Core Modules

module 2 | Activity 12: Spiritual conversations

Spiritual conversations involve open discussions with people about:[1-4]

  • Their spiritual needs
  • Spiritual struggles
  • Distress
  • Pain
  • Conflicts
  • Resources of strength and belief
  • Practices that impact on the health of the person.

Giving people the chance to express how they feel about their losses and concerns can often help them cope. Providing people, with life-limiting illnesses, the time to reflect on the meaning and purpose of life and to discuss their spiritual distress can also help.[4-7]

Spiritual conversations can focus on and clarify questions about:[4-9]

  • Identity: who am I in these changing circumstances?
  • Connectedness: who is my community, where is my place?
  • Meaning: what is the purpose of my life now?

Examples of statements which can promote spiritual conversations include:[8, 9]

“What are your hopes, expectations and fears about the future?”

“Have you got any hopes, dreams or wishes at the moment?”

“Is faith (religion or spirituality) important to you in this illness?’

“Would you like to explore religious matters with someone?”

“It is enormously painful for any of us to contemplate our own death. Are there particular fears or issues concerning you about facing death and what that means?”

 

Following these conversations, spiritual care strategies can be developed for each person. These strategies can involve:[4-7]

Settings
  • Identify places where the person feels safe
  • Ask the person what reminds them of this place. This could be a memory, a photograph or a religious symbol.
Stories
  • Allow time for the person to share the story of their life
  • Listen to their story and ask questions to explore and expand on this experience.
Systems of belief
  • Ask the family/person to explain their rituals and beliefs – and respect and support these beliefs
  • Arrange a visit from an accredited religious practitioner, if requested
  • Prepare for end of life by ensuring that any specific rituals are well documented.

Case study

Consider these points on spiritual conversations in relation to the case study on Michelle and her family.

Michelle’s illness is progressing and she acknowledges that she is dying. James Smith, the palliative care nurse, has been asked to visit Michelle and Pete at their home to review what support they need in preparing for end of life. During the visit, Michelle talks with James about what dying means and what is important to her at this time. Michelle starts to explore what will happen when she dies.

  1. What does Michelle state is important to her at this time?
  2. What specific strategies does James use to explore the meaning of illness and dying to Michelle?
  3. What specific strategies does James use to respond to:
    • Michelle’s question: ‘I am going to die soon, aren’t I?
    • Michelle’s questions about dying?
  4. What other strategies would you recommend to:
    • Explore the meaning of illness and dying to Michelle?
    • Respond to Michelle’s questions about dying?
  1. Seddigh, R., A.-A. Keshavarz-Akhlaghi, and S. Azarnik, Questionnaires Measuring Patients’ Spiritual Needs: A Narrative Literature Review. Iranian journal of psychiatry and behavioral sciences, 2016. 10(1): p. e4011-e4011.
  2. Broeckaert, B., Spirituality and palliative care. Indian journal of palliative care, 2011. 17(Suppl): p. S39-S41.
  3. Dedeli, O. and G. Kaptan, Spirituality and Religion in Pain and Pain Management. Health Psychology Research, 2013. 1(3): p. e29.
  4. Forouzi, M.A., et al., Spiritual Needs and Quality of Life of Patients with Cancer. Indian journal of palliative care, 2017. 23(4): p. 437-444.
  5. Richardson, P., Spirituality, religion and palliative care. Ann Palliat Med, 2014. 3(3): p. 150-9.
  6. Vilalta, A., et al., Evaluation of spiritual needs of patients with advanced cancer in a palliative care unit. Journal of palliative medicine, 2014. 17(5): p. 592-600.
  7. Mesquita, A.C., E.C.L. Chaves, and G.A.M. Barros, Spiritual needs of patients with cancer in palliative care: an integrative review. Curr Opin Support Palliat Care, 2017. 11(4): p. 334-340.
  8. National Breast Cancer Centre and National Cancer Control Initiative, Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer. 2003, Camperdown, NSW: National Breast Cancer Centre.
  9. Keall, R., J.M. Clayton, and P. Butow, How do Australian palliative care nurses address existential and spiritual concerns? Facilitators, barriers and strategies. Journal of Clinical Nursing, 2014. 23(21-22): p. 3197-3205.