 Australians had the second highest life expectancy in the world, behind Japan.

[Although not for our Aboriginal brothers and sisters]

Why Spiritual Care?Why Spiritual Care?

““Death is not the conclusion to a series of Death is not the conclusion to a series of medical events but a profound human medical events but a profound human experience. As someone approaches death experience. As someone approaches death their emotional and spiritual needs are as their emotional and spiritual needs are as great as if not greater than those of their great as if not greater than those of their bodies.”bodies.”

Michael Barbato, quoted in Legge 2011, ‘The death Michael Barbato, quoted in Legge 2011, ‘The death whisperers’, whisperers’, Weekend Australian MagazineWeekend Australian Magazine, 21 May , 21 May

2011 2011


““Illness, aging, and the prospect of dying can Illness, aging, and the prospect of dying can trigger profound questions about who people trigger profound questions about who people are, what their life has meant, and what will are, what their life has meant, and what will become of them during the course of their become of them during the course of their illness and perhaps after they die. Who am I? illness and perhaps after they die. Who am I? How will I be remembered? These questions How will I be remembered? These questions have the same importance in patients’ lives have the same importance in patients’ lives as do questions about treatment. Illness and as do questions about treatment. Illness and dying are essentially spiritual processes in dying are essentially spiritual processes in that they often provoke deep questions of that they often provoke deep questions of meaning, purpose, and hope.”meaning, purpose, and hope.”

Puchalski & Ferrell, 2010:3Puchalski & Ferrell, 2010:3


““I’ve been feeling increasingly I’ve been feeling increasingly disconnected, and now I’m scrambling to disconnected, and now I’m scrambling to get back some sense of wholeness. The get back some sense of wholeness. The spiritual dimension of life has become more spiritual dimension of life has become more important to me the longer the journey important to me the longer the journey goes, as it wears the soul down.” goes, as it wears the soul down.”

‘‘Donna’Donna’

– – long term cancer patient who has been on and off long term cancer patient who has been on and off the palliative care program over several yearsthe palliative care program over several years

““To the typical physician, my illness is To the typical physician, my illness is a routine incident in his rounds, while a routine incident in his rounds, while for me it's the crisis of my life. I would for me it's the crisis of my life. I would feel better if I had a doctor who at feel better if I had a doctor who at least perceived this incongruity.”least perceived this incongruity.”

Anatole Broyard was a former editor of Anatole Broyard was a former editor of The New York Times The New York Times Book ReviewBook Review, and died from prostate cancer on 11 Oct 1990, , and died from prostate cancer on 11 Oct 1990,

aged 70.aged 70.

From the patient…From the patient…

““I see no reason or need for my doctor I see no reason or need for my doctor to love me - nor would I expect him to to love me - nor would I expect him to suffer with me… I just wish he would suffer with me… I just wish he would brood on my situation for perhaps five brood on my situation for perhaps five minutes, that he would give me his minutes, that he would give me his whole mind just once, be bonded with whole mind just once, be bonded with me for a brief space, me for a brief space, survey my soul survey my soul as well as my fleshas well as my flesh.”.”

Anatole Broyard was a former editor of Anatole Broyard was a former editor of The New York Times Book The New York Times Book ReviewReview, and died from prostate cancer on 11 Oct 1990, aged , and died from prostate cancer on 11 Oct 1990, aged

70.70.


““Just as he orders blood tests and bone Just as he orders blood tests and bone scans of my body, I'd like my doctor to scans of my body, I'd like my doctor to scan me, scan me, to grope for my spirit as to grope for my spirit as well as my prostate.well as my prostate. Without some Without some such recognition, I am nothing but my such recognition, I am nothing but my illness.illness.””

Broyard, A 1992, Broyard, A 1992, Intoxicated by My Illness: And Other Writings on Intoxicated by My Illness: And Other Writings on Life and MortalityLife and Mortality (New York: Clarkson Potter, 1992), pp. 43-45. (New York: Clarkson Potter, 1992), pp. 43-45.


WHO definition of Palliative CareWHO definition of Palliative Care

Palliative care is an approach that Palliative care is an approach that improves the quality of life of patients and improves the quality of life of patients and their families facing the problem their families facing the problem associated with life-threatening illness, associated with life-threatening illness, through the prevention and relief of through the prevention and relief of suffering by means of early identification suffering by means of early identification and impeccable assessment and and impeccable assessment and treatment of pain and other problems, treatment of pain and other problems, physical, psychosocial and spiritual.physical, psychosocial and spiritual.

(emphasis added)(emphasis added)

Standards for ProvidingStandards for ProvidingQuality Palliative Care for all Quality Palliative Care for all

AustraliansAustralians

Standards make frequent reference toStandards make frequent reference to holistic needs of patients, caregiver/s, holistic needs of patients, caregiver/s,

families and communities families and communities holistic assessmentholistic assessment holistic care holistic care the provision of emotional, religious or the provision of emotional, religious or

spiritual supportspiritual support the provision of spiritual and/or pastoral the provision of spiritual and/or pastoral

care workerscare workers resources to inform staff about customs, resources to inform staff about customs,

rituals and icons important for individual rituals and icons important for individual religious expression.religious expression.

What do we mean by spirituality?What do we mean by spirituality?


Spirituality is a Spirituality is a deeply intuitive, but deeply intuitive, but not always consciously expressed, not always consciously expressed, sense of connectedness to the world sense of connectedness to the world in which we livein which we live. .

Eckersley 2007:S54Eckersley 2007:S54


The secularisation of society that has The secularisation of society that has undermined western religious undermined western religious institutions has not led to a institutions has not led to a corresponding disappearance of corresponding disappearance of belief. Instead, religion has become belief. Instead, religion has become deregulated. deregulated.

(Rumbold 2003a:1)(Rumbold 2003a:1)

Religion and spiritualityReligion and spirituality

From Bridge & Lee 2009.

Religion and spiritualityReligion and spirituality

Spirituality as relationship or Spirituality as relationship or communion/connectioncommunion/connection

Adapted from Chao et al 2002, reported in Chochinov 2006:88

(Communion with significant or sacred - Puchalski et al)

Concerns re language 1Concerns re language 1

““Research shows that, while many patients Research shows that, while many patients do not distinguish between being religious do not distinguish between being religious or spiritual, others feel alienated from or spiritual, others feel alienated from institutional religion and see themselves institutional religion and see themselves more as spiritual than as religious. This may more as spiritual than as religious. This may be particularly true for patients in Australia. be particularly true for patients in Australia. The term spirituality is vague enough to The term spirituality is vague enough to allow patients themselves to define the allow patients themselves to define the playing field.”playing field.”

Koenig 2007:S45Koenig 2007:S45

Spirituality as a web of Spirituality as a web of relationshipsrelationships

In a holistic understanding, like that promoted by In a holistic understanding, like that promoted by palliative care, spirituality is manifested in palliative care, spirituality is manifested in a web of a web of relationships that hold people together by relationships that hold people together by connecting them with places, things, aspects of connecting them with places, things, aspects of themselves, people, communities, memories, and themselves, people, communities, memories, and beliefs that give meaning to their lives and nurture beliefs that give meaning to their lives and nurture their spiritstheir spirits (Lartey 1997). So people are sustained (Lartey 1997). So people are sustained by their spirituality irrespective of whether they by their spirituality irrespective of whether they are able to recognise and articulate particular are able to recognise and articulate particular aspects of it. Some people may be reflective about aspects of it. Some people may be reflective about their spirituality, others may not, but all people are their spirituality, others may not, but all people are spiritual beings. For each person the basic pattern spiritual beings. For each person the basic pattern of the web is similar, connecting them with many of the web is similar, connecting them with many levels of the systems in which they participate. levels of the systems in which they participate. However, the detailed structure of each web is However, the detailed structure of each web is unique for every person. unique for every person.

Rumbold 2003a:2Rumbold 2003a:2

Spirituality as a web of Spirituality as a web of relationshipsrelationships

““Religious belief may or may not be part of Religious belief may or may not be part of that web. that web.

““For each of us, these relationships form a For each of us, these relationships form a unique pattern, and each of us needs that unique pattern, and each of us needs that pattern to be largely intact in order to feel pattern to be largely intact in order to feel secure, or whole.”secure, or whole.”

““Often we only become aware of strands in Often we only become aware of strands in the web when they are stretched or broken, the web when they are stretched or broken, as happens with a life-changing event like a as happens with a life-changing event like a diagnosis of serious illness in ourselves or diagnosis of serious illness in ourselves or in someone we love.” in someone we love.”

Rumbold 2003b:S12Rumbold 2003b:S12

Finally, one helpful definition of Finally, one helpful definition of spiritualityspirituality

Spirituality is the aspect of humanity Spirituality is the aspect of humanity that refers to the way individuals that refers to the way individuals seek and express meaning and seek and express meaning and purpose and the way they purpose and the way they experience their connectedness to experience their connectedness to the moment, to self, to others, to the moment, to self, to others, to nature and to the significant and the nature and to the significant and the sacred.sacred.

Puchalski, C et. al. 2009:887

Secular sources of meaning and connection

Nurturing our own spiritualityNurturing our own spirituality

““For healthcare professionals to have For healthcare professionals to have authenticity and integrity at the authenticity and integrity at the

bedside, they must ask themselves the bedside, they must ask themselves the same questions patients and families same questions patients and families

are asking and grappling with.”are asking and grappling with.”

Puchalski & Ferrell 2010, p. 170Puchalski & Ferrell 2010, p. 170

Signposts – exploring everyday Signposts – exploring everyday spiritualityspirituality

honouring the sacred allowing stillnesshonouring the sacred allowing stillness


embracing change searching for meaningembracing change searching for meaning


walking through shadow wondering at the mysterywalking through shadow wondering at the mystery


struggling finding connectionstruggling finding connection


remembering blessings forgivingremembering blessings forgiving


lasting the distance standing in uncertaintylasting the distance standing in uncertainty

Spiritual or existential needsSpiritual or existential needs

Moadel and colleagues identified “unmet Moadel and colleagues identified “unmet spiritual or existential needs” in 248 spiritual or existential needs” in 248 ethnically diverse, urban cancer ethnically diverse, urban cancer outpatients in the USA.outpatients in the USA.

Patients wanted help in Patients wanted help in overcoming fears (51%), overcoming fears (51%), finding hope (42%), finding hope (42%), finding meaning in life (40%), finding meaning in life (40%), finding spiritual resources (39%), finding spiritual resources (39%), having someone to talk with about the having someone to talk with about the

meaning of life and death (25%). meaning of life and death (25%).

(Chochinov & Cann 2005:S-104)(Chochinov & Cann 2005:S-104)


Subtle cues and clues:Subtle cues and clues:

References to not wanting to be a burdenReferences to not wanting to be a burden ““Why?” questionsWhy?” questions ““What’s the point?” referencesWhat’s the point?” references References to loss of dignityReferences to loss of dignity References to it “not being fair”References to it “not being fair” Desire to die statementsDesire to die statements

Sometimes/often no clue at all if we don’t Sometimes/often no clue at all if we don’t offer or ask (thus the importance of offer or ask (thus the importance of spiritual screening/discernment)spiritual screening/discernment)


Subtle cues and clues:Subtle cues and clues:

Patient had been talking to chaplain for Patient had been talking to chaplain for some time and in a very positive way some time and in a very positive way about how well she was coping, before about how well she was coping, before quietly adding… quietly adding…

P:P: “Well, most of the time, anyway”. “Well, most of the time, anyway”.C: [gently] “Sometimes you’re not quite so C: [gently] “Sometimes you’re not quite so

sure?”sure?”P:P: [tears welled up] [tears welled up]C: “If that’s uncomfortable when can leave it C: “If that’s uncomfortable when can leave it

there”there”P:P: “No, I need to work it through” “No, I need to work it through”


Sometimes we might make a reasonable guess:Sometimes we might make a reasonable guess:

Know disruption to their relationship webKnow disruption to their relationship web recent bereavementrecent bereavement removed from local community for treatmentremoved from local community for treatment having to stop workhaving to stop work being unable to continue with important being unable to continue with important

activitiesactivities Transition from curative to palliative Transition from curative to palliative

treatment treatment urgent need to redefine the nature of their hopeurgent need to redefine the nature of their hope

Approaching end of lifeApproaching end of life Unresolved business, wanting to repair/heal Unresolved business, wanting to repair/heal

broken strands in webbroken strands in web

What do we mean by spiritual What do we mean by spiritual care?care?

““Spiritual care is fundamentally the Spiritual care is fundamentally the ability to be present for another, ability to be present for another, entering into the sacred spaces entering into the sacred spaces where we respond with infinite where we respond with infinite respect to the mystery of another’s respect to the mystery of another’s suffering.”suffering.”

Linda M. McWilliamLinda M. McWilliam

‘‘Spiritual Interventions in Bereavement Support: Spiritual Interventions in Bereavement Support:

Theory Strategies and a Case Study’Theory Strategies and a Case Study’

Spiritual Care Australia Conference 2010Spiritual Care Australia Conference 2010


““Each person defines their own spiritual Each person defines their own spiritual needs [in their own unique way], so needs [in their own unique way], so spiritual care may not mean providing spiritual care may not mean providing answers to a person’s spiritual questions answers to a person’s spiritual questions but rather listening to them and taking but rather listening to them and taking them seriously, that is, accompanying and them seriously, that is, accompanying and supporting an individual in their supporting an individual in their exploration of their particular exploration of their particular understanding of spirituality and in their understanding of spirituality and in their development of their own sense of development of their own sense of spiritual well-being.” spiritual well-being.”

Vivat, 2008: 860Vivat, 2008: 860


““We find that spiritual care is about We find that spiritual care is about connectedness, but also about connectedness, but also about incompleteness. It is about incompleteness. It is about knowledge, but equally about what knowledge, but equally about what we do not know. It is about we do not know. It is about coherence and integrity, but also coherence and integrity, but also about vulnerability. It is about belief, about vulnerability. It is about belief, but also about doubt.” but also about doubt.”

Rumbold quoted in Hudson 2008b:41Rumbold quoted in Hudson 2008b:41


After a slow account from a patient about After a slow account from a patient about his loneliness, pain and despair, his loneliness, pain and despair, references to not seeing the point in going references to not seeing the point in going on, no fear in dyingon, no fear in dying

C: Sounds like dying has more appeal for C: Sounds like dying has more appeal for you than living just now.you than living just now.

P: [reaching out and taking my hand with P: [reaching out and taking my hand with surprising strength] Thank-you my friend, surprising strength] Thank-you my friend, thank-you.thank-you.

Patient then released my hand, rolled onto Patient then released my hand, rolled onto his back and closed his eyes. It was time his back and closed his eyes. It was time for me to leave.for me to leave.


““The person who can be silent with The person who can be silent with us in a moment of despair or us in a moment of despair or confusion, who can be silent with us confusion, who can be silent with us in our hour of grief and bereavement, in our hour of grief and bereavement, who can tolerate not knowing, not who can tolerate not knowing, not curing, not healing, and face with us curing, not healing, and face with us the reality of our powerlessness, this the reality of our powerlessness, this is the one who cares.”is the one who cares.”

Palliative Care for Infants, Children and AdolescentsPalliative Care for Infants, Children and Adolescents, , Chap 6. Quoted by Liese Groot-Alberts, PCIC, Chap 6. Quoted by Liese Groot-Alberts, PCIC,

Perth, September 2009.Perth, September 2009.

Spirituality and mysterySpirituality and mystery

[Suffering] demands that we reject simplistic [Suffering] demands that we reject simplistic answers, both "religious" and "scientific," and learn answers, both "religious" and "scientific," and learn to embrace mystery, something our culture resists. to embrace mystery, something our culture resists. Mystery surrounds every deep experience of the Mystery surrounds every deep experience of the human heart: the deeper we go into the heart's human heart: the deeper we go into the heart's darkness or its light, the closer we get to the darkness or its light, the closer we get to the ultimate mystery of God. But our culture wants to ultimate mystery of God. But our culture wants to turn mysteries into puzzles to be explained or turn mysteries into puzzles to be explained or problems to be solved, because maintaining the problems to be solved, because maintaining the illusion that we can "straighten things out" makes us illusion that we can "straighten things out" makes us feel powerful. Yet mysteries never yield to solutions feel powerful. Yet mysteries never yield to solutions or fixes - and when we pretend that they do, life or fixes - and when we pretend that they do, life becomes not only more banal but also more becomes not only more banal but also more hopeless, because the fixes never work. hopeless, because the fixes never work.

Palmer 2000: 60Palmer 2000: 60

Spirituality, mystery and meaningSpirituality, mystery and meaningWe search and we search and yet find no meaning.We search and we search and yet find no meaning.The search for a meaning leads to despair.The search for a meaning leads to despair.And when we are broken the heart finds its momentAnd when we are broken the heart finds its momentTo fly and to feel and to work as it willTo fly and to feel and to work as it willThrough the darkness and mystery and wild contradiction.Through the darkness and mystery and wild contradiction.For this is its freedom, its need and its calling;For this is its freedom, its need and its calling;This is its magic, its strength and its knowing.This is its magic, its strength and its knowing.To heal and make meaning while we walk or lie dreaming; To heal and make meaning while we walk or lie dreaming; To give birth to love within our surrender;To give birth to love within our surrender;To mother our faith, our spirit and yearning;To mother our faith, our spirit and yearning;While we stumble in darkness the heart makes our meaningWhile we stumble in darkness the heart makes our meaningAnd offers it into our life and creationAnd offers it into our life and creation

That we may give meaning to life and creationThat we may give meaning to life and creationFor we only give meaning we do not find For we only give meaning we do not find

meaningmeaningThe thing we can’t find is the thing we shall The thing we can’t find is the thing we shall

give.give.To make love complete and to honour creation.To make love complete and to honour creation.

Michael Leunig, Michael Leunig, The Prayer TreeThe Prayer Tree..


““Finally, spiritual care is implicit in good care - that Finally, spiritual care is implicit in good care - that is, care that attends to the person. It begins in is, care that attends to the person. It begins in shared human values rather than external belief shared human values rather than external belief structures. Humility, and a willingness to treat the structures. Humility, and a willingness to treat the other's experience as a social reality to be engaged, other's experience as a social reality to be engaged, not a phenomenon to be examined and then not a phenomenon to be examined and then approved or dismissed on ‘scientific’ grounds, are approved or dismissed on ‘scientific’ grounds, are required of the caregiver. A necessary condition for required of the caregiver. A necessary condition for spiritual care is preparedness to engage with the spiritual care is preparedness to engage with the other as a fellow human being. An expert stance at other as a fellow human being. An expert stance at this point can only block the possibility of spiritual this point can only block the possibility of spiritual encounter. This is not to say that there cannot be encounter. This is not to say that there cannot be expertise in offering spiritual care, but such expertise in offering spiritual care, but such expertise involves the ability to join the other in a expertise involves the ability to join the other in a process of discovery, not having expert knowledge process of discovery, not having expert knowledge that objectifies the other.” that objectifies the other.”

(Rumbold 2003a:3)(Rumbold 2003a:3)

How do we offer spiritual care?How do we offer spiritual care?


Cassidy, S ‘Sharing the darkness’


Harvey Chochinov and colleagues work on Harvey Chochinov and colleagues work on ‘Dignity Conserving Care’ and ‘Dignity ‘Dignity Conserving Care’ and ‘Dignity Therapy’Therapy’

Topics for a seminar in their own rightTopics for a seminar in their own right Evidence based understanding of what Evidence based understanding of what

constitutes ‘dignity’constitutes ‘dignity’ Models for how to conserve andModels for how to conserve and protect protect

dignity at end of lifedignity at end of life


The power of the story:The power of the story: ““listening to an elderly person’s story is listening to an elderly person’s story is

both a privilege for the listener and both a privilege for the listener and empowering for the storyteller.” empowering for the storyteller.”

(MacKinlay 2006a:79 quoted in Hudson 2008a:147)(MacKinlay 2006a:79 quoted in Hudson 2008a:147)

The patient’s choice as to how s/he wants to The patient’s choice as to how s/he wants to ‘write’ or tell the story‘write’ or tell the story connections that s/he wants to makeconnections that s/he wants to make meanings that s/he wants to givemeanings that s/he wants to give what s/he includes and omits what s/he includes and omits validation in having it heardvalidation in having it heard


The patient’s spiritual web (web of The patient’s spiritual web (web of relationships)relationships)

enquiring about symbols/photos/art already enquiring about symbols/photos/art already in the patient’s roomin the patient’s room

encouraging symbols/photos etc in rooms encouraging symbols/photos etc in rooms to nurture their connections to/relationships to nurture their connections to/relationships with people/places/beliefs/things that are with people/places/beliefs/things that are significant to their spiritual websignificant to their spiritual web

Encouraging/facilitating contact with Encouraging/facilitating contact with important people in the webimportant people in the web

Use of SignpostsUse of Signposts cards as an invitation for cards as an invitation for the patient to reflect upon their spiritualitythe patient to reflect upon their spirituality


Redefining hope within a palliative Redefining hope within a palliative contextcontext e.g. story of ‘Charles’e.g. story of ‘Charles’

Giving meaningGiving meaning SignpostsSignposts cards again cards again ‘‘Nurture for your soul’ groupNurture for your soul’ group

BlessingBlessing


Peter Roberts offering musical Peter Roberts offering musical expression of spiritual care, able to touch expression of spiritual care, able to touch

people deeply as offers care beyond people deeply as offers care beyond wordswords

As death approaches

Funeral planningFuneral planning If not already doneIf not already done

Supporting vigilSupporting vigil Music, silence, talking to personMusic, silence, talking to person Light – candlesLight – candles Protecting as sacred time and spaceProtecting as sacred time and space

Facilitating a final good-byeFacilitating a final good-bye Ritual for a family blessingRitual for a family blessing


““Don’t just do something, sit there”Don’t just do something, sit there” Recognise that most staff don’t have luxury Recognise that most staff don’t have luxury

of time to do a lot of thatof time to do a lot of that Importance of pastoral care staff who do?Importance of pastoral care staff who do? Our willingness to sit helplessly can Our willingness to sit helplessly can

sometimes be greatest gift we can offer to sometimes be greatest gift we can offer to patientpatient

Sometimes a challenge to resist the Sometimes a challenge to resist the temptation to try to fix, soothe, solve temptation to try to fix, soothe, solve (especially for those closest to the patient; (especially for those closest to the patient; special gift to patient when we canspecial gift to patient when we can

Allowing ‘difficult conversations’ (things Allowing ‘difficult conversations’ (things patient might discuss with staff as ‘too hard’ patient might discuss with staff as ‘too hard’ with family)with family)

Afterwards

Bereavement support

Reflection and remembrance services


““To heal a person, one must first be a To heal a person, one must first be a person”person”

Abraham Heschel, Jewish philosopher/theologianAbraham Heschel, Jewish philosopher/theologian


““We cannot do for others what we cannot We cannot do for others what we cannot do for ourselves.”do for ourselves.”

McKenna, quoted in Puchalski & Ferrell 2010, p. 171McKenna, quoted in Puchalski & Ferrell 2010, p. 171


““Being present to a patient’s suffering Being present to a patient’s suffering can change the clinician – his or her can change the clinician – his or her values, priorities and beliefs can be values, priorities and beliefs can be

altered by the experience of another’s altered by the experience of another’s suffering.”suffering.”

Puchalski & Ferrell 2010, p. 166Puchalski & Ferrell 2010, p. 166


How do you nourish/feed/strengthen your own spirituality?

Some possibilities from Signposts:

Allowing stillness Daring to dream Finding connection Honouring the

sacred Imagining Letting go Listening Intently Living truthfully Looking inside

Noticing beauty Practicing compassion Remembering

blessings Searching for meaningSearching for meaning Seeking balanceSeeking balance Sharing the loadSharing the load Touching the skyTouching the sky Wondering at the Wondering at the

mysterymystery


Take a moment to centre yourself before engaging with each patient (before entering their house/room/space)

Allow stillness and time, e.g. for reflection, prayer, meditation, yoga or Tai Chi

Reflect upon your spirituality as represented in your own web of relationships

Read spiritually uplifting material Laugh Enjoy nature and art

Recommended referencesRecommended references

Chochinov, Harvey 2006, ‘Dying, Dignity, and New Chochinov, Harvey 2006, ‘Dying, Dignity, and New Horizons in Palliative End-of-Life Care’, Horizons in Palliative End-of-Life Care’, CA: A Cancer CA: A Cancer Journal for CliniciansJournal for Clinicians, No. 56, pp. 84-103, available , No. 56, pp. 84-103, available at at http://caonline.amcancersoc.org/cgi/content/full/56/2/84.http://caonline.amcancersoc.org/cgi/content/full/56/2/84.

Chochinov, HM and Cann BJ 2005, ‘Chochinov, HM and Cann BJ 2005, ‘Interventions to Interventions to enhance the spiritual aspects of dyingenhance the spiritual aspects of dying’, Journal of ’, Journal of Palliative Medicine, Vol. 8, Suppl. 1, pp. S103-15, Palliative Medicine, Vol. 8, Suppl. 1, pp. S103-15, available at available at http://www.liebertonline.com/doi/pdf/10.1089/jpm.2005.8.s-http://www.liebertonline.com/doi/pdf/10.1089/jpm.2005.8.s-103.103.

‘‘Professor Harvey Chochinov: dignity therapy’, Professor Harvey Chochinov: dignity therapy’, SaturdayExtraSaturdayExtra, ABC Radio National, 31 October , ABC Radio National, 31 October 2009, available at2009, available at http://mpegmedia.abc.net.au/rn/podcast/2009/10/sea_20091031_082http://mpegmedia.abc.net.au/rn/podcast/2009/10/sea_20091031_0826.mp36.mp3


Puchalski, C, Ferrell, B, Virani, R, Otis-Green, S, Puchalski, C, Ferrell, B, Virani, R, Otis-Green, S, Baird, P, Bull, J, Chochinov, H, Handzo, G, Nelson-Baird, P, Bull, J, Chochinov, H, Handzo, G, Nelson-Becker, N, Prince-Paul, M, Pugliese, K & Sulmasy, Becker, N, Prince-Paul, M, Pugliese, K & Sulmasy, D, 2009, ‘Improving the Quality of Spiritual Care as D, 2009, ‘Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the a Dimension of Palliative Care: The Report of the Consensus Conference’, Consensus Conference’, Journal Of Palliative Journal Of Palliative MedicineMedicine, Vol. 12, No. 10, pp. 885-904, available at , Vol. 12, No. 10, pp. 885-904, available at http://healthcarechaplaincy.org/userimages/doc/Palliatihttp://healthcarechaplaincy.org/userimages/doc/Palliative_Care/Archstone_report_in_JPM_Oct%2009.pdfve_Care/Archstone_report_in_JPM_Oct%2009.pdf..

A PowerPoint presentation on the report is A PowerPoint presentation on the report is available at available at http://www.gwumc.edu/gwish/clinical/Project_Presentatihttp://www.gwumc.edu/gwish/clinical/Project_Presentation_Improving_Spiritual_Care_in_Palliative_Care.ppton_Improving_Spiritual_Care_in_Palliative_Care.ppt


Dignity in Care – the website of Harvey Chochinov Dignity in Care – the website of Harvey Chochinov and associates at Manitoba Palliative Care and associates at Manitoba Palliative Care Research, Winnipeg, Canada: Research, Winnipeg, Canada: http://dignityincare.ca/en.http://dignityincare.ca/en.

The George Washington Institute for Spirituality The George Washington Institute for Spirituality and Health, Founder and Executive Director and Health, Founder and Executive Director Christina Puchalski: Christina Puchalski: http://www.gwumc.edu/gwish/aboutus/index.cfm.http://www.gwumc.edu/gwish/aboutus/index.cfm.

Parker Palmer’s centre. “Parker Palmer’s centre. “When we reconnect who When we reconnect who we are with what we do, we approach our lives and we are with what we do, we approach our lives and our work with renewed passion, commitment, and our work with renewed passion, commitment, and integrity.”integrity.” http://www.couragerenewal.org/ http://www.couragerenewal.org/


http://www.spiritualityandpractice.com/practices/features.php?id=15309 http://www.spiritualityandpractice.com/practices/features.php?id=15309

Bloemhard, Anna 2008, Spiritual Care for Self and Others: An information booklet for professionals and volunteers working in health care with a focus on aged and palliative care, Mid North Coast Division of General Practice (NSW), at

http://www.mncdgp.org.au/system/files/sites/www.mncdgp.org.au/files/http://www.mncdgp.org.au/system/files/sites/www.mncdgp.org.au/files/

Spiritual%20care%20booklet.pdfSpiritual%20care%20booklet.pdf

The Alphabet of Spiritual The Alphabet of Spiritual LiteracyLiteracy

One (free) part of the website One (free) part of the website Spirituality & Practice: Resources for Spirituality & Practice: Resources for Spiritual JourneysSpiritual Journeys

Closing wordsClosing words

Perhaps the care of the dying is not about the care of Perhaps the care of the dying is not about the care of the body but the care of the soul… Caring for the the body but the care of the soul… Caring for the soul requires that we be fully present in situations we soul requires that we be fully present in situations we cannot control and patient as genuine meaning and a cannot control and patient as genuine meaning and a direction unfold. It means seeing familiar things in direction unfold. It means seeing familiar things in new ways, listening rather than speaking, learning new ways, listening rather than speaking, learning from patients rather than teaching them, and from patients rather than teaching them, and cultivating the capacity to be amazed. It means cultivating the capacity to be amazed. It means recognizing the power of our own humanity to make a recognizing the power of our own humanity to make a difference in the lives of others and valuing it is highly difference in the lives of others and valuing it is highly as our expertise. Finally, it means discovering that as our expertise. Finally, it means discovering that health care is a front row seat on mystery and sitting health care is a front row seat on mystery and sitting in that seat with open eyes.in that seat with open eyes.

- - Rachel Naomi Remen, Rachel Naomi Remen, from the Foreword to Puchalski & Ferrell, from the Foreword to Puchalski & Ferrell, Making Health Care WholeMaking Health Care Whole, 2010, 2010..

Thank you

pastoral care in palliative care russell armstrong barwon health palliative care program 6 june 2013

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