Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses

Gil Bar-Sela*, Michael J. Schultz, Karima Elshamy, Maryam Rassouli, Eran Ben-Arye, Myrna Doumit, Nahla Gafer, Alaa Albashayreh, Ibtisam Ghrayeb, Ibrahim Turker, Gulcin Ozalp, Sultan Kav, Rasha Fahmi, Sophia Nestoros, Hasanein Ghali, Layth Mula-Hussain, Ilana Shazar, Rana Obeidat, Rehana Punjwani, Mohamad KhleifGulbeyaz Can, Gonca Tuncel, Haris Charalambous, Safa Faraj, Neophyta Keoppi, Mazin Al-Jadiry, Sergey Postovsky, Ma'An Al-Omari, Samaher Razzaq, Hani Ayyash, Khaled Khader, Rejin Kebudi, Suha Omran, Osaid Rasheed, Mohammed Qadire, Ahmet Ozet, Michael Silbermann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)


Objective When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with unrealized potential for improved spiritual care provision: Those who are positively inclined toward spiritual care yet do not themselves provide it.Method We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.Result We had 770 respondents (40% physicians, 60% nurses) from 1Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How developed a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of results Despite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

Original languageEnglish
Pages (from-to)345-352
Number of pages8
JournalPalliative and Supportive Care
Issue number3
Publication statusPublished - Jun 1 2019


  • Cancer
  • Human development index
  • Middle East
  • Palliative care
  • Spiritual care
  • Spirituality

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Psychology
  • Psychiatry and Mental health


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