At the end of fellowship, fellows will be able to support patients and families in the spiritual and existential domain. They will learn to address patient and family suffering and identify strengths and needs within the spiritual and existential domain with basic assessment followed by appropriate interventions and referrals. To this end, they have didactic sessions about spirituality and work collaboratively with chaplains on the clinical services.
This fellowship trains participants in the following Hospice and Palliative Medicine Core Competencies:
- Manages physical symptoms, psychological issues, social stressors, and spiritual dimensions of care for the patient and family
- Manages physical symptoms and psychosocial and spiritual distress in the patient and family
- Demonstrates the ability to respond to suffering through addressing sources of medical and psychosocial/spiritual distress, bearing with the patient’s and family’s suffering and distress, and remaining a presence, as desired by the patient and family
- Demonstrates care that shows respectful attention to age/developmental stage, gender, sexual orientation, culture, religion/spirituality, as well as family interactions and disability
- Manages physical symptoms and psychosocial and spiritual distress in the patient and family
- Recognizes the role of the interdisciplinary team in hospice and palliative care
- Identifies the various members of the interdisciplinary team and their roles and responsibilities
- Recognizes common experiences of distress around spiritual, religious, and existential issues for patients and families facing life-threatening conditions, and describes elements of clinical assessment and management
- Describes the role of hope, despair, meaning, and transcendence, in the context of severe and chronic illness
- Describes how to perform a basic spiritual/existential/religious evaluation
- Describes how to provide basic spiritual counseling
- Identifies the indications for referral to chaplaincy or other spiritual counselors and resources
- Knows the developmental processes, tasks, and variations of life completion and life closure
- Describes processes for facilitating growth and development in the context of advanced illness
- Recognizes the potential importance and existence of post-death rituals and describes how to facilitate them
- Responds to requests to participate in spiritual or religious activities and rituals, in a manner that preserves respect for both the patient and family, as well as one’s own integrity, and personal and professional boundaries
- Demonstrates self-awareness and ability to recognize differences between the clinician’s own and the patient and family’s values, attitudes, assumptions, hopes and fears related to illness, dying, and grief
- Demonstrates the above skills in the following paradigmatic situations with patients or families and documents an informative, sensitive note in the medical record: Discussing severe spiritual or existential suffering; referring to tasks of life review; completion of personal affairs, including relationships and sexuality; and social and spiritual aspects of life completion and closure
- Demonstrates respect and compassion towards all patients and their families, as well as towards other clinicians
- Displays sensitivity to issues surrounding age, ethnicity, sexual orientation, culture, spirituality and religion, and disability
Didactics
Introduction to chaplaincy
Signature strengths
Balance wheel
Communication curriculum
Experiential learning
Co-visits with team chaplains
Weekly remembrance at DFCI/BWH and MGH
Memorial services
Schwartz Rounds
Journaling exercises