Communicating about Spiritual Issues with Cancer Patients

  • Lorenzo Norris
  • Kathryn Walseman
  • Christina M. PuchalskiEmail author


Many patients have expressed the importance of spirituality in their life and the wish that clinicians would discuss this topic with them and have it integrated into their health care. Clinicians also have noted the importance of spirituality, but have struggled with ways to address spiritual issues in a medical setting. Barriers to effective communication include: lack of knowledge, physician time, and fear of causing a negative reaction in patients. Understanding these barriers and developing an open-ended systematic approach is one key to starting the spiritual dialogue with patients. These dialogues are best conducted in some framework or spiritual care model. The current spiritual care models are derived from Engel’s biopsychosocial model that places an emphasis on understanding and appreciating the patients’ unique story but with the addition of a spiritual domain. Care models that are multidisciplinary can take advantage of each care team member’s strength and provide a more opportune setting to appreciate the patient story from multiple perspectives.

Tools that aid clinicians in screening for spiritual distress include the FICA. The FICA tool provides a way for healthcare providers to use open-ended questions to assess the four domains of a patient’s spirituality. While useful, these tools are meant to open the discussion that the clinician can then use to further appreciate the patient’s life and any potential spiritual crisis. Points of concern detected by a spiritual screening can indicate a potential referral for a formal spiritual assessment. Formal spiritual assessment is usually done by a board-certified chaplain or spiritual care expert with the intent of forming a spiritual care plan. A spiritual care plan is ideally formed in a multidisciplinary framework, in which the patients’ spiritual needs can be incorporated into their current medical treatment. The care plan can then be used to further inform targeted spiritual interventions such as meaning-centered group psychotherapy or the short-term life review. Entering into a dialogue about spirituality can give a sense of meaning and hope, as well as open up treatment opportunities. Approaches and models exist to help clinicians enter into this dialogue and deliver spiritually informed care.

Key words

Spirituality Religion Cancer Communication Health Spirituality and health Spiritual issues Spiritual history 


  1. 1.
    Woll ML, Hinshaw DB, Pawlik TM. Spirituality and religion in the care of surgical oncology patients with life-threatening or advanced illnesses. Ann Surg Oncol. 2008;15(11):3048–57.PubMedCrossRefGoogle Scholar
  2. 2.
    Sulmasy DP. Spiritual issues in the care of dying patients: “... it’s okay between me and god”. JAMA. 2006;296(11):1385–92.PubMedCrossRefGoogle Scholar
  3. 3.
    McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet. 2003;361(9369):1603–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psychooncology. 1999;8(5):417–28.PubMedCrossRefGoogle Scholar
  5. 5.
    Breitbart W. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer. 2002;10(4): 272–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Greenstein M, Breitbart W. Cancer and the experience of meaning: a group psychotherapy program for people with cancer. Am J Psychother. 2000;54(4):486–500.PubMedGoogle Scholar
  7. 7.
    Puchalski CM. Spirituality and end-of-life care: a time for listening and caring. J Palliat Med. 2002;5(2):289–94.PubMedCrossRefGoogle Scholar
  8. 8.
    Puchalski CM, Dorff RE, Hendi IY. Spirituality, religion, and healing in palliative care. Clin Geriatr Med. 2004;20(4):689–714, vi–vii.Google Scholar
  9. 9.
    Pargament KI, Zinnbauer BJ, Scott AB, et al. Red flags and religious coping: identifying some religious warning signs among people in crisis. J Clin Psychol. 1998;54(1):77–89.PubMedCrossRefGoogle Scholar
  10. 10.
    Pargament KI, Koenig HG, Perez LM. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol. 2000;56(4):519–43.PubMedCrossRefGoogle Scholar
  11. 11.
    Silvestri GA, Knittig S, Zoller JS, Nietert PJ. Importance of faith on medical decisions regarding cancer care. J Clin Oncol. 2003;21(7):1379–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Dorff EN. End-of-life: Jewish perspectives. Lancet. 2005;366(9488):862–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Sachedina A. End-of-life: the Islamic view. Lancet. 2005;366(9487):774–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Astrow AB, Wexler A, Texeira K, He MK, Sulmasy DP. Is failure to meet spiritual needs associated with cancer patients’ perceptions of quality of care and their satisfaction with care? J Clin Oncol. 2007;25(36):5753–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Puchalski CM. The role of spirituality in health care. Proc (Bayl Univ Med Cent). 2001;14(4):352–7.Google Scholar
  16. 16.
    McCord G, Gilchrist VJ, Grossman SD, et al. Discussing spirituality with patients: a rational and ethical approach. Ann Fam Med. 2004;2(4):356–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Ellis MR, Campbell JD, Detwiler-Breidenbach A, Hubbard DK. What do family physicians think about spirituality in clinical practice? J Fam Pract. 2002;51(3):249–54.PubMedGoogle Scholar
  18. 18.
    Ellis MR, Vinson DC, Ewigman B. Addressing spiritual concerns of patients: family physicians’ attitudes and practices. J Fam Pract. 1999;48(2):105–9.PubMedGoogle Scholar
  19. 19.
    Ellis MR, Campbell JD. Concordant spiritual orientations as a factor in physician-patient spiritual discussions: a qualitative study. J Relig Health. 2005;44(1):39–53.PubMedCrossRefGoogle Scholar
  20. 20.
    Chibnall JT, Bennett ML, Videen SD, Duckro PN, Miller DK. Identifying barriers to psychosocial spiritual care at the end of life: a physician group study. Am J Hosp Palliat Care. 2004;21(6):419–26.PubMedCrossRefGoogle Scholar
  21. 21.
    Koenig HG, Hooten EG, Lindsay-Calkins E, Meador KG. Spirituality in medical school curricula: findings from a national survey. Int J Psychiatry Med. 2010;40(4):391–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Puchalski CM, Larson DB. Developing curricula in spirituality and medicine. Acad Med. 1998;73(9):970–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Puchalski CM. Spirituality and medicine: curricula in medical education. J Cancer Educ. 2006;21(1):14–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Ellis MR, Campbell JD. Patients’ views about discussing spiritual issues with primary care physicians. South Med J. 2004;97(12):1158–64.PubMedCrossRefGoogle Scholar
  25. 25.
    Lo B, Ruston D, Kates LW, et al. Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA. 2002;287(6):749–54.PubMedCrossRefGoogle Scholar
  26. 26.
    Mystakidou K, Tsilika E, Parpa E, et al. Demographic and clinical predictors of spirituality in advanced cancer patients: a randomized control study. J Clin Nurs. 2008;17(13):1779–85.PubMedCrossRefGoogle Scholar
  27. 27.
    Hampton DM, Hollis DE, Lloyd DA, Taylor J, McMillan SC. Spiritual needs of persons with advanced cancer. Am J Hosp Palliat Care. 2007;24(1):42–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Quill TE. Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the “elephant in the room”. JAMA. 2000;284(19):2502–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Quill T, Byock I. Responding to intractable terminal suffering. Ann Intern Med. 2000;133(7): 561–2.PubMedGoogle Scholar
  30. 30.
    Koenig HG. Religion, spirituality, and medicine: research findings and implications for clinical practice. South Med J. 2004;97(12):1194–200.PubMedCrossRefGoogle Scholar
  31. 31.
    Puchalski CM, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the consensus conference. J Palliat Med. 2009;12(10):885–904.PubMedCrossRefGoogle Scholar
  32. 32.
    Borneman T, Ferrell B, Puchalski CM. Evaluation of the FICA tool for spiritual assessment. J Pain Symptom Manage. 2010;40(2):163–73.PubMedCrossRefGoogle Scholar
  33. 33.
    Anandarajah G, Hight E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician. 2001;63(1):81–9.PubMedGoogle Scholar
  34. 34.
    Puchalski C, Larson D, Post S. Physicians and patient spirituality. Ann Intern Med. 2000;133(9): 748–9.PubMedGoogle Scholar
  35. 35.
    Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy—spiritual Well-being Scale (FACIT-Sp). Ann Behav Med. 2002;24(1):49–58.PubMedCrossRefGoogle Scholar
  36. 36.
    Puchalski C. Spiritual assessment in clinical practice. Psychiatr Ann. 2006;36(3).Google Scholar
  37. 37.
    Ando M, Morita T, Akechi T, Okamoto T. Japanese Task Force for Spiritual Care. Efficacy of short-term life-review interviews on the spiritual well-being of terminally ill cancer patients. J Pain Symptom Manage. 2010;39(6):993–1002.PubMedCrossRefGoogle Scholar
  38. 38.
    Ando M, Morita T, Okamoto T, Ninosaka Y. One-week short-term life review interview can improve spiritual well-being of terminally ill cancer patients. Psychooncology. 2008;17(9): 885–90.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2013

Authors and Affiliations

  • Lorenzo Norris
    • 1
  • Kathryn Walseman
    • 2
  • Christina M. Puchalski
    • 3
    Email author
  1. 1.Survivorship Center Psychiatric ServicesThe George Washington UniversityWashingtonUSA
  2. 2.Department of PsychiatryGeorge Washington University HospitalWashingtonUSA
  3. 3.George Washington Institute for Spirituality and Health (GWish), The George Washington School of Medicine and Health SciencesThe George Washington UniversityWashingtonUSA

Personalised recommendations