Spirituality in Healthcare

I'm at a conference on Addiction Care and Addiction Medicine so of course spirituality comes up for discussion. The dominant model is Alcoholics Anonymous and Alanon, NA etc. which have a core of spirituality. But it's interesting how much spirituality is pervading medicine and healthcare in general, especially at a time when we are moved to resist religion in healthcare. Perhaps we are learning from AA and Twelve Step approaches that there is more than a semantic difference between religion and spirituality.

Tonight's dinner speaker talked about evidence-based medicine and he explained that the previous debate about using AA in Treatment Programs is coming to an end because AA practices and participation is now evidence-based. There have been enough longitudinal studies to confirm success and positive outcomes: Patients who participate in three AA meetings a week do better than those who go to one meeting, who still do much better than those who do not attend any 12 step meetings. He also mentioned that there is now a heated debate around requiring spirituality training for ICU nurses.

But perhaps the biggest marker  for institutionalized medicine though is that "Attention to spirituality" is a prerequisite for medical treatment programs that are certified by the Joint Commission on Accreditation in Healthcare.

Changing Demographics Changes Caregiving

While much of what we talk about on this blog is related to cancer it’s important to know that cancer is no longer a “stand alone” illness or disability. There is no longer a sick spouse and a well spouse—even though a lot of the discussion around caregiving is framed in that false dichotomy. Because of the dramatic shifts in demographics and changes in healthcare it’s very unlikely that a family or a household will deal only with cancer.

Here are some statistics on aging, cancer and chronic illness in the New York Capital Region:

*By 2015 the number of people over 60 will increase by 40%

*By 2012 six out of 10 people over 60 will manage more than 1 chronic illness

*By 2020 cancer survivors will increase by 55%

*By 2021 the age group of people 85+ will increase by 35%

*By 2012 the number of formal caregivers (nurses, aides, case managers) will decrease by 20%

If you look at those statistics side-by-side you’ll see the dilemma we are facing: The good news: more of us will live longer. But the fine print that we forget to read says we’ll live longer with cancer and with multiple chronic conditions. It also means that our caregivers will also live longer but with much more complicated health issues of their own. What that good and bad news really means is that most of our households will have multiple caregivers –spouses and partners will trade roles most of the time or will be simultaneously caregivers for each other.

This is a consequence of better healthcare and of the rapid changes in cancer treatment.

You may be experiencing this. One member of your family may have cancer but someone else in the family has heart disease, diabetes, rheumatoid arthritis, dementia, MS, or another form of cancer. As we age better, and live longer, this will go back and forth multiple times.

Ribbons for Caregivers?

This week I participated in a great seminar on cancer and caregiving presented by the organization To Life! Tons of new information on genetic testing and hormone replacement therapies. Answers to the questions you didn’t even know that you wanted to ask. But it was –again—the conversations with caregivers that blew me away. How much life caregivers spend without even knowing how deeply they are committed or how much it might be affecting their life and health.

I always think that people must know the impact of caregiving and then each time I talk to a group it’s there again: caregivers are working fulltime, raising kids, caring for at least one elderly parent and a spouse or partner with cancer. And they are apologizing about some part of their life they are not doing well: missed a friend’s birthday; haven’t followed international news; missed a new movie. And the big thing they are skipping is attention to their own healthcare and that has disastrous effects for the caregiver and the family.

Caregivers skip annual physicals, mammograms, blood tests, dexascans, teeth cleaning, medication monitoring. Nobody wants to go to another doctor when you are actively caring for someone with cancer—you see far too many medical waiting rooms—with awful magazines and terrible TV—and so caregivers get sick.

We know that breast cancer is hard and colon cancer is hard and lung cancer is hard but caregiving is hard too and mostly it goes unacknowledged by medical professionals even though there are big medical consequences.

So, what color is the ribbon for caregivers? Should it be a rainbow because caregiving encompasses every serious illness? Or should the caregiver ribbon be clear plastic because caregiving and its consequences are still invisible?

The High Cost of Not Dying

It may be too hard to read if you have cancer but if you have a loved one with cancer you must read the Annals of Medicine article by Atul Gawande in the August 2 2010 issue of the New Yorker magazine.

With compelling stories and plenty of grey in a black and white world Gawande invites us to consider what it means to be dying—especially of cancer—when there is no end of treatments and procedures that can be tried, applied and administered.

Most interesting is his challenge to us about how death itself has changed because we no longer stop and let a person experience it.

This excellent essay walks us through the very high cost of cancer in both dollars and healthcare system costs and the cost to us as people when we treat cancer as a problem to be fixed. We lose not just dollars but part of our humanity—and for those of us who care for or have cared for someone with cancer—we lose an essential piece of being a loved one in the truest sense of that term.

This August 2 issue is on newsstands or at your local library. Check it out. Make copies to share with friends. Talk about it now.