Cross reports on the development of a new project in London in which patients with life limiting illnesses can record their end of life preferences in a single electronic record. This method presents both a danger of reducing palliative care to its medical dimension as well as an opportunity to inform and educate healthcare staff, if appropriately adapted. We would like to share our concerns about this ‘digital death’ from the viewpoint of spiritual care, the fourth dimension of palliative care.
Many healthcare professionals do not feel confident or competent in the assessment of spiritual needs and the provision of spiritual care(1-4). Spiritual assessment may be more challenging in out-of-hours or emergency consultations, where patients and their families are often in panic, fear, and distress. Since a patient’s spirituality influences medical-decision making and medical care received near death (5), it is essential to consider spiritual needs and resources when interpreting the mobile app information regarding the do not resuscitate order.
The Coordinate My Care mobile app provides a number of opportunities to inform and educate healthcare staff as well as integrate the assessment of spiritual well-being in routine clinical practice. For example, the documentation of spiritual needs and resources in this mobile app could facilitate spiritual care in emergency situations by immediately providing relevant information about a patient’s spirituality, e.g. religious, cultural and community affiliation, sources of connection, meaningful rituals, fears of dying and/or funeral wishes. However, healthcare providers must realize that spirituality is a dynamic dimension, and that end of life preferences can change during the palliative process.
The Coordinate My Care app could be an efficient tool to improve communication at the end of life, provided that out-of-hours healthcare providers use it as a communication aide to facilitate knowledge of patients' preferences among healthcare staff, rather than a drop down menu for ‘digital dying’. As well as a communication tool to inform medical decision-making in emergency situations, this kind of app could potentially be used to assess and monitor spiritual well-being in clinical practice, and therefore may be of great benefit to holistic palliative care in future.
References
1. Kristeller JL, Zumbrun CS, Schilling RF. 'I would if I could': How oncologists and oncology nurses address spiritual distress in cancer patients. Psycho-Oncology. 1999;8(5):451-8.
2. Cobb M. Spiritual care. In: Lloyd-Williams M, editor. Psychological issues in palliative care. New York: Oxford University Press; 2003. p. 135 - 47.
3. Ellis MR, Vinson DC, Ewigman B. Addressing spiritual concerns of patients: family physicians' attitudes and practices. J Fam Pract. 1999;48(2):105-9.
4. Vermandere M, De Lepeleire J, Smeets L, Hannes K, Van Mechelen W, Warmenhoven F, van Rijswijk E, Aertgeerts B. Spirituality in general practice: a qualitative evidence synthesis. Br J Gen Pract. 2011;61(592):749-60.
5. El Nawawi NM, Balboni MJ, Balboni TA. Palliative care and spiritual care: the crucial role of spiritual care in the care of patients with advanced illness. Curr Opin Support Palliat Care 2012; 6: 269-74.
Competing interests:
No competing interests
02 May 2013
Mieke Vermandere
General practitioner; Research fellow
Lucy Selman, Jan De Lepeleire, Bert Aertgeerts
General Practice, Department of Public Health and Primary Care, KU Leuven
Kapucijnenvoer 33 blok J bus 7001, 3000 Leuven, Belgium
Rapid Response:
Re: Delivering a digital death
Cross reports on the development of a new project in London in which patients with life limiting illnesses can record their end of life preferences in a single electronic record. This method presents both a danger of reducing palliative care to its medical dimension as well as an opportunity to inform and educate healthcare staff, if appropriately adapted. We would like to share our concerns about this ‘digital death’ from the viewpoint of spiritual care, the fourth dimension of palliative care.
Many healthcare professionals do not feel confident or competent in the assessment of spiritual needs and the provision of spiritual care(1-4). Spiritual assessment may be more challenging in out-of-hours or emergency consultations, where patients and their families are often in panic, fear, and distress. Since a patient’s spirituality influences medical-decision making and medical care received near death (5), it is essential to consider spiritual needs and resources when interpreting the mobile app information regarding the do not resuscitate order.
The Coordinate My Care mobile app provides a number of opportunities to inform and educate healthcare staff as well as integrate the assessment of spiritual well-being in routine clinical practice. For example, the documentation of spiritual needs and resources in this mobile app could facilitate spiritual care in emergency situations by immediately providing relevant information about a patient’s spirituality, e.g. religious, cultural and community affiliation, sources of connection, meaningful rituals, fears of dying and/or funeral wishes. However, healthcare providers must realize that spirituality is a dynamic dimension, and that end of life preferences can change during the palliative process.
The Coordinate My Care app could be an efficient tool to improve communication at the end of life, provided that out-of-hours healthcare providers use it as a communication aide to facilitate knowledge of patients' preferences among healthcare staff, rather than a drop down menu for ‘digital dying’. As well as a communication tool to inform medical decision-making in emergency situations, this kind of app could potentially be used to assess and monitor spiritual well-being in clinical practice, and therefore may be of great benefit to holistic palliative care in future.
Correspondence to: mieke.vermandere@med.kuleuven.be
References
1. Kristeller JL, Zumbrun CS, Schilling RF. 'I would if I could': How oncologists and oncology nurses address spiritual distress in cancer patients. Psycho-Oncology. 1999;8(5):451-8.
2. Cobb M. Spiritual care. In: Lloyd-Williams M, editor. Psychological issues in palliative care. New York: Oxford University Press; 2003. p. 135 - 47.
3. Ellis MR, Vinson DC, Ewigman B. Addressing spiritual concerns of patients: family physicians' attitudes and practices. J Fam Pract. 1999;48(2):105-9.
4. Vermandere M, De Lepeleire J, Smeets L, Hannes K, Van Mechelen W, Warmenhoven F, van Rijswijk E, Aertgeerts B. Spirituality in general practice: a qualitative evidence synthesis. Br J Gen Pract. 2011;61(592):749-60.
5. El Nawawi NM, Balboni MJ, Balboni TA. Palliative care and spiritual care: the crucial role of spiritual care in the care of patients with advanced illness. Curr Opin Support Palliat Care 2012; 6: 269-74.
Competing interests: No competing interests