Patients' and Caregivers' Contested Perspectives on Spiritual Care for Those Affected by Advanced Illnesses: A Qualitative Descriptive Study

Abstract

Context: Spiritual care refers to practices and rituals addressing spiritual/religious concerns. It supports coping with loss and finding hope, meaning, and peace. Although integral to palliative care, its implementation is challenging. Objective: To understand an Australian cohort of patients' and caregivers' perspectives about experiencing and optimizing spiritual care in the context of advanced illness. Methods: Patients and caregivers of patients with ≤12 month prognosis were recruited from a broader spiritual study via criterion sampling and agreed to opt-in interviews. Participants from an Australian, metropolitan health service received a spiritual care definition and were interviewed. Transcripts were analysed using qualitative description. Results: Thirty patients (17 male; mean 70-years) and 10 caregivers (6 male; mean 58.9years) participated. Twenty-seven identified as Christian and 10 had no religion. Participants described multifaceted and contested beliefs about spirituality. Many queried the tangibility of spirituality but all valued respectful staff who affirmed personhood, that is, each individual's worth, especially when care exceeded expectations. They also resonated with positive organizational and environmental tones that improved holistic wellbeing. Participants stressed the importance of the hospital's welcoming context and skilled care, which comforted and reassured. Conclusion: While many patients and caregivers did not resonate with the term, "spiritual care", all described how the hospital's hospitality could affirm their values and strengthen coping. The phrase "spiritual care and hospitality" may optimally articulate and guide care in similar, pluralist inpatient palliative care contexts, recognising that such care encompasses an interplay of generalist and specialist pastoral care staff, and organizational and environmental qualities.

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