Communicating with Persons Who Express Spiritual Struggle at the End of Life.

This paper provides practical suggestions for how palliative care clinicians can address the expressions of spiritual struggle voiced by patients and their loved ones. In addition to practical tips for listening and responding, ethical guidance and opportunities for self-reflection related to spiritual care are briefly discussed. Principles to guide practice when the clinician is listening and responding to a patient expressing spiritual struggle include being non-directive, honoring (vs. judging) the patient's spiritual or religious experience, keeping the conversation patient-centered, focusing on the core theme of what the patient is expressing presently, using the patient's terminology and framing, and responding "heart to heart" or "head to head" to align with the patient. Ultimately, the goal of a healing response from a spiritual care generalist is to allow the patient to "hear" or "see" themselves, to gain self-awareness. To converse with patients about spirituality in an ethical manner, the clinician must first assess the patient's spiritual needs and preferences and then honor these.