Spirituality in palliative home care: a framework for the clinician.
OBJECTIVE
Spiritual care at the end of life remains poorly understood despite its promotion by the World Health Organisation. The purpose of this paper was to develop a consensus-based framework of the main elements of spiritual care in palliative home care.


METHODS
Expert meeting using the nominal group technique, followed by a two-stage web-based Delphi process, was used. Experts from three stakeholder groups (physicians, professional spiritual care givers and researchers) representing two countries (Belgium and the Netherlands) participated in this study.


RESULTS
Fourteen elements of spiritual care were retained: (1) being sensitive to patient's fear of the dying process; (2) listening to the patient's expectations and wishes about the end of life; (3) giving attention to patient's wishes about the design of the farewell; (4) offering rituals if the patient experiences them as meaningful; (5) listening to the stories, dreams and passions of the patient; (6) helping the patient find strength in inner resources; (7) connecting with the patient in truth, openness and honesty; (8) supporting communication and quality of relationships; (9) making sure the patient feels comfortable and safe; (10) seeing spirituality as an interwoven, though specific dimension; (11) caring for your own spirituality; (12) knowing and accepting your vulnerability; (13) being able to learn from your patient; and (14) having an interdisciplinary team that is there when needed.


CONCLUSIONS
The experts agreed to the 14 main elements of spiritual care in palliative home care. There were no differences in this regard between the stakeholder groups. This study provides a first step towards the development of an interdisciplinary spiritual care model in palliative home care.
Department of General Practice, Kapucijnenvoer 33 blok j bus 7001, 3000, Leuven, Belgium. mieke.vermandere@med.kuleuven.be
Mieke
M
Vermandere
Jan De
JD
Lepeleire
Wouter
W
Van Mechelen
Franca
F
Warmenhoven
Bregje
B
Thoonsen
Bert
B
Aertgeerts
D001530:Belgium; D003697:Delphi Technique; D006699:Home Care Services; D006801:Humans; D009426:Netherlands; D010166:Palliative Care; D011320:Primary Health Care; D011369:Professional-Patient Relations; D029181:Spirituality