title: How Community Clergy Provide Spiritual Care: Toward a Conceptual Framework for Clergy End-of-Life Education.
abstract: BACKGROUND
  Community-based clergy are highly engaged in helping terminally ill patients address spiritual concerns at the end of life (EOL). Despite playing a central role in EOL care, clergy report feeling ill-equipped to spiritually support patients in this context. Significant gaps exist in understanding how clergy beliefs and practices influence EOL care.
  
  
  OBJECTIVE
  The objective of this study was to propose a conceptual framework to guide EOL educational programming for community-based clergy.
  
  
  METHODS
  This was a qualitative, descriptive study. Clergy from varying spiritual backgrounds, geographical locations in the U.S., and race/ethnicities were recruited and asked about optimal spiritual care provided to patients at the EOL. Interviews were audio taped, transcribed, and analyzed following principles of grounded theory. A final set of themes and subthemes were identified through an iterative process of constant comparison. Participants also completed a survey regarding experiences ministering to the terminally ill.
  
  
  RESULTS
  A total of 35 clergy participated in 14 individual interviews and two focus groups. Primary themes included Patient Struggles at EOL and Clergy Professional Identity in Ministering to the Terminally Ill. Patient Struggles at EOL focused on existential questions, practical concerns, and difficult emotions. Clergy Professional Identity in Ministering to the Terminally Ill was characterized by descriptions of Who Clergy Are ("Being"), What Clergy Do ("Doing"), and What Clergy Believe ("Believing"). "Being" was reflected primarily by manifestations of presence; "Doing" by subthemes of religious activities, spiritual support, meeting practical needs, and mistakes to avoid; "Believing" by subthemes of having a relationship with God, nurturing virtues, and eternal life. Survey results were congruent with interview and focus group findings.
  
  
  CONCLUSIONS
  A conceptual framework informed by clergy perspectives of optimal spiritual care can guide EOL educational programming for clergy.
authors.affiliation: University of Virginia School of Nursing, Charlottesville, Virginia, USA. Electronic address: vlebaron@virginia.edu.
authors.forename: Virginia T
authors.initials: VT
authors.lastname: LeBaron
authors.affiliation: Harvard Medical School Center for Bioethics, Boston, Massachusetts, USA; Gordon-Conwell Theological Seminary, Boston, Massachusetts, USA.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Smith
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Quiñones
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Callie
authors.initials: C
authors.lastname: Nibecker
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Sanders
authors.affiliation: Scripps Clinic, La Jolla, California, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Timms
authors.affiliation: Harvard/MGH Center on Genomics, Vulnerable Populations and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Shields
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Initiative on Health, Religion, and Spirituality, Harvard University, Cambridge, Massachusetts, USA.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Balboni
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Initiative on Health, Religion, and Spirituality, Harvard University, Cambridge, Massachusetts, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Balboni
mesh_terms: D002977:Clergy / Q000193:education* / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008962:Models, Theoretical; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D036301:Qualitative Research; D029181:Spirituality; D013727:Terminal Care / Q000379:methods / Q000523:psychology; D019452:Terminally Ill / Q000523:psychology; D014481:United States
keywords: Religion; clergy; education; end of life; palliative care; spiritual care; spirituality