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Learning modules

Activity 10: Understanding spiritual needs and sources of distress

Spiritual and religious beliefs

Western societies tend to place some emphasis on biomedical aspects of end-of-life care. Some other cultures place more emphasis on the more holistic and spiritual aspects of care. [1] These beliefs can influence the way people seek assistance, make choices about their management and care and ultimately where they would like to die.

Discussion should be held with the person with a life-limiting condition and their family to understand preferences for spiritual care. People from some cultural backgrounds can interpret the involvement of spiritual care workers as an impending sign that they are near death. [2]

Grief and bereavement

The meaning of grief, what is grieved for and the way people grieve varies among individuals and within cultures. While grieving is a natural process, questioning a person about their grief may signify to them that their grief is irrational. [2]

Grief is expressed differently by people for a variety of reasons. People from some cultures may display their grief openly and even publically by crying and wailing, where people from other cultures may remain calm and appear stoic. [2]

In cultures where eating traditional food and gathering to eat with family, friends and community are important, people may express sadness at the loss of appetite. [3] The practice of artificial nutritional feeding as a life sustaining measure in people with a life-limiting condition occurs at a higher rate in some cultures compared to others. This may be due to the importance that food plays in some communities. [4]   Effective communication about a person’s body preparing itself for the end of life is required.  Discussing changes in the body through the last weeks and days can help families when changes occur. If there are concerns about nutrition and hydration supplements you could explain that preparation for end of life does not require much sustenance.  

Thinking points


  1. Sun, D., Li, S., Liu, Y., Zhang, Y., Mei, R., & Yang, M. (2013). Differences in the origin of philosophy between Chinese medicine and western medicine: Exploration of the holistic advantages of Chinese medicine. Chinese Journal of Integrative Medicine, 19(9), 706-711.
  2. Wiener, L., McConnell, D. G., Latella, L., & Ludi, E. (2013). Cultural and religious considerations in pediatric palliative care. Palliative & Supportive Care, 11(1), 47-67.
  3. Anngela-Cole, L., & Busch, M. (2011). Stress and Grief Among Family Caregivers of Older Adults With Cancer: A Multicultural Comparison From Hawaii. Journal of Social Work in End-Of-Life & Palliative Care, 7(4), 318-337.
  4. Connolly, A., Sampson, E. L., & Purandare, N. (2012). End-of-Life Care for People with Dementia from Ethnic Minority Groups: A Systematic Review. Journal of the American Geriatrics Society, 60(2), 351-360.