Communicating about spiritual issues with cancer patients

Document Type

Journal Article

Publication Date



New Challenges in Communication with Cancer Patients




Cancer; Communication; Health; Religion; Spiritual history; Spiritual issues; Spirituality; Spirituality and health


© Springer Science+Business Media, LLC 2013. Many patients have expressed the importance of spirituality in their life and the wish that clinicians would discuss this topic with them and have it integrated into their health care. Clinicians also have noted the importance of spirituality, but have struggled with ways to address spiritual issues in a medical setting. Barriers to effective communication include: Lack of knowledge, physician time, and fear of causing a negative reaction in patients. Understanding these barriers and developing an open-ended systematic approach is one key to starting the spiritual dialogue with patients. These dialogues are best conducted in some framework or spiritual care model. The current spiritual care models are derived from Engel's biopsychosocial model that places an emphasis on understanding and appreciating the patients' unique story but with the addition of a spiritual domain. Care models that are multidisciplinary can take advantage of each care team member's strength and provide a more opportune setting to appreciate the patient story from multiple perspectives. Tools that aid clinicians in screening for spiritual distress include the FICA. The FICA tool provides a way for healthcare providers to use open-ended questions to assess the four domains of a patient's spirituality. While useful, these tools are meant to open the discussion that the clinician can then use to further appreciate the patient's life and any potential spiritual crisis. Points of concern detected by a spiritual screening can indicate a potential referral for a formal spiritual assessment. Formal spiritual assessment is usually done by a board-certified chaplain or spiritual care expert with the intent of forming a spiritual care plan. A spiritual care plan is ideally formed in a multidisciplinary framework, in which the patients' spiritual needs can be incorporated into their current medical treatment. The care plan can then be used to further inform targeted spiritual interventions such as meaning-centered group psychotherapy or the short-term life review. Entering into a dialogue about spirituality can give a sense of meaning and hope, as well as open up treatment opportunities. Approaches and models exist to help clinicians enter into this dialogue and deliver spiritually informed care.