CONSENSUS REPORT 889 ''My life is meaningless.'' ''I feel useless.'' Abandonment by God or others Lack of love, loneliness Not being remembered No sense of Relatedness ''God has abandoned me.'' ''No one comes by anymore.'' Anger at God or others Displaces anger toward religious representatives Inability to forgive ''Why would God take my child. .. it's not fair.'' Concerns about relationship with deity Desires closeness to God, deepening relationship ''I want to have a deeper relationship with God.'' Conflicted or challenged belief systems Verbalizes inner conflicts or questions about beliefs or faith Conflicts between religious beliefs and recommended treatments Questions moral or ethical implications of therapeutic regimen Expresses concern with life=death or belief system ''I am not sure if God is with me anymore.'' Despair=Hopelessness Hopelessness about future health, life Despair as absolute hopelessness No hope for value in life ''Life is being cut short.'' ''There is nothing left for me to live for.'' Grief=loss The feeling and process associated with the loss of a person, health, relationship ''I miss my loved one so much.'' ''I wish I could run again.'' Guilt=shame Feeling that one has done something wrong or evil Feeling that one is bad or evil ''I do not deserve to die pain-free.'' Reconciliation Need for forgiveness or reconciliation from self or others ''I need to be forgiven for what I did.'' ''I would like my wife to forgive me.'' Isolation Separated from religious community or other ''Since moving to the assisted living I am not able to go to my church anymore.'' Religious-specific Ritual needs Unable to perform usual religious practices ''I just can't pray anymore.'' Religious=spiritual struggle Loss of faith or meaning Religious or spiritual beliefs or community not helping with coping ''What if all that I believe is not true.'' 894 PUCHALSKI ET AL.

conference built on the 2012 conference to produce a set of standards and recommended strategies for integrating spiritual care across the entire health care continuum, not just palliative care. Deliberations were based on evidence that spiritual care is a fundamental component of high-quality compassionate health care and it is most effective when it is recognized and reflected in the attitudes and actions of both patients and health care providers.

Context. The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. Objective. The main objective of this article is to present the research behind the new definition.

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BACKGROUND: Spirituality and religion are often central issues for patients dealing with chronic illness. The purpose of this study is to characterize spirituality/ religion in a large and diverse sample of patients with HIV/AIDS by using several measures of spirituality/religion, to examine associations between spirituality/religion and a number of demographic, clinical, and psychosocial variables, and to assess changes in levels of spirituality over 12 to 18 months.

Clinical studies are beginning to clarify how spirituality and religion can contribute to the coping strategies of many patients with severe, chronic, and terminal conditions. The ethical aspects of physician attention to the spiritual and religious dimensions of patients' experiences of illness require review and discussion. Should the physician discuss spiritual issues with his or her patients? What are the boundaries between the physician and patient regarding these issues? What are the professional boundaries between the physician and the chaplain? This article examines the physician-patient relationship and medical ethics at a time when researchers are beginning to appreciate the spiritual aspects of coping with illness.

Spirituality is an essential element of person-centered care and a critical factor in the way patients with cancer cope with their illness from diagnosis through treatment, survival, recurrence and dying. Studies have indicated a significant relationship between spirituality and quality of life. Spirituality, in its broadest sense speaks to the meaning patients find in their lives especially during times of stress, illness and dying. Illness can trigger deep existential issues that could trigger profound suffering and distress. A model is presented that describes the role of each member of the healthcare team in addressing patients' spirituality. Spiritual distress, as a diagnosis, requires attention and treatment just as any other clinical symptom. Spiritual resources of strength need to be identifies and recognized as positive factors in patients' coping. Finally a treatment plan needs to include the spiritual as well as the physical and psychosocial issues of patients. Chaplains and other spiritual care professionals need to be recognized as the experts in spiritual care and should be integral members of the healthcare team. Integrating spirituality as an essential domain of care will result in better health outcomes, particularly quality of life for patients across the trajectory of cancer care.