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In Reply to Salander and Hamberg

Puchalski, Christina M. MD; Blatt, Benjamin MD; Handzo, George MDiv

doi: 10.1097/ACM.0000000000000498
Letters to the Editor
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SDC

Professor, Medicine and Health Sciences, George Washington School of Medicine, and director, George Washington Institute for Spirituality and Health, Washington, DC; cpuchals@gwu.edu.

Professor of medicine and medical director, Clinical Learning and Simulation Skills (CLASS) Center, George Washington School of Medicine, Washington, DC.

Director, Health Services, Research and Quality, HealthCare Chaplaincy Network, New York, New York.

Disclosures: None reported.

The authors question the broad definition of spirituality and whether spirituality and health is a new field. We would assert that, although there is some overlap between spirituality, humanistic practice, and other related concepts in health care, there are important distinctions.

The definition of spirituality used in clinical care and in medical education is intentionally broad to be inclusive of the diverse ways people understand transcendent meaning in their lives. In several consensus conferences, experts in clinical care and medical education agreed that spirituality is an essential aspect of humanity and that spirituality encompasses individuals’ “search for meaning and purpose and their connectedness to others, self, nature, and the significant or sacred”; it embraces secular, humanist, and philosophical, as well as religious and cultural beliefs.1

Definitions of humanistic practice similarly are broad. The Gold Foundation definition is “infusing and sustaining our healthcare system with a culture of compassion, caring, and respect for patients and practitioners … [practicing] patient-centered care by modeling the qualities of integrity, excellence, compassion, altruism, respect, and empathy.”2

Clearly there is considerable overlap between the definitions of humanism and spirituality. This is not surprising since both share a common goal: the provision of compassionate care. Humanistic practice and spirituality in health, however, are also different. Humanistic care addresses patients’ biopsychosocial concerns and values any other concerns important to the patient. Spirituality in health care focuses more on the inner life of the patient, the deeper aspects of what gives patients’ (and practitioners’) lives meaning and connectedness. Spirituality in health care also distinguishes itself by creating clinical teams, which include specialist spiritual care professionals such as certified chaplains, who define their work in keeping with the broad definition of spirituality to include all patients—religious, atheist, secular humanistic, and others.

Major health care organizations have endorsed the special role of spirituality and health in addressing the deeper aspects of patients’ inner lives. Within palliative care, for example, spirituality is a required domain of care and an equal aspect of the biopsychosocial and spiritual model of care.3,4 The Joint Commission, which accredits most U.S. acute care hospitals, requires that all patients be asked about spiritual or religious issues and that hospitals assess and reassess patients for spiritual distress.5

We believe the scholarly and clinical advances that have contributed to the creation of this new field are making a significant impact in the provision of compassionate, whole-person care. The beginnings of the field of spirituality and health have allowed the scientific inquiry and discourse that will lead to more specific definitions, tested screening and assessment tools, and taxonomies and treatment protocols for spiritual distress.

Christina M. Puchalski, MD

Professor, Medicine and Health Sciences, George Washington School of Medicine, and director, George Washington Institute for Spirituality and Health, Washington, DC; cpuchals@gwu.edu.

Benjamin Blatt, MD

Professor of medicine and medical director, Clinical Learning and Simulation Skills (CLASS) Center, George Washington School of Medicine, Washington, DC.

George Handzo, MDiv

Director, Health Services, Research and Quality, HealthCare Chaplaincy Network, New York, New York.

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References

1. Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. J Palliat Med. 2009;12:885–904
2. Gold A, Gold S. Humanism in medicine from the perspective of the Arnold Gold Foundation: Challenges to maintaining the care in health care. J Child Neurol. 2006;21:546–549
3. National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 3rd ed. 2013. www.nationalconsensusproject.org/Guidelines_Download2.aspx. Accessed August 1, 2014
4. National Comprehensive Cancer Network. NCCN Guidelines for Supportive Care: Distress Management. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed August 1, 2014. [Login required to access guidelines.]
5. Joint Commission. Comprehensive Accreditation Manual for Hospitals, Standard PC.01.02.02. Washington, DC Joint Commission; 2013
© 2014 by the Association of American Medical Colleges