An exploratory study of spiritual care at the end of life.
OBJECTIVE
Although spiritual care is a core element of palliative care, it remains unclear how this care is perceived and delivered at the end of life. We explored how clinicians and other health care workers understand and view spiritual care provided to dying patients and their family members.


METHODS
Our study was based on qualitative research using key informant interviews and editing analysis with 12 clinicians and other health care workers nominated as spiritual caregivers by dying patients and their family members.


RESULTS
Being present was a predominant theme, marked by physical proximity and intentionality, or the deliberate ideation and purposeful action of providing care that went beyond medical treatment. Opening eyes was the process by which caregivers became aware of their patient's life course and the individualized experience of their patient's current illness. Participants also described another course of action, which we termed cocreating, that was a mutual and fluid activity between patients, family members, and caregivers. Cocreating began with an affirmation of the patient's life experience and led to the generation of a wholistic care plan that focused on maintaining the patient's humanity and dignity. Time was both a facilitator and inhibitor of effective spiritual care.


CONCLUSIONS
Clinicians and other health care workers consider spiritual care at the end of life as a series of highly fluid interpersonal processes in the context of mutually recognized human values and experiences, rather than a set of prescribed and proscribed roles.
Daaleman
Timothy P
TP
Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7595, USA. tim_daaleman@med.unc.edu
Usher
Barbara M
BM
Williams
Sharon W
SW
Rawlings
Jim
J
Hanson
Laura C
LC
D000328:Adult; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods / Q000523:psychology*; D010327:Pastoral Care / Q000379:methods / Q000639:trends; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D029181:Spirituality; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology*
Palliat Med. 2004 Oct;18(7):646-51
15540674
Gerontologist. 2002 Oct;42 Spec No 3:24-33
12415130
JAMA. 2006 Sep 20;296(11):1385-92
16985231
J Pastoral Care. 2001 Spring;55(1):81-97
11303456
Palliat Med. 2002 Mar;16(2):133-9
11969144
J Clin Nurs. 2006 Jul;15(7):852-62
16879378
N Engl J Med. 2007 Feb 8;356(6):593-600
17287479
Ann Behav Med. 2002 Winter;24(1):74-6
12008797
BMJ. 2004 Jul 17;329(7458):123-4
15258045
JAMA. 2002 Feb 13;287(6):749-54
11851542
Lancet. 1998 May;351 Suppl 2:SII21-9
9606363
J Palliat Med. 2006 Apr;9(2):464-79
16629575
Oncol Nurs Forum. 1997 May;24(4):663-71
9159782
Cancer Nurs. 1994 Dec;17(6):479-87
7820826
Hosp J. 1995;10(4):3-18
8698299
Palliat Med. 2002 Mar;16(2):125-32
11969143
J Pain Palliat Care Pharmacother. 2003;17(3-4):153-66; discussion 167-9
15022959
Cancer Nurs. 1999 Oct;22(5):350-7
10526428
J Palliat Med. 2008 Jul;11(6):907-14
18715183
JAMA. 2004 Jan 7;291(1):88-93
14709580
JAMA. 2000 Nov 15;284(19):2476-82
11074777
Oncol Nurs Forum. 2001 Jan-Feb;28(1):67-72
11198899
Am J Hosp Palliat Care. 2004 Nov-Dec;21(6):419-26
15612233
Lancet. 1999 Feb 20;353(9153):664-7
10030348
Cancer J. 2006 Sep-Oct;12(5):398-416
17034676
J Gerontol Nurs. 2005 Sep;31(9):27-35
16190010