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The well-being of patients, especially palliative care patients, is determined not only by medical and scientific parameters but also by how well doctors and nurses address patients' spiritual needs. Although the World Health Organization and the German Charter for the Care of the Severely Ill and Dying recognize spirituality as the fourth pillar alongside physical, psychological, and social dimensions, the reality in hospital wards is different.

Doctors and nurses often lack the time, knowledge, or courage to address patients' spiritual needs, said Arndt Büssing, MD, professor of quality of life, spirituality, and coping at the University of Witten/Herdecke in Witten, Germany, at a conference held by Diakonie, a charitable organization of Protestant churches. Spiritual needs are not discussed in clinical contexts. Nor is there clarity about who is responsible for meeting them (eg, pastors, psychologists, nurses, or doctors). Ultimately, work stress on the wards negatively affects the provision of spiritual care.

What can be done? Büssing evaluated a training program with a special curriculum developed by Diakonie and Caritas (a confederation of Catholic relief organizations) in 2020. In all, 91 nurses from diaconal institutions were trained in the curriculum. The study included 774 patients and 356 relatives. This interdisciplinary 40-hour curriculum, "Spiritual/Existential Care Interprofessional" (SpECi), aims to help meet the spiritual needs of seriously ill patients and their families.

The SpECi curriculum was tested at seven locations and includes 10 modules on topics such as "Coping with Loss and Grief," "Spiritual Resources and Sources of Strength — What Comforts, What Brings Inner Peace and Hope," and "Helpful Rituals." Through this training, employees in hospices or palliative care units are expected to better perceive the needs of their patients.

Becoming Better Listeners

The training appears to be successful. "Participants now know more about their own spirituality and can therefore better respond to and listen to patients," Büssing told the Medscape German edition. "They have a greater capacity for resonance." Thus, 85% of respondents stated that they address patients' spiritual needs significantly more often than they did before the training. In addition, 87% now wish for more time to discuss spiritual topics.

This training, however, is of little use if job and team dissatisfaction harms the well-being of the wards. Under these conditions, the opposite of the desired outcome may occur: Emotional exhaustion and distancing from those being cared for. The training did little to change the perceived workload or team satisfaction on the wards.

Things are different regarding certain spiritual care competencies. Perception, self-experience, or knowledge of other religions could be further developed through the training. "Team spirit" was low and remained low, however. "What was supposed to support the work teams did not work properly," said Büssing.

Patients' Reactions

Data from American patients with cancer showed that 72% of respondents feel that their spiritual needs are not or only minimally supported by the system.

Moreover, 20% of outpatients with pain in Germany have no contact person for their spiritual needs, according to another study by Büssing. Only 23% speak with their pastor about their questions, but 37% of patients with pain find it important to talk to their doctors about them. "So, then the doctor is supposed to provide spiritual care. However, the doctor at best refers them to the hospital chaplaincy," said Büssing.

Appreciation for Patients

The search for meaning or forgiveness is surprisingly uncommon among patients, Büssing said. "Do the dying no longer have expectations of life? Or are they simply at peace with their lives? We don't know."

It's different with so-called generativity, the desire to share one's life experiences and affirm one's own significance. This desire was just as strong as the need for emotional peace and the desire for encounters with nature.

For Büssing, the study results mean that considering spiritual needs in the healthcare system is not just optional but "indispensable." It's about appreciation for the patients. "Those who do not consider this point violate patients' dignity and often fall short of their own standards of care quality."

This story was translated from the Medscape German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.