Patients coping with advanced, life-limiting illnesses often turn to palliative care to address both their medical and emotional needs. This specialized service offers a more holistic approach to managing the pain, stress and other symptoms associated with serious conditions such as cancer and cardiovascular disease. More and more, palliative care is being credited as an essential component of medical care for these patients and their families.

It is truly groundbreaking to add spiritual care.

The Palo Alto Medical Foundation’s Palliative Medicine Department consists of an interdisciplinary team of physicians, nurses, social workers, care coordinators and medical assistants, all working together to address symptoms and improve quality of life for patients. And in 2018, thanks to the generosity of anonymous donors from Atherton, PAMF added a chaplain to two of our outpatient services.

PAMF’s five-year pilot is built upon a palliative care program started by Sharon Tapper, M.D., a retired Santa Cruz physician who still consults with Sutter Health on broader issues related to palliative care. This pilot makes PAMF’s outpatient palliative care program one of the first in the nation to incorporate spiritual care expertise.

A chaplain’s work complements that of a social worker by addressing the spiritual and psychosocial needs of palliative care patients and their loved ones. This spiritual clinician also facilitates patients’ and caregivers’ ability to communicate and support one another through complex emotions while also drawing upon each person’s spiritual needs in a way that provides comfort, reassurance and resilience. Additionally, a chaplain extends physicians’ reach, ultimately allowing doctors to manage more patients.

Rev. Charlotte Bear joined the PAMF palliative care team last July, bringing over 20 years of professional ministry work, including nine years of full-time healthcare chaplaincy work with veterans, terminally ill patients and their families. She was also a trainer, bereavement manager and director for two leading hospices in the Bay Area and has specialized in developing community-based programs that serve the unmet needs of vulnerable patients and their caregivers.

“During palliative care assessments, we regularly uncover patients facing spiritual distress, along with the anger, vulnerability and loss they often feel with advanced serious illness,” says Steve Lai, M.D., director of palliative care and support services at PAMF and chair of palliative medicine for the Palo Alto Foundation Medical Group. “It is truly groundbreaking to add spiritual care to our multidisciplinary practice—something typically found only in hospitals or hospice. Charlotte adds so much value to our care team, not just helping our patients but also improving our team wellness.”

Building PAMF’s program from the ground up will allow Rev. Bear to develop a blueprint for the organization to model clinical spiritual care best practices, including managing busy caseloads, and eventually integrate chaplains into all of PAMF’s outpatient palliative care teams.

Caring for Patients at Home

Two-thirds of patient visits by PAMF’s palliative care team are conducted in-home. Research shows that outpatient, home- based care not only improves quality of life but can also extend life. Nationally, the average length of stay in hospice is 83 days while patients typically stay in palliative care for about six months. Because this service sees patients earlier than hospice, Rev. Bear is able to build stronger relationships with them and their families.

Currently, Rev. Bear cares for nearly 100 patients across the Santa Cruz and Sunnyvale communities as she builds a programmatic framework that can be spread throughout PAMF once we add spiritual clinicians to all palliative care services. She manages up to 15 home visits a week plus telephone consultations. Initial visits last approximately 90 minutes, with follow-ups scheduled according to need.

“I have patients tell me all the time they had no idea they could have home visits for palliative care and a chaplain too,” Rev. Bear says. “I love this work because I see people where they live, and in doing so, I learn so much about their humanity. It lets me see family dynamics firsthand so I can help everyone cope better, manage illness better and ultimately find a better quality of life.”

Safe Space for Spiritual Needs

Rev. Bear’s role provides patients with an outlet for addressing spiritual matters, which often benefits their medical care. “Patients naturally want to talk to physicians about the medical aspects of their illness, but with Charlotte, they feel comfortable expressing their emotions and spiritual needs,” Dr. Lai says. “We are seeing that when spiritual distress is lowered, pain and anxiety can also be lowered, which allows for less pain medicine.”

Most of the patients Rev. Bear sees fall into one of two categories. The first group identifies with a religion but does not want to approach their own faith community or leader. Some may be estranged from their religion; others would rather work with a chaplain because, in addition to meeting all of the requirements for professional pastoral care, chaplains are specially trained in the spiritual needs of those facing serious illness.The second group does not necessarily claim a religious affiliation but self-identifies as spiritual. These patients are often seeking clarification about their spiritual experiences and want to develop spiritual practices as a resource for well-being.

“This is deep work that involves support for families and caregivers as much as for patients, providing more peace and resolution,” Rev. Bear says. “It has been so special to bring clinical spiritual practices to PAMF, where part of its stated mission is caring for the well-being of communities and serving gaps in care. This is the heart of our mission in the chaplaincy program.”

PAMF is grateful for generous community donors with a vision to initiate this pilot. Recognizing the spiritual gap in palliative care, they were deeply motivated to help ensure these patients receive this vital care in addition to their medical service.

“These special donors tell me they believe they are doing God’s work,” Rev. Bear says. “There is real therapeutic value to spiritual care. When patients journey with a serious illness, many want to reclaim their faith or deepen their authentic spirituality.”