Spiritual Care at the End of Life

  • Bianca Sakamoto Ribeiro Paiva
  • Carlos Eduardo Paiva
Part of the Religion, Spirituality and Health: A Social Scientific Approach book series (RELSPHE, volume 4)


Concerns of a spiritual nature often arise at the end of life and may significantly affect the desire to live. Caring for a person with a terminal illness is often accompanied by religious, spiritual or existential needs, concerns and questions. In this chapter, the authors highlighted the main spiritual needs of the patient with an incurable chronic disease, as well as those of their family caregivers. They also highlighted the main limitations of spiritual care during end-of-life and how healthcare professionals can include this care into their daily clinical practice. It is emphasized that the spiritual evaluation can be conducted in different ways; each professional can determine the most appropriate method for their routine. Some mnemonic tools have been developed to help healthcare professionals when taking the spiritual history. However, the important factor in this evaluation is that it should be broad, complete and not limited merely to religious aspects.


Spirituality Spiritual care End of life Palliative care Health care 


  1. Alcorn, S. R., Balboni, M. J., Prigerson, H. G., et al. (2010). If God wanted me yesterday, I wouldn’t be here today’: Religious and spiritual themes in patients’ experiences of advanced cancer. Journal of Palliative Medicine. Scholar
  2. American Nurses Association and Health Ministries Association. (2005). Faith and community nursing: Scope and standards of practice. Silver Spring: American Nurses Association.Google Scholar
  3. Anandarajah, G., & Hight, E. (2001). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. American Family Physician, 63(1), 81–89.Google Scholar
  4. Astrow, A. B., Puchalski, C. M., & Sulmasy, D. P. (2001). Religion, spirituality, and health care: Social, ethical, and practical considerations. The American Journal of Medicine.
  5. Balboni, T., Balboni, M., Paulk, M. E., et al. (2011). Support of cancer patients’ spiritual needs and associations with medical care costs at the end of life. Cancer. Scholar
  6. Balboni, M. J., Sullivan, A., Amobi, A., et al. (2013). Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. Journal of Clinical Oncology. Scholar
  7. Blaber, M., Jone, J., & Willis, D. (2015). Spiritual care: Which is the best assessment tool for the palliative settings? International Journal of Palliative Nursing. Scholar
  8. Borneman, T., Ferrell, B., & Puchalski, C. M. (2010). Evaluation of the FICA tool for spiritual assessment. Journal of Pain and Symptom Management. Scholar
  9. Candy, B., Jones, L., Varagunam, M., Speck, P., Tookman, A., & King, M. (2012). Spiritual and religious interventions for well-being of adults in the terminal phase of disease. Cochrane Database of Systematic Reviews.
  10. Clark, D. (2002). Between hope and acceptance: The medicalisation of dying. BMJ. Scholar
  11. Cobb, M. (2002). Spiritual care. In M. Lloyd-Williams (Ed.), Psychological issues in palliative care (pp. 135–147). New York: Oxford University Press.Google Scholar
  12. Curlin, F. A., Lawrence, R. E., Odell, S., et al. (2007). Religion, spirituality, and medicine: Psychiatrists’ and other physicians’ differing observations, interpretations, and clinical approaches. The American Journal of Psychiatry. Scholar
  13. De Camargos, M. G., Paiva, C. E., Barroso, E. M., Carneseca, E. C., & Paiva, B. S. R. (2015). Understanding the differences between oncology patients and oncology health professionals concerning spirituality/religiosity: A cross-sectional study. Medicine. Scholar
  14. Delgado-Guay, M. O., Hui, D., Parsons, H. A., et al. (2011). Spirituality, religiosity, and spiritual pain in advanced cancer patients. Journal of Pain and Symptom Management. Scholar
  15. Emanuel, E. J., & Emanuel, L. L. (1998). The promise of a good death. Lancet, 351.(Suppl II, 21–29.CrossRefGoogle Scholar
  16. Emanuel, L., Handzo, G., Grant, G., Massey, K., Zollfrank, A., Wilke, D., Powell, R., Smith, W., & Pargament, K. (2015). Workings of the human spirit in palliative care situations: A consensus model from the chaplaincy research consortium. BMC Palliative Care.
  17. Frankl, V. (1984). Man’s search for meaning (p. 135). New York: Simon & Schusterp.Google Scholar
  18. Gomez-Castillo, B. J., Hirsch, R., Groninger, H., Baker, K., Cheng, M. J., Phillips, J., Pollack, J., & Berger, A. M. (2015). Increasing the number of outpatients receiving spiritual assessment: A pain and palliative care service quality improvement project. Journal of Pain and Symptom Management. Scholar
  19. Hall, S. P. H, Tsouros, A. D., Costantini, M., & Higginson, I. J. (Eds.) (2011). World Health Organization – Palliative care for older people: better practices. Europe: WHO – World Health Organization. Available Acessed 10 Mar 2017.
  20. Hui, D., De La Cruz, M., Thorney, S., et al. (2011). The frequency and correlates of spiritual distress among patients with advanced cancer admitted to an acute palliative care unit. The American Journal of Hospice & Palliative Care. Scholar
  21. Hui, D., De La Cruz, M., Mori, M., Parsons, H. A., Kwon, J. H., Torres-Vigil, I., et al. (2013). Concepts and definitions for “supportive care,” “best supportive care,” “palliative care,” and “hospice care” in the published literature, dictionaries, and textbooks. Supportive Care in Cancer. Scholar
  22. Johannessen-Henry, C. T., Deltour, I., Bidstrup, P. E., Dalton, S. O., & Johansen, C. (2013). Associations between faith, distress and mental adjustment--A Danish survivorship study. Acta Oncologica. Scholar
  23. Kichenadasse, G., Sweet, L., Harrington, A., & Ullah, S. (2016). The current practice, preparedness and educational preparation of oncology professionals to provide spiritual care. Asia-Pacific Journal of Clinical Oncology. Scholar
  24. Koenig, H. G., Larson, D. B., & Larson, S. S. (2001). Religion and coping with serious medical illness. The Annals of Pharmacotherapy. Scholar
  25. MacLeod, R. (2003). Psychosocial care for non-malignant disease. In M. Lloyd-Williams (Ed.), Psychological issues in palliative care (pp. 119–135). New York: Oxford University Press.Google Scholar
  26. Maugans, T. A. (1996). The spiritual history. Archives of Family Medicine, 5, 11–16.PubMedCrossRefGoogle Scholar
  27. McCord, G., Gilchrist, V. J., Grossman, S. D., et al. (2004). Discussing spirituality with patients: A rational and ethical approach. Annals of Family Medicine. Scholar
  28. Molzahn, A. E. (2007). Spirituality in later life: Effect on quality of life. Journal of Gerontological Nursing, 33(1), 32–39.PubMedGoogle Scholar
  29. Monroe, M. H., Bynum, D., Susi, B., et al. (2003). Primary care physician preferences regarding spiritual behavior in medical practice. Archives of Internal Medicine. Scholar
  30. Muldoon, M., & King, N. (1995). Spirituality, health care, and bioethics. Journal of Religion and Health, 34(4), 329–349.PubMedCrossRefGoogle Scholar
  31. Murray, S., Kendall, M., Boyd, K., et al. (2004). Exploring the spiritual needs of people dying of lung cancer or heart failure: A prospective qualitative interview study of patients and their carers. Palliative Medicine. Scholar
  32. National Consensus Project. (2009). NCP clinical practice guidelines for quality palliative care. Available: Accessed 19 Apr 2017.
  33. Neely, D., & Minford, E. (2009). FAITH: Spiritual history-taking made easy. Clinical Teacher. Scholar
  34. Nelson, C. J., Rosenfeld, B., Breitbart, W., & Galietta, M. (2002). Spirituality, religion, and depression in the terminally ill. Psychosomatics, 43, 213–220.CrossRefGoogle Scholar
  35. Paiva, B. S., Carvalho, A. L., Lucchetti, G., Barroso, E. M., & Paiva, C. E. (2015). “Oh, yeah, I’m getting closer to god”: Spirituality and religiousness of family caregivers of cancer patients undergoing palliative care. Supportive Care in Cancer. Scholar
  36. Pearce, M. J., Coan, A. D., Herndon, J. E., et al. (2012). Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients. Supportive Care in Cancer. Scholar
  37. Peres, M. F., Arantes, A. C. L. Q., Lessa, P. S., & Caous, C. A. (2007). A importância da integração da espiritualidade e da religiosidade no manejo da dor e dos cuidados paliativos. Revista de Psiquiatria Clínica. Scholar
  38. Peteet, J. R., & Balboni, M. J. (2013). Spirituality and religion in oncology. CA: A Cancer Journal for Clinicians. Scholar
  39. Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy -spiritual well-being scale (FACIT-sp). Annals of Behavioral Medicine, 24(1), 49–58.CrossRefGoogle Scholar
  40. Puchalski, C. M. (1999). Touching the spirit: The essence of healing. Spiritual Life, 45, 154–159.Google Scholar
  41. 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. Journal of Palliative Medicine. Scholar
  42. Ramondetta, L. M., Sun, C., Surbone, A., et al. (2013). Surprising results regarding MASCC members’ beliefs about spiritual care. Supportive Care in Cancer. Scholar
  43. Rasinski, K. A., Kalad, Y. G., Yoon, J. D., et al. (2011). An assessment of US physicians’ training in religion, spirituality, and medicine. Medical Teacher. Scholar
  44. Ross, L. (1995). The spiritual dimension: Its importance to patients’ health, well-being and quality of life and its implications for nursing practice. International Journal of Nursing Studies, 32(5), 457–468.PubMedCrossRefGoogle Scholar
  45. Rousseau, P. (2003). Spirituality and the dying patient. Journal of Clinical Oncology. Scholar
  46. Saguil, A., & Phelps, K. (2012). The spiritual assessment. American Family Physician, 86(6), 546–550.PubMedGoogle Scholar
  47. Sand, L., Olsson, M., & Strang, P. (2009). Coping strategies in the presence of one’s own impending death from cancer. Journal of Pain and Symptom Management. Scholar
  48. Sloan, R. P., Bagiella, E., VandeCreek, L., et al. (2000). Should physicians prescribe religious activities? The New England Journal of Medicine. Scholar
  49. Smith, R. (2000). A good death. An important aim for health services and for us all. BMJ, 320(7228), 129–130.PubMedPubMedCentralCrossRefGoogle Scholar
  50. Stephenson, P. S., Sheehan, D., & Shahrour, G. (2016). Support for using five attributes to describe spirituality among families with a parent in hospice. Palliative & Supportive Care. Scholar
  51. Sulmasy, D. (2002). A biopsychosocial–spiritual model for the care of patients at the end of life. The Gerontologist, 42, 24–33.CrossRefGoogle Scholar
  52. Surbone, A., Baider, L., Weitzman, T. S., Brames, M. J., Rittenberg, C. N., Johnson, J., & Group MPS. (2010). Psychosocial care for patients and their families is integral to supportive care in cancer: MASCC position statement. Supportive Care in Cancer. Scholar
  53. Tarakeshwar, N., Vanderwerker, L. C., Paulk, E., Pearce, M. J., Kasl, S. V., & Prigerson, H. G. (2006). Religious coping is associated with the quality of life of patients with advanced cancer. Journal of Palliative Medicine. Scholar
  54. Wachholtz, A. B., & Keefe, F. J. (2006). What physicians should know about spirituality and chronic pain. Southern Medical Journal. Scholar
  55. Walter, T. (2003). Historical and cultural variants on the good death. BMJ. Scholar
  56. Wang, C. W., Chow, A. Y., & Chan, C. L. (2017). The effects of life review interventions on spiritual well-being, psychological distress, and quality of life in patients with terminal or advanced cancer: A systematic review and meta-analysis of randomized controlled trials. Palliative Medicine. Scholar
  57. Williams, J. A., Meltzer, D., Arora, V., et al. (2011). Attention to inpatients’ religious and spiritual concerns: Predictors and association with patient satisfaction. Journal of General Internal Medicine. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Bianca Sakamoto Ribeiro Paiva
    • 1
    • 2
  • Carlos Eduardo Paiva
    • 1
    • 2
    • 3
  1. 1.Research Group on Palliative Care and Health-Related Quality of Life (GPQual) –Barretos Cancer HospitalBarretosBrazil
  2. 2.Teaching and Research Institute, Barretos Cancer HospitalBarretosBrazil
  3. 3.Department of Clinical Oncology – Breast and Gynecology DivisionBarretos Cancer HospitalBarretosBrazil

Personalised recommendations