Treasure the Question Martyn Joseph

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Treasure the QuestionMartyn Joseph

• Mervyn McGowan with a lot of help from Tom McGowan

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How we live with the scream
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What is spirituality?

• The engagement to explore and deeply and
  meaningfully connect ones inner self to the
  known world and beyond (Kale, 2004)

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Spiritual pain

• Spiritual pain more common symptom than pain in
  cancer patients (Portenoy et al., 1994)
• Accounts for 47 of requests for physician
  assisted suicide (Meier et al 1998)
• Speck defines spiritual pain as linked to
• Sense of hopelessness
• Focus on suffering rather than pain
• Feelings of guilt/shame
• Unresolved anger
• Inability to trust
• Lack of inner peace
• Sense of dis-connectedness or fragmentation

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Psychological effects

• Religion appears to help protect against
  depression and hopelessness (Breitbart et al)
  which are associated with poorer survival in
  cancer patients (Watson et al)
• But spirituality possibly linked to
  psychological distress (Higher Education Research
  Institute 2005)

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Sometimes life doesnt make any sense
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Spiritual histories

• Speck
• In the course of your life, with all of its ups
  and downs, have you developed ways of making
  sense of things that have happened to you?
• When life has been difficult what has helped you
  to cope?
• Would you like to talk to someone about the
  effect your illness is having on you or your
  family?

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Spiritual histories

• NICE says
• Assessment of spiritual needs does not have to
  be structured, but should include core elements
  such as exploring how people make sense of what
  happens to them, what sources of strength they
  can draw upon, and whether these are felt to be
  helpful to them at this point in their life.

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National Care of the dying audit hospital
(done by Marie Curie in Liverpool and Royal
College of physicians) They looked at 2672
patients in 118 hospitals Sept Nov 2006 (BMJ
Dec 2007)

• 33 of dying patients had their spiritual needs
  assessed whereas 53 of carers had theirs assessed

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Treating spiritual suffering

• Lunn (2003) defined spiritual care as
• Meeting people where they are and assisting
  them in connecting or reconnecting to things,
  practices, ideas and principles that are at their
  core of their being the breath of their life,
  making a connection between yourself and that
  person

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Treating spiritual suffering

• Rousseau suggested a seven stage process
• Controlling physical symptoms
• Providing a supportive presence
• Encouraging life review to assist in recognizing
  purpose, value, and meaning
• Exploring guilt, remorse, forgiveness,
  reconciliation
• Facilitating religious expression
• Reframing goals
• Encouraging meditative practices, focusing on
  healing rather than cure

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• At medical school I learned to repair violins

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• It took many more years for me to hear the
  music Barry Bub

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Tenderness dialogue
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Victor Frankl
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Dignity therapy

• Based on Chochinovs work
• Targets depression, suffering, lack of meaning,
  purpose and will to live in palliative care
  patients.
• Protocol poses questions that offer
• opportunity for patients to address aspects of
  life that they feel most proud of/are most
  meaningful
• the personal history they most want remembered
• things that need to be said.
• Sessions recorded, transcribed and returned.
• Brief, done at bedside, benefits family and
  patient.

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Dignity therapy

• 91 satisfied
• 76 more dignity
• 68 more purpose
• 47 increased will to live
• 81 of benefit to family
• Reduced depressive symptoms

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Your dignity profile?
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Contemplative awarenessCommunityAuthentic
Action in the worldLife is oneA foundation
life stance opennessRootedness

• Signs of a balanced spirituality

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Another saying from a book of wisdom
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• A man (or a woman) can do nothing better than to
  eat

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• And drink

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• And find satisfaction in his work
• Ecclesiastes 224

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