Good day to you, my name is Sanjiv Gray, I'll be speaking on Addressing Challenges for Patients of a Specific Religion. The objectives of this talk is to discuss how to better understand patients or members of a religious minority, also to give an overview of the current standards, raising awareness of the challenges in providing spiritual care and also to provide practical recommendations. Religion has been described as the sigh of the oppressed creature, the heart of an heartless world, the soul of the soulless condition, it is the opium of the people. Many patients turn to their beliefs when difficult healthcare decisions are to be made. It is vital for healthcare professionals to recognize and accommodate the patient's religious and spiritual needs. Spirituality is a dynamic and intrinsic aspect of humanity that refers to the way individuals seek and express meaning, purpose, and transcendence, and is often tied to the feeling of connectiveness, to the moment, self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices. Freedom of religion is embedded in the First Amendment. The World Health Organization identifies spirituality as a core dimension of health. The Joint Commission requires an assessment of spirituality for all admitted patients, particularly among those nearing the end of life. The American Thoracic Society Policy Statement cites the identification of spiritual needs as a core competency for critical care practitioners. The American College of Critical Care Medicine and the American Thoracic Society practice guidelines recommend addressing spiritual concerns in the provision of comprehensive care to the critically ill patient. The 2004-2005 ACCM Guidelines has four specific recommendations that emphasize the importance of religious support, the assessment and incorporation of spiritual needs in the ICU care plan, spiritual care training for doctors and nurses, physician review of the interdisciplinary spiritual need assessments, and honoring the requests of patients to pray with them. Religion plays a role in the lives of patients and providers. Lack of belief in a particular religion or no religion may also play a role. This affects the perception of illness, life, death, and the afterlife. It contributes to coping, quality of life, along with physical and psychological well-being. Religion has an effect on how the patient's body is handled. A belief in a decision for fate or faith, belief in the finder odds or miracles. Families want to be at peace and know that the patient is at peace. Religion impacts decisions regarding modesty, diet, and medicines based on animal products. Patients may prefer a specific gender as their healthcare providers. Sacred prayer times, sacred days, and fasting periods may interfere with medical treatment plans. Religion affects one's sense of dignity, especially when it comes to autonomy and self-perception. Religion is intertwined with cultural traditions and expectations. Religious minority varies based on the location of practice and the hospital demographics. Minority denominations can also be found within major faiths. There are also varying interpretations of the faith, and patients can also be practicing or non-practicing. The pie chart shows the 2020 peer-reviewed survey distribution of faith within the United States. Some observations can be noted in the medical literature. Religious-based coping amongst a cohort of U.S. patients with advanced cancer saw a significantly associated increase in the use of ICU therapies prior to death. More religious ICU patients and their families reported being more optimistic about the outcomes of critical illness, having greater confidence in the efficacy of treatment. They also preferred more aggressive ICU therapies. Being active in a religious community is often associated with social and emotional support during times of illness. Physicians' avoidance of any expression of religious or spiritual sentiments can be interpreted as failure to provide culturally sensitive care to religiously observant patients. Expectations are placed on physicians and nurses to partake or facilitate religious beliefs, such as praying with patients. Challenges also include a provider's willingness to address religious concerns. Other challenges include a discomfort in discussing religion or spirituality, especially with members with different religious beliefs. There is also time constraints due to clinical responsibility. There may be a lack of reminders to address patients' spiritual concerns. Also a limited training in spiritual care, and we often defer to spiritual care professionals for these conversations, but there may be a lack of clarity regarding the process of contacting the spiritual care department or a knowledge of what services the spiritual care department provides. The benefits of providing spiritual care includes greater ICU care satisfaction, improved decision-making for comfort-focused end-of-life care, improved communication with patients feeling more informed and supported, patients having a sense of being respected and with preserved dignity, family satisfaction, and less uncertainty and decision conflict resulting in a higher emotional well-being. Time is often seen as a barrier for addressing religion due to a resource-limited healthcare system, one trying to balance patient welfare, autonomy, and social justice. These conversations regarding religion are often lengthy discussions, while there is an increasing demand for ICU services where physiology, technology, and efficiency are often characterized. The question may be asked, who should bring up religion needs? Should it be the healthcare team, the chaplain, the patient or their surrogate, or the social worker? Majority of clinicians agree that it should be their responsibility, but in practice, clinicians rarely address spiritual or religious concerns. In trying to address patients' religious needs, it's important to start by identifying if a patient ascribed to a religion and what's their relation to their goals of care. We can express empathy and concern by using open-ended questions about the importance of spiritual beliefs. We can also gain basic knowledge of religious beliefs and values around death and dying. One should avoid assumptions as this can lead to emotional distress. As we become more aware of the importance of spiritual care in the ICU, one can participate in the discussions to increase our comfort levels with the subject. Also be aware of how our own religious beliefs might influence the interactions with patients and their surrogates, then one has to have a balance between our personal belief and medical professionalism. Religious and spiritual needs should not only be offered to the dying. Spiritual and religious need discussion should be started before the ICU, especially for patients with end-stage diseases. The hospital intake form should include specific religion and place of worship. We can have early chaplain or spiritual care involvement to prevent isolation. Be sure to ask patients about their religious preference in a private area, and then have a good coordination to ensure a dying patient's body is dignified and treated with respect. This is a very sensitive time period, so involving experts is recommended, but participation is crucial for learning. It is often identified that further educational training is required for us to be familiar with and respectful of traditions and beliefs, and if possible, integrate them into the care plan. One can start by increasing the amount of cultural and religious sensitivity training. We can also have grand rounds with the palliative care or chaplain team, develop a service line where one is locked in, look at the best practices from the various critical care societies, we can involve mediators or cultural brokers, there is a Lancet series on end-of-life care, and also the Canadian Medical Association journal series, which is referenced at the end of the presentation. Community involvement is vital to addressing spiritual concerns. Building relationships with the local community helps us to know what support is available and also to identify gaps. Community-based initiatives and programs in faith settings can increase the awareness of advanced directives amongst followers. It also gives us time to build relationships and trust, which can open the door for further hospital-based outreach and teaching, also preventative care and other public health intervention. This often helps with off-hours issues. We have to ensure that the outreach is culturally sensitive. Religious patients and their family often look to their spiritual leaders for guidance with difficult decisions. Mutual respect is required. Spiritual care is essential for holistic ICU care. Widening your knowledge base about cultural and religious diversity can improve the quality of ICU care and improve patient satisfaction. We should implement systems to improve spiritual care. We can start with early palliative or chaplain service involvement. Research in this area is lacking, but is growing.

challenges faced by patients

specific religion

healthcare

religious and spiritual needs

care plans