title: Provider Difficulties With Spiritual and Forgiveness Communication at the End of Life.
abstract: BACKGROUND
  Due to an absence of communication training, provider responses to patient/family spiritual distress are highly variable. Assessing spiritual and forgiveness concerns are important to ensuring quality holistic care.
  
  
  METHODS
  Cross-sectional survey data were collected from providers attending 1 of 2 continuing education courses. The survey measured the frequency and initiation of communication about spirituality and forgiveness with patients/families, the perceived difficulty in communication across topics, and preparation and resources for these discussions.
  
  
  RESULTS
  Most participants (n = 124) were nurses followed by social workers with over half of providers having 10 years or more of clinical experience. Participants reported the highest level of difficulty in spiritual communication when talking with family after the death of a patient, followed by conducting a spiritual history with a patient. Facilitating forgiveness communication between parent and adult child, followed by facilitating forgiveness between partners was most difficult for all participants. Social workers reported much lower difficulty than nurses on all items of spiritual and forgiveness communication.
  
  
  CONCLUSIONS
  The majority of participants indicated they were involved in spiritual and forgiveness communication. The most difficult communication included talking with family after death and facilitating forgiveness between patients and families. These findings support the importance of spiritual communication in clinical practice, and the need for clinician training in communicating about spirituality and forgiveness with patients and families.
authors.affiliation: Division of Nursing Research and Education, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Wittenberg
authors.affiliation: Division of Nursing Research and Education, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors.forename: Betty
authors.initials: B
authors.lastname: Ferrell
authors.affiliation: Department of Communication, University of Memphis, Memphis, TN, USA jvgldsmt@memphis.edu.
authors.forename: Joy
authors.initials: J
authors.lastname: Goldsmith
authors.affiliation: Department of Communication, Chapman University, Orange, CA, USA.
authors.forename: Haley
authors.initials: H
authors.lastname: Buller
mesh_terms: D003142:Communication; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology; D005260:Female; D061347:Forgiveness; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D010361:Patients / Q000523:psychology; D011787:Quality of Health Care; D000068217:Social Workers / Q000523:psychology*; D029181:Spirituality; D013315:Stress, Psychological / Q000523:psychology; D013727:Terminal Care / Q000523:psychology*
keywords: communication; end-of-life; forgiveness; hospice; palliative care; spirituality