Ethical Concerns if Clinicians Have Knowledge Gaps in Spiritual Care
February 1, 2025
By Stacey Kusterbeck
During medical school, Paige Stevens, MD, benefited from learning how to provide spiritual care to patients and families. “When I transitioned to pediatric residency and pediatric critical care fellowship, I recognized that many of my colleagues had never received spiritual care training and did not feel comfortable addressing the spiritual needs of their patients,” says Stevens, an assistant professor of pediatric critical care medicine at Loma Linda University School of Medicine.
Stevens became interested in developing curricula to teach pediatricians — particularly pediatric critical care physicians — to incorporate the spiritual needs of patients into care plans. “Despite evidence that pediatric patients and their families benefit from their physicians being aware of their spiritual needs, little was known about the current knowledge, attitudes, and skills of pediatric trainees, much less those training in critical care subspecialties,” says Stevens.
Stevens and colleagues conducted a targeted needs assessment to understand the current landscape of spiritual care training for pediatric critical care trainees.1 “Having witnessed firsthand the importance of faith in coping with life-threatening illness, we welcomed the opportunity to learn more about how we could better serve our patients and their families,” says Caroline Rassbach, MD, another of the study authors and pediatrics residency program director at Stanford Medicine.
The researchers surveyed 245 pediatric fellows in critical care subspecialties (cardiology, critical care, and neonatology). Some key findings:
- Most (83%) pediatric fellows had never received spiritual care training.
- Most (72%) pediatric fellows stated that if they did receive such training, they likely would incorporate spiritual care into their practice.
- 91% stated that they never or rarely take a spiritual history. Pediatric fellows who did have spiritual care training were more likely to take a spiritual history and to refer families to spiritual care resources.
- Lack of training and lack of time were the two biggest reported barriers to providing spiritual care.
Despite spirituality and faith being very important to many patients and families, clinicians often fail to provide spiritual care.
“Spiritual beliefs are frequently at the center of ethical discussions, particularly when it comes to beliefs about therapies required to treat life-threatening illness and decisions surrounding end-of-life care,” observes Stevens.
Ethicists can help by being well-versed in skills required for taking a spiritual history, and by partnering with chaplains to ensure that patients’ beliefs are well-understood by the clinical team.
According to Kevin Kuo, MD, another of the study authors and a clinical associate professor of pediatric critical care medicine at Stanford Medicine, “Ethicists can be wonderful advocates for patients when they’ve identified lack of spiritual care impacting the patient. Educating the team regarding this specific need and engaging chaplains are two ways they can do this.”
Reference
1. Stevens PE, Rassbach CE, Qin F, Kuo KW. Spiritual care in PICUs: A U.S. survey of 245 training fellows 2020-2021. Pediatr Crit Care Med. 2024;25(5):396-406.
Paige Stevens, MD, became interested in developing curricula to teach pediatricians — particularly pediatric critical care physicians — to incorporate the spiritual needs of patients into care plans. Stevens and colleagues conducted a targeted needs assessment to understand the current landscape of spiritual care training for pediatric critical care trainees.
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