Spiritual and existential issues are significant concerns for many people nearing the end of life. While the healthcare literature continues to debate definitions of spirituality, a reasonable consensus is emerging that the core themes addressed and affirmed in spiritual discourse are identity, community, purpose and coherence. Evidence indicates that spiritual wellbeing is correlated with an increased capacity to handle symptom load, higher quality of life and life satisfaction, and reduced anxiety.
It is argued here that it is important for these issues of spiritual significance to be explored, even if the term ‘spirituality’ is not used explicitly in the conversation. While debate continues about the level of engagement that healthcare practitioners should have in spiritual care, the evidence available suggests that the core competencies underpinning spiritual care are substantially the same as those required for good personal care: relational capacity and communication skills.
This chapter suggests that spirituality should be acknowledged by clinicians in ways that are appropriate to each person in their care, so that it is clear to that person that their caregivers see spirituality as important. Spiritual needs should be addressed in a care plan at least at the level of ‘doing no harm’ — respecting understandings, beliefs, practices and relationships important to the person. However, more active spiritual interventions should not be undertaken, unless it is the person's explicit wish that spiritual care of this sort be provided by the clinical team. If this is the case, the team can decide upon the degree to which they accede to this request or involve, perhaps by referral, other appropriately qualified practitioners. In a hospital context this may be achieved by including pastoral care practitioners in the caring team; in a community context such a request is more likely to require referral.