Palliative Patients and Spiritual Distress: The Roles of Health Care Providers

Part III (of III)

The role of the doctor

Spiritual care starts with the doctor informing the patient that their illness is incurable. A terminal diagnosis is often the beginning of a spiritual awareness, as some studies have reported. In order that the patient not feel abandoned or hopelessness about a treatment’s failure, the doctor needs to be aware of the patient’s spiritual needs and perhaps continue to pursue treatment. At this stage in a patient’s illness, the language between doctor and patient changes, and, as Pronk states, “Much depends on the unhurried approach of the doctor and may require a change in mindset from that of result-oriented scientific thought and need for control” (p. 422). The emphasis is on the ability of the doctor to listen to the patient’s questions rather than being able to have all the answers. There is a need for both doctor and patient to allow themselves to be vulnerable in order to foster spiritual awareness.

Citing Peck, Pronk lists the five failures of unfulfilled spiritual care:

· Failure to listen

· Failure to encourage healthy spirituality

· Failure to combat unhealthy spirituality

· Failure to comprehend what is important to the patient

· Denigration of the patient’s humanity

(p. 422)

There is also the question of religion and how the word has different meanings for different people. It is important for the doctor to ask a patient what she or he means when they talk about religion in this context.

It is important to encourage the patient to tell her or his story, be it verbally, in writing or expressed through art. This can bring about a sense of completeness for the patient and allow for the patient to reconcile him or herself with their illness. Hearing and/or understanding the patient’s story can help the doctor understand how to address the patient’s spiritual needs. Pronk lists other forms of spiritual expression that might be supportive for the patient at this stage of life.

In conclusion, Pronk states, “it is important for the doctor to be aware of, and, if able, to respond to the need for spiritual care as an integral part of whole patient care. The relationship in spiritual care should be mutually vulnerable and mutually beneficial and, unlike other care the doctor provides, the pace and pattern of that relationship is ideally determined by the patient” (p. 424).

Pronk, Karen. "Role of the Doctor in Relieving Spiritual Distress at the End of Life." American Journal of Hospice & Palliative Medicine 22, no. 6 (November/December 2005): 419-425.