The clinical assessment of spirituality in palliative care

Background: The practice of palliative care and the specialty of palliative medicine emerged from the modern hospice movement and its foundational philosophy of treating the whole person. This holistic approach recognises that the needs of dying patients are complex and multifaceted. Spirituality is one of the dimensions of palliative care practice and it was assumed that there was sufficient robust primary data to support a synthesis of evidence. However, a critical examination of the published data found that many studies make use of unexamined assumptions and ambiguous constructs. The research in this field is therefore missing an important methodological step in the inductive cycle by failing to articulate explicit theory or identify critical concepts. Aim: To construct a conceptual model of spirituality that provides a systematic way of illustrating the essential properties, functions and relationships of how spirituality operates in the lives of palliative care patients that can be subject to empirical testing. Methods: Conceptual model building was used as a method of theoretical investigation to construct a minimal abstract and indirect representation of the way that spirituality potentially operates in the lives of patients. The model was then subject to empirical testing through generating quantitative and qualitative data from palliative care patients participating in a questionnaire and interview. Analysis: Quantitative data from the questionnaires was subject to descriptive statistics and exploratory data analysis using techniques of visual representation. Qualitative data was subject to deductive content analysis based upon categories derived from the conceptual model. Results: A Synoptic Model was developed whose theoretical claims were congruent with the findings from this sample with the exception of the disease construct. 19 patients participated in the questionnaire phase of the study and 10 participated in an interview. Patients discussed multiple aspects of spirituality including their beliefs, practices and experiences. For some patients spirituality provided an orientation to life and helped make sense of illness and its consequences. Spirituality was also a resource for some patients in helping them to face their current situation and their mortality. Discussion: The Synoptic Model provides empirically supported theoretical knowledge of spirituality that can be utilised in the context of palliative care and has implications for clinical practice in terms of patient care, education and development, and assessment. Further development and testing is required in different settings to refine the Synoptic Model’s content and specification