NCP Domain 5
Spiritual Care & Chaplaincy
Growing evidence shows that attending to spiritual needs improves quality of care, reduces unwanted interventions, and helps patients and families feel more supported. Here's what to know.
Not medical, legal, or spiritual advice. This page summarizes published evidence on spiritual care in serious illness. It does not replace consultation with your care team, chaplain, or faith community. Every patient's spiritual needs are unique. Generalized religious frameworks never supersede a patient's voiced wishes, documented advance directives, or legal health care proxy.
What Chaplains Actually Do
The National Consensus Project Clinical Practice Guidelines (4th ed., 2018) identify spiritual, religious, and existential care as one of eight core domains of quality palliative care. Board-certified chaplains are included on recommended interdisciplinary palliative teams.
Source: NCP Clinical Practice Guidelines, 4th ed., 2018
The NACC Palliative Care and Hospice Advanced Certification (PCHAC) requires 3+ years of experience, intensive coursework, and demonstrated competencies across all 8 NCP domains.
Source: NACC PCHAC certification standards
- Spiritual assessment using structured tools (FICA, HOPE, SPIRIT)
- Crisis support for patients, families, and clinical staff
- Ethical mediation in complex care decisions
- Grief counseling and bereavement support
- Ritual facilitation across faith traditions
- Goals-of-care communication support
- Documentation in the electronic health record (EHR)
How chaplains differ from community clergy
Board-certified chaplains are clinically trained professionals with graduate theological education, clinical pastoral education (CPE) units, and board certification. They serve patients of all faiths and none. Community clergy provide vital support too. Chaplains complement that role with specialized clinical training.
FICA Spiritual History Tool
A widely used tool for clinicians and chaplains to sensitively explore a patient's spiritual needs, designed for use with patients of all faiths and none.
Faith and Belief
"Do you consider yourself spiritual or religious?" / "What gives your life meaning?"
Importance
"What importance does faith or belief have in your life?"
Community
"Are you part of a spiritual or religious community?"
Address in Care
"How would you like me to address these issues in your health care?"
Source: George Washington Institute for Spirituality and Health (GWish)
NCP Domain 5 · Spiritual, religious, and existential aspects of care
Assessment tools used in serious illness
Domain 5 asks teams to screen, assess, and attend — not to assign a tradition. These instruments help a team hear what the person wants named. They do not tell the team what the person believes.
| Tool | Kind | Who uses it | What it asks | Unknown / limit |
|---|---|---|---|---|
| FICA GWish / Puchalski | Spiritual history | Any clinician, with chaplain follow-up when distress is named | Faith or meaning, Importance, Community, how to Address it in care. | A history, not a score. Does not diagnose spiritual distress or replace a board-certified chaplain. |
| HOPE Anandarajah & Hight, Am Fam Physician | Spiritual history | Primary and palliative clinicians | sources of Hope, Organized religion, Personal spirituality and practices, Effects on care and end-of-life decisions. | Screening language only. Individual answers vary inside every tradition and among people of no tradition. |
| FACIT-Sp FACIT.org | Research / outcome scale | Teams measuring meaning, peace, and faith over time | A brief scale of spiritual well-being used in oncology and palliative research. | Not a bedside conversation guide. Scores are research measures, not a pastoral plan. |
| PC-7 Fitchett / transforming chaplaincy literature | Spiritual-concerns assessment (development model) | Board-certified chaplains, chaplain-administered | Quantifies spiritual concerns in palliative patients — not a log of what the chaplain did. | Development study; further validity and reliability work called for. Not administered here. |
| PC-6 PC-6 validation study (2025) | Six-theme spiritual assessment (2025 validation) | Board-certified chaplains, chaplain-administered | Six-theme spiritual assessment for adults near end of life, inpatient, outpatient, or home settings. | Related newer model, not an interchangeable score for PC-7. Coefficients and responsiveness not extracted here. Exact revision/crosswalk relationship to PC-7 is unresolved. Not administered. |
| Spiritual Concerns Checklist BMJ Support Palliat Care 2020 (Rasch validation, Sydney/Melbourne) | Need inventory (preliminary validation) | Interdisciplinary teams looking for unmet spiritual concerns | A 17-item checklist of concerns a person may want addressed — meaning, peace, ritual, family, God or no-God. | Presence of a concern is not a diagnosis. Preliminary, setting-specific psychometrics; not interchangeable with a generic spiritual-needs list. Ask which item, if any, the person wants help with today. |
Primary links live in verified resources. Tradition-level decision rows remain on the faith & medical decisions matrix.
Clinical Evidence: Why Spiritual Care Matters
In a study of advanced cancer patients, those whose spiritual needs were inadequately supported by the medical team had higher end-of-life medical costs ($4,947 vs. $2,833 in the last week, P=0.03), were less likely to receive hospice, and were more likely to die in the ICU.
Source: Balboni et al., Cancer / JAMA Internal Medicine, PMC3791610
Higher positive religious coping was associated with greater odds of receiving intensive life-prolonging care (mechanical ventilation or resuscitation) in the last week of life, underscoring the need for skilled spiritual care that engages religiosity rather than ignoring it.
Source: Phelps et al., JAMA 2009, PubMed 19293415
"Coming to peace with God" and presence of family ranked among the most important end-of-life factors for patients, families, and clinicians, nearly as important as freedom from pain.
Source: Steinhauser et al., JAMA 2000, PubMed 11059745
Key implication: Unaddressed spiritual distress is linked to more aggressive care, higher costs, and greater suffering. When spiritual needs are attended to, patients are more likely to receive care aligned with their values.
What People Tell Us Helps
Based on user feedback and palliative care literature, not clinical outcomes data. Your experience may be different.
Common Myths →
Evidence-based corrections to hospice and end-of-life fears
Verified resources →
FICA, FACIT-Sp, CAPC spiritual toolkit, NCP Domain 5
Large language models help source and structure this content; every claim is then verified against primary sources before publication. Clinical claims cite peer-reviewed literature; no claims are published without human review. Corrections welcome via Get Involved. Last updated: 2026-08-31.
Have corrections or suggestions? Let us know. This content does not replace consultation with your own care team.