| • Identifying and assessing spiritual needs | • Listening to the patient | • Most important during critical points of clinical care | • Spiritual care is an important aspect of patient care |
| • Being a facilitator and encouragerof the patients' spiritual values | • Validating patients' spiritual beliefs | • Patients should take the initiative to start spiritual discussions | • Scientific evidence linking spirituality and positive health outcomes and values |
| • Providing spiritual care appropriate to patients' beliefs | • Remaining with patients during times of need | • In answer to spiritual issues or questions, raised by the patient | |
| • Not imposing own beliefs and values | • Being respectful of patients' beliefs | | |
| • Exhibiting a positive caring demeanourthat is genuine and non-judgemental | | | |
| • Approaching spiritual discussions with gentleness, reverence, sensitivity, and integrity | | | |
| • Being present with the patient | | | |
| • Both structured (such as, a spiritual-assessment tool) and unstructured forms of spiritual assessment | | | |
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Barriers | Physician factors | Patient factors | Contextual factors |
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| • Feeling uncertain initiating spiritual discussions | • Patient being the ‘wrong sort of person’ | • Lack of formal training and appropriate strategies |
| • Fearthat patients will misinterpret spiritual discussions as pushing religion | • Time as a limiting factor | | |
| • Concern about invasion of patients' privacy | • Setting (for example, the examination room) | | |
| • Fear of causing discomfort | • Lack of discussion of the role of spirituality among care providers | | |
| • Struggle with the spiritual language | • Lack of continuity of managed care | | |
| • Thinking that spiritual issues have lower priority than other medical concerns | | | |
| • Belief that spiritual discussions will not influence patients' lives | | | |
| • Lack of physician spiritual awareness | | | |
| • Different belief systems between physician and patient | | | |
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Facilitating factors | Physician factors | Patient factors | Contextual factors |
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| • Communicating a willingness to engage in (and have time for) spiritual discussions | • Patient being ‘the right sort of person’ | • Visiting patients at the bedside or at home |
| • Good communication techniques (such as friendly body language) | • Patients visiting the physician frequently | • Co-workers reinforcing the GP's role as a spiritual care giver |
| • Assuring patients that spiritual confidences will be received in a non-judgemental fashion | • High degree of physician–patient cultural concordance | | |
| • Patient-centred approach | | | |
| • Taking care not to abuse their position | | | |
| • A diplomatic approach when the spiritual beliefs of the physician and patient differ | | | |
| • Physicians being more spiritually inclined | | | |