An EAPC white paper on multi-disciplinary education for spiritual care in palliative care

Best et al. BMC Palliative Care (2020) 19:9 https://doi.org/10.1186/s12904-019-0508-4 RESEARCH ARTICLE Open Access An EAPC white paper on multi-disciplinary education for spiritual care in palliative care Megan Best1,2, Carlo Leget3, Andrew Goodhead4 and Piret Paal5* Abstract Background: The EAPC White Paper addresses the issue of spiritual care education for all palliative care professionals. It is to guide health care professionals involved in teaching or training of palliative care and spiritual care; stakeholders, leaders and decision makers responsible for training and education; as well as national and local curricula development groups. Methods: Early in 2018, preliminary draft paper was written by members of the European Association for Palliative Care (EAPC) spiritual care reference group inviting comment on the four core elements of spiritual care education as outlined by Gamondi et al. (2013) in their paper on palliative care core competencies. The preliminary draft paper was circulated to experts from the EAPC spiritual care reference group for feedback. At the second stage feedback was incorporated into a second draft paper and experts and representatives of national palliative care organizations were invited to provide feedback and suggest revisions. The final version incorporated the subsequent criticism and as a result, the Gamondi framework was explored and critically revised leading to updated suggestions for spiritual care education in palliative care. Results: The EAPC white paper points out the importance of spiritual care as an integral part of palliative care and suggests incorporating it accordingly into educational activities and training models in palliative care. The revised spiritual care education competencies for all palliative care providers are accompanied by the best practice models and research evidence, at the same time being sensitive towards different development stages of the palliative care services across the European region. Conclusions: Better education can help the healthcare practitioner to avoid being distracted by their own fears, prejudices, and restraints and attend to the patient and his/her family. This EAPC white paper encourages and facilitates high quality, multi-disciplinary, academically and financially accessible spiritual care education to all palliative care staff. Keywords: Spirituality, Spiritual care, Education, Palliative care, Health care professionals, Existential needs, Religious needs, Spiritual needs, Curriculum, Holistic caregiving, Spiritual assessment Background Palliative care services and interest in palliative care provision are growing across Europe [1], and while not all countries have yet developed full palliative care services with multi-disciplinary teams [2], this paper summarises a shared vision of multi-disciplinary spiritual care (SC) provision in palliative care, for which all services should aim. The content can be incorporated into * Correspondence: 5 Researcher at the Palliative Care Research Hub, Institute of Nursing Science and Practice, Paracelsus Medical Private University, Strubergasse 21, 5020 Salzburg, Austria Full list of author information is available at the end of the article existing palliative care curricula or used alone to supplement training for palliative care workers who would like further opportunities to improve their competencies in addressing and incorporating spirituality and SC into their everyday practice. Details may need to be adapted according to the setting, and care by referral may be required while palliative care services grow in SC competency. Grief and Bereavement programmes may have spiritual content. The United Nations (UN) and World Health Organisation (WHO) state that providing access to “palliative care is an ethical responsibility of health care systems, © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Best et al. BMC Palliative Care (2020) 19:9 and that it is the ethical duty of health care professionals to alleviate pain and suffering, whether physical, psychosocial or spiritual, irrespective of whether the disease or condition can be cured, and that end-of-life care for individuals is among the critical components of palliative care” [3]. The WHO defines palliative care as a process involving ‘early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’ [4]. The WHO and UNICEF’s Astana 2018 Declaration states that “palliative care must be accessible to all”, and in order to build sustainable primary healthcare, all member states have committed to “prioritize disease prevention and health promotion and will aim to meet all people’s health needs across the life course through comprehensive preventive, promotive, curative, rehabilitative services and palliative care” [5]. Thus, providing palliative care is increasingly recognized as a universal responsibility [6]. As seen in the definitions of palliative care above, the spiritual domain is, and has always been, integral to palliative care. This was established by the founder of modern palliative care, Dame Cicely Saunders, when she identified the multi-dimensional spiritual suffering at the end of life which came to be known as ‘Total Pain’ [7, 8]. As such, spirituality has always been addressed to some extent within palliative care [7, 9]. More recently, there have been international efforts to improve spiritual care not only in palliative care, but in healthcare generally [10, 11]. However, healthcare professionals still report difficulty in grasping what is meant by spirituality and spiritual care and hence often fail to meet the spiritual needs of patients [12–14]. This is a matter of concern as, according to the WHO, the spiritual dimension is an integral meaning-giving aspect of human existence and spiritual needs are commonly experienced by patients with sudden ill-health or loss, chronic conditions, and life-limiting conditions [15–24]. Building on work emerging from the USA [10, 11], the EAPC Spiritual Care reference group, a former taskforce, was formed in 2010 to improve SC provision in Europe, taking into account the diversity across the continent [12]. This EAPC White Paper has been written to provide guidance on SC education for all health care workers who provide palliative care, regardless of discipline and care context. The target groups for this paper (...truncated)