1. “Treasure the Question” Martyn Joseph Mervyn McGowan with a lot of help from Tom McGowan

3. How we live with the scream

4. What is spirituality? The engagement to explore – and deeply and meaningfully connect one’s inner self – to the known world and beyond (Kale, 2004)

6. Spiritual pain Spiritual pain more common symptom than pain in cancer patients (Portenoy et al., 1994) Accounts for 47% of requests for physician assisted suicide (Meier et al 1998) Speck defines spiritual pain as linked to: –Sense of hopelessness –Focus on suffering rather than pain –Feelings of guilt/shame –Unresolved anger –Inability to trust –Lack of inner peace –Sense of dis-connectedness or fragmentation

7. Psychological effects Religion appears to help protect against depression and hopelessness (Breitbart et al) which are associated with poorer survival in cancer patients (Watson et al) But spirituality possibly linked to psychological distress (Higher Education Research Institute 2005)

8. THE MEANING OF LIFE Sometimes life just doesn't make any sense at all. Sometimes life doesn’t make any sense

9. Spiritual histories Speck: –In the course of your life, with all of its ups and downs, have you developed ways of making sense of things that have happened to you? –When life has been difficult what has helped you to cope? –Would you like to talk to someone about the effect your illness is having on you or your family?

11. Spiritual histories NICE says “Assessment of spiritual needs does not have to be structured, but should include core elements such as exploring how people make sense of what happens to them, what sources of strength they can draw upon, and whether these are felt to be helpful to them at this point in their life.”

12. NATIONAL CARE OF THE DYING AUDIT – HOSPITAL (DONE BY MARIE CURIE IN LIVERPOOL AND ROYAL COLLEGE OF PHYSICIANS) THEY LOOKED AT 2672 PATIENTS IN 118 HOSPITALS SEPT – NOV 2006 (BMJ DEC 2007) 33% of dying patients had their spiritual needs assessed whereas 53% of carers had theirs assessed

14. “Treating” spiritual suffering Lunn (2003) defined spiritual care as: “Meeting people where they are and assisting them in connecting or reconnecting to things, practices, ideas and principles that are at their core of their being – the breath of their life, making a connection between yourself and that person”

15. “Treating” spiritual suffering Rousseau suggested a seven stage process: 1.Controlling physical symptoms 2.Providing a supportive presence 3.Encouraging life review to assist in recognizing purpose, value, and meaning 4.Exploring guilt, remorse, forgiveness, reconciliation 5.Facilitating religious expression 6.Reframing goals 7.Encouraging meditative practices, focusing on healing rather than cure

16. “At medical school I learned to repair violins”

17. “It took many more years for me to hear the music” Barry Bub

18. Tenderness dialogue

19. Victor Frankl

22. Dignity therapy Based on Chochinov’s work Targets depression, suffering, lack of meaning, purpose and will to live in palliative care patients. Protocol poses questions that offer –opportunity for patients to address aspects of life that they feel most proud of/are most meaningful –the personal history they most want remembered –things that need to be said. Sessions recorded, transcribed and returned. Brief, done at bedside, benefits family and patient.

23. Dignity therapy 91% satisfied 76% more dignity 68% more purpose 47% increased will to live 81% of benefit to family Reduced depressive symptoms

24. Your “dignity” profile?

25. CONTEMPLATIVE AWARENESS COMMUNITY AUTHENTIC ACTION IN THE WORLD LIFE IS ONE A FOUNDATION LIFE STANCE “OPENNESS” ROOTEDNESS Signs of a balanced spirituality

26. Another saying from a book of wisdom

27. A man (or a woman) can do nothing better than to eat

28. And drink

29. And find satisfaction in his work Ecclesiastes 2:24