Addressing Cancer Patients’ Spiritual Concerns

Integrating spirituality into oncology social work practice is appropriate, feasible, and necessary, said Mary Ellen Summerville, CSW, MDiv, coordinator of Cancer Care’s Spirituality Program at a recent Cancer Care seminar. Oncology social workers can help their clients with these issues.

“If we listen closely, all of us hear the spiritual concerns of our patients woven in and out of the things that they talk to us about. They are struggling with issues related to death, emotional and physical suffering, and the meaning of life. Our general response is, ‘Somebody call the chaplain,’ and although that is an appropriate response, there are other things we can do before or in addition to calling the chaplain.”

Defining Spirituality

Ms. Summerville defines spirituality as a need for and the experience of meaning, purpose, and connection. Social workers should focus on how individuals do or do not meet these needs, and they can start by taking a “spiritual history.”

She developed two types of assessment for taking such a history. These assessments are based on the work of J. W. Fowler (The Psychology of Human Development and the Quest for Meaning, Harper & Row, 1981), who suggested that there are developmental stages of spiritual growth and that growth occurs, in part, through crisis.

The first assessment looks at an individual’s overall spiritual beliefs. What are the person’s spiritual beliefs and values? To what spiritual or religious groups do they belong? Do they have spiritual practices that help them cope, such as attending worship services, reading, meditating, watching religious programming, or taking nature walks?

The second assessment examines the person’s spiritual development. What were their early religious and spiritual experiences? What is their understanding of key spiritual concerns, such as the ultimate meaning and purpose of life and mortality? Which part of the person’s religious or spiritual outlook is most meaningful and which causes confusion?

Social Worker’s Role

Ms. Summerville feels that social workers already have received enough training to deal with a patient’s spiritual concerns. Once social workers have an overall impression of the patient’s spirituality, they can use their basic psychosocial skills—ie, empathic listening, exploration, clarification, and validation of feelings—to help patients reframe their particular spiritual conflict. “For example, if a client tells me he can’t be angry with God, I would tell him about the biblical story of Job and how he contended with God. Or if he is a Christian, we can talk about Jesus asking why God has forsaken him.”

No Easy Answers

Most importantly, social workers should strive to truly empathize with a client’s struggles; they should not offer any easy answers. “Spirituality is not just for patients. It is important that we pay attention to our own spiritual beliefs, needs, and development,” Ms. Summerville said. “We may go through periods where we are feeling tremendously upset and angry and we question our own spiritual beliefs. . . . If we are going to stay in there with people, we are going to have to find a way of making meaning out of suffering, and like our clients, we are going to have to go through stages of spiritual development.”