Time Stamps

• 00:01 What is spirituality?
• 7:12 Why does spirituality matter?
• 12:03 How do we screen for it?
• 18:45 Chaplains
• 27:45 Conclusion

Show Notes

1. What is spirituality? 
   • Consensus definition (Puchalski et al., “Improving the Quality of Spiritual Care as a Dimension of Palliative Care”, Journal Palliative Medicine, 2009):
     “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” 
   • Spirituality vs Religion:
     1. Religion: Particular system of faith and worship, defined by specific practices, traditions, prayers and texts
     2. Spirituality is a universal trait of humanity. It is much more than religion, and can involve many other expressions of purpose and meaning; e.g., family, hobbies, veterans groups, volunteer work.
     3. Growing numbers of people in the United States are identifying as spiritual rather than religious, even as many as 60% in some surveys. 
2. Why does spirituality matter? 
   • Whole person care:  Asking about spirituality gets to the patient’s core values and identity, things that matter to them. It helps us build rapport and can reveal important aspects of a patient’s cultural heritage. 
   • Many patients want to discuss it:   In a survey of >1000 patients in 2011, 41% of patients wanted to speak about their religious or spiritual concerns, but only half got the chance.
   • Spiritual distress: “Impaired ability to experience and integrate purpose and meaning with life circumstances.”
     1. Occurs frequently with serious illness, trying to make sense of tragedy.
     2. Can have a major impact on a patient’s mental and physical health; associated with worse wellbeing, pain, anxiety, and depression.
   • Studies have shown that spirituality and religious involvement can be associated with improved ability to cope with illness and that supporting a patient’s spiritual needs can be a factor in facilitating clinical recovery.
   • It can also have a major impact on end-of-life care—and how we as clinicians support patients spiritually during that process makes a difference.
3. How do we screen for it? 
   • FICA tool
     1. Faith, Belief, Meaning: Determine whether or not the patient identifies with a particular belief system or spirituality at all.
     2. Importance or Influence: Understand the importance of spirituality in the patient’s life and the influence on health care decisions.
     3. Community: Find out if the patient is part of a religious or spiritual community, or if they rely on their community for support.
     4. Address/Assessment: Learn how to address spiritual issues with regards to caring for the patient
   • One question screener:
     1. “Do you have pain in the soul?”
        • Think of it like an additional item in your Review of Systems!
4. Chaplains 
   • Who are chaplains?
     1. “A Professional Healthcare Chaplain is a theologically educated, pastorally experienced, and clinically trained minister who is certified by a professional chaplaincy organization and serves as an integral member of the healthcare team. The chaplain’s primary role is to provide spiritual/pastoral care to patients/residents, their family members, and the medical staff. In addition, professional chaplaincy care provides emotional, religious, and ethical care.” (Source of quotation: https://www.hcmachaplains.com/)
   • Referral process
     1. Hospitals are required to have chaplains, and you can consult them directly or through the palliative care service. 
     2. For outpatient clinicians, reach out to the Healthcare Chaplains Ministry Association or ACPE, the Association for Clinical Pastoral Education 
     3. Example of intervention
5. Conclusion 
   • Dr. Kang: Attending to the spiritual health of our patients may have positive effects on our own spiritual health 
   • Like other social determinants of health, spirituality can have a major impact, and merits attention, screening, and referral.

Transcript

I. What is spirituality?

Flores: I, I was speaking with both of the daughters in the midst of this family meeting if your choice is to decide a plan of care that ultimately leads to a lesser time to be with your mom, a shortened life, but that we were gonna minimize her suffering, that we weren’t gonna hasten death, but we were gonna minimize her suffering. Then I think it’s a holy choice, for us to pursue. And that’s what really guided them to, to make her comfort care. 

Jafar: A holy choice. Wow. Not something I would ever consider saying in a family meeting, but coming from a presbyterian minister those are some pretty powerful words. And those of the words of Reverend Ariel Flores, a chaplain with the UCLA palliative care program in Los Angeles. He’s here with us today to discuss the role of spirituality and religion in healthcare. We’ll start off by defining just what spirituality is, how it differs from religion, why it’s so important, and how we can support it as clinicians. We’ll discuss screening tools, the role of chaplaincy, and some stories about the impact it can have in clinical care. Welcome back to At the Bedside, I’m Jafar.

Tamar: I’m Tamar.

Margot: And I’m Margot.

Jafar: We’re grateful to be joined today by one of the legends in the field of spirituality & healthcare, Dr. Christina Puchalski. She is an internist and professor of medicine at George Washington, and is the director and founder of the George Washington University’s Institute for Spirituality and Health. Her path to spirituality in medicine started well before medical school. 

Puchalski: I remember, being really struck by people who had, advanced, you know, joint disease people, one person in particular was an artist and his hands were really mangled. And, um, I just was listening to his story. And from my perspective, at that time young person, it seemed tragic and hopeless to me. That’s not at all where this person was. He was full of life and he had managed to transcend his disability. He had managed to, paint in a different way. And, you know, it, it really impressed me and it impressed me that he had so much joy and meaning in his life. And, and so that, that’s where I began to think about how we may box people into these, into their diagnoses. You know, when you read a diagnosis on a chart and you go in and that’s what you’re focusing on, that this is patient with acute leukemia, or this is patient with dementia, or, and, you know, they, people are much more than their diagnosis. And I, I, I really learned that from that experience. People who tended to be able to stay out of the hospital were people who had good social connections. And I noticed really their spiritual lives were important. They maybe were connected to a faith community, or they just had this sense of inner peace. 

Jafar:  Also with us is Dr. Irene Kang, a breast oncologist at USC Norris Comprehensive Cancer Center. She describes her own path to spirituality, not just from being raised Christian, but from a significant experience she endured with her family:

Kang: Actually lost my little sister in a car accident and, uh, so totally out of the blue, you know, like we talk about different ways of like losing people and it was just like one of those like sudden. And my brother who was 12 at the time was in a coma from the car accident and intubated, sedated in the pediatric ICU up in Oakland. Was not supposed to wake up. Like all the doctors were telling us, he’s probably gonna be a vegetable at the best and, you know, pediatrics, you never know they’re like neuroplasticity and all that. And so 30 days later he opened his eyes and then slowly over the course of weeks to months, he learned to walk again and talk again. And so, you know, needless to say our family was in and outta the hospital quite a bit. And I think part of just how medicine stepped in to be there for us, but also how like awful that period of time was, I think made such an impression on me. And so definitely was part of why I got into medicine and then was also, um, I think made an impact on how I viewed the world spiritually as well during that time.

Jafar: Ok, first, we need to get a definition on the table for what exactly we mean by spirituality. 

Puchalski: Everybody has a spirit. Everybody has some sense of meaning and purpose and some understanding of transcendence, which is a tough word for people. So something greater than ourselves, however we understand that…. could be family, it could be nature, could be, you know, the purpose that we find that we have on our life here on earth, it could be religion. It could be God, it could be however people, the divine, there are many words that people put on that, but that is something we all share and where some of the conflict comes in is around the words like my spirituality is different from yours. Every a spirituality is different from everyone else’s because we’re unique. So, um, it’s our inner life. It’s our deep inner life. So the formal definition, it’s how people search for meaning, purpose, and transcendence. That’s, that’s what spirituality is. It’s that search, We’re constantly searching and deepening that understanding of what gives us meaning and purpose and what is that transcendence for us. And that’s what our patients are going through.

Jafar: So these are things most people can recognize in their lives, even if it’s not formally named as such. And this is often where a lot of people get hung up on this topic, anchoring spirituality as religiosity, but the two are not the identical.

Flores: There is a distinction between, um, somebody who considers themselves religious and then someone who considers themselves spiritual. Religious is somebody who really expresses their, their spirituality, and their identification with a particular, religion, particular faith practice. Whereas spirituality. A lot of times when I meet, um, our patients who wouldn’t consider themselves religious, but would consider to consider themselves spiritual, uh, their hobbies of spending time, gardening, maybe it’s their volunteer work. Maybe it’s the hobbies that they had being part of these classic car rebuild groups. These are just some of the examples of patients that I have come across. They find this deep connection. This inherent meaning that they find by participating in these community groups, it could be relationships, connection, hope, maybe connection to a divine, or say something that they consider sacred, would, I would identify as spirituality.

Jafar: So, bottom line:  Don’t think that just because someone isn’t religious that they aren’t spiritual. In fact, growing numbers of people in the United States are identifying as spiritual rather than religious, even as many as 60% in some surveys.  Spirituality is a universal trait of humanity, and all of us have some sense of it in our lives, even if it’s not channeled into a specific faith practice or tradition. Spirituality addresses some of the most powerful and prevalent human needs—needs that can be threatened by illness in ways that we as clinicians can appreciate. And so with that, I’ll hand it over to Tamar to talk about the impact of spirituality on clinical care.

II. Why does spirituality matter? 

Tamar: So how does a patient’s spirituality matter in their care, and how can we, as clinicians, incorporate it into what we offer to our patients? Dr. Puchalski frames it as a crucial component of taking care of the patient as a whole person:

Puchalski: We’re really trying to understand what’s what matters most to the patient in terms of their inner life, their spiritual life. And we, we find out a lot, you know, those questions open up to a lot of different answers. It, you know, for example of what people talk about, the importance of family, and, you know, they’re just dealing with a loss of their family member. I mean, that, that, that tells you that that’s really, uh, important part, or they have a conflict. This is a person who, you know, loves their family. Now they have a conflict, you know, it, it’s about finding out more about who the person is. 

Tamar: Studies have shown that spirituality and religious involvement can be associated with improved ability to cope with illness and that supporting a patient’s spiritual needs can be a factor in facilitating clinical recovery and many patients are seeking to be supported in this way. For example, a survey of over one thousand inpatients in 2011 found that 41% wanted to speak about their religious or spiritual concerns, but only half of these patients had the chance to discuss them. Asking about a patient’s spirituality brings up many sensitive, but critical aspects of their personhood.

Puchalski: So part of earning the trust is being respectful and trying to understand who that person is and giving them a chance to, to share that, you know, if we ask about, um, anything about that person, you know, their cultural background might come up, they’re who they are. What’s important, what matters most. These are things that, you know, we, we have to build rapport. And part of that is being respectful and understanding everything that matters to that person, including their inner life and their spirituality.

Tamar: And once we recognize it as a large part of a patient’s identity, the next step is realizing that health and illness can have a big impact on the spiritual part of a person’s life, causing “spiritual distress.”

Kang: You see people, especially in hospital settings, just kind of feeling like they’ve hit rock bottom, they’re so sick or they feel alone, especially in the hospital. Um, there’s a lot of loss of hope. 

Puchalski: My faith is telling me, you know, that I’ve done everything, I’ve done everything, right. I’ve lived a good life and now I’m really suffering. You know, why would God do this to me? And that is also a bigger question of why me, you know, I just survived this or I, the chemo worked or whatever treatment worked, and I thought I was doing really well. Why now, why all of a sudden, is it metastatic? You know, and that’s a, that’s a question about the physical disease, but deep down, if you explore it, it’s basically why me, why now? 

Tamar: In patients with chronic or life-threatening illness, increased self-reported spiritual distress has been associated with increased severity of physical and psychosocial symptoms. 

And it also has an effect on end-of-life decision-making. In a multisite study of over 300 advanced cancer patients, the authors found patients who received high spiritual support from their religious communities were more likely to receive aggressive care at the end of life and to die in the ICU. But among this group, patients who got spiritual support from their clinical team underwent fewer aggressive end-of-life interventions and were more likely to use hospice – highlighting the important role we can play in helping patients navigate spirituality and health.

Reverend Flores echoed Drs. Kang and Puchalski in speaking about how he identifies spiritual distress in patients. 

Flores: A lot of the times that the signs that I, I try to look for, or I, um, asked the team to look for is when they start asking the why questions, uh, it doesn’t have to necessarily be of a, of a person of a particular faith. Um, it’s anybody who asks like the questions, like, why me, uh, why now, what did I do to deserve this? Um, what is the purpose of, of this? Um, even those with, uh, a particular faith practice who start asking these questions, sometimes you can hear, can I be forgiven? Um, they start asking what is the hope that I have in all of this? And so those are kind of the signs that I look for, um, that I can see that somebody is encountering spiritual distress. 

And those are the kind of the moments that I would really like to spend my time, uh, and processing with our patients and even their family members at bedside to really, um, go behind what those, uh, the questions, because sometimes there’s value in, in, in existential pain. 

Tamar: So supporting patients’ spiritual health is an important way to better understand them, to build rapport, and to support their physical health as well. With that in mind, Jafar will take us through an accessible approach for assessing spiritual health and distress. 

With that in mind, Jafar will take us through an accessible approach for assessing spiritual health and distress.  

III. How do we screen for it?

Jafar: So how do you actually get into talking about this with patients? It can feel like we’re plunging into a big theological discussion, but we should think about this like we do any part of a patient’s health—using validated screening tools to help guide the interview. Dr. Puchalski created one such tool to help us break down the discussion of spirituality into four key elements, all contained within the mnemonic “FICA”, which stands for “FAITH”, “IMPORTANCE”, “COMMUNITY”, and “ASSESSMENT”. So let’s start with how we ask about faith:

Puchalski: Do you consider yourself spiritual? And I would say that 95% of the time, especially these days, patients understand that they understand, even if they say, I don’t really use that word, or do you mean religious? And then I’ll say, well, it can be religion. It can be something nonreligious, however you understand that word. Oh, okay. I get it. Well, I believe blah, blah, blah. You know? Um, but some people will just say, no, I’m not spiritual. That that’s just not a place where, you know, I, I relate to that. So I always go to that second question within the F, which is meaning. So, um, well, what would you say give your, your life meaning, and that often triggers the, the sort of that deep, deep meaning within people. And many times people say, oh, well, when you’re talking about that, yeah. I guess, you know, I do consider myself spiritual because X or this is what gives me meaning

Jafar : Once you get a sense of their beliefs, the next step is to bring it into the clinical situation, and this is where the next letter “I” in FICA comes in.

Puchalski: The “I” is importance and influence. So it’s listening to, or asking how important it is in a person’s life. And then, you know, does it affect anything about what’s going on with them? You wanna contextualize it to the visit. So if you’re breaking bad news to someone, you know, how is this impacting you right now in the context of what is going on? You’re, you know, being treated for cancer, whatever, you know? Um, but I, if, if it’s a well visit and I, I have patients of all ages too, and it’s not necessarily only serious and chronic illness, I, um, many people you know, just asking, is this something that affects the way you care for yourself or your health or decisions you might make around your health? And so people might have answers to that.

Jafar: Knowing what this means on a personal level, we then want to learn what their spirituality means on a more social level. This is the next thing we look at with “C”:

Puchalski: C has to do with community, which is that extrinsic aspect. Uh, and I ask about spiritual communities and it may be church, temple, mosque, et cetera. It could be like-minded friends, very often it’s family. Um, it might be the, the yoga group, the hiking group. So, um, again, thinking broadly about that community

Jafar: Asking about these communities can be a great way to understand some of the critical external supports in a patient’s life.

Kang: I think spiritual communities can be in, you know, found in a lot of different venues. Doesn’t have to be just with the church. But I think especially with, with a cancer diagnosis, this is one of the things that I love watching for a patient’s journey is seeing their community just galvanize behind them. And, um, people from all parts of their lives, rise to the occasion and stand up to help them. And so that can be often time it’s people from their faith community that rise up and help, you know, take care of the kids or help with meals and help bring them to appointments. Um, and these practical ways of what I’ll call showing love is, is such a beautiful thing to see.

Jafar: Finally, we’ll take all of what we learned in this conversation into the last part of FICA: 

Puchalski: And the last is A, which, when we first developed this in 1996, it’s how would you like me as your clinician, or as your doctor, uh, whatever role, um, to address these issues with you, would you like me to address them in, in what way, but over the years, we’ve broadened this to assessment and plans. So it’s also thinking as, as a conversation is going on, did you, or anything that sounds like spiritual distress and you presumably would, you know, explore that a little bit more. So the A is also in the final assessment and treatment plan. If we think about the whole person in treat, uh, assessment and treatment plan, you have what’s going on physically, emotionally, socially, and spiritually. And that’s where you would chart that.

 And, you know we, I don’t think we practice patient-centered care if we don’t include spiritual health in that.

Jafar: Even if you don’t have time to dive into the whole FICA history, you might just think of spirituality as one more dimension on your Review of Systems worth checking on, even if it’s just one question: 

Puchalski: So the full assessment is let’s put that to the side of the specialists, the spiritual care professionals do that, but we’re in the realm of screening and also history. So, um, Dr. Marvin Delgado has actually developed one question and he’s done some studying: “Do you have pain in the soul?” And, um, a lot of patients actually relate to that. I, I didn’t think they would because of the word soul being charged, but pain in the soul or the spirit, you know, how, and some people even use the word, how is your spirit? So there can be these one item questions that you can ask of a patient.  In general, Dr. Delgado has found that that’s really helpful that people might say, yeah, I, I do have a pain in, in the soul. And so then he goes to something like the FICA tool to explore that more. So that’s a, that’s a, a beginning way that with our patients, especially those with serious and chronic illness.

Jafar: There can actually be a lot other clues around spiritual distress that come out of the history taking:

Puchalski: So in the social history, I will ask the FICA tool and learn a little bit more and say, I find out that the person is religious. And if I explore it more, I know that they’re religious. So I might ask, you know, especially with what you’re going through right now, have you ever felt hopeless during this time or a sense of despair or, have your religious practices helped you now. And if someone says, no, actually they don’t. So that is another key for me that that should be a definitive chaplain referral

Jafar: When I started taking in these clues and asking the right questions, I actually started to see a lot of spiritual distress among many patients I take care of as an oncologist. And yeah, many of the people who benefit most from this screening are those with chronic, serious illness–people who are trying to make sense of difficult life circumstances. What it shows me is that these patients need more layers of help than I alone can provide, but thankfully there are resources out there—we only need to understand how and who to refer them to.

IV: Chaplains

Margot: Let’s talk about the experts you can turn to for help: chaplains. 

Flores: Chaplaincy is the bridge between medicine and ministry.

Margot: Certified clinical chaplains are people with theological training, pastoral experience, and clinical training. After completing a master’s degree at a school of theology, they are ordained by their faith group. They go on to complete about 2 years of clinical pastoral education and internship, then undergo formal certification with the Healthcare Ministry Association Board. It’s a rigorous and emotionally challenging training process, as Reverend Flores describes:

Flores: I would say that the, the biggest challenge was learning more about, uh, who I am as a, as a minister, dealing with life and death. Normally in the, in the church setting, you’re, you’re not dealing with too much death. It it’s a completely different type of ministry. but I do find it really rewarding and being in this setting and with the team and really hearing the, the, stories of our patients at bedside and to really, um, plumb the depths of, of their grief,  of their sorrow, their anxieties, and also trying to find hope in the midst of all of that.

Margot: So what is the role of a chaplain on an interdisciplinary team?

Flores: My role is to be that religious and spiritual, care provider on the team. And it, it’s not specifically focused on any particular denomination, any faith practice. We ask our patients who have maybe if they’re differing, uh, faith practice than my own, uh, like we like to ask, tell me more about how does your faith inform you? How does your faith guide you in these decision and healthcare decision making? If they’re seeking a specific, person within their faith practice, we have contacts, we coordinate with, uh, to get a rabbi to come to bedside, or even our Catholic patients, again, a specific Christian denomination that they want a priest to perform a, a specific sacrament that only priest can conduct. I’m unable to do that. So I wanna make sure I can assist our patients in meeting that specific need that they may have. 

Margot: If you’re in an inpatient setting, it should be fairly easy to involve a chaplain: Hospitals are required to have chaplains, and you can consult them directly or through the palliative care service. If you’re in an outpatient setting, you can reach out to ACPE, the Association for Clinical Pastoral Education – they can point you to chaplains in your community. Dr Pulchaski explains what a chaplaincy referral looks like:

Puchalski: When you do the spiritual history and you have, you have a differential, you know, I think this person is really you know, hopeless right now about their diagnosis. And, um, seems like they have a spiritual practice, but they’ve stopped doing it. It’s really hard for them to, to talk about it. They were very upset in the visit and going through a lot of difficult life changes. Now the chaplain takes that information and they interview the patient and they ask, you know, deeper questions.They have a different way of asking questions than we do. So they’ll explore more about their faith or their other types of beliefs, you know, listen to their whole story, want to learn more about their family or significant relationships. And they’ll, they’re really trained in contemplative listening. So they’re able to let the patient talk for a long time and they’re able to ask these questions to help that person uncover more of their spiritual journey or their spiritual issue.

Margot: Chaplains can be incredibly helpful for people looking for religious support at the bedside, but can also support people with spiritual distress who don’t have a specific religious background.

Flores: As a spiritual care provider, I always define my role as exploring meaning with our patients.  We want to really tackle, um, where are all of these distressing emotions are coming from these anxieties, these fears, the outrage, as they’re concerned with their autonomy, they’re concerned with their suffering.  And now we have a lot of patients in young, especially in oncology who are facing their mortality now. And they’re asking those questions, what is beyond this life? What will go on after I pass away, what is it that, that we can’t experience that they can’t find joy in anymore? Um, a lot of our patients who, uh, again, who used to be active and now because of this life-limiting, life threatening disease, they’re unable to engage and enjoy what they formally did prior to the hospitalization. And so there’s this lack of freedom, um, this lack of independence that they are now tackling.

Margot: I think one of the best ways to understand the work chaplains do, and the influence they can have, is to hear about their impact on individual patients and their families. Reverend Flores shared two stories that illustrate the work he and his colleagues do on a daily basis. The first story was of a patient who was dying in the ICU – the family was considering transitioning to comfort care, but wanted to make sure it wouldn’t go against their Catholic faith.

Flores: And so they look over to me and ask me, “Chaplain, what is your opinion?” In Catholic healthcare, the, the language that’s discussed there is that, um, disproportionate and extraordinary, um, treatments can be withdrawn if it’s causing more suffering. And in this case, if we were to continue on this plan of care, the patient would be enduring much suffering and just guiding them to really, um, have them process, uh, that their faith would allow them to make that decision of making their mom DNR, to pursue comfort care. 

Margot: Reverend Flores also shared a story of a family that was holding out for a miracle.

Flores: There was one patient that was in our ICU who, um, was dying with COVID. And she was a, a very young mom with young children and her husband because of his faith practice was really saying that God is going to heal her. You’re gonna see that, that this miracle is going to happen. And the palliative care team was brought in to kind of establish, uh, early goals, uh, with the, the husband. Within the few weeks we, we knew that her trajectory was not gonna be good. And because I had already built rapport with him, I, I really wanted to discuss more about, uh, what is it about miracles? What is it about his faith? That’s guiding his decision making. And in, in that, in those one-on-one conversations, he was just really scared of, of losing his wife and that his children were gonna have a Christmas without their mom. And that’s what he was really fearing. And he also felt that if he were to think any type of negativity, that i was the, the enemy  who was kind of causing him to doubt. And again, just guiding him really more about his theology to really, to really engage more with what he was hoping and what he was fearing. And to really affirm that, like I do hope that you get that miracle. I fear that you won’t be, you won’t get it. And that really started connecting with them. And then we had a family meeting with his pastor and several other family members, and to really lay it out that his wife was not going to survive. And I remember speaking with his pastor on this zoom call and she really was in favor of, we are playing God, you know, we should allow her to pass away because she is suffering. And that the medical team is not our enemy and that they’re really trying to help us and pro, and I remember speaking with the husband over the zoom call and saying that maybe this is what the miracle that you were hoping for is that you, along with your pastor, along with her family and your family are able to come together and come up with a way to ease her suffering and that, um, you, you would be able to all collectively be able to say goodbye, uh, to her.

And then the, the next few days they put her on comfort care and we were able to have him come to bedside when she passed away. 

Margot: Chaplains have the training and experience to connect with our patients in ways that may be challenging for those of us coming from more secular backgrounds, and can be an indispensable resource for patients and families going through some of the hardest times of their lives.

V. Conclusion

Jafar:  Spirituality can feel like a huge topic to take on with patients, but I hope our discussion today showed how impactful and medically relevant this topic can be, particularly those facing serious illness, regardless of their religious background or lack thereof. It can also have a big impact on those of us who support patients in their spiritual distress.

Kang: Yeah. I definitely think caring for patients as they struggle with some of the hardest things in life is incredibly meaningful. It’s an incredible privilege. And I think watching people go through that teaches me what’s important in life as they’re kind of deciding what’s important for their life. It’s a huge privilege to walk beside them in that. I think getting back to the idea of the act of giving is also simultaneously filling your own cup is very true, true in, in how I feel kind of attending to my patients spiritual needs actually affects my own spiritual needs and spiritual health.

Jafar: Spirituality is a universal expression of our humanity, and it’s a dimension of our health that can grow or suffer with the rest of our health. If we care about mental health and social determinants of health, all the other aspects of the patients’ world, we should care about this potentially critical aspect of their inner world, and there are screening tools and chaplaincy resources that are there for us when we do.

Tamar: Thanks for tuning in!  We know these topics can stir up more questions than answers, and we look forward to hearing more about your experiences with spirituality in Medicine. Please continue the conversation with us online at our Facebook page, on Twitter, or email us directly. Find show notes and contact information for us on our website: coreimpodcast.com

If you enjoyed listening to our show, please give us a review on iTunes or whichever podcast app you use; it helps other people find us.  We work really hard on these podcasts so we’d love to hear from you.  Let us know what we are doing right and how we can improve.  And as always opinions expressed in this podcast are our own and do not represent the opinions of any affiliated institutions. 

Finally, special thanks to all our collaborators on this episode, our wonderful audio editor Daksh Bhatia, our music editor Solon Kelleher, our illustrator Michael Shen, moral and executive support from Shreya Trivedi, and most importantly thanks to you, our listeners!

References

“ACPE.” ACPE: The Standard for Spiritual Care and Education, https://acpe.edu/. 

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