“To Cherish Each Day as it Comes”: a qualitative study of spirituality among persons receiving palliative care

Abstract

Purpose

Spirituality is one of the main aspects of palliative care. The concept is multidimensional and encompasses the existential realm as well as value-based and religious considerations. The aim of this study was to explore spirituality from the perspective of persons receiving palliative care and examine their experience of spirituality and its influence on their lives and well-being.

Methods

Qualitative interviews were conducted with ten persons receiving palliative care from Palliative Care Services in Iceland. The interviews were tape-recorded, transcribed and analysed. The study is in the field of practical theology and used the theoretical approach of hermeneutical phenomenology.

Results

Thematic analysis found that the spiritual dimension was of significance for the participants who understood it as a vital element connected to seeking meaning, purpose and transcendence in life. Religious and non-religious aspects of spirituality were expressed including strong spiritual components of family relationships, the meaning of God/a higher being and spiritual practices which served as a key factor in giving strength, activating inner resources and motivating hope. Nine of the participants expressed their spirituality as faith.

Conclusions

Spirituality was experienced broadly as an important dimension of how participants lived with terminal illness. Religious and non-religious characteristics were recognised which reveals the complex nature of the phenomenon. Faith was a significant part of the participants’ spirituality indicating the importance of attending to this aspect of palliative care. The study suggests the potential contributions of theological approaches which are relevant for palliative care research and practice.

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Notes

  1. 1.

    See also the WHO definition on the website http://www.who.int/cancer/palliative/definition

  2. 2.

    The EAPC definition is: “Spirituality is the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant and/or the sacred” [15].

  3. 3.

    The definition from the USA, the National Consensus Project for Quality Palliative Care, is: “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred” [15].

  4. 4.

    Nolan describes four “moments” or modes of presence that include (1) “evocative presence”, (2) “accompanying presence”, (3) “comforting presence” and (4) “hopeful presence”. Building on these “moments” he proposes a theory of chaplain as hopeful presence where he “questions the perception that chaplains are primarily providers of religious care”. In a palliative setting the essential core of chaplain’s care is “care for the soul of the dying other” [19].

  5. 5.

    Another article is in progress where the themes regarding characteristics of existential and spiritual distress, death and life after death will be presented.

  6. 6.

    According to Creswell criterion sampling is appropriate in phenomenological studies when it is essential that all participants have experienced the same phenomenon. In this study, the phenomenon under study is spirituality among persons receiving palliative care [26].

  7. 7.

    The definition of family adopted in the study stresses that the family defines itself. Wright and Leahey have set forth this useful definition in their clinical work that emphasises that “the family is who they say they are” [28]. The family is “a group of individuals who are bound by strong emotional ties, a sense of belonging, and a passion for being involved in one another’s lives” [29].

  8. 8.

    These prayer verses were for example The Lord’s Prayer, the Passion Hymns of Hallgrimur Petursson, an Icelandic clergyman and hymn writer (d. 1674) and/or prayers that where formulated in the participants’ own words.

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Acknowledgements

This study was supported by the Landspitali—University Hospital Research Fund and the Science Fund of The Icelandic Chaplaincy Association.

The authors would like to thank the participants in the study for their invaluable contribution and the health care professionals for their assistance.

Ethical approvals

The National Bioethics Committee of Iceland approved the study, reference VSN 06–078. The Data Protection Authority of Iceland approved the study, reference 2006/385. Permission was granted by the Chief Medical Executive of Landspitali.

Conflict of interest

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

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Correspondence to Gudlaug Helga Asgeirsdottir.

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Asgeirsdottir, G.H., Sigurbjörnsson, E., Traustadottir, R. et al. “To Cherish Each Day as it Comes”: a qualitative study of spirituality among persons receiving palliative care. Support Care Cancer 21, 1445–1451 (2013). https://doi.org/10.1007/s00520-012-1690-6

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Keywords

  • Spirituality
  • Palliative care
  • Theology
  • Qualitative research