title: Patient versus health care provider perspectives on spirituality and spiritual care: the potential to miss the moment.
abstract: BACKGROUND
  Spirituality and spiritual care are well recognized as important facets of patient care, particularly in the palliative care population. Challenges remain, however, in the provision of such care. This study sought to compare patient and health care professional (HCP) views on spirituality/spiritual care, originally with a view to exploring a simple question(s) HCP's could use to identify spiritual distress, but evolved further to a comparison of how patients and HCPs were both concordant and discordant in their thoughts, and how this could lead to HCP's 'missing' opportunities to both identify spirituality/spiritual distress and to providing meaningful spiritual care.
  
  
  METHODS
  Patients (n=16) with advanced illnesses and HCP's (n=21) with experience providing care to those with advanced disease were interviewed using a semi-structured interview guide. Qualitative analysis distress and spiritual care, and screening for spiritual distress).
  
  
  RESULTS
  Within each category there were areas of both concordance and discordance. Most notably, HCP's struggled to articulate definitions of spirituality whereas patients generally spoke with much more ease, giving rich examples. Equally, HCP's had difficulty relating stories of patients who had experienced spiritual distress while patients gave ready responses. Key areas where HCP's and patients differed were identified and set up the strong possibility for an HCP to 'miss the moment' in providing spiritual care. These key misses include the perception that spiritual care is simply not something they can provide, the challenge in defining/ recognizing spirituality (as HCP and patient definitions were often very different), and the focus on spiritual care, even for those interested in providing, as 'task oriented' often with emphasis on meaning making or finding purpose, whereas patients much more commonly described spiritual care as listening deeply, being present and helping them live in the moment.
  
  
  CONCLUSIONS
  Several discrepancies in perception of spirituality, spiritual distress and spiritual care may hinder the ability of HCP's to effectively offer meaningful spiritual care. A focus on active listening, being led by the patient, and by providing presence may help limit the risk of a disconnect, or a 'miss', in the provision of spiritual care.
authors.affiliation: Sunnybrook Health Sciences Center, Toronto, Canada. debbie.selby@sunnybrook.ca.
authors.forename: Debbie
authors.initials: D
authors.lastname: Selby
authors.affiliation: Sunnybrook Health Sciences Center, Toronto, Canada. debbie.selby@sunnybrook.ca.
authors.forename: Dori
authors.initials: D
authors.lastname: Seccaraccia
authors.affiliation: Sunnybrook Health Sciences Center, Toronto, Canada. debbie.selby@sunnybrook.ca.
authors.forename: Jim
authors.initials: J
authors.lastname: Huth
authors.affiliation: Sunnybrook Health Sciences Center, Toronto, Canada. debbie.selby@sunnybrook.ca.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kurppa
authors.affiliation: Faculty of Nursing, University of Toronto, Toronto, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fitch
mesh_terms: D001291:Attitude of Health Personnel; D001293:Attitude to Death; D006801:Humans; D007407:Interviews as Topic; D010166:Palliative Care; D029181:Spirituality
keywords: Spiritual care; palliative care; spiritual distress