Spirituality at the end of life

Please be aware - this information is for healthcare professionals

Spirituality is a broad term relating to our thoughts and feelings about our own being and purpose. It may be based more on individual philosophies, rather than established faiths. Faith and religion refers more specifically to particular beliefs, rituals and practices, which may be deeply significant to a person’s spiritual life.

Spirituality can be very important to a person at the end of their life, even if they do not follow a religion. They may develop new spiritual beliefs or reconsider their beliefs completely.

Some people at the end of their life may draw strength or benefit from spiritual practices such as meditation, mindfulness or using mantras. It’s a good idea to speak to the person and their family about spirituality to make sure their needs in this area are being taken care of. This may help the person avoid some spiritual pain.

Spiritual pain happens when people lose a sense of meaning or purpose in life and have unmet emotional or spiritual needs. They may begin to reflect on their past and, in doing so, may find themselves asking difficult questions about life and its meaning.

Some people may also experience distressing feelings and emotions, including regret, unfulfillment, anxiety and fear. They may also worry about unresolved issues with family and friends or feel sadness about leaving loved ones. Some people may experience a process of detaching from the world and getting ready for a next stage – whatever they believe that to be.

Emotional and spiritual pain is not the same as depression.

Being aware of a person’s spiritual needs is an important part of end of life care. By acknowledging a person’s spiritual pain, you can guide them in understanding their feelings and help them feel better able to cope with whatever lies ahead.

What are some signs of spiritual pain?

The person may say things that indicate that they are experiencing a loss of meaning or purpose in life, such as:

• I am so alone.
• I feel hopeless. What’s the point?
• I don’t know who I am any more.
• I don’t want to be a burden.
• I need to make amends.

The person may not verbalise their spiritual pain, so it’s important to be aware of their behaviour and actions too. For example, they may seem afraid of being alone or refuse help when they appear to need it.

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How can I help? 

One of the most important things you can do is listen without passing judgement or dismissing what the patient is saying. Try to understand and accommodate your patient’s beliefs, without imposing your own. If your patient is thinking about worries from the past, you can encourage them to talk about good memories as well. If they’re anxious or afraid, try to understand what they’re worried about. For example, some people are afraid of the pain becoming too much, or being alone when they die. These are things their care team can help with. If it seems appropriate, holding hands or a hug may be reassuring.

Questions about life and its meaning are profound, so don’t feel like you always need to have an answer. Leave room for listening, thoughtfulness and stillness.

You may also encourage the patient to find coping techniques. This may include doing things they enjoy, writing down thoughts and feelings and finding ways to relax.

 Some people may find it helpful to find out more about how they are feeling for themselves. You could suggest the patient reads our information on emotional and spiritual pain.   

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Who else can help?

There are people who can help the patient better understand what they’re feeling. Some may already have their own faith leader or spiritual advisor, or you could offer to arrange a visit from one.

The local hospital, hospice and palliative care team may have a chaplaincy service. This is usually led by a member of clergy, with a team of trained volunteers. They will talk to people of any religion or if they have no faith.
Talking to a psychologist or counsellor, a specialist palliative care social worker or going to local support group may also be helpful.

It would be a good idea to discuss this with the patient and ask them what kind of support they would prefer.

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How do I cope with my own emotions?

It can be difficult if someone you are caring for is distressed. It’s important to be aware of your own thoughts and feelings, as your emotions may come to the surface. Support may be available from a chaplain or other professional support, if you want it. If you’re not sure how to get in touch with a chaplain, speak to your manager.

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Points to remember

  • Don’t be surprised if someone says they feel overwhelmed or sad about dying. Try not to dismiss such feelings, which are deeply important at this time.
  • You can suggest coping techniques such as relaxation, meditation, or writing down thoughts and feelings.
  • You can also help the person contact a spiritual advisor if they wish. You can also put them in touch with an NHS or hospice chaplain.
  • Don’t feel like you always need to have an answer. These are profound questions. Leave room for listening, thoughtfulness and stillness.
  • As a professional, don’t promote your own beliefs or religion to your patient or their loved ones.
  • Be aware of your own thoughts and feelings, as your emotions may come to the surface. Support may be available from a chaplain or other professional support, if you want it. Your manager can tell you more.

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