Spiritual health care : an enquiry into the spiritual care of patients with cancer within the acute hospital and the specialist inpatient palliative care unit in England and Wales

Question: What are the features of the spiritual care of patients with cancer within hospice and the acute hospital? Objectives: To identify: guidelines relating to spiritual care, the means whereby spiritual needs are assessed key features of spiritual care, perceptions of spiritual care stakeholders, perceptions of health professionals, patients and relatives. Methods: A mixed method design incorporating three phases. Phase I-a survey of the views of chaplains in 151 hospices and 195 trusts. Phase II -a phenomenological enquiry into the perceptions of spiritual care amongst 16 stakeholders. Phase III -a multiple case study in 4 health settings. Data handling: Phase I data: collected by postal questionnaire; analysed using SPSS. Phase II data: collected by recorded interviews; analysed using NUD*IST software. Phase III data: collected from case studies involving observation, documentation and recorded interviews; analysed using NUD*IST software and biographical and documentary techniques. Conclusions: Spiritual care is founded on the assumption that all people are spiritual beings. It affirms the value of each person and acknowledges the search for meaning in the big questions of life and death. Institutions determine the spiritual needs of patients using both formal and informal means. Such needs are met through the provision of physical resources and human resources. Chaplains figure prominently, although a broad view of spirituality is currently attracting a wider ownership. Within both settings, chaplaincy is almost exclusively Christian. Hospices with funded chaplaincy provide a higher level of service than hospices with voluntary chaplaincy. There is a greater demand for religious care in hospitals rather than hospices. Illness may prompt a patient's spiritual (re-) awakening, articulated through religious imagery possibly stretching back to childhood. Patients' non-religious needs include someone to listen and to 'be there'. Religious (Christian) needs centre around holy communion, prayer and worship.