Dr. Wilson Mertens on the importance of spiritual counseling in the care of cancer patients

A Physician's Support for Incorporating Spirituality Into the Healing Process

Many cancer programs have incorporated “alternative” or “complementary” cancer therapies in their offerings, in an effort to engage patients and caregivers known from survey data to employ unconventional healthcare approaches [1]. However, few programs have robust spiritual or religious approaches to their supportive care components; this omission is the more regrettable given that religion constitutes an important aspect of their lives, and that many patients become more religious after a diagnosis of cancer [2, 3].

Perhaps the most likely explanation for this is the uneasiness felt by clinicians and healthcare program administrators, of offering care that might cause distress to patients who hold religious convictions of differing types and intensity. Yet, experience has demonstrated the remarkable patient receptiveness to chaplaincy in the inpatient hospital setting; indeed, a recent Gallop poll revealed that 95% of respondents believed in a higher power, and 82% felt the need to experience spiritual growth [4].

Cancer programs find themselves in a quandary with regard to delivery of psychosocial services: while early detection has led to dramatic increases in patient volumes, revenue challenges and a shortage of behavioral heath professionals make the goal of providing services to all in need, difficult. Incorporating chaplaincy might help to address both the challenges to spirituality individuals face as well as the desire to provide broader counseling by establishing non-clinical relationships with as many patients and families as possible.

I joined our cancer program as medical director in 2000, and was presented with the unique opportunity to work with a chaplain specifically assigned to our service. While accustomed to the intermittent ministry of hospital inpatient wards, the availability of a chaplain, attached not to the patient’s local church or synagogue but to an ambulatory healthcare setting, providing counsel and support to patients in the context of a relationship developing over time, was utterly new. Adding to the novelty was the discovery, or perhaps my developing awareness, of the widespread receptiveness of patients and their families to spiritual support provided by a cancer program. Finally, the opportunity for reconciliation for patients estranged from their faith has had a profound calming effect for many facing the struggle of their lives.

Chaplaincy and spiritual support in our program provides both comfort and discovery. It is an approach we have used for the implementation of other so-called alternative or complementary therapies: to provide support and relief without questioning or affirming an unproven intervention’s ability to change patient outcomes, while asserting a commitment to determine the true impact on patients through scientific study. Varieties of individual, group, and community chaplaincy programs are offered, planned, or led by our chaplain; many are evaluated for patient satisfaction and need [5, 6]. Others are involved in clinical trials, approved by our institutional review board, designed to determine if an aspect of spiritual support improves the patient state.

But the most striking impact of cancer program-based chaplaincy is the growing openness with which patients proclaim their faith in the clinical setting. Increasingly, patients feel a unity of effort between cancer treatment, chaplaincy, and belief. While I must confess that, being trained as a physician and not in the ministry, I felt initially uncomfortable by these demonstrations and conversations, I never cease to be impressed by the concurrent expressions of hope, relief, and acceptance that bolstered spiritual belief can achieve. Now these conversations are commonplace in our program and in my practice, and represent an important part of the journey to recovery and peace for many of our patients and their families.

The health benefits of spirituality are, fortunately, a growing area of investigative and clinical interest. When a cancer program provides such support for patients a twofold message is conveyed; the religious community supports the patient’s pursuit of physical well-being and physicians support their effort to incorporate spirituality into the healing process. Additional goals, including clinical investigation and outcomes assessment must be pursued to fully document and appreciate the impact of this aspect of caring.

References

[1] VandeCreek L, Rogers E, Lester J. “Use of alternative therapies among breast cancer outpatients compared with the general population.” Alternative Therapies in Health and Medicine 1999;5: 71-76.
[2] Fehring RJ, Miller JF, Shaw C. “Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer.” Oncology Nursing Forum 1997;24:663-671.
[3] Eidinger RN, Schapira D. “Cancer patients’ insight into their treatment, prognosis, and unconventional therapies.” Cancer 1984;53: 2736-2740.
[4] Gallup G Jr, Lindsay DM. Surveying the Religious Landscape. Chicago and London: University of Chicago Press; 1999.
[5] Dann N.J., Mertens W.C. “Taking a ‘leap of faith': acceptance and value of a cancer program-sponsored spiritual event.” Cancer Nursing 2004; 27:134-141.
[6] Dann N.J., Higby D.J., Mertens W.C. “A structured spiritual service for cancer patients and families: analysis of attendee responses.” Annual Meeting, American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004 (poster). Proceedings of the American Society of Clinical Oncology 2004; 23: 758 (abstr).

Wilson Mertens is the medical director of the Baystate Regional Cancer Program, and of Cancer Services, Baystate Health System, Springfield, Massachusetts, and associate professor of medicine, Tufts University School of Medicine, Boston. He completed his undergraduate and medical training at The University of Western Ontario, London, Canada. A medical oncologist, Dr. Mertens has specialty board certifications from the Royal College of Physicians and Surgeons of Canada and the American Board of Internal Medicine. He also holds a masters of science in business administration from Madonna University, Livonia, Michigan. His previous positions include director of Biometry and Outcome Measurement, London Regional Cancer Center, and director of quality assurance and associate professor of medicine at the Barbara Ann Karmanos Cancer Institute at Wayne State University, Detroit.