Spiritual care in the integrated care paradigm: a road map for physiological aging and chronic illness

Background: Spiritual care has been shown to be beneficial for patient in the settings of oncology and intensive care [1-5]. We propose that the quality of care given to the aging or to individuals with chronic illness might also improve as a result of the inclusion of spiritual care interventions in the integrative care models which guide the management of such individuals. The research studies to date that point to a positive impact of spirituality on patient outcomes in this patient population, have been criticized for the lack of a strong theoretical framework [6- 11]. The need for spiritual care is recognized, but a theoretical model has not been developed, and testable spiritual interventions have not been defined. In addition, there are also key reasons that have to do with the conceptualization of integrative care itself — the focus on the integration of ‘services’ which have a direct economic component is reflected in the WHO definition of integrated care: “Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency” to the individual [12, p.6]. The person in the WHO scheme is always to be seen as part of an entity and a system of beliefs, culture, religion and a community ecosystem and not to be seen as a "single" person. Similar reports from the IOM (Institute of Medicine) (13, p.20) focus on the essentials of a “systems engineering” approach to fixing an aliening health care system, defining essential and necessary steps best depicted by the following diagram. The individual, labeled as patient, is the white circle with no subscript. Although the word spiritual evokes fears in some people that esoteric concepts undermine the scientific rationality, we would argue that conceptually spiritual care is based on the rational concept of how we define a person in