Spiritual History in Hospice Care

Kenny McCarthy.

Spiritual history-taking is the process of interviewing a patient in order to come to a better understanding of their spiritual needs and resources. A spiritual history can be integrated into existing formats such as the social history section of the clinical database.

Compared to screening, history-taking uses a broader set of questions to capture salient information about needs, hopes, and resources. The history questions are asked in the context of a comprehensive examination by the clinician who is responsible for providing direct care or referrals to specialists.

The information from the history permits clinicians to understand how spiritual concerns could either complement or complicate the patient’s overall care. It also allows the clinician to incorporate spiritual care into the patient’s overall care plan. Unlike spiritual screening, which requires only brief training, those doing a spiritual history should have some education in and comfort with issues that may emerge and knowledge of how to engage patients comfortably in this discussion.

The goals of the spiritual history are to

Invite patients to share spiritual and religious beliefs, and to define what spirituality is for them and their spiritual goals.

Learn about the patient’s beliefs and values.

  • Assess for spiritual distress (meaninglessness, hopelessness) as well as for sources of spiritual strength (hope, meaning, and purpose).
  • Provide an opportunity for compassionate care.
  • Empower the patient to find inner resources of healing and acceptance.
  • Identify spiritual and religious beliefs that might affect the patient’s health care decision-making.
  • Identify spiritual practices that might be helpful in the treatment or care plan.
  • Identify patients who need referral to a chaplain or other equivalently prepared spiritual care provider.

There are clinical history tools available that can be used to collect and document clinical information. Several tools have been developed for this purpose including;

(a) FICA (Faith, Beliefs, Importance, Community, Address in care or action).

(b) SPIRIT (Spiritual belief system, Personal Spirituality, Integration, Rituals and restrictions, Implications, and Terminal events).

(c) HOPE (Hope, Organized religion, Personal spirituality, Effects of care and decisions), and Domains of Spirituality (developed for use by social workers).

Generally, these tools include more objective data (e.g., religious affiliation, spiritual practices) while touching upon deeper and more subjective spiritual aspects (e.g., meaning, importance of belief, sources of hope).

What to look for in spiritual history

  • Existential concerns
  • Lack of meaning
  • Questions meaning about one’s own existence
  • Concern about afterlife
  • Questions the meaning of suffering
  • Seeks spiritual assistance
  • Abandonment by God or others
  • Lack of love, loneliness
  • Not being remembered
  • No sense of Relatedness
  • Anger at God or others Displaces anger toward religious representatives
  • Inability to forgive
  • Concerns about relationship with deity
  • Desires closeness to God, deepening relationship
  • Conflicted or challenged belief systems
  • Verbalizes inner conflicts or questions about beliefs or faith
  • Conflicts between religious beliefs and recommended treatment
  • Expresses concern with life, death or belief system
  • Despair, Hopelessness about future health, life
  • Despair as absolute hopelessness
  • No hope for value in life
  • Grief, loss
  • The feeling and process associated with the loss of a person, health, relationship
  • Guilt, shame Feeling that one has done something
  • wrong or evil
  • Feeling that one is bad or evil
  • Reconciliation Need for forgiveness or reconciliation from self or others
  • Isolation Separated from religious community or other
  • Religious-specific Ritual needs
  • Unable to perform usual religious practices like prayer
  • Religious or spiritual struggle, Loss of faith or meaning
  • Religious or spiritual beliefs or community not helping with coping
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