Making Health Care Whole: Integrating Spirituality into Health Care

CHRISTINA M. PUCHALSKI, MD, is the founder and executive director of the George Washington Institute for spirituality and health, Washington, DC, and professor of medicine and health sciences at the George Washington University School of Medicine. Dr. Puchalski is an internationally recognized pioneer in the field of spirituality and health, well-known both for her twenty years of research in palliative care and interprofessional spiritual care and for her creation of national educational and clinical models that have been emulated by leading universities and hospitals.

BETTY FERRELL, RN, PhD, is a research scientist at the City of Hope National Medical Center in California. She has devoted over thirty years to oncology nursing and research in the areas of quality of life, palliative care, and spiritual care. In 2007, Dr. Ferrell completed a master's degree in theology, ethics, and culture from Claremont Graduate University, and, in 2009, she and Dr. Puchalski led a national consensus conference on improving the quality of spiritual care in palliative care.

During the past fifteen years, there has been growing interest in and attention to spiritual care as a dimension of palliative care services. This book is based on a consensus conference and associated project activities built on nationally peer-reviewed guidelines that were developed by the National Consensus Project for Quality Palliative Care (NCP, 2004) and endorsed by key national palliative care organizations to provide spiritual care for seriously ill and dying patients.

While the NCP guidelines recognize spirituality as an essential dimension of palliative care, uniformity of spiritual care practice is lacking across health care settings. Barriers to standardized implementation include varying understandings and definitions of spirituality, lack of resources and practical tools, and limited professional education and training in spiritual care. The purpose of the consensus conference was to establish a common language and model for interdisciplinary spiritual care, identify resources and tools that have practical applications for health care settings, and develop recommendations that will advance the practice of spiritual care in palliative care settings. Achieving a consensus on spiritual care, both conceptually and pragmatically, requires engagement, deliberation, and dialogue among key stakeholders.

Conference participation was by invitation. Invitees included a representative sample of forty national leaders, encompassing physicians, nurses, psychologists, social workers, chaplains and clergy, other spiritual care providers, and health care administrators. Over the following months, a consensus document was revised yet again to incorporate the feedback from conference participants. The version of the document was sent to a panel of 150 expert reviewers for additional comments. While the focus of the conference was on palliative care, because palliative care is defined from the time someone is diagnosed with a serious illness, the material in this book is applicable to most care across the life cycle. Support for this consensus document and consensus conference has been provided by the Archstone Foundation, a private grant-making organization whose mission is to prepare society for an aging population.

The goal of this document is to advance the practice of spiritual care and inform future policy and research efforts.