Spiritual Care: Improving our understanding of the spiritual dimension of illness and establishing an evidence base for spiritual care
Spirituality is a wider concept than religion, with religious, philosophical and secular forms of expression identifiable in modern societies – especially in the West. Spiritual care aims to support people struggling with questions related to meaning, purpose, and religious and/or non-religious beliefs and values. Spiritual care is a core component of palliative care, but one that is often neglected in clinical practice and research.
The Cicely Saunders Institute aims to contribute to research in this field through a multi-component programme of research led by Rev Dr Peter Speck and Dr Lucy Selman. Rev Dr Speck contributed to a recent Cochrane report on spiritual and religious interventions in the later stages of disease which identified a dearth of robust science in this area.
Central to our work in spiritual care research is Dr Selman’s PhD study of spiritual well-being and its measurement in sub-Saharan Africa, which has resulted in the following publications:
- Selman L, Speck P, Barfield R, Gysels M, Higginson IJ, Harding R. Holistic models for end of life care: establishing the place of culture. Progress in Palliative Care 2013, online first: http://dx.doi.org/10.1179/1743291X13Y.0000000063 – Reviews the neglect of spiritual care and cultural dimensions of care in previous models of holism and presents an alternative model.
- Selman L, Speck P, Gysels M, Agupio G, Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll T, Sebuyira Mpanga L, Ikin B, Higginson J I, Harding R. 'Peace' and 'life worthwhile' as measures of spiritual well-being in African palliative care: a mixed-methods study, Health and Quality of Life Outcomes 2013, Jun 10;11(1):94. – Explores the use of the ‘peace’ and ‘life worthwhile’ items of the APCA African POS and their relation to the Spirit 8 measure of spiritual well-being.
- Selman L, Siegert R, Higginson IJ. , Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll T, Mpanga Sebuyira L, Ikin B, Harding R. The “Spirit 8” successfully captured spiritual wellbeing in African palliative care: factor and Rasch analysis, Journal of Clinical Epidemiology 2012, 65(4): 434-43. – Explores the construct validity of the Spirit 8 measure and establishes its utility in African palliative care contexts.
- Selman L, Harding R, Gysels M, Speck P, Higginson IJ.. Journal of Pain and Symptom Management 2011, Apr;41(4):728-53. – The first comprehensive, systematic review of all measures containing spiritual items used in palliative care populations, examining the conceptual content of those tools validated cross-culturally.
- Selman L, Siegert R, Harding R, Gysels M, Speck P, Higginson IJ. A psychometric evaluation of measures of spirituality validated in culturally diverse palliative care populations. Journal of Pain and Symptom Management 2011, Oct 42(4): 604-622 – Psychometric evaluation of tools identified in the systematic review as cross-culturally validated.
In November 2009, the Department of Palliative Care held the first Sir Halley Stewart Trust Symposium on spiritual care, which led to the publication of the report Spiritual care recommendations for Black and minority ethnic groups receiving palliative care in the UK.
In September 2010, this was followed up by Recommendations for spiritual care for people receiving palliative care in sub-Saharan Africa, a collaboration with spiritual care experts across Africa. These recommendations have been referenced by the Department of Health and the African Palliative Care Association, and Dr Selman also contributed to the UK Department of Health’s eLearning module on spiritual care in end of life care https://portal.e-lfh.org.uk/Component/Details/364896
The EAPC Spiritual Care Taskforce was founded in 2010 with the aim of furthering spiritual care in palliative care in Europe. Dr Selman has been co-chair of the Research sub-group of the Taskforce since 2011. In this role she led an international survey (n=971) of palliative care clinicians’ and researchers’ research priorities in spiritual care (Selman et al., 13th World Congress of the European Association for Palliative Care, Prague 2013. European Journal Palliative Care, Abstract FC 12.4; publication currently under review). With continued support from the Sir Halley Stewart Trust and building on this work, an expert meeting on spiritual care was held at the CSI in October 2012 to work on specific areas for future research in spiritual care.
Dr Selman is currently leading InSpirit, an international focus group study to explore patients’ and caregivers’ experiences of and preferences regarding spiritual care, funded by the Sir Halley Stewart Trust.
Our work in spiritual care also intersects closely with our growing theme of research into culture and ethnicity, in which spirituality and religion have been identified as central to the ways people locate meaning in advanced disease, such as cancer. Dr Koffman and colleagues’ work has found that spiritual and religious resources enable some people to cope more effectively with the physical and psychological vicissitudes of their illness.
The following publications are a result of this work:
- Koffman J, Morgan M, Edmonds P, Speck P, Siegert R, Higginson I.J. Meanings of happiness among two ethnic groups living with advanced cancer in south London: A qualitative study. Psycho-Oncology 2013;22:1096-1103.
- Koffman J, Morgan M, Edmonds P, Speck P, Higginson I.J. "I know he controls cancer" The meanings of religion among Black Caribbean and White British patients with advanced cancer, Social Science & Medicine 2008;67:780-789.
- Koffman J, Morgan M, Edmonds P, Speck P, Higginson I.J. Cultural meanings of pain: a qualitative study of Black Caribbean and White British patients with advanced cancer, Palliative Medicine 2008;22:349-359.
Tel: 0207 848 5566
Note: in 2013-2014 Dr Selman is on secondment to the University of California, San Francisco.