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Toward a clinical model for patient spiritual journeys in supportive and palliative care: Testing a concept of human spirituality and associated recursive states

Published online by Cambridge University Press:  30 July 2020

Rebecca Johnson Open the ORCID record for Rebecca Johnson [Opens in a new window] ,
Joshua Hauser  and
Linda Emanuel
Rebecca Johnson*
Affiliation:
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
Joshua Hauser
Affiliation:
Northwestern Feinberg School of Medicine, Jesse Brown (Chicago) VA Medical Center, Chicago, IL
Linda Emanuel
Affiliation:
Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
*
Author for correspondence: Rebecca Johnson, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair St, 19th Floor, Chicago, IL 60611, USA. E-mail: [email protected]
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Abstract

Objective

In 2015, a Chaplaincy Research Consortium generated a model of human spirituality in the palliative care context to further chaplaincy research. This article investigates the clinical fit of (a) the model's fundamental premise of universal human spirituality and (b) its 4 proposed stage descriptors (Discovery, Dialogue, Struggle, and Arrival).

Method

First, we collected qualitative data from an interdisciplinary palliative care focus group. Participants (n = 5) shared responses to the statement “the human spirit has essential commonalities across [ … ] groups and [ … ] attributes.” Participants also shared vignettes of spiritual care, and 48 vignettes illustrating patients’ spiritual journeys were subsequently taken from the transcript of that group. Second, we invited different mixed discipline palliative care professionals (n = 9) to individually card sort these vignettes to the model's 4 stage descriptors; we conducted pattern analysis on the results. We then administered a third step, convening six physicians to complete the card sort again, this time allowing designation of cards to one or two of the 4 stage descriptors.

Results

Focus group participants were supportive of the model's all-encompassing definition of spirituality. The concept of “connectedness” was a shared focus for all participants, connectedness and spirituality appearing almost synonymous. Pattern analysis of assigned 48 vignettes to the 4 stages showed stronger consensus around Discovery and Arrival than Struggle and Dialogue. Results of the additional card sort suggested Struggle and Dialogue involve oscillation and are harder to think of as a steady state as distinct from processes associated with Discovery or Arrival.

Significance of results

“Connectedness” is a productive concept for modeling human spiritual experience near the end of life. As one healthcare professional said: “this connectedness piece is [ … ] what I always look for … ” Although further work is needed to understand struggle and dialogue elements in peoples’ spiritual journeys, discovery and arrival shared consensus among participants.

Keywords

CancerCluster analysisConceptual modelEnd of lifeSpirituality
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 1 , February 2021 , pp. 28 - 33
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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