Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Public Health research institute, Amsterdam, The Netherlands.
Spiritual caregiver, Dijklander Hospital, Hoorn and Purmerend, The Netherlands.
BMC Palliat Care. 2019 Nov 9;18(1):98. doi: 10.1186/s12904-019-0484-8.
Spiritual care is an important aspect of palliative care. In the Netherlands, general practitioners and district nurses play a leading role in palliative care in the primary care setting. When they are unable to provide adequate spiritual care to their patient, they can refer to spiritual caregivers. This study aimed to provide an overview of the practice of spiritual caregivers in the primary care setting, and to investigate, from their own perspective, the reasons why spiritual caregivers are infrequently involved in palliative care and what is needed to improve this.
Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 31 spiritual caregivers, followed by an online focus group with 9 spiritual caregivers, analysed through open coding.
Spiritual caregivers provide care for existential, relational and religious issues, and the emotions related to these issues. Aspects of spiritual care in practice include helping patients find meaning, acceptance or reconciliation, paying attention to the spiritual issues of relatives of the patient, and helping them all to say farewell. Besides spiritual issues, spiritual caregivers also discuss topics related to medical care with patients and relatives, such as treatment wishes and options. Spiritual caregivers also mentioned barriers and facilitators for the provision of spiritual care, such as communication with other healthcare providers, having a relationship of trust and structural funding.. In the online focus group, local multidisciplinary meetings were suggested as ideal opportunities to familiarize other healthcare providers with spirituality and promote spiritual caregivers' services. Also, structural funding for spiritual caregivers in the primary care setting should be organized.
Spiritual caregivers provide broad spiritual care at the end of life, and discuss many different topics beside spiritual issues with patients in the palliative phase, supporting them when making medical end-of-life decisions. Spiritual care in the primary care setting may be improved by better cooperation between spiritual caregiver and other healthcare providers, through improved education in spiritual care and better promotion of spiritual caregivers' services.
精神关怀是姑息治疗的一个重要方面。在荷兰，全科医生和地区护士在初级保健环境中在姑息治疗中发挥主导作用。当他们无法为患者提供充分的精神关怀时，他们可以向精神关怀者寻求帮助。本研究旨在概述精神关怀者在初级保健环境中的实践，并从他们自己的角度探讨精神关怀者为何很少参与姑息治疗，以及需要做些什么来改善这种情况。
采用顺序混合方法，由 31 名精神关怀者在线填写包含结构化和开放式问题的问卷，随后由 9 名精神关怀者在线参加焦点小组讨论，通过开放式编码进行分析。
精神关怀者提供有关存在、关系和宗教问题以及与这些问题相关的情感的关怀。实践中的精神关怀方面包括帮助患者寻找意义、接受或和解、关注患者亲属的精神问题并帮助他们所有人道别。除了精神问题外，精神关怀者还与患者和亲属讨论与医疗相关的话题，如治疗意愿和选择。精神关怀者还提到了提供精神关怀的障碍和促进因素，如与其他医疗保健提供者的沟通、建立信任关系和结构性资金。在线焦点小组中，建议在当地多学科会议上熟悉其他医疗保健提供者的精神问题，并促进精神关怀者的服务，这是理想的机会。此外，还应为初级保健环境中的精神关怀者提供结构性资金。
精神关怀者在生命末期提供广泛的精神关怀，并在姑息阶段与患者讨论许多不同的话题，在做出医疗临终决策时为他们提供支持。通过改善精神关怀教育和更好地推广精神关怀者的服务，改善精神关怀者与其他医疗保健提供者之间的合作，可以改善初级保健环境中的精神关怀。
