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This chapter looks at case studies to analyse the desired skills, attitudes, and knowledge needed to assess the spiritual needs of palliative patients. It looks at several questions such as: Under what circumstances would a spiritual history be needed? Why to screen for spiritual distress? What constitutes a spiritual history or assessment? Can overt spiritual beliefs lead to inner spiritual distress? How can clinicians effectively respond to patient beliefs when they differ significantly from their own beliefs and affect treatment decisions? What constitutes spiritual care? Who provides spiritual care?

This chapter discusses the spiritual or religious issues in the care of the dying. It looks at the influence of the Liverpool Care Pathway for the Dying Patient (LCP) in religious and spiritual care and the available research of spiritual care in relation to palliative care. The chapter provides working definitions for spiritual care and religious care, and examines how and when to make an assessment of a patient's spiritual and religious needs, and who should meet these needs. It also presents detailed guidelines on dealing with the needs of different religious groups, including atheists, Buddhists, and Mormons. How to meet the non-spiritual needs is also studied.

Chapter 3 describes common spiritual needs as well as unique factors that can shape how the end of life is experienced. The meeting of spiritual needs is essential (Langegard & Ahlberg, 2009), as it supports patients who seek wholeness in the midst of profound vulnerability (Goldberg & Crespo, 2003). Advances in medicine may further extend the time patients have for spiritual challenges to inform life meaning (Grant, 2007). Hospice social workers can support patients in this process provided that they are aware of what patients consider are spiritual needs. This chapter reviews research that suggests spiritual needs may be shaped by personal and contextual factors. Some spiritual needs may not be met due to declining health (Hermann, 2006), but the recognition of spiritual needs may also reveal biopsychosocial needs that can be.

This chapter discusses the concept of the spiritual seeking of Americans. In America, the first spiritual awakening dates back to the 1830s and 1840s, and that is associated with the emergence of the transcendentalist movement and renowned figures such as Emerson and Thoreau. What is new about American spiritual seeking in the post-1960s era is its pervasiveness. Prior to the 1960s, only a small proportion of Americans attempted to fulfill their spiritual needs outside the domain of denominational religion. Since then, a vastly expanded spiritual marketplace has produced a growing trend toward uncoupling religion and spirituality. The autonomy associated with spiritual seeking is different. This chapter charts a path that may have relatively little truck with the ways established in traditional religious beliefs and practices. It is constituted by a personal autonomy that tends to be somewhat removed from, rather than in singular conversation with, church-based religion.

This chapter holds that palliative day care is the fastest growing but least researched component of palliative care services. There is a wide diversity of provision between services with some being more medical and some more social in emphasis. Palliative day care is a complex service with emphasis on addressing patients' physical, psychological, social, and spiritual needs within an environment that acknowledges individuality and the need for flexibility. The impact of palliative day care provision on the use of other palliative care, health, and social services has not been evaluated. Evaluation of palliative day care is not easy but is essential if services are to be targeted effectively and resourced adequately in future.

This chapter outlines childhood’s spiritual strengths and needs. Psychological theories and empirical research suggest that spiritual capacity is a natural condition of early childhood, arising in everyday experience. Contemporary scholarship identifies key strengths that underpin childhood spirituality. These include children’s heightened sensitivity to non-verbal, embodied, and emotional ways of knowing, and a less dominating verbal and intellectual approach to experience. This privileges children’s spiritual capacity for ‘relational consciousness’, and is evident in attention to mystery, delight, despair, wonder, the present moment, a sense of place, and connotative meaning-making. Without sensitive approaches to nurture in education and care, these capacities are vulnerable to erosion. Four areas of spiritual need are proposed: for child-led listening, for adult presence and humility, for space (physical, emotional, and auditory), and a need for imaginative play. Together, these can provide safe ways to explore the profound existential issues common in even the youngest children.

Psychotherapy is an integrative and integrated part of modern patient/relation-centered care in the advanced and terminal phases of physical illness. Psychiatric disorders (e.g. depressive spectrum, stress-related, and anxiety disorders), other clinically significant psychosocial conditions (e.g. demoralization, existential pain) and interpersonal, psychological, and spiritual needs have to be addressed by psychological intervention. Supportive-Expressive Group Psychotherapy (SEGT), Meaning-Centered Psychotherapy (MCT), Managing Cancer and Living Meaningfully Therapy (CALM), cognitive-existential therapy, dignity therapy (DT) and other psychotherapeutic interventions have been developed over the last 40 years. These treatments have proved to be effective in increasing the patients’ sense of dignity, purpose, and meaning, and to reduce demoralization, anxiety, and existential distress at the end of life. Also Family Focused Grief Therapy (FFGT) and grief therapy have shown to be effective in overcoming anxiety, depression, and complicated grief symptoms both before and after loss. Psychotherapy should thus be considered a mandatory ingredient of palliative care.

This chapter presents the first of two case studies examining prominent, but dissimilar, senior citizen musical groups in Evergreen Town. The aim was to learn about the specific aspects of music participation that were relevant to group members’ quality of life. The Graceful Singers, a traditional church choir, was studied using an ethnographic approach, with the researcher in the role of participant-observer and interviewer. An examination of the church home and choir history; participants’ musical histories, music learning processes, and beliefs; and the choir’s function in the church and community showed that the choir’s role in participants’ quality of life was complex. It was a juxtaposition of fulfilled expectations derived from past musical histories and participation and fulfilled psychological and spiritual needs, through a culture that was extremely welcoming, interactive, and supportive. Overall, participants’ membership in the Graceful Singers choir was or had been a vitally important contributor to their quality of life.