Challenges and Approaches to Assessing and Addressing Palliative Patients’ Spiritual Needs

Considerable attention continues to be paid to debating spirituality and related concepts: both the term itself, and also spiritual wellbeing, and how the latter relates to psychological, emotional, existential, or social wellbeing, needs, and distress. Alongside these debates, it is also generally agreed that palliative care patients’ spiritual needs are frequently not well met, and spiritual care overall is suboptimal. This may be partly due to difficulties with reaching conceptual agreement, which often stagnates in the position that consensus on definitions is impossible, since spirituality is always individual. Yet, there is some common understanding of spiritual care, with shared broad dimensions, while also usually highlighting the individuality of each person's needs, and therefore of the care they require. The nature of needs and care in this area also unsettles the customary approach to health and social care interventions, which is usually sequential: assessing need/s, planning intervention/s, implementation, and then evaluation (often through re-assessment), enabling planning for next steps. Thus, assessments generally occur before, and separately from, any intervention. However, assessing spiritual needs entails enquiry into the person’s spiritual concerns, which of itself is (or initiates) an intervention, so, a spiritual assessment is always also a spiritual intervention, and an initial assessment is simultaneously an initial intervention. Uncertainty around this phenomenon may also contribute to suboptimal provision of spiritual care. Conversely, use of a suitable assessment tool may enable and support palliative care professionals to at least begin to identify and engage with palliative patients’ spiritual concerns.