title: Organization-level principles and practices to support spiritual care at the end of life: a qualitative study.
abstract: BACKGROUND
  Though most models of palliative care specifically include spiritual care as an essential element, secular health care organizations struggle with supporting spiritual care for people who are dying and their families. Organizations often leave responsibility for such care with individual care providers, some of whom are comfortable with this role and well supported, others who are not. This study looked to hospice programs founded and operated on specific spiritual foundations to identify, if possible, organizational-level practices that support high-quality spiritual care that then might be applied in secular healthcare organizations.
  
  
  METHODS
  Forty-six digitally-recorded interviews were conducted with bereaved family members, care providers and administrators associated with four hospice organizations in North America, representing Buddhist, Catholic, Jewish, and Salvation Army faith traditions. The interviews were analyzed iteratively using the constant comparison method within a grounded theory approach.
  
  
  RESULTS
  Nine Principles for organizational support for spiritual care emerged from the interviews. Three Principles identify where and how spiritual care fits with the other aspects of palliative care; three Principles guide the organizational approach to spiritual care, including considerations of assessment and of sacred places; and three Principles support the spiritual practice of care providers within the organizations. Organizational practices that illustrate each of the principles were provided by interviewees.
  
  
  CONCLUSIONS
  These Principles, and the practices underlying them, could increase the quality of spiritual care offered by secular health care organizations at the end of life.
authors.affiliation: Saint Elizabeth Research Centre, Saint Elizabeth Health Care, 90 Allstate Parkway, Suite 300, Markham, ON, Canada, L3R 6H3. PaulHolyoke@saintelizabeth.com.
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0002-4130-5383
authors.initials: P
authors.lastname: Holyoke
authors.affiliation: Department of Religious Studies, Memorial University of Newfoundland, St. John's, NF, Canada, A1A 5S7.
authors.forename: Barry
authors.initials: B
authors.lastname: Stephenson
mesh_terms: D000328:Adult; D005260:Female; D066296:Grounded Theory; D006801:Humans; D008297:Male; D015279:Organizational Culture; D010166:Palliative Care / Q000379:methods*; D036301:Qualitative Research; D029181:Spirituality
keywords: Best practices; End of life care; Interdisciplinary team; Palliative care; Secular health care; Spiritual care; Volunteers