Skip to main content
SpringerLink
Log in

Spirituality in palliative home care: a framework for the clinician

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Spiritual care at the end of life remains poorly understood despite its promotion by the World Health Organisation. The purpose of this paper was to develop a consensus-based framework of the main elements of spiritual care in palliative home care.

Methods

Expert meeting using the nominal group technique, followed by a two-stage web-based Delphi process, was used. Experts from three stakeholder groups (physicians, professional spiritual care givers and researchers) representing two countries (Belgium and the Netherlands) participated in this study.

Results

Fourteen elements of spiritual care were retained: (1) being sensitive to patient’s fear of the dying process; (2) listening to the patient’s expectations and wishes about the end of life; (3) giving attention to patient’s wishes about the design of the farewell; (4) offering rituals if the patient experiences them as meaningful; (5) listening to the stories, dreams and passions of the patient; (6) helping the patient find strength in inner resources; (7) connecting with the patient in truth, openness and honesty; (8) supporting communication and quality of relationships; (9) making sure the patient feels comfortable and safe; (10) seeing spirituality as an interwoven, though specific dimension; (11) caring for your own spirituality; (12) knowing and accepting your vulnerability; (13) being able to learn from your patient; and (14) having an interdisciplinary team that is there when needed.

Conclusions

The experts agreed to the 14 main elements of spiritual care in palliative home care. There were no differences in this regard between the stakeholder groups. This study provides a first step towards the development of an interdisciplinary spiritual care model in palliative home care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Higginson IJ, Sen-Gupta GJ (2000) Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med 3:287–300

    Article  PubMed  CAS  Google Scholar 

  2. Townsend J, Frank AO, Fermont D et al (1990) Terminal cancer care and patients’ preference for place of death: a prospective study. BMJ 301:415–417

    Article  PubMed  CAS  Google Scholar 

  3. Tang ST (2003) When death is imminent: where terminally ill patients with cancer prefer to die and why. Cancer Nurs 26:245–251

    Article  PubMed  Google Scholar 

  4. Miaskowski C, Dodd M, Lee K (2004) Symptom clusters: the new frontier in symptom management research. J Natl Cancer Inst Monogr 32:17–21

    Article  PubMed  Google Scholar 

  5. Nolan S, Saltmarsh P, Leget C (2011) Spiritual care in palliative care: working towards an EAPC Task Force. EJPC 18:86–89

    Google Scholar 

  6. King MB, Koening HG (2009) Conceptualising spirituality for medical research and health service provision. BMC Health Serv Res 9:116

    Article  PubMed  Google Scholar 

  7. World Health Organisation (1990) Cancer pain relief and palliative care: report of a WHO Expert Committee

  8. Puchalski C, Ferrell B, Virani R et al (2009) Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. J Palliat Med 12:885–904

    Article  PubMed  Google Scholar 

  9. Millison MB (1995) A review of the research on spiritual care and hospice. Hosp J 10:3–18

    PubMed  CAS  Google Scholar 

  10. Sinclair S, Pereira J, Raffin S (2006) A thematic review of the spirituality literature within palliative care. J Palliat Med 9:464–479

    Article  PubMed  Google Scholar 

  11. Hummel L, Galek K, Murphy KM, Tannenbaum HP, Flannelly LT (2008) Defining spiritual care: an exploratory study. J Health Care Chaplain 15:40–51

    Article  PubMed  Google Scholar 

  12. Ross L (2006) Spiritual care in nursing: an overview of the research to date. J Clin Nurs 15:852–862

    Article  PubMed  Google Scholar 

  13. Edwards A, Pang N, Shiu V, Chan C (2010) The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research. Palliat Med 24:753–770

    Article  PubMed  CAS  Google Scholar 

  14. Shih FJ, Lin HR, Gau ML et al (2009) Spiritual needs of Taiwan’s older patients with terminal cancer. Oncol Nurs Forum 36:E31–E38

    Article  PubMed  Google Scholar 

  15. Tan HM, Braunack-Mayer A, Beilby J (2005) The impact of the hospice environment on patient spiritual expression. Oncol Nurs Forum 32:1049–1055

    Article  PubMed  Google Scholar 

  16. Murray SA, Kendall M, Boyd K, Worth A, Benton TF (2004) Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliat Med 18:39–45

    Article  PubMed  Google Scholar 

  17. Grant E, Murray SA, Kendall M, Boyd K, Tilley S, Ryan D (2004) Spiritual issues and needs: perspectives from patients with advanced cancer and nonmalignant disease. A qualitative study. Palliat Support Care 2:371–378

    Article  PubMed  Google Scholar 

  18. Stephenson PL, Draucker CB, Martsolf DS (2003) The experience of spirituality in the lives of hospice patients. J Hosp Palliat Nurs 5:51–58

    Article  Google Scholar 

  19. McGrath P (2003) Spiritual pain: a comparison of findings from survivors and hospice patients. Am J Hosp Palliat Care 20:23–33

    Article  PubMed  Google Scholar 

  20. McGrath P (2003) Religiosity and the challenge of terminal illness. Death Stud 27:881–899

    Article  PubMed  Google Scholar 

  21. Kawa M, Kayama M, Maeyama E et al (2003) Distress of inpatients with terminal cancer in Japanese palliative care units: from the viewpoint of spirituality. Support Care Cancer 11:481–490

    Article  PubMed  Google Scholar 

  22. Hart A Jr, Kohlwes RJ, Deyo R, Rhodes LA, Bowen DJ (2003) Hospice patients’ attitudes regarding spiritual discussions with their doctors. Am J Hosp Palliat Care 20:135–139

    Article  PubMed  Google Scholar 

  23. Chao CS, Chen CH, Yen M (2002) The essence of spirituality of terminally ill patients. J Nurs Res 10:237–245

    Article  PubMed  Google Scholar 

  24. Hermann CP (2001) Spiritual needs of dying patients: a qualitative study. Oncol Nurs Forum 28:67–72

    PubMed  CAS  Google Scholar 

  25. Bailey ME, Moran S, Graham MM (2009) Creating a spiritual tapestry: nurses’ experiences of delivering spiritual care to patients in an Irish hospice. Int J Palliat Nurs 15:42–48

    PubMed  Google Scholar 

  26. Daaleman TP, Usher BM, Williams SW, Rawlings J, Hanson LC (2008) An exploratory study of spiritual care at the end of life. Ann Fam Med 6:406–411

    Article  PubMed  Google Scholar 

  27. Bush T, Bruni N (2008) Spiritual care as a dimension of holistic care: a relational interpretation. Int J Palliat Nurs 14:539–545

    PubMed  Google Scholar 

  28. Sinclair S, Raffin S, Pereira J, Guebert N (2006) Collective soul: the spirituality of an interdisciplinary palliative care team. Palliat Support Care 4:13–24

    Article  PubMed  Google Scholar 

  29. Harrington A (2006) The ‘connection’ health care providers make with dying patients. J Relig, Spirit Aging 18:169–185

    Article  Google Scholar 

  30. Boston PH, Mount BM (2006) The caregiver’s perspective on existential and spiritual distress in palliative care. J Pain Symptom Manag 32:13–26

    Article  Google Scholar 

  31. Wright MC (2002) The essence of spiritual care: a phenomenological enquiry. Palliat Med 16:125–132

    Article  PubMed  CAS  Google Scholar 

  32. Carroll B (2001) A phenomenological exploration of the nature of spirituality and spiritual care. Mortality 6:81–98

    Article  Google Scholar 

  33. Jones J, Hunter D (1995) Consensus methods for medical and health services research. BMJ 311:376–380

    Article  PubMed  CAS  Google Scholar 

  34. Gallagher M, Hares T, Spencer J, Bradshaw C, Webb I (1993) The nominal group technique: a research tool for general practice? Fam Pract 10:76–81

    Article  PubMed  CAS  Google Scholar 

  35. Stolper E, van Leeuwen Y, van Royen P et al (2010) Establishing a European research agenda on ‘gut feelings’ in general practice. A qualitative study using the nominal group technique. Eur J Gen Pract 16:75–79

    Article  PubMed  Google Scholar 

  36. Dunham RB (2012) Nominal group technique: a user’s guide. http://www.sswm.info/sites/default/files/reference_attachments/DUNHAM%201998%20Nominal%20Group%20Technique%20-%20A%20Users'%20Guide.pdf Accessed 8 August 2012

  37. Bazan S (1998) Enhancing decision-making effectiveness in problem-solving. Clin Lab Manag Rev 12:272–276

    CAS  Google Scholar 

  38. Carney O, McIntosh J, Worth A (2010) The use of the nominal group technique in research with community nurses. J Adv Nurs 23:1024–1029

    Article  Google Scholar 

  39. Elwyn G, O'Connor A, Stacey D et al (2006) Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ 333:417

    Article  PubMed  Google Scholar 

  40. CheckMarket. http://www.checkmarket.com. Accessed 8 August 2012

Download references

Acknowledgments

This work was supported by the Constant Van de Wiel Fund in General Practice, KU Leuven. The authors thank Agnes van Swaay and Karel van Spaendonck for moderating the nominal groups. We also thank the experts who participated in this study (in alphabetical order): Anne Beyen, Harmke Boon, Johan Coppens, Katrien Cornette, Marc Cosyns, Marianne Dees, Wim Dekkers, Luc Deliens, Marc Desmet, Yvonne Engels, Marie-José Gijsberts, Roel Hekking, Koen Herwijers, Marina Kuyper, Carlo Leget, Jo Lisaerde, Betty Morel, Mick Raeven, Hans Schilderman, Willemjan Slort, Richard Starmans, Karin Steenbakkers, Joep van de Geer, Bart Van Den Eynden, Hanneke van Laarhoven, Jacqueline van Meurs, Pieter Vandecasteele, Paul Vanden Berghe, Claude Vandevoorde, Carel Veldhoven, Etje Verhagen, Anja Visser, Kris Vissers, Marijke Wulp, and Filip Zutterman.

Conflict of interest statement

The authors declare that there is no conflict of interest. They have full control of all primary data and agree to allow the journal to review their data if requested.

Author information

Authors and Affiliations

  1. Department of General Practice, Kapucijnenvoer 33 blok j bus 7001, 3000, Leuven, Belgium

    Mieke Vermandere, Jan De Lepeleire, Wouter Van Mechelen & Bert Aertgeerts

  2. Radboud University Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands

    Franca Warmenhoven & Bregje Thoonsen

Authors
  1. Mieke Vermandere
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan De Lepeleire
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wouter Van Mechelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franca Warmenhoven
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bregje Thoonsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bert Aertgeerts
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mieke Vermandere.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vermandere, M., Lepeleire, J.D., Van Mechelen, W. et al. Spirituality in palliative home care: a framework for the clinician. Support Care Cancer 21, 1061–1069 (2013). https://doi.org/10.1007/s00520-012-1626-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-012-1626-1

Keywords

Search

Navigation