Advancing Spiritual Care Through Research

TC Fellow reviews articles

Transforming Chaplaincy Fellow Kelsey White reviews two recent articles of particular interest:

Gil Bar-Sela et al., (2018). “Training for awareness of one’s own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses.” Palliative and Supportive Care,

This article summarizes results of a cross-sectional study conducted by leaders from the Middle East Cancer Consortium (MECC) who sought to replicate the Balboni et al. (2013) Religion and Spirituality in Cancer Care Study. With an impressive response rate of 79% of nurses and 63% of physicians, this particular paper examines the barriers to spiritual care provision by clinicians. From a primarily medical oncology setting, the respondents identified limited time, insufficient training, and private space as the most frequent challenges to providing spiritual care. Only the lack of training ended up being predictive of the actual provision of care; not having enough space or time did not seem to determine whether a clinician would actually spiritually care for a patient.

Rev. Kelsey White, MDiv, MPH, BCC

The discussion explored targeting a group of clinicians with “unrealized potential” for spiritual care provision. They acknowledge the disconnect between the clinicians’ valuation of spiritual care and the actual provision of spiritual care, but continue to emphasize that providing training to the 21% who most fully identify as such would decrease barriers. They also name the importance of one’s individual spiritual identity – predictive of providing actual care – and training that can improve one’s spiritual awareness. The research team’s conclusion that “training programs and other efforts can help staff personally connect to the idea of spirituality, such as helping staff to find the personal points of connection to spirituality in their work” (p. 7), seems a bit of a stretch after 46% of their sample believed spiritual care would best be done by other healthcare team members and 39% felt uncomfortable with providing spiritual care.

In short, the team offers a rich snapshot of the role of one’s own spirituality in the provision of care. From this researcher’s perspective, identifying how the response “not at all spiritual” predicted one’s value of spiritual care without providing it can stand on its own as a helpful finding for the chaplaincy community.  It is unnecessary to extend the conclusion that education or training can break down barriers for those in that category. After all, if there is one thing chaplains know well, it is that even when someone is in touch with their own spirituality, it doesn’t mean they want to provide that care to others.


Gil Bar-Sela and colleagues (2019). “Human Development Index and its association with staff spiritual care provision: A Middle Eastern oncology study.” Supportive Care in Cancer,

The second paper in the series, published in 2019, offers a thought-provoking analysis on the connection between a country’s development and clinical care professionals’ attitudes about spiritual care. This analysis looked at the questions on the appropriateness of providing spiritual care, training in spiritual care, and the perception of the impact of providing that care where impacted by an individual’s country of birth.

Using the same sample, which consisted primarily of  women (61%), moderately religious individuals (43%), primarily Muslims (73%), and predominately nurses (60%), participants’ country of residence was given its corresponding economic and education development level from the United Nations’ Human Development Index (HDI).  The development level of a participant’s home country was a significant factor in determining that individual’s spiritual care attitudes and practices. Individuals from more developed countries were more positive about the exploration of spirituality in the discussion of healthcare preferences and placed more value on discussions about patients’ spirituality and practices as compared to individuals with home countries in the low HDI category. Those in the latter group were more focused on the provision of actual spiritual practices, such as prayer, when compared to those from higher HDI countries. Within the sample of participants from high HDI countries, attitudes about the provision of spiritual care were actually less positive than those found by Balboni and colleagues (2013) in the U.S. However, the Middle Eastern participants were more likely to be actually providing spiritual care than their U.S. colleagues.

This paper provides further confirmation of the important role of culture and one’s country of origin in spirituality – not only for patients, but also for how nurses and physicians provide spiritual care and what they believe about its role in advanced cancer care. The authors emphasize the need to consider the cultural and economic context when developing spiritual care interventions and providing further clinician education.

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