VNAA Blueprint for Excellence
PATHWAY TO BEST PRACTICES
Patient and Caregiver
Engagement:
Beliefs and Spirituality
VNAA Best Practice for Hospice and
Palliative Care
Beliefs and Spirituality
Patient/caregiver engagement is key to successful hospice outcomes.
Information sharing and support of patient/caregiver participation in
identifying Beliefs that impact decision making and the experience of
care are not only central to hospice philosophy but are now a part of
hospice quality reporting.
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Beliefs and Spirituality
Why Beliefs
• Spirituality has been associated with increased coping skills and
better quality of life at the end of life (Vallurupalli, 2012).
• Spiritual support has been shown to reduce suffering (Chochinov,
2005; NCP, 2013).
• National Consensus Project for Quality Palliative Care recognizes
the importance of spiritual care. (NCP 2013).
• CMS now requires hospices to initiate a discussion with patients or
caregivers about spiritual beliefs/existential concerns within five
days of admission.
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Beliefs and Spirituality
Definition of Best Practices
1. The patient and/or caregiver are
asked about spiritual/existential
concerns through use of a structured
instrument such as FICA (see below).
2. The results of those discussions are
documented and incorporated into
the Care Plan.
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Beliefs and Spirituality
Critical Interventions/Actions - Beliefs
Documentation should include a structured tool for staff to ask about
spiritual/existential concerns in a consistent manner. Assessment
domains recommended include:
– Patient/caregiver source of strength
– Important relationships and organizations
– Support network
– Current spiritual needs
– Theological issues
– Any cultural beliefs or rituals surrounding death
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Beliefs and Spirituality
Critical Interventions/Actions –
Beliefs - 2
• CMS requires that a discussion take place with the patient/caregiver
to assess spiritual/existential concerns. There is no comprehensive
list of those concerns.
• Incorporate patient beliefs and/or spiritual concerns into the care
plan.
• Every patient/caregiver should be offered pastoral care by someone
who is able to address spiritual needs, beliefs or concerns.
• Plan ahead to ensure that the spiritual advisor of the patient’s
preference is available in the final hours.
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Beliefs and Spirituality
Critical Interventions/Actions –
Beliefs - 3
• Identify tools to assist staff in initiating
culturally appropriate and sensitive
discussions.
• Train all staff on how to initiate
culturally appropriate and sensitive
discussions and offer education on how
cultural and religious traditions impact
end of life care planning.
• Incorporate role-playing into staff
training as assessing spiritual beliefs and
values may be challenging. (Lunder,
2011)
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Beliefs and Spirituality
Critical Interventions/Actions –
Beliefs - 4
Key principles of taking a spiritual history include (Puchalski, Cristina
M. 2000)
• Taking seriously the importance of spirituality in the quality of life
of each person
• Addressing spirituality in each visit with a patient
• Respecting patients’ privacy
• Practicing awareness of one’s own beliefs
• Taking care not to impose those beliefs on others
• Make referrals to chaplains or other spiritual resources as
appropriate
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Beliefs and Spirituality
Standardized Tools - Beliefs
No standard tool is available that can be universally applied to all
patient populations in hospice and palliative care settings (Selman,
2011). Beliefs and values can be evaluated as a component of several
validated, multi-domain assessment tools such as:
• NEST – Needs at the End of Life Screening Tool – numeric rating
scale that addresses several issues including religious beliefs and
sense of purpose.
• ESAS – Edmonton Symptom Assessment Tool – multi-symptom tool
that includes a measure of “wellbeing”.
• CAPC - Center to Advance Palliative Care “Policies and Tools for
Hospital Palliative Care Programs” – a hospital specific document
that includes a Spiritual Care Assessment tool.
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Beliefs and Spirituality
Standardized Tools – Beliefs - 2
FICA (acronym for the four aspects of healthy spiritual conversations
between clinicians and patients). Facilitates and encourages health
care professionals to have spiritual conversations with patients.
• F Faith, belief, meaning – Ask patients about their personal faith or
spiritual beliefs, values or practices that help cope with stress.
• I Importance and influence – What is the importance of an
individual’s faith? Are there beliefs that might influence their health
care decision making?
• C Community – does the patient have a religious or spiritual
community and if so how does it provide support?”
• A Address/action in care- “How should I address these issues in
your health care?”
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Beliefs and Spirituality
Measurement
1. Percent of patients/responsible party who were asked about their
spiritual/existential concerns. (HIS F3000)
2. Percent of patients whose care plan included interventions
regarding spiritual beliefs or concerns.
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