One of the great strengths of palliative care is its conception of the human being using the biopsychosocial-spiritual model. In contrast to most areas of healthcare, the provision of spiritual care has been an integral part of palliative care since its inception. It is known that spiritual needs increase as life draws to a close, and that spiritual care can relieve the pain of spiritual distress. Yet research has shown that many healthcare professionals, including palliative care staff, feel ill-equipped to deliver spiritual care.

I am involved in developing a program to train Australian healthcare professionals in spiritual caregiving in collaboration with St Vincent’s Health Australia. As part of our groundwork, we decided to look at what had been found to be beneficial in similar programs worldwide. We performed a systematic review to identify what training programs have been developed to assist clinical healthcare staff to feel more comfortable and more competent to deliver spiritual care. We were interested to know what content was included in these programs, and the teaching methods used to deliver the training, as well as the outcomes achieved, and what facilitators and challenges they encountered.

The details of the methodology and the full results can be found in the published paper here: The Content, Teaching Methods and Effectiveness of Spiritual Care Training for Healthcare Professionals: A Mixed-Methods Systematic Review

We identified 55 training courses internationally that had been formally evaluated. Looking through these programs, we found that they were quite varied with regard to what content they included and how it was taught, reflecting the fact that, as yet there are no standard models of how this training should be done. The literature seems to support the idea that training in the provision of spiritual care in almost any form is well received by providers, improves their knowledge of spiritual care provision, and improves their confidence in being able to provide it.

Facilitators of spiritual care training included the involvement of chaplains, opportunities for practice and reflection, application of spiritual care assessment tools, training being conducted online, and support provided by managers. Identified challenges included competing healthcare priorities, negative perceptions of spirituality and spiritual care, resistance towards focusing on one’s own spirituality, staff feeling inadequate, and a need for ongoing training so that learning was not forgotten. Evidence for whether this training actually improves the patients' perception of whether their own spiritual needs are met is weak to non-existent. 

In summary, there is good news and bad news. Spiritual care training has been shown to be effective in increasing levels of spiritual care competency and confidence for a range of healthcare staff. However, more work is needed to identify exactly how patients are impacted by staff training, and to discover what is needed to maintain the benefits of training over time.

Associate Professor Megan Best, Research Associate, Institute for Ethics and Society, University of Notre Dame Australia

This work will be presented at the Oceanic Palliative Care Conference 2021.