Secular / Humanist / Existential Values

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Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Physician or nurse: Care, symptoms and what to expect.
• Psychologist or counselor: Existential distress and meaning-centered support, where available.
• Palliative care team: Serious-illness conversations and comfort, where available.
• Humanist or non-religious pastoral counselor: Non-religious support with meaning and loss, where such roles exist.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Global, Belgium, UK, Ireland, Denmark, Denmark, New Zealand, Taiwan, Kenya, India, Israel, Mexico, Canada. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

Guidance, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Abstract only:

Read from the abstract. The full paper may add or qualify this.

Place from authors:

The place is taken from the authors' affiliations, not from where data were collected.

• Global · Guidance · 2016

  WHO's program-manager guide for palliative care services says spiritual distress and existential concerns should get the same intensity and priority as psychosocial and physical distress or pain.

  Limits: Guidance, not outcomes

  What others could learn: Existential concerns can be treated as a named, routine part of palliative assessment and care planning, with a menu of options (spiritual carer, dignity-centered care, meaning-oriented therapy, legacy-building, art, journaling) rather than a faith-specific response.

  Conditions, limits and source

  Conditions that matter:

  Requires trained staff or volunteers and time in the care pathway. The options are offered 'where available', so a setting without a spiritual carer or psychologist needs another route.

  Cannot be inferred:

  Does not show that any listed option works, is available in a given country, or suits a particular patient. Does not address non-religious people specifically. The 2016 text may have been superseded.

  Limits:

  Normative guidance for planners, not an evaluation. The same paragraph says support 'may involve a spiritual carer' and lists options 'where available'. It does not define spiritual carer roles for non-religious people or say how existential concerns should be elicited.

  Source: World Health Organization, Planning and implementing palliative care services: a guide for programme managers (Section 2.3 'Addressing psychosocial and spiritual needs', printed p. 12 (PDF p. 17)). Where: Global. Population: People receiving palliative care, with their families. Published 2016-10-20; retrieved 2026-10-11.

• Belgium, UK, Ireland, Denmark · Reported experience · 2020

  Seventeen humanist chaplains from Belgium, the UK, Ireland and Denmark who attended a 2015 conference described four themes in their work, including caring for all fellow human beings and struggling with a non-supportive environment.

  Limits: Abstract only

  What others could learn: Some humanist chaplains describe their role as caring for all fellow human beings. Whether non-religious patients value or use the service was not studied.

  Conditions, limits and source

  Conditions that matter:

  Depends on a recognized, funded humanist chaplaincy profession, which the authors say exists in the Netherlands after several decades. Respondents also report an unsupportive environment, so institutional recognition is a condition, not a given.

  Cannot be inferred:

  Not patient experience or outcomes. Does not show how many hospitals employ humanist chaplains in any country, or that the role is equally recognized across the four countries sampled.

  Limits:

  Abstract only; full text not retrieved. Self-selected attendees of one conference, so views are those of chaplains, not of patients. The abstract describes the Netherlands only as a brief history (decades long, 'firmly integrated in public institutions') and reports no Dutch respondents.

  Source: Journal of Health Care Chaplaincy (Schuhmann C, Wojtkowiak J, van Lierop P, Pitstra A); abstract via PubMed, Humanist chaplaincy according to Northwestern European humanist chaplains: towards a framework for understanding chaplaincy in secular societies (Abstract). Where: Belgium, UK, Ireland, Denmark (context: Netherlands). Population: Humanist chaplains who attended an international conference on humanist chaplaincy in the Netherlands in 2015. Published 2020-02-04; retrieved 2026-10-11.

• Denmark · Measured outcome · 2023

  In a Danish register-linked survey published in 2023, 81.9% of included respondents reported at least one strong or very strong spiritual need in the past month, and religious needs were lowest of four dimensions.

  Limits: Abstract only

  What others could learn: In this Danish sample, inner peace, generativity and existential needs were higher than religious needs, so a care conversation can ask about peace, legacy and meaning without presuming faith.

  Conditions, limits and source

  Conditions that matter:

  Spiritual matters are 'rarely addressed in healthcare' in such societies per the authors, so asking needs a prompt, a team routine and a referral route that does not default to religious care.

  Cannot be inferred:

  Not representative given 25.6% response. Does not show unmet need, that people want clinicians to ask, or that patients in Denmark differ from the sample. Does not generalize to other secular countries.

  Limits:

  Response rate 25.6%, so non-response bias is possible. Self-reported needs in the general population, not patients. Four dimensions (religious, existential, generativity, inner peace) are the authors' framework. Religious or spiritual affiliation, praying or meditating, and low well-being raised the odds of spiritual needs. The abstract does not report results by non-religious status.

  Source: The Lancet Regional Health - Europe (Stripp TK, Wehberg S, Büssing A, Koenig HG, et al.), Spiritual needs in Denmark: a population-based cross-sectional survey linked to Danish national registers (Abstract, Findings). Where: Denmark. Population: Adults aged 18+ surveyed from a population-based sample of 104,137 (26,678 responded, 25.6%). Published 2023-03-12; retrieved 2026-10-11.

• New Zealand · Measured outcome · 2019

  In a New Zealand community hospice sample (size not in abstract), organized religion was not a major support factor; some nonreligious participants rated high on intrinsic religiosity and were among the most hopeful.

  Limits: Abstract only

  What others could learn: A person who says 'not religious' may still hold meaning-related convictions, so ask what gives hope. The abstract reports joyful memories and meaningful relationships as the main sources of hope, and fear of being a burden as the main distress.

  Conditions, limits and source

  Conditions that matter:

  The abstract suggests systematic spiritual assessment for all patients, not only those with a declared faith, plus a biography service and psychotherapy. These need hospice staff time and trained facilitators.

  Cannot be inferred:

  Not representative of New Zealand or of nonreligious people. Does not show that biography services or psychotherapy reduce death anxiety. Association only.

  Limits:

  Abstract only; full text not retrieved. Sample size and method are not in the abstract. The authors call for larger and more diverse samples.

  Source: American Journal of Hospice and Palliative Medicine (Byrne A, Morgan T); abstract via PubMed, Patterns of Religiosity, Death Anxiety, and Hope in a Population of Community-Dwelling Palliative Care Patients in New Zealand-What Gives Hope If Religion Can't? (Abstract). Where: New Zealand. Population: Community-dwelling hospice patients in the last 6 months of life. Published 2019-12-09; retrieved 2026-10-11.

• Taiwan · Measured outcome · 2026

  In a 2026 nonrandomized study of 24 terminal cancer patients in Taiwan (12 vs 12), dignity-related distress fell significantly over time with dignity therapy but not with comfort care alone; no between-group test was reported in the abstract.

  Limits: Abstract only

  What others could learn: Dignity therapy was rated acceptable by patients and families in one Taiwan sample, and the abstract reports themes of meaning-making and mutual understanding. A team could pilot it before committing staff time.

  Conditions, limits and source

  Conditions that matter:

  Needs a trained dignity therapy facilitator, time for interview and editing of the legacy document, and Mandarin-language materials. Family members also completed a feedback questionnaire.

  Cannot be inferred:

  Not proof of efficacy, and not specific to non-religious people (religious status is not in the abstract). Says nothing about long-term effects or other East Asian countries.

  Limits:

  Abstract only. Very small, nonrandomized sample, so allocation bias is possible. The abstract does not describe how patients were allocated. Dignity-related distress used a Mandarin version of a published dignity inventory, named here and not reproduced. Short follow-up (two weeks). The authors call the evidence preliminary.

  Source: European Journal of Oncology Nursing (Chiu, Lai, Fan, Fang, et al.); abstract via PubMed, Cultural acceptability and potential effectiveness of dignity therapy for patients with terminal cancer in Taiwan: A Quasi-Experimental study (Abstract, Results). Where: Taiwan. Population: Terminal cancer patients (12 intervention, 12 control). Published 2026-01-24; retrieved 2026-10-11.

• Kenya · Measured outcome · 2020

  In a randomized trial of 144 advanced cancer patients at a private Kenyan hospital, one dignity therapy session did not significantly improve overall symptom distress (the trial's quality-of-life measure) at 6 weeks; anxiety showed a trend (p = 0.059).

  Limits: Abstract only

  What others could learn: A single dignity therapy session did not shift broad symptom ratings, so outcomes should match the intervention (for example meaning or dignity). The trial did not test multiple sessions.

  Conditions, limits and source

  Conditions that matter:

  Private hospital setting; legacy documents were given to patients. Facilitator training, delivery cost and time are not in the abstract.

  Cannot be inferred:

  Does not show dignity therapy fails on dignity or meaning outcomes, which were not the primary outcome. Not representative of public hospitals or other African countries. Says nothing about non-religious patients.

  Limits:

  Abstract only (the PMC full text was not read). One session only. The primary outcome was a symptom distress measure, not a dignity or meaning measure. Retrospective trial registration. Eleven lost to follow-up and seven died by 6 weeks.

  Source: BMC Palliative Care (Weru J, Gatehi M, Musibi A, et al.), Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life (Abstract, Conclusion). Where: Kenya. Population: Adults with advanced cancer (72 per arm; mean age about 50; 70% female). Published 2020-07-23; retrieved 2026-10-11.

• India · Reported experience · 2026

  Authors of a 2026 interview study with 20 advanced cancer patients at a Kerala palliative service conclude spiritual wellbeing extends beyond religious practices and is shaped by relationships, illness experience and cultural context.

  Limits: Abstract only

  What others could learn: Participants described spiritual wellbeing as involving relationships and coping resources (acceptance, peer inspiration, prior life experience) as well as faith and prayer, so a spiritual history that asks only about religious practice may miss sources of strength.

  Conditions, limits and source

  Conditions that matter:

  Interviews in the patient's own language; palliative outpatient service with time for open-ended conversation. The authors recommend holistic, culturally sensitive palliative care.

  Cannot be inferred:

  Not representative of India or Kerala. Says nothing about secular or atheist patients specifically. Does not test any intervention.

  Limits:

  Quoted from the abstract; the full text was not read. Single center, purposive sample of 20, interviews translated from Malayalam to English. Spiritual beliefs and practices were one of four themes alongside suffering, social support and coping. The study does not focus on non-religious patients.

  Source: BMJ Open (Biji, Kc, Nair, Shenoy, et al.); abstract via PubMed, Spiritual wellbeing in advanced cancer patients receiving palliative care in a tertiary cancer centre in northern Kerala, India: a qualitative study (Abstract, Conclusions). Where: India (Kerala). Population: Adults with advanced cancer receiving outpatient palliative care (n=20). Published 2026-09-15; retrieved 2026-10-11.

• Israel · Measured outcome · 2018

  In a cross-sectional interview study of 202 Israeli oncology outpatients, lack of inner peace, grief and inability to accept events were key expressions of spiritual distress; faith-related items were not significantly associated with it; loss of meaning was mixed.

  Limits: Abstract only

  What others could learn: In this sample, distress was expressed as lack of inner peace, grief and difficulty accepting illness rather than through faith-related items, so a clinician could ask about peace and acceptance as well as belief.

  Conditions, limits and source

  Conditions that matter:

  The authors added newly developed Israeli items and say interventions should address the culture-specific expressions of distress. Patients requesting spiritual care were more likely to be in distress, which supports offering it on request.

  Cannot be inferred:

  Not specific to secular Israelis (affiliation not in the abstract). Not representative of all Israel or all cancer patients. Does not show which intervention reduces distress.

  Limits:

  Abstract only. Compared a self-diagnosis of spiritual distress against a published spiritual well-being scale and other items, some newly developed by the authors; those instruments are named, not reproduced. Single country sample of outpatients; the abstract does not report secular or religious affiliation.

  Source: Supportive Care in Cancer (Schultz M, Meged-Book T, Mashiach T, Bar-Sela G); abstract via PubMed, The cultural expression of spiritual distress in Israel (Abstract, Results). Where: Israel. Population: Oncology outpatients (n=202). Published 2018-03-30; retrieved 2026-10-11.

• Mexico · Measured outcome · 2022

  In a preliminary pretest-posttest study of 29 Mexican patients with stage IV lung cancer and emotional distress, 24 completed three dignity therapy sessions and improved on anxiety, depression, hopelessness and dignity-related distress; quality of life did not change.

  Limits: Abstract only · Place from authors

  What others could learn: A team adapting dignity therapy to a new language and culture could pilot it with patients whose distress is already identified and ask afterward what changed. In this study, patients reported that it increased their meaning and purpose, sense of dignity and will to live.

  Conditions, limits and source

  Conditions that matter:

  Patients were in active treatment and already distressed, and received three sessions. The abstract does not describe how the therapy was adapted, who delivered it or where. The authors suggest the therapy can be used in the context of Latin American patients.

  Cannot be inferred:

  Without a control group, improvement cannot be attributed to dignity therapy. The abstract does not report participants' religion or secular identity, so it cannot show how the therapy works for people without religion. Not representative of Mexico or Latin America.

  Limits:

  Abstract only: no full text was retrieved and no open-access licence was found. Single group without a control, small, described by the authors as preliminary. Five of 29 did not complete. The author list includes the developer of dignity therapy. Standard scales named in the abstract are not reproduced here.

  Source: Palliative & Supportive Care (Gonzalez-Ling A, Galindo Vazquez O, Rascon-Gasca ML, et al.); abstract via PubMed, Dignity therapy in Mexican lung cancer patients with emotional distress: Impact on psychological symptoms and quality of life (Abstract, Results). Where: Mexico. Population: Mexican adults with stage IV lung cancer undergoing active medical treatment with baseline emotional distress (29 started, 24 completed). Published 2022-02; retrieved 2026-10-11.

• Canada · Measured outcome · 2018

  In a randomized trial of 305 adults with advanced cancer at one Toronto cancer center, CALM psychotherapy plus usual care produced modestly less severe depressive symptoms than usual care alone at 3 and 6 months.

  What others could learn: A service looking for a brief, structured way to talk about meaning, relationships and mortality with patients could consider CALM-style sessions, delivered flexibly and with caregivers invited when the patient agrees. Effects here were small, so it is an option to test locally, not a standard.

  Conditions, limits and source

  Conditions that matter:

  Most participants were expected to receive three to six sessions of 45 to 60 minutes over 3 to 6 months from trained therapists (social workers and psychiatrists who completed a 2-day workshop and supervised cases). The paper describes four domains: symptom management and communication with health care providers; changes in self and relations with close others; spiritual well-being and the sense of meaning and purpose; and mortality and future-oriented concerns.

  Cannot be inferred:

  Does not show effects in other languages, cultures or health systems, or for people with a shorter prognosis. Does not show how the therapy performs for people with or without religion. Not a comparison with other psychotherapies.

  Limits:

  Single site with mostly English-speaking, white, well-educated participants, per the authors. Unblinded, and the trial authors include the intervention's codevelopers. Effect sizes were small and confidence intervals reach close to zero. Compliance with at least three sessions was 54.3% at 3 months and 77.5% at 6 months in the CALM group. The paper does not report participants' religious affiliation. A German randomized trial of CALM (PMID 32803815; abstract read, not used here) found no difference from supportive counseling. Outcome scales are named in the paper; items are not reproduced here.

  Source: Journal of Clinical Oncology (Rodin G, Lo C, Rydall A, et al.); PMC open access, Managing Cancer and Living Meaningfully (CALM): A Randomized Controlled Trial of a Psychological Intervention for Patients With Advanced Cancer (Abstract, Results (UC is usual care)). Where: Canada (Toronto, Ontario). Population: Adults with advanced cancer and an expected prognosis of at least one year (n=305; 151 CALM, 154 usual care), English-fluent, recruited from outpatient oncology clinics. Published 2018-08-10; retrieved 2026-10-11.

• The sourced examples include guidance, reported experience, measured outcome. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.