Spirituality as an Ethical Challenge in Indian Palliative Care: A Systematic Review

Objectives: Spiritual care has been recognized as an essential component of palliative care. However, patients’ experience of spirituality is context dependent. Western definitions and findings regarding spirituality may not be applicable to patients of non-Western origin, such as Indian palliative care patients. Given the particular socio-cultural, religious and economic conditions in which palliative care programs in India operate, we decided to undertake a systematic review of the literature on spirituality among Indian palliative care patients. We intended to assess how spirituality has been interpreted and operationalized in studies of this population, determine which dimensions of spirituality are important for patients, and analyze its ethical implications. Methods: In January 2015, five databases were searched (ATLA, CINAHL, EMBASE, PsycINFO, and PubMed) using a combination of controlled and non-controlled vocabulary. A content analysis of all selected reports was undertaken to assess the interpretation and dimensions of spirituality. Data extraction from empirical studies was done with a data extraction sheet. Results: 39 empirical studies (12 qualitative, 21 quantitative, and six mixed method studies) and 18 other studies (10 reviews, four opinion articles, and four case studies) were retrieved. No systematic review on spirituality in Indian palliative care has been published. Spirituality was the main focus of only six empirical studies. The content analysis revealed three dimensions of spirituality: relational, existential, and values. Religion is prominent in all dimensions. The patients’ experience of spirituality is determined by the specifically Indian context which leads to particular ethical issues. Significance of Results: Since spiritual wellbeing largely contributes to quality and life, and because of the substantial presence of people of Indian origin living outside India, the observations of this review are of international relevance. Moreover, this review illustrates that spirituality can also be an ethical challenge and more ethical reflection on spiritual care provision is needed.status: publishe