The 4 Corners of Palliative Care: The Role of Spiritual Support

Libby Boatwright, D.Min, BCC
June 30, 2016
Libby Boatwright, D.Min, BCC

The Rev. Libby Boatwright, D.Min, BCC, is Chaplain for Outpatient Oncology Palliative Medicine for Stanford Health Care in Palo Alto, California.

I am part of a palliative care team at Stanford Health Care. We are a fully integrated care team that works to relieve physical and emotional suffering and provide social, psychological, and spiritual support for patients and their families. We call our kind of care the “Four Corners of Palliative Care” and integrate its principles into our daily work. Here are those 4 corners.

  1. First Corner. A doctor and nurse practitioner, who cover medical issues.

  2. Second Corner. A social worker, who handles the familial, practical, and sociological aspects of a patient’s life.

  3. Third Corner. A specialist or psychologist, who covers a patient’s emotional and psychological needs.

  4. Fourth Corner. A chaplain and spiritual care advisor, who explores meaning and purpose, assesses spiritual needs, and asks if the patient has a faith community or support team in place.

I am privileged to be the fourth corner.

Members of the palliative care team work collaboratively and independently. Currently the social worker and I see patients together so we don’t duplicate our efforts. Working together also helps us have a united voice when we share our information with the doctor and nurse practitioner. Together, the second, third, and fourth corners can provide insight on how members of the first corner can approach a patient’s medical issues.

This patient story shows how spiritual distress can affect a person’s treatment and how a chaplain or spiritual care advisor can help people in need. 

Fatigued, frightened, and disappointed with God: Heather’s* story

Heather recently revealed to us how fatigued and frightened she felt and why she didn’t want to continue chemotherapy and radiation therapy. Heather was suffering, with growing debt and bills she could not pay. Her family was tired of taking her to appointments and missing work. Her mother had quit her job to stay with Heather.  Heather told us that she felt she was being “punished by God” for all her past choices and was prepared to give up. We encouraged her to vent all of the anxiety and sadness she felt about her family and lack of support from her church. Then we allowed some silence so she could rest her thoughts.

In the conversation that followed, the social worker suggested some options that could help her cope with the financial burdens of her care. Once Heather seemed more at ease, she was able to express some of her deep disappointment with God. She told us her thoughts on forgiveness and prayer, meditation, and even the idea of inviting small groups of people to her house for short visits.

A return of confidence

Heather began to feel ready to continue with treatment. Then, like a carpenter who frames the corners of a window, we prepared the doctor and nurse practitioner for their visits. The problems on Heather’s charts were “distress,” “fatigue,” and “concern for continuing treatment,” but the other corners of palliative care were able to offer the back story. Knowing that she had been provided with resources, the doctor and nurse practitioner felt that Heather might be open to proceeding with her treatment. Most importantly, she felt heard and honored. share on twitter 

*Name changed to protect privacy.


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