小西 達也

Through our survey of Multinational Association of Supportive Care in Cancer (MASCC) members and its analysis, we sought to gain a broader, more inclusive perspective of physicians' understanding of patients' spiritual care needs and improve our approach to providing spiritual care to patients. We developed a 16-question survey to assess spiritual care practices. We sent 635 MASCC members four e-mails, each inviting them to complete the survey via an online survey service. Demographic information was collected. The results were tabulated, and summary statistics were used to describe the results. Two hundred seventy-one MASCC members (42.7 %) from 41 countries completed the survey. Of the respondents, 50.5 % were age a parts per thousand currency sign50 years, 161 (59.4 %) were women and 123 (45.4 %) had a parts per thousand yen20 years of cancer care experience. The two most common definitions of spiritual care the respondents specified were "offering emotional support as part of addressing psychosocial needs" (49.8 %) and "alleviating spiritual/existential pain/suffering" (42.4 %). Whether respondents considered themselves to be "spiritual" correlated with how they rated the importance of spiritual care (p a parts per thousand currency signaEuro parts per thousand 0.001). One hundred six respondents (39.1 %) reported that they believe it is their role to explore the spiritual concerns of their cancer patients, and 33 respondents (12.2 %) reported that they do not feel it is their role. Ninety-one respondents (33.6 %) reported that they seldom provide adequate spiritual care, and 71 respondents (26.2 %) reported that they did not feel they could adequately provide spiritual care. The majority of MASCC members who completed the survey reported that spiritual care plays an important role in the total care of cancer patients, but few respondents from this supportive care-focused organization actually provide spiritual care. In order to be able to provide a rationale for developing spiritual care guidelines, we need to understand how to emphasize the importance of spiritual care and, at minimum, train MASCC members to triage patients for spiritual crises.

In this article, I define spiritual care as the "support of the careseeker's subjective/spiritual life." Spiritual care is provided for people in spiritual crises, where their existing foundational/core beliefs are dysfunctional in their situation. Such people are required to let go of their existing dysfunctional foundational/ core beliefs, and to continue their subjective lives without their foundational/core beliefs until new ones have been developed. The spiritual care should support the careseekers in such process. In this article,"the provision of 'Ba'(space/opportunity) for the careseekers' belief-free inner-exploration/self-expression" is proposed as a definition of the spiritual care. This definition can be described also as "the support of the careseekers' subjective/spiritual lives." This definition coincides with the spiritual care that the author has actually provided in his clinical practice, which means that this definition works in the actual clinical setting. Further, it is also shown that the Clinical Pastoral Education program mainly provided in the United States, which is considered to invite their students to be free from their own beliefs by becoming conscious of their beliefs, is effective as training for the ones to provide such spiritual care. Lastly, it is expounded that the proposed definition has affinity with some of the existing definitions of spiritual care widely known by people in the Japanese medical clinical setting.