S2E4 | Keeping the faith: Spiritual support’s role in the cancer journey
S2E4 | Keeping the faith: Spiritual support’s role in the cancer journey
With a cancer diagnosis comes many worries and questions—what will treatment be like? How do I tell my friends and family? For many cancer patients, the diagnosis also comes with existential questions about life, the world around them and their place in it. Some find solace, meaning and purpose through the guidance of a spiritual support program—an increasingly important part of the integrative care model for patients of faith. What exactly is spiritual support, and what role does it play in the cancer journey? On this episode of Focus on Cancer, our host, Pat Basu, MD, MBA, President & CEO of Cancer Treatment Centers of America® (CTCA), sits down with Rev. Percy McCray Jr., Director of Faith-Based Programs at CTCA®, to answer these and other questions.
Rev. Percy McCray, Jr.Director of Faith-Based Programs, Cancer Treatment Centers of America
Pat Basu: Hi. I'm Pat Basu, president and CEO of Cancer Treatment Centers of America and the host of Focus on Cancer. We have a very special guest on today's show, Reverend Percy McCray, Jr., who is the director of the Signature Pastoral Care program at CTCA and a fully- ordained minister. But Percy recently has also had a new perspective on what it's like to be a cancer patient, was recently diagnosed with colon cancer. And Percy, thank you so much for being on the show, but before we even get into the incredible program that you lead, how are you doing?
Percy McCray: Well, Pat, it's a pleasure to be here with you. Thank you for having me, and I'm doing well. I'm doing very well. I'm very blessed and fortunate. As mentioned, I was diagnosed with colon cancer back in July of 2019. I had experienced some symptoms and had been around this conversation long enough to know to listen to my body and be attentive to some things, and so I did some follow- up screenings and et cetera. And sure enough, I was diagnosed with early stage 1 colon cancer, found a 4. 4 size centimeter tumor on the right side of my colon, had surgery to remove one- third of my colon to take care of that. And I kiddingly tell people today, " Just refer to me as Reverend Semi- Colon." But on a very serious note, I am doing exceptionally well. I feel great. And at this stage of the game, I have just received my recent evaluation in January, and I was told that there is no evidence of disease at this point. So we are grateful and excited and hopeful as we move forward. So thank you for asking.
Pat Basu: Well, I'm so, so glad to hear you're doing well. I love your sense of humor about it. You have such an amazing gift of making people feel comfortable and safe in an environment and just so thankful for all you do for so many patients. Again, I can't wait to get into what I think is just such a powerful and unique program. But just in terms of your diagnosis, Percy, sometimes in talking to patients, I think of cancer as unlike other diseases which tend to have this progression, cancer all too often seems to be lightning out of a blue sky. Despite your familiarity with this and despite your spiritual support of so many patients, was that feeling similar for you? Was it just this jolt out of the blue?
Percy McCray: As you know, I've been in this arena for 20- plus years, serving and supporting cancer patients, and in a very interesting and ironic way, it was almost as if I had been in a dress rehearsal, unconsciously being groomed and prepared for the potentiality of one day being told that I would be a cancer patient. And thus, when I was told that, I was not terribly shocked or surprised. I was not emotionally taken aback. It required a moment for me to digest, as I think is the case for any and all cancer patients initially, hearing that term being directly associated to you. But for many years, I have been talking the walk of cancer. I've been very, very vehement and very supportive of encouraging people to believe and expect good things to happen and to be hopeful. But then it became time for me to actually walk that talk, and I believe that that was part of the next assignment for me, to authentically be able to speak to this audience and look them in the eye and say, " I too now know how you feel. I too understand what it means to hear those terms." And I too can now say with a greater sense of authenticity and compassion that one's sense of faith and spirituality potentially can empower them to work through the rigors and the challenges, of emotionally, mentally, physically being told that you have cancer. And so it became a gift for me, having the fact that I had served and supported this community for so long. So the simple answer is I was really not taken aback, and I really was not surprised.
Pat Basu: Amazing. I really always enjoy just your perspective on frankly all things and even just your metaphoric to a dress rehearsal there prior to, as you mentioned, being on stage with this affecting you. And again, I am just so glad that you're doing well. And it does sound like it did, despite your 20- plus years in doing what you do, that it did change your perspective in talking to patients. Let's shift into exactly what you do. When we talk about spiritual support, when we talk about pastoral care in the setting of patient care, tell our audience, what is that and what does it mean?
Percy McCray: When I started in this arena 20- plus years ago, there was a lot of very fuzzy misunderstanding about this very dynamic. And I recall being given the opportunity by leadership at Cancer Treatment Centers of America back on that fateful day when I was given the keys to the car and I was told, " We're going to give you this much room to work with, and don't crash the car, but make spirituality a real presence in this environment, but allow it to have a respectful balance with regard to the dynamics of medical care, and make sure that there is an amalgamation, a marriage, a partnership." And so to answer your question, spiritual care within the clinical context is not necessarily praying away cancer per se. There certainly are patients and caregivers who are praying that their cancer will be somehow removed, either by a hand of God or by the actions of good clinical medical care. And what I have been able to walk a very consistent balance of is that we do not dictate to God under any set of circumstances of when and how he does whatever he will do. But that we will leave any door open that will allow that to take place while we are walking the path of good clinical care and understanding and utilizing all of the tools and the resources that are available to us intellectually, biologically, medically and et cetera. And the way that I've been able to reconcile that and help people in the faith community to strike a respectful balance is a particular scripture that says that every good and perfect gift comes from above. And so medicine and science is a gift, and that gift came from God. And so we can still align our spiritual sensibilities of calling upon and drawing upon the help of God while utilizing and working through good medical clinical practices and combine those two forces together to create the possibility of a force that will allow patients to potentially move forward and hopefully survive a bout of cancer. And so we are really there to meet people where they are as they walk into our care, and then help them to understand that we are reaching across their cultural belief systems and into those belief systems to support them with genuine care, love and guidance, that we are hopeful in attempting to allow the best of everything that we have available to us to work on their best behalf and potentially make a difference in their life and, if nothing else, provide them with a hopeful and optimistic journey along the way.
Pat Basu: Fantastic. And in broader medicine now, we talk about a concept called full- person care, the notion that it's not just purely medical care, but there are the social determinants of health, there are the behavioral components of health. And so many people are familiar with the idea of emotional wellness and physical wellness and that all of these play a role together, a synergistic role in making us feel better. So many times, I think most of our audience can relate, that when you feel better emotionally, spiritually, mentally, your body feels better, and vice versa. Would the following metaphor make sense in your world? Just as we practice comprehensive cancer care and the integrative care model where you have multiple team components, whether it's radiation therapy or nutritional therapy, what you offer and what you lead, Percy, is very similar to that. Some patients need this and benefit from this, and in other cases, it may be an adjunctive part of the model. Personally, I believe that everybody certainly could use emotional support, but specifically with your program, you see yourself as a part of the integrative team. Is that correct?
Percy McCray: That's correct. The pastoral care spiritual support team and all of the facilities of Cancer Treatment Centers of America, they understand very clearly that at the end of the day, that they are not a separate entity unto themselves. We are not a church. We are not a faith- based organization. We're not even a spiritual organization. We are an organization that understands and respects, as you have so adequately articulated, the holistic, integrative model of care. And when we use the word holistic, some people tend to get lost with that term, and I like to always highlight spelling that term W- H- O- L- E, looking at all of the moving, connecting components that makes a human being what they are. The composite nature of human beings have several moving mechanisms, but they are all interconnected, as you stated, and in theory they have impact one upon another. And so the pastoral care spiritual support team understand that we are part of the integrative model, and that we're part of a team of other healthcare professionals that focus on other disciplines like emotional support, behavioral support, et cetera, et cetera, that we tie into that team, and we play the part of allowing individuals to utilize what they deem appropriate for them in terms of spiritual care and spiritual support. We do not dictate that conversation or even the focus of what spirituality means to that individual. We're really there to allow that patient to drive the bus, and we are fortunate that we're being allowed on that bus to be a passenger or a partner with that individual. So our teams are indoctrinated around the idea that we are there to aid and assist where patients want to go, where they're desiring to go, and how can we align ourselves with their unique and specific spiritual proclivities and support them accordingly. And if that is not appropriate for them and if that is not desired, then we're there to simply be a friendly face and a smile to say that we're here to encourage you today and let you know that we love you and we care for you. So there is no agenda from our team's perspective. The agenda is being set by the patient and their caregiver.
Pat Basu: I think that's so important for you to mention because sometimes, as is the world, especially the world in 2021, people can hear certain words and certain programs and maybe misconceive or hypothesize that a program is something very different than what you've described. But to be clear, not only you're not forcing anything on anybody, but you are really there fundamentally to help people in their time of need, to meet patients where they are in their journey. And just like occupational therapy or speech therapy may not be for all patients, similarly, spiritual support may not be for all patients as well, correct?
Percy McCray: Pastoral care and spiritual support basically can be brought to the table, but individuals can certainly reject that or say that that is not something that they desire to have. And so typically, we are introduced to patients, just to introduce our services and to check in on the well- being, a temperature check, if you will, of the well- being of a patient and to let them know what certainly is available to them, but certainly and never to force anything upon anyone at anytime. And again, to make sure that that patient feels like that they are the primary driver of their care and the choices and options that are available to them.
Pat Basu: Absolutely. Absolutely. And you and I have discussed this before, but certainly as human beings, we have sometimes just these big life questions. Why am I here, or what's the purpose of life? What's the meaning of life? These things that all of us, I think it's fair to say, struggle with or are on a continuous journey. And cancer, as it does in so many ways, has this really uncanny ability to stop us in our tracks and sometimes bring those big questions to the fore, sometimes really set the smaller, trivial things that used to trouble us or bother us in life and just say, " Wait. Hold on." It puts things in perspective. And one of the many important functions of spiritual support that you and others provide is to help frame and add some perspective to some of those questions, is it not?
Percy McCray: That is absolutely accurate, and it's important to understand the power of spirituality in that context. Because believe it or not, spiritual support then begins to provide for many what I call the three R's, a reason, a resource and a right to work through the mental, emotional and on many levels physical rigors of cancer treatment and all of the different dynamics that are associated with it. A cancer diagnosis definitely arrests the attention. One of the former patients that I supported many years ago, I will never forget how she articulated this to me, and I didn't have a grasp upon it until I heard those words being said to me directly and personally was the fact that cancer is the only word that you hear in big, bold letters in your head, that literally you don't hear anything else, and it stops and it arrests your attention. And when you come out of that state of suspended animation, then there are many big life questions that begin to bubble up to the surface. There is a ton of things that this disease will cause people to begin to ruminate over and think about and process, and spirituality and spiritual support provides a framework, as you stated, for people to begin to work through that and potentially put some solid sensibility around that. As an example, when I was diagnosed and told that I had cancer, I began to think about, what does this mean for me personally? And then moving forward, how do I translate that into my relationships, into my work, into my day- to- day environment? And for me personally, I was able, as stated earlier, to associate it with an ongoing and elevated call and mission to the cancer community, but to do that in a more authentic manner because now I can speak from a first- hand perspective versus a second- hand or a third- hand perspective. Many cancer patients, when told that they have cancer, actually find renewed purpose. They find new creative mechanisms and ways to express themselves in their community, in their family. They dial into a sense of being more courageous about things that they never considered doing, as one patient said to me, that a cancer diagnosis and spiritual support helped bring out her warrior spirit. So there's a lot or very profound dynamics that then can come forward, but spiritual support empowers individuals to take what in many cases can be viewed as a very negative experience and a negative challenge to begin to re- engineer how I can make this work and take my life in a different direction to create greater meaning, value and purpose in my personal life, in my family, in my local community, at my church. Pat, I can't tell you how many people have started ministries, personal ministries, out of being diagnosed as a cancer patient that they never thought that that would be anything that they would ever do with regard to their diagnosis. But because of spiritual support, it enabled and it grounded them and it gave them a greater perspective that helped them to re- engineer how they viewed themselves, and more importantly, what could they do as a result of now being a person with cancer.
Pat Basu: Wow. I love what you said. I love what that patient said in terms of bringing out her warrior spirit. And in particular, I love this notion that cancer really sharpens one's focus and tightens one's lens on the rest of their life and how they want to live that life, and this is a way to help channel or thought- partner to that positive energy as people see, as they often do, a cancer diagnosis as a big, if not the inflection point in one's life. And really you're helping to support that. The other thing you mentioned there, Percy, was this notion of community, and I'm sure that as many people hear this and they nod their heads and they say it makes sense, one question they might have is, well, I might be a part of a community already and have a community pastor or priest or rabbi. And they might be wondering, how is it different or how does this interact with spiritual care in the oncology setting versus this community leader of faith that they might be used to interacting with? Can you talk a little bit about that?
Percy McCray: I grew up basically a third- generation pastor on my mom's side of the family. Church was basically the family business for my family, and so all I ever knew was a community local church and the office of the pastorate that stood in a community within four walls and a steeple that basically provided spiritual support and encouragement and development to that group of people. And when I finally made the decision to answer my own personal call to follow that path, I applied myself to some didactic training, some seminary Bible college exercises. It's important, at the end of the day, to receive counsel from experts, if you will, who are inside of that clinical environment, who understand the nuances of the language, of the temperament, of the different highs and lows that patients go through. We can be a supplement as an adjunct of support to the good work and the great work that all local churches and local pastors and faith leaders are providing, but adding another dimension and dynamic that includes ministry to patients mentally, emotionally and physically dealing with the effects of cancer.
Pat Basu: That's such an important point. As you were articulating that, I've had this discussion before that particularly in times of need sometimes these pillars in the community, whether it be pastors or leaders of faith, doctors sometimes, educators, people sometimes look at those individuals as somebody who can do it all. But I think you talk to most people in those respective professions, and I've had some of these conversations, they say, " I don't feel comfortable with some of the needs that this individual might have," across those channels, and certainly it makes sense that that happens with community leaders of faith. And in fact, you've developed this phenomenal program that really trains ministers on how to counsel their cancer patients in their community. Can you share a little bit more about that?
Percy McCray: Yeah, Pat, it's the greatest privilege that I've had in my life. It's been my life's work to this point. This program now is roughly 18 years old. It's entitled Our Journey of Hope. This ministry support training basically was birthed at the bedside of a patient at Cancer Treatment Centers of America in Chicago. And as a result of a lot of time that was spent with this particular patient, who was not doing very well, basically we turned back after a couple of subsequent visits and began to look remarkably better and began to progress and get better, basically asked me if I would be willing to sit down with her local pastor and his consortium of pastors in the community and share some helpful tips or insights of what pastoral care support or spiritual support is within a clinical context, not in a church context. And I think that's the key distinction to be made here. And so I proceeded to do so. I put together a little rough PowerPoint presentation, and I took my happy self down to this local church community of about 20 pastors who were all called together to say okay, yeah, what are you going to tell us about healthcare and ministry and cancer? And we simply shared with them very practical insights from a clinical, medical perspective of how we could merge and amalgamate, again, respectful spiritual support and not undermine medical care and clinical excellence, that the two forces or principles could work together and not fight against one another. And that began the process of what we now call Our Journey of Hope. Fast forward, here now 18 years later, we have trained over 2, 000, probably close to 3, 000 churches worldwide now with this program in helping to train local pastors or faith leaders to go back to their local respective community congregations and start a cancer care ministry. So we wanted to extend the focus and the vision and the passion and the energy of really taking good care of our patients, but we wanted to do that even as they left out of the purview of our facilities when they went back to their local congregations that we would now provide their local churches with the ability to provide good, solid spiritual support in a practical way of treating and addressing cancer. And so close to 3, 000 churches now have been trained, Africa, Europe, Canada, South America, and of course, throughout all of the United States of America with Our Journey of Hope, and I am blessed and I am privileged, and we are empowering the entire community to bless and make a difference potentially in the lives of those people that they serve.
Pat Basu: Wow. Absolutely incredible. I often think about a goal of impact being to make impact exponential, meaning there's so much we can do with the direct people that we touch and can help, but when you help somebody else help someone else, then you start getting into that second- order effect where the sphere of impact and just making the world a better place grows exponentially. And clearly, with touching thousands of churches around the country and around the world, you've had that. So I'm just incredibly proud and thrilled to hear that. So let's say you're a patient with a diagnosis of cancer at the Cancer Center and looking for spiritual support. What does that look like? How does this integrate with the care plan? What are the services that are offered? And how can patients engage in those services?
Percy McCray: First and foremost, individual group prayer. We are available as a team, and we have an amazing pastoral care team at all of our sites. So for those patients who desire to have prayer, we have settings and opportunities where groups of people can come together. We have chapels in all of our regional facilities where we provide spiritual support services. We have representatives from the different faith communities, the Catholic community, the Jewish community, the Muslim community, that we can bring into our facility to provide individual prayer, group prayer if that is something that is desired by a patient or a caregiver, different things along those lines. We provide the ability to have individual or family counseling with family members that desire to sit and have a discourse and to talk through the dynamics of their sense of well- being and what they may be working with and struggling with. We provide counseling for those individuals. Again, phone consultations. Particularly in the era of COVID, for all of us, we've had to resort to being creative in how to maintain contact with patients if we can't have direct contact with them. But even prior to COVID, the ability to have phone consultations when patients leave from our facility to go back to their residential communities. Some of our patients travel out- of- state. We also need to make ourselves available to the patients' and the caregivers' respective spiritual leadership in their local community. So we also sit down or we have conversations with the faith leadership of people's local congregations, so that their pastors or their rabbis or their priests feel comfortable with the spiritual care that is being provided to their congregation member, and that in some cases they like to have some sense of how things are going. Obviously, we must respect the privacy of all patients' healthcare because of HIPAA, but again, to be able to have a connecting point with the local faith community with regard to how their congregational member is doing. Because they're disconnected from their local faith community, we also provide relationship to the local faith leadership of that particular patient. So these are some things that are done on a daily basis, very intentional and very structured in how, from a grassroots perspective, we apply spiritual support to patients and our caregivers.
Pat Basu: Percy, as you speak, I'm struck by the parallels to the clinical aspects of medicine. And even just your staying connected with the community, in your example there, is very akin to the same continuity of care that we might do from an oncology perspective with a primary care physician that is taking care of the patient, so that everybody's connected and on the same page to really get to a better place and a better outcome for the person that matters most here, which is the patient and their supporters. So really wonderful. And just a question, you touched on this already in your remarks here, but for those that might be wondering, can you address, let's say a patient is of a different faith or denominational background than some of the pastors on the team. How do you meet those patients where they are in those situations?
Percy McCray: Super important question, Pat, and let me first answer that by saying I have a monthly regional call with all of our pastoral representatives and spiritual support leaders at all of our facilities, and as a standing agenda item on every meeting is, let's talk about what are we doing to make sure that everyone of any faith orientation is being supported. What are some of the relationships that you are building or have built so that we can share concepts and ideas across the enterprise and make sure that we always keep that in our line of sight and never forget, at the end of the day, that this is not about our spiritual orientation. This is about the patient's spiritual orientation. And are we attuned to making sure that we're meeting those needs accordingly? So literally, we have built community relationships with all of the corresponding faith communities, and we make sure that we are providing that follow- up in a timely fashion, that every patient feels that their needs are being respected and honored from a unique faith perspective, given that information, and we reach out, and we make that connection on their behalf.
Pat Basu: If a patient were to, let's say, not necessarily be, I'll use the words, religious in this case, as opposed to spiritual, but they wanted to engage with you and your team, could they?
Percy McCray: Absolutely. I want to say it again, and I want to be clear about this. Absolutely. At the end of the day, no matter what the spiritual orientation is or not of an individual, at the core of any authentic sense of faith and spirituality should be the commitment of love of community and love of humanity. And so I can recall the days when I was still doing bedside chaplaincy, where there had been many patients who they wanted me to be very clear on the fact that they were, again, agnostic or in some cases atheistic, but would I be willing to still sit and talk with them or come by and visit and just provide a friendly hello or a supportive word. Again, the focus is and should be and will forever be that every patient that comes through the front door of Cancer Treatment Centers of America is to be loved, honored and respected and provided a pathway by which that they feel honored. And so our pastoral care teams are adept, trained and prepared to do just that with each and every individual that walks through the front door.
Pat Basu: Phenomenal. So proud to be having a conversation like this with you. So proud to hear an answer like that and proud to call you a teammate and colleague. As we begin to bring what has been an incredible conversation, I could talk to you for hours, to a close here, just a couple of final things here. I think you've done an incredible job of describing what spiritual care is all about and how it works, how you meet the patient where they are. Let's talk a bit about studies or evidence or outcomes. You touched on a study earlier on, but in terms of this being a part of the integrative care model, what have been the results? If we look at certain side effects of what's, I often say in cancer, managing the side effects is as important as managing the disease itself. Which side effects are you able to manage with spiritual care?
Percy McCray: There are three different areas specifically and some studies that helps us to really wrap our head around the potential effectiveness of spiritual support to cancer patients. Number one is depression and anxiety. There is a study from the National Library of Medicine that basically shows a positive and significant relationship between spiritual well- being, mental health and quality of life in cancer patients. So that gives us something to understand, that we're not just there to be decoration. We're not just there just to have a good moment with patients, but potentially the application of spiritual support can help patients work through the dynamics of depression and anxiety. The second category is coping with pain, being able to deal with pain. We know, and as you well know, Pat, that pain management is a major dynamic in the treatment of cancer, surgery and et cetera, et cetera. So one of the other possible benefits of spiritual support according to, again, by the same group, National Library of Medicine, shows that patients with pain use a number of cognitive behavioral strategies, and this is an interesting way that they've worded this, to cope with their pain, including religious or spiritual factors. And I'd like to say or rituals such as prayer or seeking spiritual support to manage their pain. And so when we understand the potential impact and the effect of the spiritual support in its proper perspective, we also may have the ability to help people work with or cope and manage with their pain. And then the third category is insomnia as a side effect. Prayer and spiritual music may help ease anxiety and return a patient to a state of calm that will allow them to potentially gain some rest and relax. So these are three big areas that many cancer patients struggle through that spiritual support has a possible impact to help negate or at least manage on some level.
Pat Basu: Amazing. Really, really amazing. And going back to what I said before in terms of cancer being not just a disease of the body but a disease of the mind and one where managing a patient's symptoms throughout is essential to good cancer care outcomes is so critical. You've clearly given us some of the examples where, for the right patient population, this has been a really impactful, not just leading indicator, but outcomes- changing impact that you deliver. So again, thank you for that. I'm sure there are so many other things that we can go into, but I just want to maybe end it with one last thought or question. What's your one wish in improving the patient experience, and how can the cancer community better support patients from a spiritual support perspective?
Percy McCray: Well, first of all, let me say thank you so much, Pat, for allowing me to share this platform with you. On my podcast that I do, Help, Hope and Inspiration, shameless plug, I end every episode with a very similar question. I typically ask everyone that I interview, " What gives you hope or what keeps you hopeful?" My greatest wish at the end of the day for all healthcare institutions, this is certainly true for Cancer Treatment Centers of America, is to continue to be respectful and to understand that spirituality is an important component that makes a difference and matters to a lot of people. And that when they come into the healthcare environment, those individuals are nervous, they are apprehensive, they are afraid, and in many cases they are wondering if they will have to ultimately make a decision between their belief and faith in God and their belief and faith in medicine. And I am here to declare and send the clarion call that there doesn't have to be that type of tug- of- war and push- and- pull, that those two worlds can come together in a way that is comprehensive and that is respectful one of another's discipline, but more importantly brings value to the patient who for Cancer Treatment Centers of America, we value more important than any other individual school of thought, it is only about and always will only be about the patient. What do they want? What do they value? And how can we deliver that to them in an effective, timely manner that benefits their mental, emotional, spiritual and physical well- being toward health and healing? At the end of the day, to be accepting, more accepting, more supportive and more responsive to the faith community that allows them to believe that we care about them and that we are concerned and willing to partner with them to provide them with a reason, with a resource to believe that tomorrow potentially can be a better day.
Pat Basu: Wow. Well, what an incredible way and place to end, Percy. You are a busy guy who is truly, truly changing lives and changing the world. So I appreciate you spending time with me today on Focus on Cancer, and just really, really lucky to have you on the show and such a pleasure. Thanks again, Percy.
Percy McCray: Well, God bless you, Pat, and God bless the work of CTCA, and I just leave on this note. Remember, we've got work to do, so let's keep chopping the wood. God bless.