New focus on spiritual care in healthcare

The new clinical guideline "Existential and spiritual aspects in palliative care" has been released after seven years of work. The guideline was developed by an expert group along with researchers from the University of Southern Denmark, the Danish Multidisciplinary Cancer Groups (DMCG-Pall), and the Secretariat for Clinical Guidelines in the Cancer Area.

Research shows that people suffering from serious illnesses such as cancer may face several existential and spiritual challenges, and that support and care for these challenges are important for their well-being and quality of life.

Illness triggers existential reflections

However, both national and international studies show that healthcare professionals find it difficult and challenging to support and care for patients' existential and spiritual needs - particularly in Denmark, where the population generally exhibits a high degree of privacy regarding these needs.

- In the worst case, this can mean that patients do not receive the existential and spiritual care they need and that they become existentially lonely, says Niels Christian Hvidt, professor in the research unit General Practice at SDU.

- When people are affected by illness and impending death, it usually triggers many existential reflections and needs. It can be thoughts such as "Who am I now?" "Who will take care of me and my loved ones?" "What is the meaning of what I am experiencing?" "Is there a God I can seek comfort from?" or "Is there something on the other side if I die from this illness?". 

Healthcare breakthrough

The guideline aims to alleviate the challenges that healthcare professionals face in handling the significant existential questions that seriously ill patients have and contribute to relieving their existential/spiritual pain.

The guideline is based on many years of international and Danish research. It combines research knowledge with Danish clinical experience in a series of recommendations on how to best take care of Danish patients' existential and spiritual needs.

- It is an important breakthrough in healthcare because it has been possible to summarize the best insights into how we support existential and spiritual pain and suffering in a culture that is considered to be very little religiously inclined, but where the existential and spiritual needs are present as in any other culture, says Niels Christian Hvidt.

Need to equip professionals

The guideline has been in progress for seven years. It is based on a similar Dutch guideline, but adapted to Danish culture and clinical practice.

Lisbet Due Madsen, former director of Arresødal Hospice, is one of the leaders in developing the guideline.

- The goal has been to help healthcare professionals feel confident in discussing with patients and their families when questions and considerations about life's big questions, life and death, meaning, hope, despair, guilt, shame, and more arise. It may also encourage them to reflect on these issues themselves, she says.

During her many years working in the palliative care field, Lisbet Due Madsen has realized the need to equip healthcare professionals to naturally address existential topics that we all face in life and that are close to us.

- When we started, we were often met with questions about whether we should even be dealing with these topics in healthcare. But all experience shows that if we are to embrace the human being in all that it encompasses, we must also be able to offer spiritual care.

Used for educating future nurses

Karen Stølen, associate professor and PhD at the nursing program in Hillerød, has taught spiritual and existential care for many years and is part of a national network on the subject for higher education institutions.

She believes that compiling evidence in a guideline makes it more concrete and will provide an additional and more manageable tool in education.

- Spiritual care as a teaching area has been prioritized differently across the country's nursing programs and has often been very person-dependent. The clinical guideline can help spread evidence-based knowledge about spiritual-existential care as a valuable and important nursing competence in clinical practice. The guideline will therefore have a positive impact on the nursing education, but also on diploma modules in palliative care at further and continuing education levels.