How to partner with your faith community

Help in meeting spiritual needs

Jeanne S. Twohig, MPA, senior advisor, Duke Institute on Care at the End of Life, unabashedly asserted that there is a crisis in our country as to the quality of the vision for our health care futures.

Twohig, who noted the Durham, NC-based institute with which she is affiliated is housed in the divinity school vs. the medical school at Duke University, is a program developer focused on how to build better systems and better delivery of spiritual care. The goal is to design more rigorous systems as health care facilities strive to offer quality palliative care to patients.

Twohig, speaking at the National Hospice and Palliative Care Organization's (NHPCO) 11th Clinical Team Conference and Pediatric Intensive, noted that there are now 77 million baby boomers, or those born between 1946 and 1964, with the oldest boomers at 64 and the youngest at 46.

"Our country is getting older," noted Twohig, who explained that it is the "oldest of the old" demographic group that is growing at the most rapid pace. For example, she noted that in 2000 there were 85,000 centenarians, but by 2050, it is projected that there will be 850,000 centenarians.

Another aspect of the aging is that women typically outlive their companions, leading to the question of who will care for the traditional caregivers. Fewer people will be contributing to Social Security, she said, which leads to the question, "Who is going to care for us, and how is it that we want to be cared for?"

What patients want at EOL

Twohig referenced the 2000 study in The Journal of the American Medical Association by another Duke researcher, Steinhauser et al, regarding the "attributes rated as important by more than 70% of patients but not physicians," which included:

• "be mentally aware;

• "be at peace with God;

• "not be a burden to family;

• "be able to help others;

• "pray;

• "have funeral arrangements planned;

• "not be a burden to society;

• "feel one's life is complete."1

According to Twohig, "Faith communities are natural allies, and providers of palliative care need alliances with community spiritual providers." Such alliances are a well-organized way to engage with a community as a whole, she said.

Spirituality is important to people, Twohig said, although we live in what is largely a medicalized society, or what she calls the DMZ, or the "divinity-medical zone." She noted that there are many cultural issues associated with this DMZ, as well as "tremendous" role confusion, since physicians historically have not been trained in meeting spiritual needs. Even now, courses on spiritual care are not routinely taught in the divinity school or the medical schools, Twohig says.

Other challenges to providing quality spiritual care include quality "measurement issues" and a "fragmented notion of what spirituality is," she said.

Twohig said her goal is to develop new ways to meet the spiritual needs of this "tsunami of baby boomers" that is coming, to rethink the ways to provide care, because "the way we are doing it is insufficient." And because, she said, "boomers are not quiet about getting their needs met," there is likely to be a coming demand for better spiritual care.

The recommendations from the February 2009 Consensus Conference on Improving the Quality of Spiritual Care as a Dimension of Palliative Care include the suggestion that spirituality should be considered a "vital sign," just like any other physical vital sign. "That gets at the question: 'Are you at peace?'" Twohig said.

Another target for improving the quality of spiritual care is at the point the discharge plan is developed, she said. Twohig asks, if the patient has had spiritual care as an inpatient, how can that plan of care be carried to the outpatient setting? Futhermore, she asked, what is a way to unite the inpatient and outpatient delivery systems and the community?

The answer might be found with the faith community, or community religious and spiritual leaders. Twohig said that some of the reasons hospices and palliative care teams should reach out to the faith community in their areas is answered by the fact that eight out of 10 people identify with a particular faith community. A faith community is a naturally occurring community, she said, and there is often good communication within such networks.

"Faith leaders need the skills that hospices have," because while community clergy tend to be comfortable with formal rituals, i.e., delivering the funeral sermon, they are not as comfortable with the "end-of-life conversations," Twohig said.

There is an opportunity to leverage what hospice now offers by linking with the faith community, she said.

"Hospice is a movement as much as a type of health care delivery . . .The power of one becomes exponential in all this," Twohig said.

With the growing immigrant community in the United States, there are times when a patient might not choose to share with a hospital chaplain. With the changing face of America, there might be some belief systems that "may not yet have been embraced by chaplaincy," she said.

The point of reaching out to the faith community in a hospice/palliative care service area is this, she said: "What it is really about is embracing that patient."


1. Steinhauser KE, et al. Factors considered important at the end of life by patients, families, physicians, and other care providers. JAMA 2000;284:2476-2482.