When it comes to eradicating pain, I turn to medicine.
When it comes to dealing with pain. I look to the saints
Imani Perry 2023
Spirituality in Teledermatology
by Timothy Klufas BA,*
New York Medical College, Valhalla, NY tklufas@student.nymc.edu
Abstract: The psychosocial burden of cutaneous disease has been documented across a variety of dermatologic conditions. There are a number of methods to manage the non-physical impacts of dermatologic disease, with a notable one being spirituality. Spiritual care, often provided by chaplains, is more readily available in inpatient environments. In the context of the wide-scale uptake of teledermatology as a result of the COVID-19 pandemic, it is important to incorporate holistic elements of care into virtual modalities as well in order to optimally promote health equity and outcomes. In this viewpoint, we discuss the potential utility of integrating spirituality in teledermatology.
Introduction: Dermatologic conditions are among the most common concerns of patients, comprising up to 15% of visits with general practitioners. [1] While infrequently life-threatening, they can considerably impact a patient’s life through their visibility and associated symptoms. This effect exists across age groups, affecting pediatric and adult patients alike. A third of dermatology patients experience some form of psychiatric or psychosocial distress. [2] The results have been well-documented in cutaneous conditions, including acne, alopecia, psoriasis, and atopic dermatitis. [3] Further, patients may not feel comfortable discussing psychiatric health concerns with certain providers, leading to missed opportunities for intervention. [2,4] The mental health consequences of these conditions can exacerbate their existing conditions and have implications for broader dimensions of health and quality of life.
Spirituality – the broad notion representing how patients interpret and ascribe meaning to life – has been linked to resilience, purpose, and overall well-being. [5] While non-physical challenges associated with patient illnesses are more easily managed in the inpatient setting where spiritual care is more readily accessible (ex. chaplains), this may not be the case in settings of virtual care, that have gained significant relevance following the start of the COVID-19 pandemic. Herein, we discuss the role of spirituality in dermatology and propose its implementation in the teledermatology setting.
Patients Turn to Spirituality to Make Meaning of their Health Conditions
Spirituality has been defined as, “a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.” [6] In medicine, patients may understand their illnesses in different ways, based on what they value. The specific role of spirituality has been studied in many subdisciplines in medicine, and prior literature addresses the importance of implementing the Faith/Belief, Importance/influence, Community, Address (FICA) tool in dermatology encounters.[7] The importance of spirituality metrics within the quality-of-life surveys of patients with skin disease and proposed incorporation of the FICA spiritual health tool in taking spiritual histories during patient encounters has also been emphasized as a way to address this frequently overlooked dimension of patient health within dermatologic care. [7] One single-center observational prospective study identified unmet spiritual needs among patients with varying severe skin disease (systemic clerosis, lupus erythematosus, early-stage malignant melanoma) of having a severe skin condition. [8]
Spirituality should be integrated into Teledermatology
The COVID-19 pandemic resulted in significant changes to healthcare delivery, with the adoption of teledermatology increasing from 14.1% of dermatologists before the pandemic to 96.9% during the pandemic; 58% continue to use it following the pandemic [9], largely among academic practitioners. [10] Additionally, teledermatology has been found to connect patients from historically difficult-to-reach and underserved populations, including Medicaid-insured, geriatric, and resource-poor urban and rural groups [11]; therefore it is especially important to implement holistic elements of care in delivery formats with improved reach in an effort to improve health equity broadly. With several dermatologic conditions now optimally suited to telemedicine, including atopic dermatitis, acne, and psoriasis [12] that have mental health components, teledermatology is well-positioned to integrate spirituality care.
Traditionally, the spiritual needs for inpatients have been within the scope of chaplains. Translating to the virtual format, the World Health Organization defines ‘tele-chaplaincy’ as the “delivery of spiritual care where patients and providers are separated by a distance,” [13]suggesting that these efforts have been considered may be feasible in the context of telemedicine. Further, there have been important developments in this realm, with tele-chaplaincy being implemented in large health systems across the US, including the Veterans Health Administration (VHA), the second largest integrated U.S. health system. Additionally, other large systems including Ascension Health and the Mercy System have also implemented tele chaplaincy formats. [13] At one academic medical center, a telehealth palliative care program that included spirituality targeted severely ill hospitalized patients and their relatives, and gathered favorable reviews from patients. [14] Tele-chaplaincy has also demonstrated success in the outpatient setting, as reported by a large Southeastern US outpatient care center. [15] Given the impact of dermatologic disease on a patient’s identity, teledermatology offers unique opportunities for dermatologists to practice holistic patient-centered care. In practice, this can be accomplished using the FICA questionnaire or another alternate screening tool to assess patients’ spiritual health and better serve their health more holistically, including their dermatologic conditions as well as possible resultant impacts on non-physical health dimensions.
Refrences
1. Kerr OA, Tidman MJ, Walker JJ, Aldridge RD, Benton EC. The profile of dermatological problems in primary care. Clin Exp Dermatol. 2010;35(4):380-383. doi:10.1111/j.1365-2230.2009.03586.x
2. McDonald K, Shelley A, Jafferany M. The PHQ-2 in dermatology—standardized screening for depression and suicidal ideation. JAMA Dermatol. 2018;154(2):139. doi:10.1001/jamadermatol.2017.5540
3. Basavaraj KH, Navya MA, Rashmi R. Relevance of psychiatry in dermatology: Present concepts. Indian J Psychiatry. 2010;52(3):270. doi:10.4103/0019-5545.70992
4. Connor C. Management of the psychological comorbidities of dermatological conditions: practitioners’ guidelines. Clin Cosmet Investig Dermatol. 2017;10:117-132. doi:10.2147/ccid.s111041
5. Manning L, Ferris M, Narvaez Rosario C, Prues M, Bouchard L. Spiritual resilience: Understanding the protection and promotion of well-being in the later life. J Relig Spiritual Aging. 2019;31(2):168-186. doi:10.1080/15528030.2018.1532859
6. Dalle Ave AL, Sulmasy DP. Health care professionals’ spirituality and COVID-19: Meaning, compassion, relationship. JAMA. 2021;326(16):1577. doi:10.1001/jama.2021.16769
7. Roman J, Elpern DJ. Spirituality in dermatology practice: Return to the soul. JAMA Dermatol. 2017;153(7):629. doi:10.1001/jamadermatol.2017.0501
8. Human-Friedrich Unterrainer, Lukanz M, Pilch M, et al. Spirituality and mood pathology in severe skin conditions: a prospective observational study. Arch Derm Res. 2016;308(7):521-525. doi:10.1007/s00403-016-1672-5
9. Kennedy J, Arey S, Hopkins Z, et al. Dermatologist perceptions of teledermatology implementation and future use after COVID-19: Demographics, barriers, and insights. JAMA Dermatol. 2021;157(5):595. doi:10.1001/jamadermatol.2021.0195
10. Ahmad M, Marson JW, Litchman GH, Perkins SH, Rigel DS. Usage and perceptions of teledermatology in 2021: a survey of dermatologists. Int J Dermatol. 2022;61(7). doi:10.1111/ijd.16209
11. Maddukuri S, Patel J, Lipoff JB. Teledermatology addressing disparities in health care access: A review. Curr Dermatol Rep. 2021;10(2):40-47. doi:10.1007/s13671-021-00329-2
12. Beer J, Hadeler E, Calume A, Gitlow H, Nouri K. Teledermatology: current indications and considerations for future use. Arch Derm Res. 2021;313(1):11-15. doi:10.1007/s00403-020-02145-3
13. Winiger F. The changing face of spiritual care: current developments in telechaplaincy. J Health Care Chaplain. 2023;29(1):114-131. doi:10.1080/08854726.2022.2040895
14. Palma A, Rojas V, Ihl F, et al. Implementation of a palliative hospital-centered spiritual and psychological telehealth system during COVID-19 pandemic. J Pain Symptom Manage. 2021;62(5):1015-1019. doi:10.1016/j.jpainsymman.2021.04.016
15. Sprik P, Keenan AJ, Boselli D, Cheeseboro S, Meadors P, Grossoehme D. Feasibility and acceptability of a telephone-based chaplaincy intervention in a large, outpatient oncology center. Support Care Cancer. 2021;29(3):1275-1285. doi:10.1007/s00520-020-05598-4
Author Bio: Timothy Klufas is a third-year medical student at New York Medical College. He received his bachelor’s degree in psychology from the University of Connecticut and went on to complete a certificate in public health from UConn. Prior to medical school, he worked in various roles, including research on sickle cell disease and autism, as well as being a COVID-19 contact tracing supervisor for Connecticut. During the pandemic, he was appointed by Governor Ned Lamont to Connecticut’s COVID-19 Vaccine allocation committee. Around this time, he decided to pursue another interest and opened a construction consulting company that he continued to operate during the first year of medical school. In his free time, he enjoys traveling, gardening, and doing DIY projects.
