In July, I had the great privilege of attending and presenting at the 7th Annual Spirituality and Health Summer Institute that was hosted in Washington, DC by the George Washington Institute for Spirituality and Health, aka “G-Wish." In contrast to a large conference, this institute was relatively small and intimate (approximately 65 participants and 20 presenters), allowing for much conversation. Participants came from all over the United States and the world (Canada, India, Africa, Australia, Switzerland, The Netherlands), which lent a fascinating perspective. The participants represented a variety of disciplines including physicians, nurses, chaplains, psychologists, educators, ethicists and social workers, working in various settings (hospitals, clinics, hospice, prison). There were very few social workers present and I was asked to encourage my social work colleagues to participate in future institutes because we are a missed voice at the table.

Among the many excellent presentations offered, there was a very engaging discussion by Margaret Mohrmann, MD, PhD, entitled “Why Is This Still So Hard? Resistance to Teaching About Spirituality (and Ethics).” She spoke eloquently and powerfully about the intersection among medicine, religion and ethics, and made the analogy that separating the three areas is like trying to separate the inseparable parts of a person—mind, body and spirit. Essentially, she stated, we are “one thing” and that to be “divided into parts” is just one of many conceptual models that has served to undermine our fundamental wholeness.

I was invited to speak about how I integrate spirituality into my oncology social work practice. I spoke briefly about my personal journey and how essential my spiritual connection and expression are in my life. I emphasized the importance of having a collaborative relationship with the team, especially the chaplains. It is important to acknowledge, however, that often, patients allow themselves to become vulnerable and open up about their spiritual concerns unexpectedly. Much of that hinges on timing and the “chemistry” between the patient and the particular health care provider. This speaks to the importance of each member of the team being able to address “the basics” of a spiritual screening (i.e., using a validated tool, such as the FICA [Puchalski & Romer, 2000], can help). As all members of the team are better able to identify spiritual concerns, it can lead not only to rich and deep conversations with patients but also to, I am certain, generate more referrals chaplaincy.

There was a strong emphasis on including spirituality in medical training. I recognize that social workers in health care do various things and, depending on the setting, may or may not have the expectation or time to explore a patient’s emotional or spiritual life. I spoke with one physician who told me that the social workers in his hospital work only on discharge planning and practical concerns and do not engage with patients around coping or exploring their worldview. I am not sure if this means that these social workers are not interested in that line of conversation but this physician was surprised when I suggested that he involve them in his program (an exciting partnership between medical residents and chaplain trainees). I believe that many social workers would grab opportunities to talk with patients about existential issues if they felt empowered to do so, even if only for a few minutes. I want to add that I am not placing a higher value on this type of conversation. Discussions about the more practical concerns are equally as important.

Given that there may be a higher demand for concrete interventions in the workplace, it is important for social workers to determine how they are nourished by their work in order to keep going and to prevent burnout. At the institute, we talked about the importance of having “sacred moments” with our patients (Kenneth Pargament, PhD, presented on this topic), both for the patient and the clinician. It is when we share moments of authentic vulnerability and interpersonal truth that the experience may feel transcendent for all involved. It is in those precious moments of connection, that we, as human beings, are seen and received by one another. I suggest that those are moments when we are made whole.

I am grateful to Dr. Christina Puchalski and Rev. George Handzo who led the institute and presented an informative overview of the history of the inclusion of spirituality in medicine. I left the institute feeling very excited and optimistic about the future of a more wholistic health care system. As interest grows in spirituality, there is an increasing need for interdisciplinary leadership in this area. We were taught that there is an expectation that every member of the team become a “spiritual care generalist,” meaning that we are each responsible for addressing a patient’s spiritual concerns, just as any one of us might address physical pain and suffering. That is, to care for the whole person. The chaplains on the team are the “spiritual care specialists,” upon whom we should call once a need has been identified and the patient is open to a visit. It is critical that we, as social workers, build partnerships with the chaplains. Together, we can achieve much more together than either discipline can achieve alone in supporting our patients in their healing. I strongly encourage my colleagues in oncology social work to attend future GWish events, as I am sure that our experience and perspective would be welcomed and valued in that forum.

Reference

Puchalski, C., & Romer, A. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3, 129-137.