Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : Improving Care for the End of Life : 6.5 Help Patients Address Issues of Meaningfulness and Spirituality

Because life's emotional and spiritual issues can become even more important to so many people as they approach death - and to the people who love them - organizations need to honor and respect this aspect of a patient's experience. Doing so requires creativity and sensitivity and an awareness that supporting patients' spiritual needs can bolster support for their physical and emotional needs.

Take a Spiritual History

Dr. Christina Puchalski of the George Washington University and the National Institute for Healthcare Research has developed a questionnaire she uses to teach doctors, nurses, social workers, and medical students how to take a spiritual history. The acronym for the assessment is FICA:

Specific questions to ask include:

F =
  • What is your faith or belief?
  • Do you consider yourself spiritual or religious?
  • What do you believe in that give meaning to your life?
I = Importance
  • Is faith important in your life?
  • What influence does it have on how you take care of yourself?
  • What role do your beliefs play in regaining your health
C =
  • Are you part of a spiritual or religious community?
  • Is this of support to you and how?
  • Is there a person or group of people you really love or who are really important to you?
A =
  • How would you like me, your health care provider, to address these issues in your care?(Referrals to chaplains, other spiritual resources, further discussion)

Taking a spiritual history is basically listening to a patient's stories, to their beliefs, their fears, and their hopes. Discussing beliefs is a good way to introduce other issues about end-of-life care. FICA is meant to be used as a guide to introduce the conversation about spirituality. A complete spiritual history takes less than two minutes, so it can be used in any setting. Of course, if deeper issues arise, the conversation may take longer. Asking patients about their spirituality is a way to help them tap into their own sense of hopefulness. This method seems to be acceptable to physicians while promoting a conversation patients find helpful. To date, more than 60 medical schools are teaching the method, and many physicians have begun to use it.

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ ].

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