Toward a Fully Fledged Integration of Spiritual Care and Medical Care.

In this article, we aimed to set out current problems that hinder a fully fledged integration of spiritual and medical care, which address these obstacles. We discuss the following five statements: 1) spiritual care requires a clear and inclusive definition of spirituality; 2) empirical evidence for spiritual care interventions should be improved; 3) understanding patients' experiences of contingency is paramount to deliver effective spiritual care; 4) attention to spiritual needs of patients is a task for every health care practitioner; 5) courses on spirituality and spiritual care should be mandatory in the medical curriculum. Current problems might be overcome by speaking each other's language, which is crucial in interdisciplinary research and in good interdisciplinary collaboration. Using a clear and inclusive definition of spirituality and substantiating spiritual care using medical standards of evidence-based practice is a way to speak each other's language and to increase mutual understanding. Furthermore, including spirituality in the medical curriculum would raise awareness of medical practitioners for their task of attending to patients' spiritual needs and, subsequently, to better and more appropriate referral for spiritual care. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved

Relating to the Experience of Contingency in Patients With Advanced Cancer:An Interview Study in U.S. Patients

Context. Being diagnosed with incurable cancer can be a life-changing experience, evoking different spiritual questions and needs. Confronting a serious life-threatening event occurs not only often unexpected but also can disrupt a person's self-image and ideals of their personhood. This confrontation makes it difficult for people to integrate it into their personal life story-otherwise referred to as an experience of contingency. Objectives. Different modes of relating to the contingent life event of having cancer have been studied in a Dutch patient population. Here we present an interview study in an U.S. population with advanced cancer patients. Methods. We included eight American patients with advanced cancer from the George Washington University Cancer Center. All patients were interviewed twice discussing their life events and life goals using a semistructured interview model. All interviews were transcribed and analyzed focusing on how patients described the way they related to the experience of having advanced cancer. The constant comparative method with a directed content analysis approach was used to code the themes in the interviews. Results. The analyses show that the four modes of relating to contingency that we found in the Dutch study population can also be found in an American advanced cancer patient population. Differences were found in the extended way American patients described the fourth mode of ``receiving.'' Conclusion. This study ensures a broader and deeper understanding of relating to the experience of contingency in having incurable cancer, which is crucial in developing accurate spiritual care in the palliative phase of patients. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved

Mea Culpa: A Qualitative Interview Study on the Role of Guilt and Forgiveness with Non-Religious and Multireligious Inmates

Within monotheistic religions, guilt and forgiveness have long been important themes. In The Netherlands, however, the influence of traditional religions is declining. This qualitative interview study explored how non-religious and multireligious inmates experience guilt and forgiveness, and how the humanistic chaplain could address these issues within counselling. Guilt and forgiveness are complex constructs that are individually and subjectively experienced. Most inmates experience personal guilt and regret for what they have done. Some inmates cope with these feelings in a repressive way, where others have an active coping style. Both multireligious and non-religious inmates have a need for interpersonal forgiveness, especially from close relatives. In addition, multireligious inmates also have a transcendent need for forgiveness from a personal god. The humanistic chaplain may help inmates with an active reflection on guilt and forgiveness, which can contribute to a development on an existential level. Guilt and forgiveness ought to be approached from a counselling perspective and attention should be paid to the multiple meanings of personal responsibility. An active and critical reflection on guilt and forgiveness may lead to new meanings of the (criminal) past and create a positive change in the behaviour of detainees

Mea Culpa: A Qualitative Interview Study on the Role of Guilt and Forgiveness with Non-Religious and Multireligious Inmates

Within monotheistic religions, guilt and forgiveness have long been important themes. In The Netherlands, however, the influence of traditional religions is declining. This qualitative interview study explored how non-religious and multireligious inmates experience guilt and forgiveness, and how the humanistic chaplain could address these issues within counselling. Guilt and forgiveness are complex constructs that are individually and subjectively experienced. Most inmates experience personal guilt and regret for what they have done. Some inmates cope with these feelings in a repressive way, where others have an active coping style. Both multireligious and non-religious inmates have a need for interpersonal forgiveness, especially from close relatives. In addition, multireligious inmates also have a transcendent need for forgiveness from a personal god. The humanistic chaplain may help inmates with an active reflection on guilt and forgiveness, which can contribute to a development on an existential level. Guilt and forgiveness ought to be approached from a counselling perspective and attention should be paid to the multiple meanings of personal responsibility. An active and critical reflection on guilt and forgiveness may lead to new meanings of the (criminal) past and create a positive change in the behaviour of detainee