Help to Address Spiritual Distress

Betty R. Ferrell, PhD, RN


February 26, 2015

Research Priorities in Spiritual Care: An International Survey of Palliative Care Researchers and Clinicians

Selman L, Young T, Vermandere M, Stirling I, Leget C; Research Subgroup of European Association for Palliative Care Spiritual Care Taskforce
J Pain Symptom Manage. 2014;48:518-531

Study Summary

Spiritual distress, including meaninglessness and hopelessness, is common in persons with advanced disease. Spiritual care is a core component of palliative care, yet it is often neglected by healthcare professionals, owing to the dearth of robust evidence to guide practice. The purpose of this study was to determine the research priorities of clinicians and researchers and thus inform future research on spiritual care in palliative care.

An online, cross-sectional, mixed-methods survey was conducted. Respondents were asked whether there is a need for more research in spiritual care, and if so, to select the five most important research priorities from a list of 15 topics. Free-text questions were asked about additional research priorities and respondents' opinion on the single most important research question. Data were analyzed thematically.

In total, 971 responses, including 293 from palliative care physicians, 112 from nurses, and 111 from chaplains, were received from 87 countries. The mean age was 48.5 years (standard deviation, 10.7 years), 64% were women, 65% were Christian, and 53% reported their work as "mainly clinical."

Less than 2.5% of respondents believed that there was no need for further research in spiritual care. Integrating quantitative and qualitative data demonstrated three priority areas for research:

Development and evaluation of conversation models and overcoming barriers to spiritual care in staff attitudes;

Screening and assessment; and

Development and evaluation of spiritual care interventions and determining the effectiveness of spiritual care.


This first international survey explored researchers' and clinicians' research priorities in spiritual care, and found international support for research in this domain. These findings provide an evidence base to direct future research and highlight the particular need for methodologically rigorous evaluation studies.

This project was conducted by the European Association for Palliative Care Spiritual Care Taskforce, which was initiated in 2011. It builds on an evolving literature that has recognized how essential spiritual care is and how limited our preparation has been in this area.[1,2,3,4,5,6]

The study is very interesting and offers diverse perspectives, the participants were from 87 different countries, and 35% self-identified as non-Christian. The sample also included diverse professions as well as a mix of both clinicians and researchers.

The article is very informative, and a strength is that it provides both quantitative ranking of research priorities in spiritual care and qualitative comments. The quantitative ranking of research priorities was as follows:

1. Evaluate screening tools used to identify patients with spiritual needs.

2. Develop and evaluate conversation models for spiritual conversations with palliative care patients.

3. Evaluate the effectiveness of spiritual care.

4. Develop and evaluate spiritual interventions—pastoral counseling, interventions by nonspecialist spiritual care providers (physicians, nurses).

5. Determine the prevalence of spiritual distress among people with incurable progressive illness in different cultural and religious populations.

6. Conduct longitudinal studies to understand how patients' spiritual needs change.

7. Develop spiritual care interventions for palliative care staff.

8. Determine the best spiritual outcome measures for research and audit purposes in palliative care.

9. Develop and evaluate models of spiritual care (community engagement, spiritual care in palliative home care).

10. Develop spiritual care interventions for family carers.

The qualitative data presented in the article are equally informative and were analyzed in major themes. The top five themes were:

Responding to spiritual needs and evaluating spiritual interventions;

Investigating the effectiveness of spiritual care;

Understanding spiritual needs and spiritual distress;

Identifying spiritual needs (screening); and

Questions related to spiritual discussions or conversations.

The responses remind us of the broad nature of spirituality and that this domain extends far beyond religion. This is an excellent study to guide research and practice in spiritual care as a key dimension of palliative care.



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