#  Video: Interprofessional Palliative Care 

 





October 30, 2024

 

 

     ![Kerry Maloney](/sites/g/files/omnuum5526/files/styles/hwp_16_9__480x270/public/2025-03/Screenshot%202025-03-17%20142648.png?itok=M9LXNK6S) 

 



 

Naomi Saks, MDiv ’10, Chaplain at University of California, San Francisco Medical Center offered remarks via Zoom about her new book, "Intentionally Interprofessional Palliative Care." Naomi was joined by one of her co-authors Chaplain Paul Galchutt.

Sponsored by the Office is Religious and Spiritual Life. This event took place on October 30, 2024.



 

\[MUSIC PLAYING\]

**SPEAKER 1**: Harvard Divinity School.

**SPEAKER 2**: Interprofessional Palliative Care, October 30, 2024.

**KERRY MALONEY**: Welcome. We are so glad you've joined us for this webinar to celebrate the publication of a very important new book, Intentionally Interprofessional Palliative Care. It's published by Oxford University Press in the spring of 2024, and was co-edited by one of our speakers tonight and one of our distinguished alumni, Naomi Tzril Saks, from whom you will hear this afternoon. And Naomi is joined by her colleague and our guest, whom we are thrilled to have, Paul Galchutt, from Rush University Medical Center. I'll introduce them both in a moment.

My name is Kerry Maloney. I am the Chaplain and Director of Religious and Spiritual Life here at HDS. My office's mission is to stand at the intersection of the intellectual and spiritual life of the school and of the people who comprise it-- faculty, staff, students, and alum.

And that is a very broad umbrella. It gives me the excuse to throw parties like this one, to celebrate the books of our community members, to host all kinds of very important events that have to do with the shaping of the way people carry out the diverse kinds of ministry and religious and spiritual leadership that we study in practice here at HDS.

So before we begin, I want to remind us that we gather this afternoon here on the campus of Harvard Divinity School, on land that belongs to the Massachusett tribe. And we call to mind the people of that community, past, present, and future, the original inhabitants of Cambridge and Boston. We honor those folks and the land itself. So we hold a moment of silence to remember that we are on borrowed, even stolen, land.

We are celebrating, as I said, this really beautiful book, Intentionally Interprofessional Palliative Care. And thanks to our guests tonight, you are being given the great gift of a discount if you want to purchase it, a 30% discount. There's a QR code for that, which will be posted online, which I think our dear friends in Development and External Relations are about to post on the chat here, on the webinar chat for you. And there's a QR code, if you want it, in the handouts in your seats, if you want to scan that and access it.

I want to say that this event is, indeed, being sponsored by not only my office, but by the Office of Development and External Relations, which helps to oversee alumx relations. So we are thankful particularly to Kristen and Chandra for being here tonight and helping that happen. We're thankful to our friends in HDS IT for showing up and making this digitally possible. And we're also thankful to our friends in the Office of Ministry Studies, the department that oversees our Master of Divinity program, for co-sponsoring this as well.

So many of our students, like Naomi some years ago, are aspiring to be chaplains of one sort or another, many of them health care chaplains. So that happens a lot thanks to the formation that they experience in and through the Office of Ministry Studies. So I'm delighted to have those folks as partners tonight in this event-- so thank you.

Let me introduce our speakers and tell you what the plan is for our time together. We will be listening to our guests tonight for about 35 or 40 minutes as they talk about the themes in their book and some of their particular experiences with the themes as chaplains. They both have long experience as health chaplains. And then we are going to turn it over to questions that you might have, either in the room or online. So you'll have a chance to be in conversation with our visitors.

And then we'll do that for a little bit. And then I'll give them a chance to offer any concluding remarks they might want to make. And we will be done in just an hour from now. 6:15 PM, Eastern Daylight Time. This is our last week of being able to say daylight time. Very soon, it's going to be Standard time. And we will be in the dark at this hour. But right now, I'm looking at a beautiful window here in Sports Hall, that is looking out on our campus green. And you can still see it because it's still light and beautiful out there.

So let me introduce our guests. Naomi Tzril Saks is a board-certified chaplain and assistant adjunct professor, who serves in palliative care with the Division of Palliative Medicine at the University of California, San Francisco. She's the Director of their Individual and Collective Well-Being Program for the Hospice and Palliative Care Fellowship, and is an ordained rabbinic pastor. She has 18 years of experience working in health and in palliative care, in particular.

Naomi completed a fellowship in palliative medicine at Brigham and Women's Hospital in Boston and earned her Master of Divinity degree from here, right here, at Harvard Divinity School, in 2010. That seems impossible. It seems like you were here a year ago, Naomi. But here it is, 14 years ago. Her work is inspired and informed-- excuse me-- by integrated, contemplative, and somatic approaches to well-being, cultural and spiritual humility, health care equity, and transdisciplinary collaboration and education.

Naomi, you honor us with your return to campus tonight. Digitally, in person, you're always welcome. We feel more at home when you show up, so thank you for being here.

Naomi is joined by her colleague, Paul Galchutt, who is one of the contributing authors to this new book. He's the Assistant Director of Engagement with Transforming Chaplaincy in the Department of Religion, Health, and Human Values at Rush University Medical Center in Chicago. In addition to being a Cambia Health Foundation Sojourn Scholar, he's a PhD student at the University of Maryland, Baltimore, and serves as the Associate Editor of the Journal of Health Care Chaplaincy.

So I think we are in very competent hands. I would also point out that in the room here tonight, in Swartz Hall, we have the Reverend Doctor Gloria White-Hammond, who is both a pediatrician and a minister and is a specialist in palliative care medicine and functions as a wonderful bridge for us, a human and spiritual bridge for us, between the divinity school and the medical school, and I'm sure will be a great contributor to our conversation.

So thank you for being with us. Let's--

\[APPLAUSE\]

\--yeah, right. No, she's shaking her head. Forget it. We buy it. You're astounding. We're so lucky to have you, Gloria.

So I'm going to turn it over to you, Naomi and Paul. And we'll start with you, Naomi. And then you have the floor for about 30 or 35 minutes and then we'll have questions. Does that sound like a good plan? Yes? Good. All right. Well, thank you all.

**NAOMI SAKS**: Oh. Hello, everyone. Good evening. So wonderful to be here in the glow of Harvard Divinity School. Thank you so much, Kerry This is truly one of my home, away from home. So it's lovely to be here with you.

We really want to share both this special book and this whole idea of intentionally interprofessional palliative care. I'm going to give you a little intro to the book. And then Paul and I are going to talk a little bit about the main points and why it's so important.

So as you probably know, anyone in health care, and also people who've been on the periphery of health care, the World Health Organization, the National Association of Physicians, the palliative care organizations all say that interprofessional collaboration, both in education and in practice, are essential for patient outcomes, for well-being of the clinicians, and also for generally inclusive care. The issue is that this has never really been operationalized. How do we actually operationalize the synergy that happens when all different professions are working together?

At any given point, anywhere in this country, not just in palliative care teams, but on every team in health care, you could have really smart, wonderful people that are working together. They could have all different training, all different perceptions about what they're doing in the name of collaboration. And, in addition, what we know, even from contact theory in the 1950s and '60s, even though you just put a lot of smart people together, doesn't mean they're going to know how to collaborate and they're going to create a new organism. So this book is a love letter to interprofessional collaboration in both health care and palliative care, and actually in any kind of teamwork.

This idea for this book was started by my dear friend DorAnne Donesky. She's a nurse practitioner in palliative care and also long time educator in interprofessional field. And then she asked myself and a physician, Michele Milic, and a social work PhD, Cara Wallace, and asked us to help co-edit this book.

And when we envisioned this book, we said we want this to be different. We want it to be interprofessionally created, interprofessionally edited, interprofessionally written. And it sounded great at the beginning. And then COVID hit. And so we definitely had some amazing experiences together.

But we asked author pairs all over the country, interprofessional pairs-- some of them had known each other. Some of them have never met each other-- to write different chapters on interprofessional clinical practice, collaboration, and education in all different settings. And that's where Paul came in. We also had three other fabulous chaplains that definitely should be on your radar, Allison Kestenbaum-- and then Amy Bolton at NYU, Allison Kestenbaum at UC San Diego, and Kafunyi Mwamba at Stanford. And so along with many other professions, we went ahead and co-created this book.

The real heart of this book is this idea of being intentionally interprofessional. So lots of times we say we're multi-professional or we're multidisciplinary. And that usually means that there's a lot of amazing professions I work with. I know them well. They're my colleagues.

Some of them I kind of know what they do. I don't always know their job description. Some of them go in by themselves. They do really good work. They come out again. I may read their chart notes. I may not. But there's no real overlap.

And so this idea of intentionally interprofessional is making sure that interprofessional synergy-- this idea that we are so much more than our individual professions and that holistic care and actually inclusive care that brings in, especially in this audience, the inner life of people, the spiritual, existential, religious-- it depends on all members of the team-- chaplains, social workers, physicians, physical therapy, occupational therapy, music thanatology-- this idea that we need to actually be intentional now about it. It is no longer OK to not be able to learn how to collaborate.

And this book puts collaboration at the center. So it looks at it like a clinical skill like pain and symptom management, or a clinical skill like a psychosocial screening. It looks at collaboration as a skill that we all need to learn and that we all actually have to work at.

And I'm going to share a few more ideas of the book. But that's the basic premise. And it's really an exciting project and also part of a movement, I feel, in the last probably five-- mostly five years-- in health and in palliative care, where we are pushing the envelope about how we can include every domain in health care and really include all of the voices of all professions in research, clinical care, and education, as well as the overall well-being of all the professions-- so very exciting.

And Paul, I'm going to turn it over to you for some of your thoughts, and also wanted to hear a little bit just about what your experience was like creating this book. And then some of the-- maybe starting on some of the main points that you really came away with.

**PAUL GALCHUTT**: Yeah. No-- thanks Naomi, to you and to your co-editors, for creating this text. And it's created a little fanfare in our field of hospice and palliative care. So that's exciting. Thanks to all of you who are kindly joining us, either online or in person there in Massachusetts. So I'll have to get on campus one of those days.

And, yeah, how this worked out for me to be a part of this, I had a beloved chaplain colleague who had said that this probably might not be the best fit for her. So she kindly wondered if I would be interested? And, yeah, I jumped right into the seat and said, I'd love to do this.

And luckily, I got paired up with-- she now is Dr. Jaime Goldberg. She's a social work professor at the University of Wisconsin, Madison. But at the time, I didn't know Jaime. And we had the opportunity to-- because of this-- do a crash course-- palliative care.

If you are tuning in and you're part of it, you know that-- I wouldn't say it's a small town. But there's a lot of opportunities to get to know people through it. So we had a lot of mutual friends in the biz, if you will. And so we fast friends.

But one of the things I appreciate Jamie saying, being relatively new to publishing at the time, was the clarity around saying, just from the beginning, which set the tone in a positive way, was for her to be the first author-- like that wasn't clear. And just that was an important part for who she was becoming as a professor, finishing her PhD work. I think it just went from there in terms of the clarity of the communication.

We, of course, didn't always agree on things, but because, I think, of a foundational basis that gets set up, it was fun. It was engaging. I learned a lot. And I hope all the other teams had some similar experiences.

Going through the book, what's been fun for me, thinking about Jaime and the chapter that we wrote together related to the work that gets done in the acute care hospital setting was-- the nuances that show up a little bit, may be different-- like in the chapter we wrote versus the great chapter that you and the editorial team wrote at the beginning-- I mean, not like we're talking vast changes, but, um, that's a little bit of a nuance, which is-- I mean, I think we need it in the field. But that, to me, has been some of the fun.

And I think that happens on the healthy palliative care teams because if you've been a part of that-- and I didn't say-- yeah, I didn't-- I should mention, I was on a palliative care-- inpatient palliative care team for 10 years at the University of Minnesota Medical Center. I have a lot of fond memories, but we also had our hard moments, too. That's because of tragedies that happen in people's lives-- that happened-- but also because of disagreement and conflict and even power dynamics that show up, not just in our setting, but thanks-- because of your book, we know what happens elsewhere.

**NAOMI SAKS**: Thanks, Paul-- and really good point, too. We had author pairs across the country. So we found that everybody was interpreting interprofessional collaboration differently. So we actually didn't have a common language all the time.

And as you all probably know, most palliative care teams, and even I could say health care teams, are rarely staffed with a full-time chaplain, always full-time social worker. Most of the palliative care teams across the country don't have a full-time chaplain. They might even have a part-time. They might have none. They might have a borrowed chaplain. And so that really influences what kind of voice and direction and leadership that chaplains can lead.

I feel very nostalgic. I want to go back to my time at HDS, because I actually think this energized this book. When I was at HDS and I was going to be a chaplain, I looked around. It was 2007 or '06. And I looked around at what chaplains that I saw were doing.

And they were going in rooms. They were very nice people. They seemed to be praying. I was in my training. They were nice to us. They weren't sure what we were doing.

And so I looked at-- Harvard Divinity School gave me this huge invitation to be the thing I wanted to see in the world. And so I started to look around. And I said, where can chaplains serve at the height of their practice? And where can I use all the amazing education-- the fellowship, the bioethics training, the grief counseling training, the interreligious education, and the absolute-- the justice orientation-- everything that I learned and also was so influenced by HDS?

I looked around. And I said, hey, the palliative care team, I think this is one of the main places that I can actually serve at the height of my experience and passion. And that's when I started to learn about spiritual screening from George Fitchett and others. He was a mentor to me.

And if you don't know him, he is the grandfather of our research background. And Paul is the next generation, who is doing extraordinary work. And there's many others now. There is starting to be a little avalanche of amazing chaplain-led interprofessional research that is just extraordinary. So I'm going to give that a little plug.

So I learned about the spiritual screening, which is a few short sentences to identify distress and need in patients, because they're not hiring enough chaplains, that every person in a hospital, a clinic, a nursing home or prison, other places, can get a spiritual assessment. So I learned that I could teach all of my colleagues a couple of short sentences, both to make them aware of the domain of spiritual, existential, and religious care, but also show them that this is something they can do. And then they could identify the need and bring that back to chaplains and spiritual care coordinators and specialists.

So when I was writing this book, I went back to 2014, when they did-- when there was an amazing interprofessional collaboration to design-- to talk about spiritual care and health care. And they really created this model-- Christina Piotrowski and others-- this model of really integrating spiritual screening in every kind of clinical care. So when we were writing this book, I was thinking why can't every colleague on the team know how to do screening in every domain?

And so the center of this book is this generalist/specialist model, that says that we are all generalists in palliative care. We all are also specialists, as experts, in the certain skills of palliative care. But we're all generalist in other domains. And we're specialists in our own domain. So I'm a specialist in spiritual, existential, and religious care. But my physician colleagues, they're a specialist in physical and medical care.

So what we did is we created this model, that everyone on the team is screening in all the domains. So let's say I go into a room. I always do a physical screen or a psychosocial screen. And I'm taught by my social work colleagues, my physician colleagues. But every single member of our team-- and now, actually, many people in our whole hospital, every time they go into a room, they know how to do a spiritual screen, identify need, and bring that information back so the people get help.

What happens in some hospitals where this isn't happening, or there aren't chaplains or spiritual care specialists to teach this, is that whole parts of people's identity is being not addressed. So that's when you have a goals of care meeting. And somebody-- you haven't talked to them about their inner life at all. And they start-- the conversation starts to go towards comfort care or hospice care. And everyone feels like they're on the same page.

And then the person's wife said, oh no, I'm praying for a miracle. We can't do anything. And then every-- then the oxygen comes out of the room because the people-- it's not because they're not caring-- they're not loving people, they don't care about this-- They were never trained to engage this kind of value. We're trained to engage many kinds of values.

If we have a patient and they say our daughter is-- we want to live another month because our granddaughter is getting married, we say, oh, my God, that's amazing. Can we see a picture? What are you going to wear? Where is it going to be? If someone says, I want to live another month to spread the Gospel of Jesus, we just go, psst. And it's only because we haven't learned how to engage that value.

So the first thing is this generalist/specialist model. And everyone in our division is taught how to do screening in every domain-- every year, every new person on our team-- psychosocial, spiritual, existential, physical. And we're going to add ethical and cultural and all these. And other ones, but we're starting there.

And the second is this idea of transdisciplinary collaboration is the best model of collaboration. That means you have a flat hierarchy. Everybody leads from their seat. Everybody is experts in palliative care. And they also are experts in specific domains.

There's constant communication. And there's a synergy that we all co-create the care plan together. So that's really, I would say, the center of the book. And that's really what we talk about when we're talking about intentional interprofessional palliative care.

**PAUL GALCHUTT**: OK, I feel like I could pack it up.

\[LAUGH\]

Yeah, I can definitely add. So I feel like you just gave a little commercial to where I was the last couple of days. I was in Washington, DC, where I had the pleasure-- and thank again to Kerry for the very kind introduction. And she mentioned the Reverend Doctor Gloria White-Hammond, who I met in Washington, DC at the Interprofessional Spiritual Care Education Curriculum.

And I know this is being recorded. I'm kind of glad. Maybe it won't be distributed, but this would have been an exceptional billboard for that course. It's exactly what you talked about.

For me, I often will say we have data that indicate that-- I mean, I think anywhere around 70% of people, in a general, sort of categorical way, say they want their spiritual care addressed. I mean, the Dr. Natalie Hancock study, that was published in JAMA, in 2015-- 249 care conferences. There were only two chaplains in any of those care conferences. 16% of the conferences addressed religion and spirituality of the surrogate decision-maker, family members. And 78% of them said they wanted to have that be addressed. So we could drive a truck through that.

So what I want to say is the need is there. So if we're doing person-centered care, and most of the people that we encounter say, I want my religion and spirituality addressed, I think we-- yeah, I think we owe it to them.

And it sounds like you have a quick audience. And what I loved about people who were drawn to palliative care, who became the rotating medical students, the NP students that would come through, they were eager. They were like, yeah, "nobody ever taught me this in med school." Nobody ever taught me this. I should say in nursing school, because obviously there's a holistic approach there, which I think they do get more of that than they do in med school.

But, yeah, you're speaking of a Christian by background. So you're speaking gospel to me in that way. And that's how I guess more of this transformation is going to happen, the more that we can do this. Because I think some of what we encounter are people naming-- like this feels a little uncomfortable. And, similarly, I think your book addresses-- or through the various chapters-- I think that's the point.

So, chaplain, if you went through your clinical pastoral education and you never learned how to facilitate the goals of care conversation, it's part and parcel of being a palliative care chaplain. So let's do it and jump into it. So I'm excited you laid it out so well, Naomi, and look forward to hearing what we keep talking about-- what's next?

**NAOMI SAKS**: Absolutely. Thanks. So there's so many amazing opportunities in this area. And I think it's really right to say that all of our training is different. We can't say the physician training across the board is the same, or nurses' training or chaplains or social workers. There's so much cross-fertilization that's happening.

But that also means we're not all speaking the same language. So the ways that we can do that is to say, OK, what are we all doing in the name of palliative care? And then what are we actually looking at for domains.

And this really-- the exciting things-- and Paul, you're on the forefront-- is it's not just in clinical care. This has to be in leadership advocacy. People really have to-- and all of us have to lead from our seat and say, we really can't do this without a social worker at the table. We can't do this without a spiritual care expert at the table.

I get a lot of influence, really showing that this is an equity and diversity issue. We used to call spiritual care, even the idea that we'd include this, religious accommodation. So we are still-- most hospitals, clinics, and institutions are still working on this very backward, biased idea that we are a dominant culture. We're humanist and we're rational. And we're going to give-- whenever we feel like it and it works for us, we're going to give "religious accommodations" to these minority people that have beliefs or existential preferences.

I was working with a Tibetan Lama, Rinpoche, a couple of years ago. And my job is to speak this value in languages that many people can hear in a split second.

\[FINGERS SNAPPING\]

My clinical job is very much focused on that.

So this gentleman-- I was talking to him while he was still conscious. And he said, I don't care about the medicine. He doesn't care what kind of flavored Jello he gets. He doesn't care about the way the room looks. What I care about is that my body lays in state for as long as possible, so that my consciousness can go to the Bardo state and that I can have an auspicious reincarnation and then help thousands of generations to come.

So here I am. I said, got it. OK. So my job is to go close that door and to speak to the nurse directors, the physician team, bed control, everyone, to say, for this man and this person, we may not be able to get three days. We may not be able to get even 24 hours. But for this family and this culture and this whole community, this is more important than anything. But I was trained to do that.

And so the dear invitation that I give all my colleagues is that this is what you signed up for. When you were signing up for nursing school, when you were signing up for medical school, when you were signing up for physical therapy school, you wanted-- your heart wanted this kind of inclusive care, that we see people as people, only we weren't given all the training and parts. And we're also-- we can only look at certain patterns at a time.

And there's certain commitments that become dominant. You need the bed. I completely understand that. It's a business model at the same time. But there's also this huge opportunity to say, are we or are we not going to include the whole person in the care or are we going to tell people to banish parts of them off?

And everyone understands that. And people are so excited to learn just a couple of sentences to identify need in all these areas, and especially to be able to swim in the waters of spiritual, existential, and religious care. It's just so essential.

And when they learn a little bit, they get very excited. Nobody wants to open a box they don't know how to deal with and don't know how to close. But once they understand the box a little bit, and that they can engage, just like any other value, they start to get quite excited. It's lovely to see.

**PAUL GALCHUTT**: I mean, I think-- boy, a lot there. So one of the things that it does remind me of is over the years, when I've worked with physicians, they're slammed. I know they're charting at pajama time. And I don't minimize that. I mean, that's a huge source of stress.

I mean, some of the conversations I've had, related to these spiritual screens is give me two questions. Put it in a bullet point. Give me a card. And I'll do that. Or make it a protocol, give me an alert in the Epic or in the electronic health record, which is cool.

But the other thing I think, that you brought up-- and I think was a part of when I get to hang out with any of the medical learners, for example, that rotated with the team when I was at the University of Minnesota Medical Center-- yes, there are those propositional knowledge bullet points. But, also, I'm guessing you-- I think you hinted at this or talked about this-- how to invite when you have that intake-- I didn't do a lot of co-visiting or joint visiting in my setting. And that's another big variable piece about the profession that gets addressed in the book.

But let's say the physician is leading the conversation primarily. And she like, it's just beautiful. It is like-- the room was warm. The light is on. And it's like the most spiritual thing. And then you talk to the physician later. And he said that was incredibly spiritual. And it was.

And, to me, this is connecting the dots because I think people who are drawn to this whole person care, who want to become palliative NPs or clinical social workers in the space-- yeah, I think we're birds of a feather when it comes to that, that we're people who are drawn to the story. We're drawn to these really crucial elements that are incredibly nurturingly spiritual, as well as the struggles. I mean, like you said, the screen-- part of that is to draw out what's bad, what's wrong. But thank you-- your comments got me going again.

**NAOMI SAKS**: Absolutely. And I think for people who are watching this and for all of us in this profession, we can't ignore the fact that there's challenges. It takes resources and money to have fully staffed teams. There is still a bias, I would say, in health care, that you can either be scientific and rational or you can be spiritual and mystical.

But those two things don't exist. And people don't exist that way. They don't separate that stuff. The people we care for, they show up whole. I just cared for a surgeon who said, Naomi, I don't know who I am anymore if I can't use my hands.

And I think that there's something out there. It's a mystery-- but I'm not sure. I've never really wanted to talk to anyone about it. So this idea that somehow we are separate and these things show up separate, we know it's not true.

And the other invitation we have is for people that we work with, who maybe haven't been trained in spiritual, existential, and religious care, is to start looking and noticing themselves. What do they think death is? What do they think hope is? How do they interpret peace?

What do they mean when they say well-being? What do they mean when we say, suffering? These big questions that rarely people get time to unpack, but they want to. And so they live inside themselves, as stories that are untold.

And we get the invitation of saying, we need to hear those stories. We need to hear how this is living in you. You are swimming in the most intense issues of the human condition. And there are places where they don't get opportunities.

So narrative medicine, all the things that are happening-- dignity therapy-- to make sure these stories are told is important. But I would be remiss, because there's a lot of people that said, Naomi, we can't really blur the professions or there's a lot of-- there's some gatekeeping or it's too expensive or it's really too-- it's not practical for us all to be learning together or do research. Or, often with chaplains, we don't get protected time to do research projects and QI projects. So it's sometimes hard for us to be at the table.

But I would say, if we consider collaboration as an advanced skill in health care, that actually it should be taught like a surgical intervention. That would be my one recommendation, that we build on our interprofessional competencies. The Interprofessional Education Collaborative, HIPEC, they have amazing competencies that can be applied to all different teams and really show you how to become collaborators.

Apply cross-domain screening, like I mentioned, is really one of the most beautiful invitations to help people see that they really can care for the whole person. And, also, that we really need outcome-based evidence of interprofessional practice, both financial, both outcome-- that it increases and improves health care. And we just don't have that kind of evidence yet.

So we really need interprofessional research teams to really work on this. And I don't know if you want to jump in. I'm speaking your language.

**PAUL GALCHUTT**: Yeah, you totally speak my language. I'm happy to jump in with some recommendations. Obviously, I see Kerry. Kerry's is it OK to offer what I would throw out as a couple of recs.

**KERRY MALONEY**: OK to raise, yeah.

**PAUL GALCHUTT**: OK. Yeah. So it's my understanding that Dr. Justin Sanders was at Harvard for a while. He's now the palliative medical director up at McGill in Montreal.

He had written in a 2022 paper these words. It was, I think, an article that he had been a part of with Dr. Karen Bullock. And I think it was like a truism. But I like the way that he wrote it in the paper, which was the reason why we need to measure is because when we measure things, it gets seen. And until we see things, we can't change them.

And chaplains, I think, have been in the past as a field, resistant to "how do you measure this?" I don't think we have a choice. And so you could say more about that. But we need to keep moving towards change.

I jump on Betty Ferrell's train, who has said in the past, if we're not doing spiritual care, we're not doing palliative care. So, yeah, I've been to my palliative care rounds. And it took an hour and a half intake with that nurse practitioner.

And he gets down there. He's like, Paul, you know we're in rounds the next day. We got to everything else, but we couldn't address the spiritual. I mean, I think Betty Ferrell's challenges, does that just make us enhanced hospitalists if we don't have spiritual care involved, especially with the chaplain on the team, staffed at a level that would be appropriate to the census size for that organization and for what happens on a regular basis?

And the final thing is similar to what you're naming. If there's chaplains that are tuning in, we have to up our game. Not only gathering data, but part of that data is how does the evidence apply to our practice, toward how it is that we need to improve what we do so that we can show up at the table and say, we're ready to play and put me in? Thank you.

**KERRY MALONEY**: Well, thank you both. You are compelling witnesses to the importance of transdisciplinary collaboration and the power of that and how we miss some of the most significant things in a person's care and in our capacities to show up and be caregivers if we don't do that.

I'm going to open the questions, with a couple of questions myself, and then turn it to some questions in the room. Naomi, you tantalizingly said on two or three occasions, there are two or three questions that I can ask, that are quick, spiritual assistance. But you never said what they were. So we, in the room, are hanging on every word, waiting for that revelation. So if you can share those with us, that would be terrific.

And then my second question is a general one, for the people in the room and also those watching online, many of whom are aspiring to be health chaplains and/or, if they are already that, palliative care chaplains. What specific advice might the two of you offer, in addition to, obviously, good CPE training and all of that, two or three pointers of ways to get into this very necessary, important field?

So those are my two questions. And then I know we have some other questions in the room. So Naomi, what are those wonderful diagnostic questions that you ask?

**NAOMI SAKS**: So not to get Paul mad at me, there are some validated screens. And I have tried them both for myself and tried to teach them. And they fly so-- they go flat. And so that doesn't mean that they aren't great. There's ones that-- do you have spiritual pain, pain deep inside, that's not physical? There's a number of different ones.

And so I teach those. I show people them. Number one, I tell them to find language that they can use, that gets to the content. That's the number one thing. Most clinicians say, what do you turn to that gives you strength? And what do you turn to that helps you cope?

Neither of those are spiritual screens because people could-- they could say, oh, my wife. And they walk out of the room. And I walk in the room. And they say I've been praying for a miracle or I've been really trying to meditate on this. But they won't share that with necessarily everyone on the team because they don't feel like that's invited in.

So I've come up with two myself. I don't use spiritual screens because I'm the intervention. But this is the one that I have-- many people feel comfortable with. But, in general, I tell them to find their own words.

So the spiritual screen has to have two things. It has to say, what is your practice? What do you turn to? And are you able to turn to it now?

We don't worry about people that are Christian Scientists. And they have practitioners. And they have a whole community. And they're doing fine. And they're using it for nutrition. And they're getting through their diagnosis with this beautiful belief system.

Those aren't the people we worry as much about. We worry about the people who are not able to access whatever nutrition they used to have.

So mine is, what do you turn to when life is challenging like this? And you have to use a menu-- God, meditation, love, family, nature. And are you able to turn to it now?

So that's my spiritual screen. I need to know if there is something-- a content or something that's been supporting them, but are they actually able to find nutrition in that now?

**KERRY MALONEY**: I don't know, Paul, if you want to add any screens or things? OK.

**PAUL GALCHUTT**: No. I mean, I could-- like you said, practices are-- I certainly love when it's psychometrically tested. And we have some valid, reliable results and over a swath of people. But I do have to say, humbly, related to the organization I work with, there is actually a big work group. And I think what they are trying to figure out is that it is sort of disease-specific or condition-specific for these questions.

But for the one that would-- for example, Stephen King, 2017 paper, the two questions that get used the most. I mean, that was with a population of people that had a stem cell transplant. And some of them were 40 years out from that. So is it generalizable? I mean, some of these really important questions that are crucial.

But they weren't people actively getting-- they weren't hospitalized and getting a blood marrow transplant, for example. But, yeah, you make a great point. And we still have a lot of work to do.

**NAOMI SAKS**: And then, Paul, any tips you can give people that are interested in palliative care, spiritual care, chaplaincy, or the related field?

**PAUL GALCHUTT**: Yeah. Thanks for your interest. I mean, I'm curious what you're going to say as well. I mean, we have-- most of our data indicates that a lot of what chaplaincy does, especially for supporting people with physical illness, is to get drawn into cases and circumstances. And it's the-- yeah, certainly it's the middle of the night and the intensive care unit, kind of episodes.

But like everybody in the palliative care team, we love early intervention. And we love to get involved. But, yes, it's serious illness. My guess is if you're interested, you're probably drawn to that.

I think it was through the ATS, the American Theological Schools, that came out-- and those data are fascinating-- about how the pendulum has shifted toward people who are not going into congregational communities, whatever-- faith background, religious-- that they get somehow maybe exposed to clinical pastoral education. Or, they have a family experience. And that light gets turned on about, maybe this is what I'm summoned to do, whatever my, quote "calling" is, whatever that-- I think that's great.

So, certainly, you-- Naomi, I mean, if you want to speak more to the channels of how that happens? But I'm very interested. I think Wendy Cadge, in her most recent book, has a book on death-- dying-- and how people who-- a lot of people who are drawn to this work are drawn to this space.

But I think the best part of the book that you write is-- I think there's many ways to do it. Amy Bolton, the chapter she was a part of-- it could be in hospice-- that aspect-- or it could be the parts that you and I have been mostly involved in, Naomi, whether it be a clinic or maybe in-patient. So, yeah, I'd love to hear your thoughts, too.

**NAOMI SAKS**: So, yeah-- thanks. Thanks, Paul.

So there's many ways to get into this subspecialty of medicine. But it is a subspecialty. And that does mean that you need additional training.

There are some people that will be hearing this and they really want a quieter career. They want to maybe just be at the bedside. Maybe they want to work part-time. They want to-- And that's absolutely fine.

I still would encourage them to get extra skills in this specialization. You really need to know grief counseling. You need to know serious illness communication. You absolutely need to know advanced care planning and how to have discussions with people.

You absolutely need to know about suffering and what that means-- death anxiety. You have to know how to guide people at the end of life. So that's just-- everyone needs to know that.

But let's talk to the people who actually want to rock this field. And that's what HDS actually infused in me, that I wanted to change. I wanted this field to be the thing that I wanted to be in the world and see that. Those are the people that really do need to get additional training, whether it's certificates out of so many different places-- Maryland, where Paul is going. There's also online things now.

There's very few fellowships in palliative care for chaplains. But I would encourage you to look because that does change. And if you can't get any other training, take a year in hospice. There's nothing better for a foundation. It's not the same as inpatient palliative care. But it'll give you a foundation that you'll use for the rest of your life.

And then this is the part. You need to have courage. You're going to be speaking truth to power if you care about this. And sometimes it's shaky.

And so you need to have your colleagues. And you need people that are your people, because you do have to speak in languages that many people can hear. And sometimes there's a lot of truth telling. And so if you want to lead in this field, that is something else you have to be doing.

**KERRY MALONEY**: Thank you both so very much, holding up the truth that you have made clear to us, that spirituality is not an obstacle or a threat in ostensibly secular and very busy medical settings. It is a resource and a gift. And a vital one, that we can't ignore. We ignore it at our own peril and at the peril of the patients we serve. So thank you for that.

Thank you for being witnesses to that and for being yourselves-- love letters to this work, this field, and to all of us. So thank you for your time tonight. And thank you all for being with us.

\[APPLAUSE\]

**NAOMI SAKS**: Thank you so much.

**SPEAKER 2**: Sponsors-- Office of the Chaplain and Religious and Spiritual Life.

**SPEAKER 1**: Copyright 2024. The President and Fellows of Harvard College.