How do palliative care professionals perceive the spiritual needs of patients at the end of life?

Objective: to collect empirical evidence about the identification and care of spiritual needs for patients in palliative care units. Method: an anonymous questionnaire was designed and 1200 copies were distributed through the Medicina Paliativa journal to palliative care professionals all over Spain. Questionnaires included items on the detection, assessment, and care of spiritual needs in end-of-life patients. We received 202 completed questionnaires from 72 physicians, 73 nurses, and 57 psychologists, social workers, priests, and volunteers. Data were analyzed using a qualitative systematic content analysis and standard statistical quantitative procedures. Results: the return ratio was 17%. Among all 202 questionnaires analyzed, 31% of participants reported many difficulties in identifying spiritual concerns from sentences collected from their patients. Twenty-eight percent stated that nearly all of their patients expressed spiritual concerns, and 56% affirmed that only a minority of their patients did. Forty percent of all professionals interviewed expressed that they had little or very few abilities to respond to situations where patients showed spiritual suffering. Only 23% of professionals agreed that the spiritual needs of patients in their unit were taken into account regularly in the multidisciplinary team sessions, whereas 63% reported that such issues were never dealt with in clinical team sessions. Thirty-nine percent of professionals shared that they always or nearly always talked about death with their patients, whereas 43% said that they never or very rarely did so. From the content analysis of 463 literal expressions from patients, as collected by their carers, a taxonomy of 12 different types of existential-spiritual needs is proposed. This empirical categorization offers interesting clues about the rationale on which a model of spiritual care at the end of life should be based. Conclusion: data collected suggest that existential-spiritual needs are not properly cared for in most palliative care units in our country. Health professionals show an insufficient level of awareness in identifying spiritual distress in their patients. Additionally, our survey detected an inability to deliver appropriate care, and difficulties to discuss such issues in clinical team sessions. Copyright © 2008 Arán Ediciones, S.L.