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Chaplains play important part of integrated palliative care

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Knowledge about culture is key

One reason chaplains are such a key part of the palliative care team is that they are seen by patients from a different perspective, Dr. Gurprit S. Lamba said. “Chaplains lend their ears, act as friends, and provide company to these patients,” Dr. Lamba said in an interview. “Discussing spiritual/religious matters helps these individuals cope better. Chaplains can provide more meaningful services with knowledge about different cultures, doctrines, and traditions, so that they can tailor their meetings accordingly.

“Studies have shown that psychiatrists are less religious and show less religious affiliation than their patients and than the population in general. As Dr. Dunn mentioned, chaplaincy programs for atheists also exist. Psychiatrists, with chaplains, can work with any individual to improve and optimize treatment. The critical part lies in assessment of patients’ religious views and spirituality along with their families’ opinions before offering meeting with chaplains.”

Dr. Lamba is a geriatric psychiatrist affiliated with BayRidge Hospital in Lynn, Mass.


 

EXPERT ANALYSIS FROM AAGP 2016

References

Using a variety of validated palliative care scales, such as the Edmonton Symptom Assessment Syndrome (ESAS) for physical complaints, the Center for Epidemiologic Studies Short Depression Scale, the Mini Mental Adjustment to Cancer scale (Mini-MAC), and the positive and negative RCOPE questionnaire for religious coping, among other scales, Dr. Dunn and her associates found that the change in baseline of overall spiritual health after intervention from the chaplain improved slightly in most measures. Mean baseline scores for the ESAS went from 25 to 24.4 post-intervention. The difference between baseline depression scores fell from 4.2 to 4.1.

Mini-MAC scores improved, particularly in “fighting spirit” and levels of fatalism (P = .084 and P = .036, respectively). In addition, maladaptive coping skills also improved (P = .018).The findings have helped Dr. Dunn in her work as a geriatric psychiatrist, especially when treating cancer patients, or in settings where there is not as much time for a full clinical assessment. “I think of patients in terms of their core needs and what I can do right now to help patients meet those needs.” Dr. Dunn cited, as an example, patients who feel like they don’t belong and are lonely. “If they’re in an assisted living home, can I get them to enter [the communal space]? That’s very different than thinking of them in terms only of depression.”

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