The Book of Job in Pediatric Hematology/Oncology: Context for Distinct Spiritual Narratives and Addressing Suffering
Moderator: Ben Snyder, MD, PGY-3 Meds/Peds Resident, Indiana University
Panelists: Alex Lion, DO, Assistant Professor of Pediatrics in the Division of Pediatric Hematology-Oncology, Indiana University School of Medicine and Riley Hospital for Children; Rabbi Bruce Pfeffer, MAHL, BCC, System Chaplaincy Indiana University Health; Reverend Anastasia Holman, Director of Chaplaincy Education for Indiana University Health; Richard Gunderman, MD, Chancellor's Professor of Pediatrics, the John A. Campbell Professor of Radiology, Indiana University SOM
Many challenges exist to providing holistic care to patients and addressing the entirety of disease impact in terms of suffering. A truly holistic approach involves addressing all needs that suffering induces for a patient and their family including mental, physical, and spiritual needs. However, the secondary suffering of providers is often lost in the assessment of the suffering of patients, and this lack of attention to the unique spiritual needs of providers and support staff has impacts on patient care. As a significantly secular scientific endeavor at this point in history, little attention is given to education on spirituality through the course of academic medical training leading to discomfort in addressing questions of the impact of spiritual narrative on a patient’s disease course and experience of suffering.1-3 With data illustrating hesitancy toward assessing and addressing spiritual needs it is important to remember the importance of spirituality particularly in the setting of life-limiting or life-altering illness. An additional impact occurs on the personal narrative of physicians and care providers as they compassionately engage with the suffering of patients. Disease that alters quality of life and even directly impacts a patient’s personal identity impact the provision of holistic care as is seen in the provision of oncologic care given the uniquely transformative nature of a cancer diagnosis. Impacts on identity shape the personal narrative of suffering and dying for patients creating a unique story for patients as individuals. While it is true that unique spiritual narratives impact the experience and interpretation of suffering by patients, the same is true of spirituality and its impact on the care provided by physicians and hospital staff.4
Caring for pediatric patients induces a unique emotional burden for providers and support staff alike 5, 6 and particularly in pediatric oncology where the spiritual narratives of families often serve an important role in understanding and processing suffering.
The unique spiritual background possessed by individual providers within the field of pediatric oncology was previously assessed in a 2007 survey and demonstrated that a large majority of 85-percent of academic pediatric oncologists regarded themselves as spiritual, but only half felt that their spirituality impacted clinical care and decision-making.7 However, the survey did not assess if the personal lives of the providers surveyed or individual interpretations of the suffering of their patients were impacted by their spiritual understanding of the world. Direct assessments of the impact of individual spiritual beliefs of physicians or support staff have not been undertaken to provide clarity on the impact of spiritual narrative on the processing of suffering. Unique in the context of suffering and idiosyncratic spiritual narrative is the Biblical book of Job contained in the Hebrew Scriptures and revered not only for its theological content but also for its distinctive literary architecture. Job is a text that is revered in the history of three major world religions: Judaism, Christianity, and Islam. It is also seen as a unique piece of ancient literature given the juxtaposition of prose and poetic expertise in describing theological concepts and addressing the humanistic aspects of suffering.
As such, the book of Job is an excellent centering text to unite non-religious and religious alike in the discussion of distinctive spiritual narratives as well as clinician and patient response to suffering in the setting of disease. Of particular interest to our team, is the discussion of Job in an interfaith context and applied to the discipline of pediatric hematology/oncology. As previously described, the experience of suffering in pediatric cancer creates trauma for parents,8 staff,9 and practitioners leading to difficulty in adjustment for families and burnout for care providers.10 Much attention is now given to physician and staff wellness, through practices of mindfulness and meaning-making, but spirituality is at times neglected as an important aspect of worldview necessary for trauma interpretation and generation of values.
In the context of the varying spiritual narratives of providers, it can be challenging to find common ground for discussion of spirituality. Given the commonality of the book of Job within multiple spiritual traditions and the interest the book generates for its vivid yet relatable portrayal of the human experience of suffering, this biblical text can serve as a meeting place for sharing spiritual distinctives and cultivating spiritual understanding for persons of both spiritual and secular backgrounds. The proposed panel will be interdisciplinary, including voices from chaplaincy, medical humanities, and pediatric oncology. The panelists’ reading of Job will reflect their own interpretive lens, from within Jewish and Christian theologies. Examples of questions to be addressed by the panel include:
1)What theological perspectives or personal experiences inform your view of suffering within your role as a provider within the healthcare system?
2)How does your interpretation of the book of Job inform your understanding of suffering in pediatric hematology/oncology? 3)How can we use the testimonies of Job’s friends to inform our attendance of the suffering of our patients?
4)How can the book of Job inform interfaith discussion of spirituality in the context of suffering?
References
1.Balboni MJ, Sullivan A, Amobi A, et al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. J Clin Oncol. Feb 1 2013;31(4):461-7. doi:10.1200/JCO.2012.44.6443
2.Deliz JR, Fears FF, Jones KE, Tobat J, Char D, Ross WR. Cultural Competency Interventions During Medical School: a Scoping Review and Narrative Synthesis. J Gen Intern Med. Feb 2020;35(2):568-577. doi:10.1007/s11606-019-05417-5
3.Piscitello GM, Martin S. Spirituality, Religion, and Medicine Education for Internal Medicine Residents. Am J Hosp Palliat Care. Apr 2020;37(4):272-277. doi:10.1177/1049909119872752
4.Ramondetta L, Brown A, Richardson G, et al. Religious and spiritual beliefs of gynecologic oncologists may influence medical decision making. Int J Gynecol Cancer. Apr 2011;21(3):573-81. doi:10.1097/IGC.0b013e31820ba507
5.Superdock AK, Barfield RC, Brandon DH, Docherty SL. Exploring the vagueness of Religion & Spirituality in complex pediatric decision-making: a qualitative study. BMC Palliat Care. Sep 12 2018;17(1):107. doi:10.1186/s12904-018-0360-y
6.Tan AJN, Tiew LH, Shorey S. Experiences and needs of parents of palliative paediatric oncology patients: A meta-synthesis. Eur J Cancer Care (Engl). May 2021;30(3):e13388. doi:10.1111/ecc.13388
7.Ecklund EH, Cadge W, Gage EA, Catlin EA. The religious and spiritual beliefs and practices of academic pediatric oncologists in the United States. J Pediatr Hematol Oncol. Nov 2007;29(11):736-42. doi:10.1097/MPH.0b013e31815a0e39
8.van der Geest IM, van den Heuvel-Eibrink MM, Falkenburg N, et al. Parents' Faith and Hope during the Pediatric Palliative Phase and the Association with Long-Term Parental Adjustment. J Palliat Med. May 2015;18(5):402-7. doi:10.1089/jpm.2014.0287 9.Sinclair HA, Hamill C. Does vicarious traumatisation affect oncology nurses? A literature review. Eur J Oncol Nurs. Sep 2007;11(4):348-56. doi:10.1016/j.ejon.2007.02.007
10.Whitford B, Nadel AL, Fish JD. Burnout in pediatric hematology/oncology-time to address the elephant by name. Pediatr Blood Cancer. Oct 2018;65(10):e27244. doi:10.1002/pbc.27244
Caring for pediatric patients induces a unique emotional burden for providers and support staff alike 5, 6 and particularly in pediatric oncology where the spiritual narratives of families often serve an important role in understanding and processing suffering.
The unique spiritual background possessed by individual providers within the field of pediatric oncology was previously assessed in a 2007 survey and demonstrated that a large majority of 85-percent of academic pediatric oncologists regarded themselves as spiritual, but only half felt that their spirituality impacted clinical care and decision-making.7 However, the survey did not assess if the personal lives of the providers surveyed or individual interpretations of the suffering of their patients were impacted by their spiritual understanding of the world. Direct assessments of the impact of individual spiritual beliefs of physicians or support staff have not been undertaken to provide clarity on the impact of spiritual narrative on the processing of suffering. Unique in the context of suffering and idiosyncratic spiritual narrative is the Biblical book of Job contained in the Hebrew Scriptures and revered not only for its theological content but also for its distinctive literary architecture. Job is a text that is revered in the history of three major world religions: Judaism, Christianity, and Islam. It is also seen as a unique piece of ancient literature given the juxtaposition of prose and poetic expertise in describing theological concepts and addressing the humanistic aspects of suffering.
As such, the book of Job is an excellent centering text to unite non-religious and religious alike in the discussion of distinctive spiritual narratives as well as clinician and patient response to suffering in the setting of disease. Of particular interest to our team, is the discussion of Job in an interfaith context and applied to the discipline of pediatric hematology/oncology. As previously described, the experience of suffering in pediatric cancer creates trauma for parents,8 staff,9 and practitioners leading to difficulty in adjustment for families and burnout for care providers.10 Much attention is now given to physician and staff wellness, through practices of mindfulness and meaning-making, but spirituality is at times neglected as an important aspect of worldview necessary for trauma interpretation and generation of values.
In the context of the varying spiritual narratives of providers, it can be challenging to find common ground for discussion of spirituality. Given the commonality of the book of Job within multiple spiritual traditions and the interest the book generates for its vivid yet relatable portrayal of the human experience of suffering, this biblical text can serve as a meeting place for sharing spiritual distinctives and cultivating spiritual understanding for persons of both spiritual and secular backgrounds. The proposed panel will be interdisciplinary, including voices from chaplaincy, medical humanities, and pediatric oncology. The panelists’ reading of Job will reflect their own interpretive lens, from within Jewish and Christian theologies. Examples of questions to be addressed by the panel include:
1)What theological perspectives or personal experiences inform your view of suffering within your role as a provider within the healthcare system?
2)How does your interpretation of the book of Job inform your understanding of suffering in pediatric hematology/oncology? 3)How can we use the testimonies of Job’s friends to inform our attendance of the suffering of our patients?
4)How can the book of Job inform interfaith discussion of spirituality in the context of suffering?
References
1.Balboni MJ, Sullivan A, Amobi A, et al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. J Clin Oncol. Feb 1 2013;31(4):461-7. doi:10.1200/JCO.2012.44.6443
2.Deliz JR, Fears FF, Jones KE, Tobat J, Char D, Ross WR. Cultural Competency Interventions During Medical School: a Scoping Review and Narrative Synthesis. J Gen Intern Med. Feb 2020;35(2):568-577. doi:10.1007/s11606-019-05417-5
3.Piscitello GM, Martin S. Spirituality, Religion, and Medicine Education for Internal Medicine Residents. Am J Hosp Palliat Care. Apr 2020;37(4):272-277. doi:10.1177/1049909119872752
4.Ramondetta L, Brown A, Richardson G, et al. Religious and spiritual beliefs of gynecologic oncologists may influence medical decision making. Int J Gynecol Cancer. Apr 2011;21(3):573-81. doi:10.1097/IGC.0b013e31820ba507
5.Superdock AK, Barfield RC, Brandon DH, Docherty SL. Exploring the vagueness of Religion & Spirituality in complex pediatric decision-making: a qualitative study. BMC Palliat Care. Sep 12 2018;17(1):107. doi:10.1186/s12904-018-0360-y
6.Tan AJN, Tiew LH, Shorey S. Experiences and needs of parents of palliative paediatric oncology patients: A meta-synthesis. Eur J Cancer Care (Engl). May 2021;30(3):e13388. doi:10.1111/ecc.13388
7.Ecklund EH, Cadge W, Gage EA, Catlin EA. The religious and spiritual beliefs and practices of academic pediatric oncologists in the United States. J Pediatr Hematol Oncol. Nov 2007;29(11):736-42. doi:10.1097/MPH.0b013e31815a0e39
8.van der Geest IM, van den Heuvel-Eibrink MM, Falkenburg N, et al. Parents' Faith and Hope during the Pediatric Palliative Phase and the Association with Long-Term Parental Adjustment. J Palliat Med. May 2015;18(5):402-7. doi:10.1089/jpm.2014.0287 9.Sinclair HA, Hamill C. Does vicarious traumatisation affect oncology nurses? A literature review. Eur J Oncol Nurs. Sep 2007;11(4):348-56. doi:10.1016/j.ejon.2007.02.007
10.Whitford B, Nadel AL, Fish JD. Burnout in pediatric hematology/oncology-time to address the elephant by name. Pediatr Blood Cancer. Oct 2018;65(10):e27244. doi:10.1002/pbc.27244