8 Assessing spiritual needs in a hospice setting: all talk and no trousers
Authors: Bradley Victoria , Gutjahr Jessica , Young Katherine , Dawe Rhys 
Published: May 2024

IntroductionThe rhetoric of Palliative Care encompasses physical, psychological, social and spiritual domains.1However, this last element is often the most contentious in both definition and application2–4and has often been neglected in practice to the detriment of patient quality of life.5–7AimDespite evidence that significant numbers of patients wish to discuss spirituality with their healthcare team,8–10and a corporate commitment to spiritual care11an audit of practice locally demonstrated the majority did not have assessment of spiritual need on admission to the hospice.12This study aimed to understand this low enquiry rate by exploring potential barriers to a health care worker undertaking spiritual assessment.MethodFive focus groups were conducted and recorded over 5 months – 2 with nursing staff, 2 with junior doctors and 1 with senior management. The audio records were transcribed verbatim and subject to thematic analysis.ResultsThis study suggests four over-arching themes obstructing spiritual assessment:• lack of understanding of concepts of spirituality• dissonance of spiritual issues with healthcare culture• social discomfort with the concept of spirituality• personal discomfort with the topic of spiritualityConclusionThis study supports and expands on the published literature,13,14and attempts to create a taxonomy of obstacles to spiritual assessment and care. Recognition of and education around these themes has been undertaken in an attempt to improve rates of spiritual assessment on admission, but re-audit has yet to show any positive improvement.15Effecting change in spiritual assessment and care to meet the rhetoric remains a challenge.References. Graham F, Clark D. WHO definition of palliative care. Medicine2008;2(36):64–6.. Gordon T, Mitchell D. A competency model for the assessment and delivery of spiritual care. Palliat Med2004;18(7):646–51.. Swinton J. Identity and resistance: why spiritual care needs ‘enemies’. J Clin Nurs2006;15(7):918–28.. Kellehear A. Spirituality and palliative care: a model of needs. Palliat Med2000Mar;14(2):149–55.. Balboni TA, Paulk ME, Balboni MJ, Phelps AC, Loggers ET, Wright AA, et al. Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. Journal of Clinical Oncology2009;28(3):445–52.. Hermann CP. The degree to which spiritual needs of patients near the end of life are met. Oncology nursing forum; 2007.. Pearce MJ, Coan AD, Herndon JE, Koenig HG, Abernethy AP. Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients. Supportive Care in Cancer2012;20(10):2269–76.. Borneman T, Ferrell B, Puchalski CM. Evaluation of the FICA tool for spiritual assessment. J Pain Symptom Manage2010;40(2):163–73.. Daaleman TP, Nease Jr DE. Patient attitudes regarding physician inquiry into spiritual and religious issues. J Fam Pract1994;39(6):564–9.. Williams JA, Meltzer D, Arora V, Chung G, Curlin FA. Attention to inpatients’ religious and spiritual concerns: Predictors and association with patient satisfaction. Journal of general internal medicine 2011;26(11):1265–71.. Sir Michael Sobell House Hospice [Internet] 2017 [cited 1st March 2017]. Available from: www.sobellhouse.org.. Bradley V, Young K, Dawe R. Audit of Documentation to establish rates of spiritual assessment of patients on admission to Sir Michael Sobell House Hospice 2015.. Balboni MJ, Sullivan A, Enzinger AC, Epstein-Peterson ZD, Tseng YD, Mitchell C, et al. Nurse and physician barriers to spiritual care provision at the end of life. J Pain Symptom Manage 2014;48(3):400–10.. Steinhauser KE, Voils CI, Clipp EC, Bosworth HB, Christakis NA, Tulsky JA. “Are you at peace?”: one item to probe spiritual concerns at the end of life. Arch Intern Med 2006;166(1):101–5.. Bradley V, Gutjahr J. Re-Audit of Documentation to establish rates of spiritual assessment of patients on admission to Sir Michael Sobell House Hospice 2016.