Introduction
Spirituality, together with psychological and physical wellness, is an essential aspect of terminally ill patients’ life quality. Terminally ill patients frequently question their faith, a phenomenon that is well documented in research. Yet, in many end-of-life situations, the ability of spirituality to enhance the life quality of patients facing life-threatening illnesses is not adequately explored. A likely reason is that many health practitioners treat spiritual matters as an afterthought in palliative care rather than seeing spirituality as a realm on par with the physical, social, and psychological ones. Accordingly, this essay demonstrates that a lack of consensus on the value of spirituality in academia and medical practice generally leads to a haphazard and impulsive response to patients’ spiritual concerns.
Spirituality in the Context of End of Life Care
Contextualizing spirituality at the end of life care emerges as a challenge for researchers. This may be because the concept of spiritual care is vast. It is occasionally indistinct from conventional nursing care and psychosocial care, limiting the potential to investigate it. For example, in their study, Taylor et al. (2017) found that spiritual care predominantly correlated with diagnosing and reinforcing a patient’s faith in many care terminal care settings. Spiritual care may vary based on environment, culture, and circumstances in a diverse society. These factors complicate the understanding of spirituality in terminally ill patients and, more broadly, in healthcare.
The above issues underscore the challenge of underpinning the definition of spirituality in research. In its broadest sense, many people understand spirituality as a person’s pursuit of purpose and meaning in life and their encounter with the divine. Steinhauser et al. (2017) define it as a concept that involves the relationships an individual makes with others, with oneself, with nature, and with the divine worlds, both within and beyond mainstream religion. Thus, spirituality refers to how people pursue and profess purpose and meaning and how they feel affiliated to the present, themselves, those around, essence, and the transcendent. On the other hand, religion is defined as a structured set of beliefs, habits, and methods of worship (Puchalski et al., 2020). While religion can be used to convey spirituality, a few people concentrate on the cultures, interpersonal relationships, and rites of religion rather than the spiritual underpinnings (Paloutzian & Park, 2021). In this sense, religion and spirituality are multifaceted concepts capable of existing side by side within the same foundation while also being deemed separate phenomena.
Health beliefs are interconnected with an individual’s cultural heritage and religious or spiritual affiliations. Patients’ perspectives and experiences with the disease, treatment, and death are shaped by their heritage, principles, ideologies, life encounters, and a sense of life purpose (Puchalski et al., 2020). At the end of life, disease-related worries, social or extrinsically influenced circumstances, and spiritual and psychological issues have an effect on the continued existence of one’s sense of dignity. Loue (2017) notes that these factors are typically influenced by a feeling of individual freedom and self-perception. Individual freedom can be associated with both decision-making ability and operational ability. Additionally, terminally ill patients’ perceptions of independence can be defined as a feeling of freedom combined with the ability to make one’s choices.
End-of-life decisions can sometimes reveal the purpose of life, unresolved issues, and final preparations. Spiritual, religious, and ontological convictions, aspirations, norms, and encounters may impact terminally ill patients’ decision-making. Culture significantly affects end-of-life choices due to cultural standards, customs, and individual traits (Matzo & Sherman, 2019). Patients’ attitudes and the circumstances surrounding the choices they must make can evolve as they approach the end of their lives. The benefits of integrating patients in their treatment encompass enhanced physician-patient interaction, increased patient contentment, and an elevation in their sense of dignity.
Conversely, failing to communicate and comprehend patient wishes during end-of-life care can result in needless anguish, distress, and unnecessary use of limited resources. Patients at the end of life care encounter numerous and complicated choices. When these are combined with the spiritual, physical, and psychosocial pain that commonly precedes life-threatening disease, it becomes increasingly difficult for terminally ill patients to make informed decisions (Puchalski et al., 2020). In general, this decisional conflict frequently indicates a state of confusion regarding a particular set of alternatives, feeling misinformed and abandoned confusion regarding individual values and views, and disappointment with the decision. Ultimately, the difficulties faced while negotiating these complexities impact patients’ end-of-life journey and wellness.
Spirituality in End of Life Care Research
The relationship between spirituality and health is currently the subject of much investigation. In addition to being researched by medics, psychiatrists and other specialists are also interested in it. Most of these studies utilize different methodologies depending on the specific palliative care settings being investigated, study population, and aims of the investigation. Despite these varied approaches, many commonalities exist across the end of life care research. According to Steinhauser et al. (2017), palliative care research is often divided into three categories: coping and mortality. These three areas of research are examined comprehensively in the subsequent sections.
Coping
Spiritual patients may draw on their beliefs to cope with the disease, suffering, and other challenges. Spiritual people tend to have a more optimistic attitude and a higher quality of life. This attribute can also reflect at the end of life care settings involving such individuals. This notion was proven by Riklikienė et al. (2020), who found that spiritual and religious individuals with terminal cancer demonstrated increased levels of life satisfaction, happiness, and reduced symptoms and anguish. In this view, spirituality emerges as a crucial element of metaphysical reality as defined by quality-of-life measures. Higher life quality for patients with a terminal illness was associated with optimistic assertions on those measures. In the study, these included a purposeful individual existence, the achievement of life objectives, and the belief that one’s life was valuable up to the present state (Riklikienė et al., 2020). This implies that spirituality furnishes terminally ill patients with optimistic ways of coping with their situations.
Spirituality has likewise been associated with reduced suffering in terminally ill patients. In many studies, spiritual well-being has been linked with the capacity to appreciate life even while experiencing symptoms, such as agony (Carlson et al., 2016; Poletti et al., 2019). This implies that palliative care teams can target spirituality as a core therapeutic priority alongside physical, social, and psychological domains. In particular, some researchers have shown that aspects of spirituality, for example, personal devotion are as practical as other mainstream non-pharmacological approaches for pain alleviation end of life care settings (Kisorio & Langley, 2016). Furthermore, the majority of patients studied in these investigations have expressed an increased preference for devotion when faced with challenging decision-making situations. Thus, when standard therapeutic approaches such as intravenous discomfort relievers, relaxation exercises, and touch or massage fail, patients are more likely to resort to prayer to alleviate their suffering. These findings emphasize the need for professionals working in end-of-life settings to integrate devotion as alternative therapy when typical pain medication becomes ineffective.
In light of the above findings, it suffices to say that spirituality may help people deal with sickness and confront death. In one study of women with obstetric and gynecologic cancer, more than 95% of the participants stated that spiritual beliefs enabled them to deal with their conditions compared to typical pharmacological interventions (Gichuki & Kanyingi, 2018). Religion had a major impact on the lives of these individuals, particularly after coming to terms with their irreversible illnesses. Some participants (90%) expressed their wish for others to pray for them, while 87% stated that they preferred specialists to lead them in prayer (Gichuki & Kanyingi, 2018). Studies involving HIV-positive patients have shown consistent results. For example, Kendrick (2018) determined that HIV-positive individuals who expressed higher spiritual devotion were not as scared of dying as their HIV-negative counterparts. The courageous attitude portrayed by HIV-positive patients in the face of terminal illness is not strange to most Christians. Christian teachings encourage followers to be courageous and turn to God when faced with all manner of tribulations.
Perhaps the most important value of spirituality in the care of terminally ill people is its ability to enable surviving victims to cope with grief. Grief can be persistent and complicated for people with an incurable disease and their loved ones. Often it starts with the inability to accept the diagnosis of a terminal illness, which can be by the person diagnosed with the illness or their close family members. Eventually, grief can worsen upon losing a family member with a terminal illness. Treating grief is complicated for caregivers because individuals experience and cope with it differently. In most cases, physicians recommend family members undergoing grief seek therapy. Some popular treatments are cognitive behavioral therapy and grief therapy (Pearce, 2019). These interventions are always effective when applied by expert psychiatrists.
However, research has shown that religious beliefs are effective in helping individuals overcome grief when the interventions of person-centered therapies fail. One such study discovered that nearly all parents who lost children to cancer found solace in their religious beliefs (Khursheed & Shahnawaz, 2020). As a result, those parents were better able to cope with their own physical and emotional needs. Those families also reported an increase in their religious adherence in the year leading up to their child’s demise. These findings imply that spirituality can be explored as a supplementary therapy by psychiatrists to assist surviving families of terminally ill patients in coping with the loss of their loved ones.
Coping with end-of-life emotions frequently requires teaching not just the individual experiencing the illness, but all the individuals who will be caregiving for that patient. A significant amount of anxiety and unpleasant feelings related to serious disease emanates from a feeling of powerlessness and inability to comprehend what is occurring (Maddux & Winstead, 2016). The social worker and other hospice staff may give advice, interact with the person via psychotherapy, and assist them in living as comfortably as possible for as long as possible.
Mortality
Even though death is an inevitable aspect of life, many people try all they can to escape it. However, helping patients accept that death is a part of life might help them live more completely in the present moment. Awareness of one’s mortality might help people appreciate the time they have left. Spiritual individuals typically have a heightened sense of their mortality compared to those who are non-spiritual (Balboni et al., 2017). This fact is well-documented at the end of life care research. Outside the realms of spirituality, individuals can accept their mortality through death with dignity laws (Reel, 2018). Although many religious individuals hold to historical customs and interpretations of corporeal life’s ultimate path, contemporary medical science has allowed patients to actively re-examine some beliefs.
However, many terminally ill patients still resort to their traditional beliefs to understand mortality. For instance, research has shown that most terminally ill patients do not consider death with dignity when evaluating effective options of ending their anguish (Briscoe & Kinghorn, 2017). For these patients, death was inevitable because all humans are mortal, and interfering with the process does not alter this. Thus, many Christians seek solace in their religious beliefs to understand mortality and death. In perspective, this research further underpins the role of spirituality in helping terminally ill patients understand mortality. According to Verkerk (2016), spiritual terminally ill patients regularly reflect on a critical life question: “What is the significance of my existence?” For most people, this is a profoundly spiritual issue to which explanations emerge in the solace of isolation when they are at ease, rather than when occupied by a frenzy of physician’s visits, therapies, or testing.
The findings above show that healthcare professionals, especially those working with terminally ill patients, play a fundamental role in supporting their spiritual beliefs. Principally, physicians must evaluate their religious convictions before engaging in their patients’ spirituality or sharing their own. This should be the first step when conducting a spiritual examination of terminally ill patients. According to Timmins & Caldeira (2019), this evaluation of one’s spiritual beliefs may encompass a reflection on personal views and practices, good and unpleasant encounters, sentiments toward religion and healing, and confidence and capacity to deal with diverse patients’ spiritual concerns. Sometimes doctors might not even regard themselves as spiritual, might not have to talk about spirituality, and might have varying levels of comfort or aptitude when addressing spiritual issues. Undertaking a spiritual evaluation and providing spiritual assistance, instead of being a forced task, is akin to extracting a cultural history and sympathizing following a disappointing diagnosis (Timmins & Caldeira 2019). In this way, they give another avenue for understanding and supporting people’s experiences with health and sickness.
The most fundamental action a clinician can undertake is to engage terminally ill patients sympathetically. Patients’ values are essential to them irrespective of whether they are devoted to their religious practices. By attending, clinicians demonstrate their concern for their clients and acknowledgement of this aspect of their life. Empathetic listening might be everything that is required to help a terminally ill patient feel at ease. Documenting the patient’s religious viewpoint, history, expressed influence on medical treatment, and willingness to address the issue is an additional approach to integrating spiritual evaluation. Clinicians might discover this knowledge useful in the long run when revisiting the issue or at moments of emergency when avenues of consolation and purpose become critical.
A second strategy to include the evaluation is to think about how cultural cultures and practices could influence mainstream clinical procedures. Some individuals of the Jehovah’s Witness religion reject blood transfusions; adherents of spiritual cures may postpone standard medical treatment in anticipation of supernatural healing; and Hindu and Muslim women prefer to resist delicate exams by male doctors, especially when they are female. Some patients may suffer significant emotional distress if they feel an illness is the result of a lack of faith or a series of misdeeds committed by them. Patients’ acute and chronic medical conditions must also be taken into account by clinicians.
In outpatient and inpatient environments, Ramadan fasting may have an impact on glucose management and other metabolic considerations. Dietary restrictions imposed by religious beliefs, such as halal or kosher legislation, may need adjustments to typical nutrition advising by doctors. It is fundamental to note that patients might not stick to every single practice or doctrine of their religion. When clinicians inquire about a patient’s clinical treatment, they should refrain from drawing conclusions about the patient’s own medical habits and principles.
Lastly, in rare cases, the religious beliefs of the patients and practitioners may agree. This is a situation where a clinician might contemplate providing faith-based assistance if the patient desires this. The patient or the clinician may lead this kind of devotion. It is important not to presume that a doctor’s religiosity is the same as that of their clients, considering the broad diversity of spiritual traditions practiced in heterogeneous communities. It is inappropriate for a spiritual examination to focus on prayer, and doctors must refrain from asking their patients whether they believe in a particular religion.
Conclusion
Terminally ill patients might endure emotional, social, physical, and spiritual anguish. While clinicians are entrusted with identifying these requirements and delivering patient-centered care, they receive scant evidence-based directions on pastoral care. Clinicians worldwide seem to demonstrate an inability to evaluate and handle the spiritual realm, leading to patients’ spiritual needs being ignored. This essay has explored different research findings that reinforce the fundamental value of spirituality in the care of terminally ill people. Nurses, healthcare administrators, and industry policymakers can utilize the reported findings to develop proper mechanisms for incorporating spiritual care in end-of-life settings.
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