NCP Domain 5
Spiritual Care & Chaplaincy
Spiritual care is one of the eight domains in national palliative-care guidance. The studies below report patient priorities and associations with end-of-life care; they do not establish that chaplaincy caused the observed differences.
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.
For chaplains and spiritual care teams
Help a person say what matters, keep control of what is shared, and carry it accurately into the conversation with their care team. Support is for people of any faith and none. Nobody has to name a religion to use it, and a person can decline or postpone any spiritual discussion.
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The workflow
1. Invite
Ask whether the person wants to talk about meaning, faith, or what matters. They can decline or postpone.
2. Listen
Hear it in their words. Note what they say, not what a tradition would predict.
3. Confirm
Read it back. Record whether they confirmed the wording, and whose words these are.
4. Choose what to share
The person chooses which sections the team sees. Private and undecided sections stay out.
5. Prepare the handoff
A neutral summary for the next professional, with decisions, uncertainty, and open disagreement kept visible.
6. Identify next steps
Name the requested support and the role responsible for it.
7. Revisit
Say what should bring the group back, such as a date, an event, or the person asking.
What chaplains can contribute
- Meaning, identity, and existential concerns
- Spiritual and religious concerns, when the person raises them
- Relationships and family dynamics
- Communication between the person, family, and team
- Support the person asks for, such as a ritual or a visit from their own community
Chaplains do not all hold the same credentials. Training, certification, and staffing differ by country and by employer, and U.S. board certification is not a worldwide standard. Ask what a given service offers.
Try a fictional example
Synthetic content. No real person, no measured benefit, no clinical recommendation.
- Meaning and identity, no religion namedA chaplain listens for what gives a person steadiness without asking them to name a faith.
- Faith-related concerns, person-chosen counselThe person names a source of counsel they want involved. No treatment preference is assumed from it.
- Family disagreement and language accessThe family disagrees; the person prefers another language. Their chosen role is kept as stated.
Examples by care topic
- Mental health: What getting better would mean, day to day
- Substance use & recovery: Recovery goals in the person's own terms
- Dementia & caregiving: The person's voice, with a caregiver's needs kept apart
- Fasting & medicines: A medicine plan around a fast
- Blood & blood products: Blood choices, written down one by one
- How much to know, and who decides: How much to know, and who should hear it
- Food & medicine ingredients: Food and medicine ingredients that fit
- Privacy, modesty & clinician gender: What would make an examination acceptable
- Transplant decisions: Weighing a transplant, without pressure on family
- Pregnancy, birth & loss: What matters at birth, and who is there
- A child's serious illness: A child's own words, alongside the parents'
- Vaccine & screening questions: Questions about a vaccine, heard first
- Genetic testing & results: What to learn from a genetic test, and who is told
- Meaning, without assuming religion: Support with meaning, no religion wanted
- Grief & bereavement: What matters around a death, and after
- Living with a long-term condition: Making the treatment load fit a life
- Rehabilitation & recovery goals: Rehabilitation goals in the person's own words
- Intensive care & family presence: What the patient has said, and what the family needs
- Pain & pain-medicine decisions: What pain relief should make possible
- Surgery & anesthesia: What an operation should make possible
- Migrant & refugee health: Being understood, in her own language
- Emergency care: A written plan, read in time
- Infectious illness & isolation: Staying close during isolation
- Oral health & dental care: Eating with others, without pain
- Health care in prison or jail: Who to call, from inside
- Homelessness & unstable housing: Care that fits where he is
- Violence, abuse & safety: Her pace, her privacy
- Disasters & humanitarian crises: What must come with him
What Chaplains Actually Do
The 2018 National Consensus Project guidelines describe spiritual, religious, and existential aspects of care as one of eight domains of quality palliative care. The guidance does not show that any single spiritual-care intervention improves outcomes.
- 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
Hospital chaplains support people across faiths and no faith. Community clergy can also be important. Training, certification, and staffing vary, so ask the hospital or hospice how its spiritual-care staff are credentialed and what support is available.
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. Its wording belongs to its publisher, so Values in Care links to it instead of reproducing it.
Official FICA page at GWish, George Washington University
Excerpts, translations and adaptations need the publisher's written permission. Instrument rights register.
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 | A four-part structure named by its acronym. The wording is the publisher's; see the official page. | A history, not a score. Does not diagnose spiritual distress or replace a qualified chaplain. Not reproduced here; permission needed to excerpt or adapt. |
| 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. | A concern signals something to explore; diagnosis requires clinical assessment. 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.
Evidence and Its Limits
These observational and survey studies can describe associations and priorities. They cannot prove that spiritual care caused a particular treatment, cost, or outcome.
In an observational study of advanced cancer patients, people 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 2011, PMC3791610
In a prospective cohort of patients with advanced cancer, 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. The study did not establish that religious coping caused the treatment pattern.
Source: Phelps et al., JAMA 2009, PubMed 19293414
In a national survey, patients and bereaved family members ranked "coming to peace with God" nearly the same as freedom from pain. Other priorities varied within and across respondent groups, so spiritual concerns should be asked about rather than assumed.
Source: Steinhauser et al., JAMA 2000, PubMed 11074777
These studies describe associations and priorities, not proof that spiritual care changed costs or treatment. They support asking each patient whether spiritual concerns matter to them and offering qualified help when requested.
Questions Spiritual Care Can Explore
Examples of discussion topics, not measured outcomes or promises of benefit.
Common Myths →
Sourced answers to common hospice and end-of-life fears
Resource library →
Spiritual history frameworks, FACIT-Sp, CAPC spiritual toolkit, NCP Domain 5
Clinical claims link to published evidence. Review status and unresolved limits are documented in the methodology. Corrections welcome via Get Involved. Last updated: 2026-10-13.
Have corrections or suggestions? Let us know. This content does not replace consultation with your own care team.