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As a palliative care physician who does not believe in God, I have felt awkward when patients ask me to pray with them. How do I support them in their religious beliefs and practices while maintaining my own integrity?

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...

How can we help a patient create her legacy and share it before she dies? She has no family and is relatively new to our area, but she wants to know she won't be forgotten. What can we do?

No matter what your patient has done in her life, she can create a legacy. She can gain a place in the hearts and memories of people if she weaves love, gratitude and forgiveness into the last chapter of her life story. This is the simple, yet profound, wisdom that comes from Dr. Ira Byock’s identification of the four statements that matter...

I am caring for an elderly patient who believes that he will be healed miraculously. As he continues to deteriorate physically, he struggles with the possibility that he may not have enough faith to be healed. What can I say to him?

Your patient is carrying a double burden – his health problems and his self-blame for not being healed. It may be that his sense of failure about not being healed is reinforced by members of his family or faith community who believe that prayers offered in deep faith will be answered. As his prayers for healing go unanswered, he may also feel...

I am caring for an elderly patient who does not allow us to control her pain because she believes that her physical suffering is a sacrifice that will help her son to get to heaven. Her struggle with pain is upsetting to the whole team and to her family, but we feel helpless to do anything about it. Do you have any advice?

Pain and symptom management are central to end-of-life care . When a patient does not allow us to do all we can to control symptoms, it can be very unsettling. We may feel frustrated in witnessing suffering that seems unnecessary and have difficulty understanding why the patient is not willing to receive what we have to offer. Often we use...

I work with a colleague who believes that she has a duty to share her religious faith with dying people. I sometimes feel she is not respecting the patient’s privacy or boundaries, but what should I do about this?

Death and dying often elicit a heightened awareness of the importance of spirituality in patients, families and health care professionals. Caring for dying people and their families may offer opportunities to help them find meaning, love, hope and peace in the midst of very difficult circumstances. With these opportunities comes the responsibility...

I’m providing care to a patient who belongs to a religion that is totally unfamiliar to me. I sense that religion is very important to her, but how do I support her in her religious belief and practice?

Your question indicates sensitivity and recognition of the important role the patient’s religion plays in her illness experience ― an essential component of spiritual care at the end of life, in and of itself. Your sense of inadequacy in addressing spiritual and religious issues is common among health care professionals, even among spiritual...

My religious beliefs and practice support me in my palliative care work. I find it easy to talk about spirituality and religious faith with my patients. I also pray with them when they request it. However, how do I pray with someone from another religion who prays to a different God than I do?

Attending to the spiritual struggles and needs of patients and families is part of palliative care philosophy and practice. Clearly, you have spirituality on your radar as you care for patients and have integrated it into your practice. Your comfort in opening up conversations with patients about their spiritual perspectives and religious...

Our homecare nurses visit a mother of teenage children who is deteriorating rapidly after a long illness. She wants to continue treatments that are no longer effective and is not willing to consider palliative care. She says that she will never quit fighting for life because that would mean she has lost hope. Do you have any suggestions about how we can support her and her family?

Your patient clearly has a lot to live for and wants to live well in spite of her health issues. She does not see palliative care as an opportunity to improve her quality of life and physical comfort, but rather as a sign that she has given up and lost hope. She continues to cling to hope for a cure although this appears medically impossible.

We have a middle-aged patient who appears troubled and anxious much of the time. When he is alone, his anxiety increases almost to the point of panic. His physical symptoms are well controlled, but he seems to be suffering emotionally and, perhaps, spiritually. He does not talk easily about what he is experiencing. How can we respond to his anxiety?

When patients are uncomfortable or in distress, even though their physical symptoms are well controlled, they may be experiencing spiritual pain . Spiritual pain is often experienced in the midst of a life-limiting illness and is “a great mimicker, often presenting as physical pain, anxiety or depression , anorexia , insomnia or shortness...

We regard spirituality as an important aspect of palliative care. However, we do not have regular chaplain services in our program and so it often gets neglected. How can we broach spiritual issues with patients?

Assessing and responding to the spiritual needs of patients and families are important aspects of person-centred, comprehensive palliative care. However, hospice palliative care programs and settings vary widely in their spiritual care resources. Ideally, every palliative care team should include a certified spiritual care provider (i. e.,...

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