As your question suggests, some patients believe or intuitively sense that illness has a spiritual as well as a physical dimension. For them, receiving medical care is part of a bigger picture that involves their spirituality and/or religious faith. As they face the anxiety of a life-limiting illness, patients may turn to familiar spiritual practices or resources for reassurance, hope and a sense of peace. For other patients, illness becomes an occasion for deepening their religious or spiritual perspectives in ways that go beyond their faith’s tradition. In either case, patients often experience spiritual struggles that test and temper their beliefs, values and practices. Clinicians may experience tension when providing care to a patient whose spiritual beliefs do not align or are in conflict with their own. Studies demonstrate that clinicians may avoid spiritual issues for fear of offending their patients or because they lack training and skills in this area.[1]

Although the philosophy of palliative care has always included the spiritual dimension, we are still growing in our understanding of how to respond to the religious and spiritual needs of patients. While there is no blueprint or philosophy that can adequately address all the questions that come up in practice, the report on the 2009 Consensus Conference on Spiritual Care in Palliative Care provides helpful recommendations.[2]

Your question seeks the right balance between respecting a patient’s request for your spiritual support and preserving your personal integrity. In the end, this balance is personal and the result of “trial and error” for each professional caregiver. One or more of the following suggestions may help you strike the right balance:

• Candidly acknowledge to the patient that you are not a praying person, but you recognize that prayer is important to the patient, and you are willing to remain present in a quiet way while he or she prays.
  • Variations of this approach:
    • Tell the patient that although you are not a praying person, you will make a point of thinking about him or her in the coming days. If appropriate, you may also tell the patient that you will send positive thoughts his or her way.
    • Suggest that you spend a few moments of silence together to quietly reflect on the patient’s concerns and hopes in your own way.
• State that praying with patients is not part of your practice, but that you could refer the patient to a spiritual care provider. In addition to praying with the patient, mention that a spiritual care provider could discuss any other spiritual needs that he or she may have.
• Use the request for prayer as an opportunity to discuss the patient’s thoughts and feelings about his or her illness. Ask what the patient’s prayer would be and what spiritual resources are important to him or her. This is an opportunity to explore how the palliative care team could support the patient’s spiritual needs. You might conclude the conversation by saying, “I recognize how important what we’ve been talking about is to you. With your permission I’d like to talk to other team members about what you’ve shared so we can work together to make sure that your spiritual needs are met.”
  

A professional caregiver’s spirituality, even if it is not religion-based, is an important resource in the provision of care. It provides motivation and direction for compassionate and competent care. While it may be quite different from the patient’s spirituality, it provides grounding for appreciating the importance of the patient’s spiritual needs. At times, a caregiver’s response may disappoint patients who expect the caregiver to join them in their religious practices. However, other patients will feel a deepening trust and comfort when caregivers relate to them in authentic ways and draw from the wells of their own spiritual resources.

References

1. Balboni MJ, Sullivan A, Amobi A, et. al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. J Clin Oncol. 2013;31(4):461-467.

2. Puchalski C, Ferrel B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the consensus conference. J Palliat Med. 2009;12(10):885-904.