Hospice spiritual care

Domain XV · Nature, philosophy, social & rites of passage · Cicely Saunders · 1967 · London

What it is

Hospice spiritual care is not a psychotherapy. It is a service: "pastoral, spiritual and/or religious care and support" offered to patients, families, carers and staff of all religions and beliefs, including none, delivered mainly by chaplains as members of the multidisciplinary team (MDT). Its…

Format

• Stage 3. Ongoing care within the MDT. Chaplains are part of the MDT for the dying person's individual care plan; people may be supported to practise their religion or belief, observe festivals and, where feasible, hold ceremonies in the care setting; some may want a chaplain of their own religion,…
• Session counts: none are given for chaplaincy itself. MCP: 7 or 8 sessions. Dignity therapy: brief, a recorded interview followed by return of an edited document; the exact number of meetings is.

Who practises it, and how they are trained or regulated

• Version followed: hospice and healthcare chaplaincy as NHS England's NHS Chaplaincy: guidelines for NHS managers on pastoral, spiritual and religious care (August 2023) sets it out (these guidelines say hospice chaplains are expected to follow them). Alongside it: the FICA Spiritual History Tool as the George Washington University Institute for Spirituality and Health (GWish) publishes it; Cicely Saunders' concept…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• numbness, over-involvement, rescuing. Working: you can stay present without being overwhelmed.
• pressure to attend; one person's distress overshadowing others. Working: staff say they feel supported and able to continue.
• the client feeling handed off; duplicated or conflicting messages. Working: one shared plan, and the client knows who does what.
• clients feeling unable to refuse religious input from their therapist. Working: the client can say what they want from each role.
• guilt at not finishing; legacy items written under family pressure. Working: the client finishes something that feels like theirs.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.