Faith & medicine at the bedside - caring for the caregiver

Faith & Medicine At The
Bedside: Caring For The Caregiver
SHERRY-ANN BROWN, MD, PHD
NARDIA MCFARLANE, MD
MARK NYMAN, MD
Painting from www3.stcamilluscenter.org
@drbrowncares
drbrowncares@gmail.com
Please see ‘Women in Medicine & Dentistry’ @
www.cmda.org for an MP3 of the talk available for
purchase online.

Outline
 Jesus, Healer
 Faith in America
 Need for a Spiritual component
 The Needs of the Caregiver
 Power Tools for your Toolbox
 Patient Stories
@drbrowncares

Mathew 9:35
Jesus went through all the towns and villages, teaching in their
synagogues, proclaiming the good news of the kingdom and
healing every disease and sickness.
@drbrowncares

Jesus, Healer
St Francis Xavier Major Seminary, http://sfxms.blogspot.com
@drbrowncares

Jesus, MD
Archdiocese of Washington, http://blog.adw.org/2010/02/the-diagnosis-is-dire-but-the-doctor-is-in/
@drbrowncares

Jesus, Bedside
http://www.ely.anglican.org
@drbrowncares

Jesus, Power
http://draltang02.blogspot.com/
@drbrowncares

Faith in America
 According to an online poll of 2,455 U.S. adults by
Harris Interactive in November 2007:
 __% of adult Americans believe in God.
 __% of the public believe in miracles.
 __% believe in the existence of
heaven.
@drbrowncares

Faith in America
 According to an online poll of 2,455 U.S. adults by
Harris Interactive in November 2007:
 82% of adult Americans believe in
God.
 79% of the public believe in miracles.
 75% believe in the existence of
heaven.
@drbrowncares

http://www.gallup.com
Organized Religious Preferences in the
United States, 2012 (Gallup poll)
@drbrowncares

The Need for a Spiritual
Component
 In a study at the Dana-Faber Cancer Institute:
 __% patients/nurses/physicians felt providing spiritual care was
important AND appropriate
 __% patients frequency of spiritual care provided
 __% patients positive impact of spiritual care
 Spiritual care training for physicians, OR:
 _x more likely to provide spiritual care
 _% had received prior training
Balboni et al, J Clin Oncol 2013 1;31(4):461-7
@drbrowncares

The Need for a Spiritual
Component
 In a study at the Dana-Faber Cancer Institute:
 80% patients/nurses/physicians felt providing spiritual care was
important AND appropriate
 15% patients frequency of spiritual care provided
 100% patients positive impact of spiritual care
 Spiritual care training for physicians, OR:
 7x more likely to provide spiritual care
 14% had received prior training
Balboni et al, J Clin Oncol 2013 1;31(4):461-7
@drbrowncares

The Needs of the Caregiver
 Patient Story: I Cannot Die Tonight
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 1.4 million cancer diagnoses in 2006 in USA
 Similar number of family/primary caregivers
 Caregiver vital for trajectory of disease
 Spouses typically primary caregivers
 ¾ caregivers in USA are women
 Female - independent risk for poor well-being
Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98
Ferrell et al, Seminars in Oncology Nursing 2012 28(4):256-261
@drbrowncares

 Caregiver’s life radically altered by diagnosis
 Profound spiritual needs
 Wrestle with faith
 Witness pain and suffering
 Struggle to maintain hope
 Spiritual needs key for whole-person support
Ferrell et al, Seminars in Oncology Nursing 2012 28(4):256-261
@drbrowncares

 Females with private prayers/spiritual conversations
 Successfully cope
 Find meaning
 Look beyond immediate burden
 Finding meaning
 may explain positive outcomes
 can produce spiritual growth
Carson, Sem Onc Nurs 1997 pp271-274
@drbrowncares

 More religious family members
 feel more positively about role as caregivers
 get along better with those they care for
 Providing care for the caregiver
 Equips caregiver to address patient’s needs
Weaver et al, Southern Medical Journal 2004 97(12):1210-1214
@drbrowncares

 “To cure sometimes, relieve often, comfort
always”
 Spiritual strength: strength which gives the ability
to face difficulties & overcome adversities
 Meaning of life: a sense of purpose to life or that
life is part of a greater plan or mission
O’Connor and Skevington, Br J Health Psychology 2005 10 (pt 3):379-398
Wessel,Conn Med 1980 44(2):111-2
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Stress-buffering hypothesis
of spirituality
Kim et al, Support Care Cancer 2007 15:1367-1374
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(p<0.001)
of spirituality
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 Psychological distress from increased caregiver stress can
be attenuated by maintaining faith and spirituality
 Caregivers who are low in spirituality need help to derive
faith and meaning in the context of cancer care
Colgrove et al, Annals Behav Med 2007 33:90-98
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of spirituality
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 Maintaining faith/finding meaning buffer[s]
adverse effect of caregiving stress on mental
health
 Mortality rates higher for stressed caregivers
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 Caregivers who felt that the caregiving role was
meaningful, perceived themselves to be healthier than
those caregivers who saw little or no purpose in the
caregiving role
 Spirituality helps caregivers find meaning in their role,
leading to improved health
@drbrowncares

of spirituality
Commentary:
The previous slide indicates that we need to interpret these studies
with caution. The figure is from a cross-sectional, retrospective
study with self-reported data. As with any cross-sectional data,
there is no overt determination of causality or directionality. This
means that the data could be interpreted in at least two ways:
• It has been suggested that caregivers who are more spiritual
may embrace love, faithfulness generosity, and selflessness.
They may view caregiving as a spiritual duty leading to positive
appraisal and fulfilling their spiritual calling, while neglecting
self-care.
• Conversely, the data could suggest that caregivers who in
general experience a greater decline in physical health pursue
more spiritual coping mechanisms, regardless of their baseline
spirituality.

 Female caregivers:
 Use spiritual resources more than men
 More likely to experience negative effects
 Stress-buffering effects same for both sexes
@drbrowncares

 Medicine needs to further integrate these scientific findings
into clinical practice to promote better patient care
Weaver et al, Southern Medical Journal 2004 97(12):1210-1214
@drbrowncares

Assessing/Addressing
Spiritual Needs
Meeting
Caregiver’s
Spiritual Needs
Caring For
The
Caregiver
Power Tools:
Key
Concepts
PLiWA
Power Tools:
Key
Resources
Triple C
Power Tools:
SIDNEY AC
Key
Questions
@drbrowncares
drbrowncares@gmail.comBrown, 2015, SMJ 108(1):67

Power Tools – Key Questions
SIDNEY AC
1. Has faith or spirituality been of support as you face your loved one’s
illness?
2. Is spirituality important to you, as you provide support for your loved
one?
3. Is your spirituality similar or different from your loved one’s spirituality?
4. Have you encountered spiritual needs that you have as a family
caregiver?
5. What has this caregiving experience been like for you?
6. Have you been able to find meaning in your caregiving experience?
7. Do you have a faith community, minister, or clergy available to you?
8. Has your spirituality changed since your loved one became ill?
SIDNEY AC:
Support, Important, Different, Needs, Experience, You, Available,
Changed
@drbrowncares
QuestionsadaptedfromFerrelletal,2012,SemOncNurs
Brown, 2015, SMJ 108(1):67

Mary’s story (parts 1, 2, 3)
The Needs of the
Caregiver: SIDNEY AC
What feelings/ processes did Mary experience?
 shock, denial, sadness, anger, acceptance
 bargaining with God
 intense pain with grieving
 need to know loving/sustaining God
Patient and caregiver may be out of synchrony
@drbrowncares

The Needs of the
 Mary…
 Believes in a personal, loving God
 Clearly aware of spirituality in her life
 Relies on spirituality to cope with caregiving
@drbrowncares

The Needs of the
 Caregivers of clinic patients TOP 10
 Hope for the future
 Strong faith in God
 Caregivers of hospice patients TOP 10
 Prayers from others
 Strong faith in God
Harrington et al, 1996
@drbrowncares

Meeting
Caregiver’s
Spiritual Needs
Caring For
The
Caregiver
Power Tools:
Key
Concepts
PLiWA
Power Tools:
Key
Resources
Triple C
Power Tools:
SIDNEY AC
Key
Questions
Assessing/Addressing
Spiritual Needs
@drbrowncares

Power Tools – Key Concepts
PLiWA
Presence
• Being fully in the room with the caregiver – mind, body, and spirit
Listening deeply
• Hearing intention behind caregivers’ words
• Uncovering underlying needs
Bearing witness
• Accompanying caregiver on journey
• Sitting with caregiver in the midst of suffering
Acts of compassion
• Tangible responses that aid caregiver in feeling spiritually
supported
PLiWA
Presence, Listening deeply, Witness, Acts of Compassion
@drbrowncares
ConceptsadaptedfromFerrelletal,2012,SemOncNurs
Brown,2015,SMJ108(1):67

The Needs of the
Caregiver
 Caregivers…who had questioned their faith or felt distant
from or angry with God, reported higher levels of
depression as caregiving burden increased
@drbrowncares

The Needs of the Caregiver:
SIDNEY AC, PLiWA
 Patient story: Brokenness
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The Needs of the
Caregiver
 Spiritual needs
 To feel connected to others
 To be listened to
 To be able to question and ask ‘why?’
@drbrowncares

The Needs of the
Caregiver
 Caregivers sometimes need encouragement to:
 Express needs
 Accept help
 Stay connected with others
 Continue to engage in spiritual activities
@drbrowncares

The Needs of the
Caregiver: Triple C
• Patient stories: One Day At A Time
Stepping Aside, Letting Go
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The Needs of the
Caregiver: Triple C
• Teamwork among:
• Health professionals (caring nurses),
• chaplains, and
• community clergy.
@drbrowncares
ConceptsadaptedfromWeaveretal,2004,SMJ
Brown, 2015, SMJ 108(1):67

The Needs of the
Caregiver:
SIDNEY AC, PLiWA
 Patient story: Because He Lives
@drbrowncares

Developing Your Toolbox
1. What are your sources of hope, strength
and comfort?
2. What helps to get you through the
difficult times in your life?
3. Would you like someone to pray with
you?
@drbrowncares

High Yield Points
 Interest in caregiver as a whole person
 Caring respectable manner
 Assess and meet caregivers’ spiritual needs
 Develop toolbox
 Ease patient suffering
@drbrowncares

Quotes to consider
“I think, therefore I am.” ~ Rene Descartes, French
philosopher, writer, and mathematician
“I AM; therefore I think…”
• inspiration to exhort patients
• wisdom to encourage caregivers
@drbrowncares

Quotes to consider
 “God will be in that hospital room with you…
There will be times when you can heal, though
you cannot cure.”
Kushner, Medicine and Caring: Thoughts on Compassionate Care
and a Religious Worldview, Medical Grand Rounds, Mayo Clinic 2012
@drbrowncares

References
 Balboni et al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and
physicians and the role of training. J Clin Oncol. 2013 1;31(4):461-7.
 Borrell-Carrio et al. The Biopsychosocial Model 25 years later: Principles Practice and Scientific Inquiry. Ann Fam Med.
2004; 2:576-582.
 Carson. Spiritual care: the needs of the caregiver. Semin Oncol Nurs. 1997;13(4):271-4.
 Colgrove et al. The effect of spirituality and gender on the quality of life of spousal caregivers of cancer survivors. Ann
Behav Med. 2007;33(1):90-8.
 El Nawawi et al. Palliative care and spiritual care: the crucial role of spiritual care in the care of patients with
advanced illness. Curr Opin Support Palliat Care. 2012 Jun;6(2):269-74.
 Ferrell et al. Deriving meaning and faith in caregiving. Semin Oncol Nurs. 2012;28(4):256-61.
 Kim et al. Psychological distress of female cancer caregivers: effects of type of cancer and caregivers' spirituality.
Support Care Cancer. 2007;15(12):1367-74.
 MacLean et al. Patient Preference for Physician Discussion and Practice of Spirituality. J Gen Inter Med. 2003; 18:38-43.
 Phelps et al. Addressing spirituality within the care of patients at the end of life: perspectives of patients with
advanced cancer, oncologists, and oncology nurses. J Clin Oncol. 2012 30(20):2538-44.
 Post et al. Physician and Patient Spirituality: Professional Boundaries Competency and Ethics. Ann Intern Med.
2000;132: 578-583.
 Rumbold. A Review of Spiritual Assessment in health care practice. MJA. 2007;186:S60-62.
 Steinhauser et al. Factors considered important at the end of life by patients, family, physicians, and other care
providers. JAMA. 2000 284(19):2476-82.
 Weaver et al. The role of religion/spirituality for cancer patients and their caregivers. South Med J. 2004;97(12):1210-4.
 Wessel. To cure sometimes, to relieve often, to comfort always. Conn Med. 1980 44(2):111-2.
@drbrowncares

Questions?
@drbrowncares

Faith & Medicine At The
Bedside: Caring For The Caregiver
SHERRY-ANN BROWN, MD, PHD
NARDIA MCFARLANE, MD
MARK NYMAN, MD
Painting from www3.stcamilluscenter.org
@drbrowncares

Faith & medicine at the bedside - caring for the caregiver

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