"Diagnosing" and "Managing" spiritual distress in palliative care: Creating an intellectual framework for spirituality useable in clinical practice

Definitions of Palliative Care emphasise the holistic nature of care and specifically name spiritual care as an essential element of that care. However, many health professionals are reluctant to engage in spiritual care, often for fear of imposing their own beliefs on a patient at a particularly vulnerable time. We sought to develop a framework for the identification and management of spiritual issues in health care. We found that religion and spirituality were considered as interchangeable concepts, where religion is more properly considered as organising spiritual expression through a formal set of beliefs. Spirituality is best considered as a search for greater meaning, purpose, and direction in living. The key to addressing spirituality is to recognise its role in a person's attempt to make sense of what they are experiencing. The health practitioner's best response is to create an environment in which the patient can express their distress in a secure setting, and identify what, within their belief systems, could provide comfort. Translating this framework into "diagnosing" and "managing" the person's spiritual state helps health practitioners to understand the observations and actions that are inherent in achieving this. The critical importance of the health practitioner acknowledging their own spiritual and religious state, and being willing to offer empathy to the sufferer, is emphasised in this framework.