The Case of the End-of-Life Evaluation

October 19, 2021 by Deborah Christensen MSN, APRN, AOCNS®

Ron, your 73-year-old patient, decides to transition to hospice care after receiving lung cancer treatment for three years. His partner finds Ron’s decision to move to hospice difficult to accept and encourages him to look for a clinical trial or try alternative treatments. You suggest that the couple speaks with a hospital chaplain, and Ron agrees. His surprised partner says, “Why do you want to talk with a chaplain? We’ve never been religious!”

What Would You Do?

Hospital chaplains provide patients with cancer and their families with support and spiritual care, regardless of their religious affiliation or secular practice. The National Coalition for Hospice and Palliative Care defines ( spiritual care as “a dynamic and intrinsic aspect of humanity through which individuals seek meaning, purpose, and transcendence and experience relationship to self, family, others, community, society, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.” The Joint Commission also includes spiritual care as one of its provisions for accreditation.

Nurses are more likely to address patients’ spiritual care and refer them to chaplaincy than their physician counterparts, and several tools ( are available to assist nurses with a spiritual assessment (see sidebar). Asking about a patient’s spiritual beliefs and how those principles influence their medical decisions is central to many of the tools. To engage in quality spiritual communication, nurses should have a personal presence and awareness of how personal beliefs can influence spiritual conversations.

Prior to suggesting chaplaincy, you ask Ron what beliefs give his life meaning. Ron says he doesn’t adhere to a religion and feels that living a good life is most important. He wonders, however, “What makes a life good?” You recognize Ron’s answer as a sign of spiritual distress and suggest chaplaincy. You also explain to Ron and his partner that the chaplain would be visiting as a spiritual consultant, not a religious advisor.

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