Spiritual and Religious Care – During Chronic Illness and Cancer

Seeking support from religion and spirituality to resolve life's problems is entirely natural and normal. However, uncovering one's inner spiritual potential to help cope with problems and benefiting from religion are not things everyone can always achieve alone. People may therefore often need professional assistance with adapting to difficult situations such as serious illness. Before discussing spiritual care, which has a place in healthcare worldwide and in our country, particularly during serious illnesses such as cancer, we can discuss spirituality itself.

What is spirituality?

Spirituality is an individual's effort to understand and accept their relationships with themselves and others, their place in the universe and the meaning of life. By this definition, spirituality is a value concerning human existence. Everyone has questions about life and death and answers to those questions. Spirituality also results from lifelong experiences and acquired knowledge. In a sense, people form their own spirituality through the answers they find about life's purpose.

Spirituality is easily likened to or integrated with religion but is fundamentally different. Their differences can be described as follows: unlike spirituality, religion is a subjective teaching rich in tradition, imposing social roles and responsibilities and having defined limits and rules. It includes beliefs about health, illness, death, sin, the afterlife and responsibility toward others. Spirituality, on the other hand, may be considered religion's first component, but is too broad to be limited to religious beliefs and practices.

Spiritual beliefs and values may or may not be connected with an organized religion. People without strong religious beliefs can also have a spiritual dimension. A person can have spiritual values without feeling they belong to any religion or being a member of one.

What is spiritual care?

Spiritual care means being alongside people experiencing pain, distress, sadness, fear, loneliness and hopelessness following sudden adverse changes such as illness, disability or disaster; supporting them in terms of their beliefs; guiding them in fulfilling customs and worship; and helping them give new meaning to their lives and existence.

Illness and treatment naturally affect a person's spirituality. People may not know what to do or how to think; they expect help and support and seek comfort, encouragement and attention. This is where spiritual care matters. Almost every religion and spiritual movement has forms of worship and rituals. Being able to perform these positively affects spirituality and gives meaning.

Throughout human history and the search for healing, health and spirituality have been linked. In almost all human communities, while material means of healing were sought, the role of forces beyond the material world also accompanied this search. Historical and worldwide examples of spiritual care show spiritual structures within healthcare institutions in Islamic, Christian and other religious societies of their time. However, these approaches were based on a particular religion. Today's societies have become more multicultural and diverse. This requires spiritual care to include many religions, which is also the current professional perspective.

The medical field providing supportive treatment for serious and progressive illnesses, particularly cancer, palliative care, also addresses this need of patients and families. The World Health Organization (WHO) defines palliative care as an approach improving the physical, psychosocial and spiritual care of patients and their families. The spiritual burden of serious illness affects both patients and families. Spiritual care therefore includes both the patient and their relatives.

The Duke University Center for Spirituality, Theology and Health describes individuals' illness-related spiritual needs as follows:

• The need to make sense of illness: Patients worry about why they developed this illness and what consequences it will have for their own and their family's future. They wonder about the possible outcomes of a condition causing long-term physical problems, how to cope with the illness and how to carry its emotional burden.

- Related topic: The moment time stands still: RECEIVING A CANCER DIAGNOSIS!

• The need for "meaning" as illness continues: During illness, motivation to cope and keep fighting must be renewed from time to time.
• The need for spiritual beliefs to be accepted, respected and supported: Spiritual values are very important to everyone. Patients therefore value having the professionals caring for them respect their spiritual values.
• The need to focus the mind on subjects other than illness: Patients need their minds to move away from illness and concerns about themselves. Spiritual matters provide a healthy, powerful area on which to focus attention.
• The need for feelings of taking control and relinquishing control: Illness and hospital experiences can make patients feel lonely and excluded. Experiences such as knowing that people from their religious community are praying for them or receiving visits help patients feel valued and loved by the Creator.
• Accepting and coping with death: Experiences such as serious illness and hospitalization make patients realize they will not live forever. Many people fear the process of dying more than death itself, because it is a period when they lose control over themselves and their lives and feel uncomfortable and alone. Patients may also feel spiritually unprepared for death because of fears such as punishment afterward. Here again, they need professionals to guide them, reduce anxiety and offer hope.
• The need to forgive and be forgiven: Some people may see illness as punishment. With thoughts of death, their need to forgive and be forgiven increases. Spiritual and religious beliefs help people forgive others and seek forgiveness, and help them release guilt and anger in a healthy way.
• The need for gratitude during illness: Feeling gratitude for the health and human relationships they have helps patients adapt more easily to illness and develop a more positive outlook. Religious beliefs and stories strengthen gratitude. Accounts of religious figures' experiences help develop positive role models to guide them during illness.
• The need to feel hope: Hope drives motivation. Without hope, patients may give up the struggle. Spiritual beliefs, an important source of hope, are therefore highly important during treatment.

Healthcare has criteria or measurements identifying physical needs, such as physical examination findings or laboratory results. Assessing patients' spiritual distress and needs — in other words, examining them in this respect — is also important. Scales and questionnaires exist to evaluate a person's need for spiritual care.

In 1981, at a meeting in Lisbon attended by almost all the world's medical associations, Article 11, entitled the Right to Religious Assistance, of the World Medical Association Declaration on the Rights of the Patient stated that a patient has the right to request or refuse spiritual and moral comfort, including assistance from a religious representative of their own faith .

The situation in religious and spiritual care in Türkiye:

In Türkiye, spiritual support services were specified in the Patient Rights Regulation published on 01.08.1998 in Official Gazette No. 23420, Article 38, as follows: "Within the means of healthcare institutions and organizations, necessary measures are taken to allow patients to freely fulfill their religious duties. Provided that institutional services are not disrupted, others are not disturbed, and medical treatment organized and conducted by staff is not interfered with in any way, a religious official appropriate to their beliefs is invited upon request to offer religious guidance and spiritual support."

In Türkiye, Spiritual Support and Guidance Services began as a pilot in six provinces under the cooperation protocol signed on 07.01.2015 between the Ministry of Health and the Presidency of Religious Affairs to provide spiritual support in hospitals. These were Ankara, İstanbul, Ordu, Erzurum, Kayseri and Samsun. From December 2016, the service had been introduced in 14 provinces. Personnel selected to provide these services are required to have completed a four-year undergraduate theology degree.

Many studies show better outcomes during treatment when spiritual support or religious care is provided. Professional spiritual care services tailored to the illness, its stage, and the patient's culture and values need to be developed. Adopting spiritual care education, training professionals in the field, and increasing scientific studies and research can produce much more meaningful results.

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