Nurturing Family Conference Competence and Confidence: When Physical and Emotional Suffering are Complicated by Spiritual Dissonance
Erich J. Grant MMS, PA-C, faculty member, Wake Forest School of Medicine; F. Keith Stirewalt, PA-C, MBA, MDiv, Chaplain for Clinical Engagement, Wake Forest Baptist Health; and Caroline Sisson, PA-C, MMS, Assistant Professor, Physician Assistant Program, Wake Forest School of Medicine
The authors submit that there is little published evidence that competencies associated with effective family conferences and end of life decision-making are commonly taught or measured in medical training programs. This workshop will provide attendees with a fundamental structure for effective, interprofessional family conferences and the opportunity to design a high-fidelity simulation to help learners acquire and practice relevant skills.
In what appears to be an increasingly secular culture, the interaction of theological beliefs and the world experienced can be overlooked. In fact, theological beliefs frequently enter into the clinical space of suffering. “The Spiritual Assessment” by Saguil and Phelps surmised, “more than 80% of Americans perceive religion as important.” Yet, “most ambulatory and hospitalized patients report that their physician never discussed beliefs with them.”1
Our workshop focal point centers on the integration of the patient’s/family’s Theology of Health (TOH) and its influence on the family meeting. The term “Theology of Health” represents the continuous reconciliation of our state of health through the lens of our spiritual belief system. Encountering severe illness often disrupts the patient’s belief matrix, causing suffering due to a mismatch of stated theology and the experienced clinical world.
We propose that in times of suffering, the patient’s Theology of Health may greatly influence clinical communication, affecting conversations about goals of care.
Added to this theological complexity are the concepts of TOH elasticity and the rabbinic tradition of ‘black fire’ and ‘white fire.’ TOH elasticity addresses the rate at which patients and their families theologically compensate for the experienced world of suffering. The rate mismatch between patient/family acceptance of probable medical outcome and the clinician’s acceptance may cause friction within the family meeting context. In the rabbinic tradition, the words on the page (more obvious) relate to ‘black fire’ while ‘white fire’ represents the less obvious theological quandaries that may develop as we experience the world between the words, between the sentences, and between the paragraphs. Often, clinicians are taught to listen for ‘black fire’ (overt) theological statements but may not observe ‘white fire’ (covert) statements of more importance to the patient. Unrecognized spiritual language may misdirect providers from theological suffering.
We believe that focused interprofessional education involving clinicians and hospital chaplains can help to impart knowledge of the influence of Theology of Health in the family conference and develop skills for honoring and addressing theological dissonance.
Development workshop goals:
Through small group interaction and reflection, participants will develop educational methods and simulations that foster effective interprofessional collaboration between medical and spiritual providers with theological components of suffering. The methods formulated should foster awareness of the role of TOH and resulting resonance and dissonance with the observed clinical context. Students should be able to describe the structure and domains of an effective family conference, taking into consideration possible TOH complexity.
In what appears to be an increasingly secular culture, the interaction of theological beliefs and the world experienced can be overlooked. In fact, theological beliefs frequently enter into the clinical space of suffering. “The Spiritual Assessment” by Saguil and Phelps surmised, “more than 80% of Americans perceive religion as important.” Yet, “most ambulatory and hospitalized patients report that their physician never discussed beliefs with them.”1
Our workshop focal point centers on the integration of the patient’s/family’s Theology of Health (TOH) and its influence on the family meeting. The term “Theology of Health” represents the continuous reconciliation of our state of health through the lens of our spiritual belief system. Encountering severe illness often disrupts the patient’s belief matrix, causing suffering due to a mismatch of stated theology and the experienced clinical world.
We propose that in times of suffering, the patient’s Theology of Health may greatly influence clinical communication, affecting conversations about goals of care.
Added to this theological complexity are the concepts of TOH elasticity and the rabbinic tradition of ‘black fire’ and ‘white fire.’ TOH elasticity addresses the rate at which patients and their families theologically compensate for the experienced world of suffering. The rate mismatch between patient/family acceptance of probable medical outcome and the clinician’s acceptance may cause friction within the family meeting context. In the rabbinic tradition, the words on the page (more obvious) relate to ‘black fire’ while ‘white fire’ represents the less obvious theological quandaries that may develop as we experience the world between the words, between the sentences, and between the paragraphs. Often, clinicians are taught to listen for ‘black fire’ (overt) theological statements but may not observe ‘white fire’ (covert) statements of more importance to the patient. Unrecognized spiritual language may misdirect providers from theological suffering.
We believe that focused interprofessional education involving clinicians and hospital chaplains can help to impart knowledge of the influence of Theology of Health in the family conference and develop skills for honoring and addressing theological dissonance.
Development workshop goals:
Through small group interaction and reflection, participants will develop educational methods and simulations that foster effective interprofessional collaboration between medical and spiritual providers with theological components of suffering. The methods formulated should foster awareness of the role of TOH and resulting resonance and dissonance with the observed clinical context. Students should be able to describe the structure and domains of an effective family conference, taking into consideration possible TOH complexity.