COMMENTARY

Do We Provide Spiritual Care to Terminally Ill Patients? Should We?

Betty R. Ferrell, PhD, RN

Disclosures

January 29, 2015

Nurse and Physician Barriers to Spiritual Care Provision at the End of Life

Balboni MJ, Sullivan A, Enzinger AC, et al
J Pain Symptom Manage. 2014;48:400-410

Study Summary

Spiritual care from medical practitioners is infrequent at the end of life, despite national standards. This study aimed to describe nurses' and physicians' desires to provide spiritual care to terminally ill patients and assess 11 potential barriers to spiritual care. This was a survey-based, multisite study conducted from October 2008 through January 2009. All eligible oncology nurses and physicians at four Boston academic centers were approached for study participation; 339 nurses and physicians participated (response rate, 63%).

Most nurses and physicians want to provide spiritual care within the setting of terminal illness (74% of nurses vs 60% of physicians; P = .002); however, 40% of nurses and physicians provide spiritual care less often than they would like to. The barrier most often endorsed by nurses was "lack of private space," and by physicians, it was "lack of time," but neither influenced the provision of spiritual care.

Significant barriers experienced by both nurses and physicians that predicted the lack of provision of spiritual care included inadequate training, a belief that spiritual care is not part of the medical professional's role, and worry that the power inequity between patient and clinician makes spiritual care inappropriate (Table).

Table. Barriers to Spiritual Care Provision Experienced by Both Nurses and Physicians

Barriers Nurses Physicians
OR 95% CI P value OR 95% CI P value
Inadequate training 0.28 0.12-0.73 .04 0.49 0.25-0.95 .04
"Not my professional role" 0.21 0.07-0.61 .004 0.35 0.17-0.72 .004
Power inequity with patient 0.33 0.12-0.87 .03 0.41 0.21-0.78 .007

CI = confidence interval; OR = odds ratio

A minority of healthcare professionals (21% of nurses and 49% of physicians, P = .003, respectively) did not desire spiritual care training. Those less likely to desire spiritual care training reported lower self-ratings of spirituality. When combining results from nurses and physicians, the most frequently endorsed barriers considered "moderately significant" or "very significant" included lack of time (72%), inadequate training (61%), lack of privacy (52%), and the belief that spiritual care was better offered by others (50%).

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