Mercy screens cancer patients for spiritual distress, provides spiritual care plans

February 1, 2017


Carol Rollins of Aberdeen, Ohio, learned on Oct. 3 from biopsy results that she has stage two lung cancer. Since then, she's been in and out of doctors' offices and the hospital. She's undergone 20 radiation treatments as well as chemotherapy to shrink her tumor.

Her sister died of lung cancer a year ago. Rollins said having this cancer is scary, and "it's hard to get through it."

But, the spiritual support she is receiving through a program at Mercy Health of Cincinnati, the system where she is receiving cancer care, is easing the strain, she said. Lori McKinley, a chaplain with a region of Cincinnati's Mercy Health, has been meeting with, calling, praying with and providing spiritual counsel to Rollins.

Chaplain Sue Motz, seated at center right, explains how to use the spiritual distress screening tool and the protocol for initiating follow-up care to nurses, discharge planners and patient care assistants at Mercy Health – Anderson Hospital in Cincinnati.

Rollins said McKinley "really lifted me up."

Rollins said McKinley never fails to put her at ease when she calls. "It is comforting," Rollins said. "We've talked about God and prayed together. I told her, 'I don't believe this is God's fault. He's a good God.'"

Rollins is receiving the spiritual care because her responses to questions on a spiritual screening tool flagged her to the hospital's spiritual care team as someone who may be in need of support. She took McKinley up on her offer of spiritual care planning and follow-up.

The distress screening and follow-up program that the spiritual care team launched in November 2015 has resulted in increasing numbers of cancer patients at Mercy getting spiritual care consults and follow-on services, according to McKinley.

New standards
In 2015, the Commission on Cancer added to its credentialing standards requirements that cancer programs assess the psychosocial needs of cancer patients. However, neither organization specified precisely how provider organizations were to conduct the assessment or follow-up.

The Mercy system, which has 23 hospitals in Ohio and Kentucky, developed its own distress screening tool and integrated it into the system's electronic health record. That tool asks cancer patients to rate on a 10-point scale their distress; their level of concern with practical matters such as finances, job, transportation and housing; and their level of emotional, spiritual and physical health. There are two questions related to the level of emotional concern and three related to spiritual concern. The patient's health care provider, usually a nurse, administers the tool and enters the responses in the medical record.

Spiritual care follow-up
McKinley is a chaplain on the spiritual care team for Mercy's east market, which includes three hospitals and a network of outpatient sites around Cincinnati. She said she and her team developed a protocol for oncology nurses to send a referral for a spiritual care team consult whenever patients rate their spiritual or emotional concern level at a "4" or higher, on the 10-point scale. A chaplain on the team then visits that patient, usually in the person's hospital room. (Currently, inpatients with a primary diagnosis of cancer receive the screening.)

The chaplain talks with the patient about his or her concerns and offers to work with the patient to develop and implement a spiritual care plan. It's up to the patient whether to do so. Much of the follow-up work involves referring patients to spiritual resources in the community; and most, but not all, of those resources are free.

According to information from Mercy, the spiritual care plan addresses spiritual struggles, emotional distress, life adjustment, difficulties in making decisions, unresolved conflict, and grief. It also may include end-of-life planning. It can incorporate everything from arranging for a patient to receive Holy Communion before a surgical procedure to providing counseling to children whose parent has been diagnosed with late-stage cancer.

McKinley explained that while assessing distress is becoming standard nationwide for cancer patients, "what we've developed here that's unique is — when people express emotional and spiritual concerns, there's follow-up" by the spiritual care team.

McKinley said the protocol likely will be rolled out to other Mercy regions after it's been in use longer in the east market.

Increased engagement
McKinley said her team is developing ways to measure the impact of the approach, including by keeping track of how many people are screened, how many are flagged for follow-up and how many are referred to other practitioners, such as oncology psychologists at Mercy. Its preliminary data indicates that in up to 75 percent of cases, patients reported feeling emotional, spiritual or physical distress or anxiety over meeting practical concerns such as transportation to follow-up care, McKinley said.

She said the program has elevated awareness among frontline clinicians about the need to be mindful of distress in cancer patients. Conducting the screenings and referring the patients, nurses "have become more engaged in the spiritual and emotional lives of patients," McKinley said. She noted it is not uncommon now for a nurse to enter notes on a cancer patient's emotional health in the medical record, which was a rarity in the past.

The change "is great," said McKinley. "And what's powerful is that you see a narrative in the medical record of this patient's story. They're not just a diagnosis" — clinicians have related to them personally.


Copyright © 2017 by the Catholic Health Association of the United States
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