Spiritual Care in Healthcare: Elements of Best Practice, A Scoping Review

January 30, 2023

Richard Egan, Associate Professor Dunedin School of Medicine,

University of Otage Aotearoa New Zealand, and

Cheryl Holmes, CEO Spiritual Health Association, Australia

In November 2021 we, (Cheryl Holmes and Richard Egan), were involved in an international online meeting and made an important and unexpected discovery. Both of our respective organisations were undertaking a literature review to look at the elements of best practice spiritual care in healthcare. Further, we found that we were both planning for this review to inform larger and more ambitious projects to co-design national models for spiritual care in health in our respective countries. It did not take us long to realise the benefits of combining our teams, resources and energies, and a dynamic partnership was created.

The Spiritual Care in Healthcare: elements of best practice literature review assembles the latest evidence of the components, elements, and characteristics that indicate a quality model of spiritual care within healthcare settings.

Specifically, the two questions framing this review were:

1. What are the current models, frameworks, guidelines, standards and best practices (abbreviated to MFG’s for the purposes of the report) of spiritual care in healthcare internationally?

2. What are the elements that contribute to a best practice model of spiritual care in healthcare?

The Australian team led the review into the grey literature while the team from Aotearoa New Zealand steered the study of the peer-reviewed literature. The peer-reviewed literature originated from 18 countries, with Iran and the USA contributing the largest number of papers. Forty-one peer-reviewed articles and 74 grey literature documents met the criteria for inclusion in the review. The grey literature primarily included models published and promoted by professional bodies from around the world, including from the United Kingdom, United States, Australia, Canada, and Aotearoa New Zealand.

After the extensive analysis what did we find? In summary, the scoping review of the literature found:

There is no universal approach to spiritual care MFG within healthcare settings.
Thirteen common elements of spiritual care MFGs in healthcare were identified (as shown in Figure 1).
There is a lack of recognition of Indigenous spiritual care within the spiritual care MFGs.
The theoretical underpinnings of spiritual care MFGs are not consistently stated.
Current spiritual care MFGs reviewed in this report were developed primarily by large professional associations, whose voices/perspectives are dominant in spiritual care MFG in healthcare.

Figure 1: The common elements that make up a spiritual care in healthcare model, framework, guideline etc. *An element added to by the Authors, not discussed in the literature review results

What does this mean for the sector? In the future there is need for consistent application of evidence-based models of spiritual care across healthcare, and these models need to be accepted practice, rather than simply recommended. This would require wide acceptance of a number of concepts and approaches:

A broad-based approach to spiritual care, inclusive of all cultures and spiritualities, with an inclusive consensus-based approach to developing spiritual care MFG in healthcare.
The acceptance by all healthcare providers, administrators, and governments that spiritual care is an integral part of whole person care, requiring system integration and adequate resourcing.
Testing and evaluation of MFG is critical to assess best practice of spiritual care in healthcare.
MFG flexibility for contextualising local approaches to spiritual care.

In Australia the scoping review has already been used to inform our co-design project to develop a national model for spiritual care in health. In August 2022, Spiritual Health Association began consulting with health services, academics, consumers, and faith communities to co-design a contemporary and consistent spiritual care model to ensure that patients, no matter where they are in Australia, can receive the best possible care. This new model will address some quality challenges that are evident through consumer and health service research. Once finalised, the model will be trialled in select health services with a view to implementation Australia-wide. You can find out more about the co-design project here

In Aotearoa New Zealand the recent restructuring of our health system and the establishment of the Te Aka Whai Ora / Māori Health Authority offer a unique opportunity to better cater to our population’s spiritual care needs. Our rōpū (group) is still planning and looking for funding to co-design a national framework for spiritual care in healthcare.

Finally we offer our thanks to authors of the report, Noeleen Venter, Heather Tan, and Chris Arnison. We acknowledge too the work of the global community of researchers and professional associations in spiritual care, without whom this report would not exist.

Richard Egan richard.egan@otago.ac.nz and

Cheryl Holmes ceo@spiritualhealth.org.au