key: cord-0050435-9uhzpjtk
authors: Ferrell, Betty R.; Handzo, George; Picchi, Tina; Puchalski, Christina; Rosa, William E.
title: Spiritual Care in the Global Sphere
date: 2020-09-21
journal: J Pain Symptom Manage
DOI: 10.1016/j.jpainsymman.2020.09.031
sha: d062e7b782af8dc8d03e6ad07bcfeee1d91c8d90
doc_id: 50435
cord_uid: 9uhzpjtk

nan

To the Editor,

We are grateful to Saad and De Medeiros from Brazil for their critically important comments on increased access to spiritual care. 1 They address key issues related to spiritual care delivery, specifically in the global sphere. As Saad and De Medeiros suggest, it is not only spiritual traditions, faiths, and customs that vary significantly by culture and context, but also the social dynamics informing how spiritual care is provided in various countries. COVID-19 has called clinicians across specialties and health systems to urgently consider how spiritual care is prioritized, valued, and integrated at generalist and specialist levels to promote whole-person palliation across the lifespan. 2, 3 High-quality interprofessional spiritual care in the 'age of pandemic' carries substantive implications for spiritual and existential wellbeing and the effective alleviation of serious healthrelated suffering, especially at the end of life and during bereavement. 4, 5 As the palliative care community continues to advance the importance of spiritual care integration, we should prioritize education for stakeholders and multisector partners accordingly to ensure clear understanding that spirituality encompasses many aspects of a person's inner life. Religiosity is not synonymous with but may be a component of spirituality and spiritual values for many patients. A global consensus-derived inclusive definition of spirituality describes it as a search for meaning, purpose, and transcendence and experience of a relationship to whatever is significant or sacred to a person. 6 To the point of Saad and De Medeiros, we concur that "[a]theists and agnostics may also have… beliefs and questions about meaning and purpose." 1 It is vital to emphasize spiritual care that is individualized for the human spirit at hand, free of labels or categorization. The goal is J o u r n a l P r e -p r o o f holistically supportive spiritual engagement of the person experiencing serious illness, whether or not they have an identified religious affiliation. Spiritual care that is inclusive, respectful, and honors the recipient as the expert navigator of their personal inner journey is imperative.

In 2014, the World Health Organization (WHO) called for the strengthening of palliative care as a component of comprehensive care throughout the life course. 7 Repeatedly throughout the document, 7 the WHO acknowledges interprofessional spiritual care as vital to palliative care, in addition to physical and psychosocial care. They note that palliative care -including spiritual care -is an ethical responsibility of all health systems and health professionals.

The Lancet Commission on Global Access to Palliative Care and Pain Relief later focused on quantifying the worldwide burden of serious health-related suffering in terms of physical and psychological symptoms that could be strategically mitigated using an "Essential

Package" accessible to all, particularly those in low-and middle-income countries. 8 The commission articulated the importance of spiritual care but also the difficulty in measuring and conceptualizing spiritual challenges. Further research will be needed to provide evidence that demonstrates the value of spiritual care as it relates to both outcomes and cost.

Dr. Frank Ostaseski reminds us: "In life-transforming moments such as dying… we have a sense of looking into the vast unnamable… Each taste of this experience expands our love and draws us further toward the endless, inexhaustible mystery of being. 9 Of course, such moments are possible not only at the end of life but at an infinite number of points along the illnesswellness spectrum of living and dying. This realization is just one universal concept that is honored through the provision of quality spiritual care beyond boundary, border, and system.

J o u r n a l P r e -p r o o f

Should spiritual care be covered by healthcare insurance and health systems?

The Urgency of Spiritual Care: COVID-19 and the Critical Need for Whole-Person Palliation

Interprofessional spiritual care in the time of COVID-19 -Briefing Note. Global Palliative Care and COVID-19 Series

Fostering Existential Maturity to Manage Terror in a Pandemic

The alleviation of suffering during the COVID-19 pandemic

Improving the spiritual dimension of whole person care: reaching national and international consensus

WHA resolution 67.19: Strengthening of palliative care as a component of comprehensive care throughout the life course

Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report

The Five Invitations: Discovering What Death Can Teach Us About Living Fully