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Northeast Florida Medicine
Vol. 67, No. 1 2016
57
Palliative Care
During screening the medical professional or social
worker, determines when to consult a professional chap-
lain. Questions may reveal religious ritual needs, faith
group needs or strength and support needs, which would
trigger a chaplain referral. For example, a patient may
disclose a sense of isolation from his/her faith community.
Another consult opportunity would be a patient who
conveys anger and/or frustration which may or may not
be directed towards anyone in particular, his/her higher
power, the illness itself, etc. Still another indicator would
be family members who are voicing differences of opinion
regarding treatment options and/or end-of-life decisions.
Additionally, chaplain referrals are not limited to the
final stages of a patient’s disease or to patients and/or
families who identify themselves as religious or spiritual.
Existential distress and its potential complexities are not
limited to the religious or spiritual. One example would be
a patient’s family who is asking, “Why is this happening
to her? She’s always been a good person who helps others.
She shouldn’t be suffering.” Another example may be a
patient who is struggling with broken relationships and
expressing a need to give or receive forgiveness. Often, it is
simply the desire of a patient or family member for more
in-depth listening that warrants a pastoral care referral.
The Role of the Chaplain
The role of spiritual care within palliative medicine
in the United States can be seen from the earliest days
of this movement. Chaplains have been integral in de-
veloping and promoting the concept and philosophy of
palliative care since the early 1990s.
10
They now serve
on palliative care interdisciplinary teams as specialists
in helping to alleviate and relieve suffering of patients
and their loved ones. This is accomplished by partici-
pating in daily rounds, providing spiritual and religious
support to patients and families, offering their presence
in family meetings alongside other team members and
providing spiritual support to palliative care teams. As
men and women with expertise in spiritual, religious and
existential distress, they are trained in family systems
and dynamics and the art of skilled and active listening.
This offers a unique and essential layer of support for
patients, families and staff. In a culturally sensitive and
non-judgmental manner, chaplains seek to understand
(vs. “fix”) the patients and/or family members, often
providing insights to their respective palliative care teams
that might otherwise be missed. In addition to offering
these insights, the palliative care chaplain’s role includes
written spiritual assessments of patients, which leads to
the building of spiritual care plans. These plans may in-
clude advance care planning conversations, goals of care
discussions, grief support, end-of-life support, family
support or religious resources. The chaplain’s role also
includes a generous orthodoxy for religious ritual support
and a responsibility to communicate with clergy in the
community as is indicated.
Finally, an essential aspect of the chaplain’s role is
providing education, pastoral presence, support and
encouragement to the interdisciplinary team. This sup-
port includes education regarding self-care and stress
management techniques, facilitation of reflective and
devotional moments and debriefings. These duties are
not marginal to patient care, but rather integral to it.
According to many, the chaplain’s caring for the team in
areas such as loss and grief, compassion fatigue, ethical
decision-making and personal spiritual, religious or ex-
istential distress has a far-reaching and positive impact
on the overall effectiveness of the team.
Conclusion
Spiritual screening, history-taking and assessment are
significant responsibilities of the entire palliative care
interdisciplinary team. While the professional chaplain
is the specialist in spiritual, religious and existential
matters, basic spiritual screening and history-taking is a
team endeavor. Recognition and screening of such matters
can be effectively accomplished by team members as they
acquire fundamental skills and make use of resources such
as The Spiritual Assessment Tool-FICA. Such tools assist
in identifying the need to refer a patient to a professional
chaplain for spiritual care at an advanced level. The chap-
lain will proceed to address the spiritual and religious needs
of the patient and family, ultimately assisting the team
with the alleviation of pain and suffering for patients and
their families facing advanced serious illness. As the team
works collaboratively to care for patients and families,