Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-17T16:16:42.445Z Has data issue: false hasContentIssue false

Chapter 2 - Spiritual Assessment

Published online by Cambridge University Press:  07 October 2022

Christopher C. H. Cook
Affiliation:
Institute for Medical Humanities, Durham University
Andrew Powell
Affiliation:
Formerly Warneford Hospital and University of Oxford
Get access

Summary

This chapter discusses why a spiritual assessment is necessary when planning a patient’s mental health care and treatment. It considers the following reasons why psychiatric patients’ spiritual needs should be addressed: (1) the role of spirituality in helping people to stay well, which aligns with the current strengths-based approach to care; (2) patient/carer demand; and (3) increasing research evidence of a positive link between spirituality and mental health. The various approaches to spiritual assessment are described, including the initial brief screening, the spiritual history and the more in-depth assessment that may need to be undertaken by a chaplain or therapist. Tools relevant to each approach are presented before considering what happens after the assessment. Finally, some of the challenges associated with spiritual assessment are discussed, such as documenting/sharing information about spiritual issues, conflict between clinician and patient worldviews, and clinician discomfort/lack of preparedness. Links to educational resources are provided.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allott, K., Steele, P., Boyer, F. et al. (2020) Cognitive strengths-based assessment and intervention in first-episode psychosis: a complementary approach to addressing functional recovery? Clinical Psychology Review, 79, 101871.Google Scholar
American Psychiatric Association (1990) Guidelines regarding possible conflict between psychiatrists’ religious commitments and psychiatric practice. American Journal of Psychiatry, 147, 542.Google Scholar
Anandarajah, G. and Hight, E. (2001) Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. American Family Physician, 63, 8189.Google Scholar
Balboni, T. A., Fitchett, G., Handzo, G. F. et al. (2017) State of the Science of Spirituality and Palliative Care Research Part II: screening, assessment, and interventions. Journal of Pain and Symptom Management, 54, 441453.CrossRefGoogle ScholarPubMed
Barber, J. M., Parkes, M., Parsons, H. and Cook, C. C. H. (2012) Importance of spiritual well-being in assessment of recovery: the Service-user Recovery Evaluation (SeRvE) scale. The Psychiatrist, 36, 444450.Google Scholar
Bélanger, B., Beauregard, L., Bélanger, M. and Bergeron, C. (2020) The Quebec model of recording spiritual care: concepts and guidelines. In Peng-Keller, S. and Neubold, D., eds., Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care. Cham: Springer, pp. 5375.Google Scholar
Best, M., Leget, C., Goodhead, A. and Paal, P. (2020) An EAPC white paper on multi-disciplinary education for spiritual care in palliative care. BMC Palliative Care, 19, 9.CrossRefGoogle ScholarPubMed
Brady, M. J., Peterman, A. H., Fitchett, G., Mo, M. and Cella, D. (1999) A case for including spirituality in quality of life measurement in oncology. Psycho‐Oncology, 8, 417428.Google Scholar
Büssing, A., ed. (2019) Measures of Spirituality/Religiosity. Basel: MDPI.Google Scholar
Cook, C. C. H. (2004) Addiction and spirituality. Addiction, 99, 539551.CrossRefGoogle ScholarPubMed
Cook, C. C. H. (2013) Recommendations for Psychiatrists on Spirituality and Religion. Position Statement PS03/2013. London: Royal College of Psychiatrists.Google Scholar
Cook, C. C. H. (2015) Religion and spirituality in clinical practice. BJPsych Advances, 21, 4250.Google Scholar
Cook, C. C. H. (2020) Religion and psychiatry: research, prayer and clinical practice. BJPsych Advances, 26, 282284.Google Scholar
Cook, C. and Grimwade, L. (2021) Spirituality and Mental Health. London: Royal College of Psychiatrists.Google Scholar
Cotton, S., McGrady, M. E. and Rosenthal, S. L. (2010) Measurement of religiosity/spirituality in adolescent health outcomes research: trends and recommendations. Journal of Religion and Health, 49, 414444.Google Scholar
Culliford, L. (2007) Taking a spiritual history. Advances in Psychiatric Treatment, 13, 212219.Google Scholar
Daaleman, T. P., Frey, B. B., Wallace, D. and Studenski, S. A. (2002) Spirituality Index of Well-Being Scale: development and testing of a new measure. Journal of Family Practice, 51, 952.Google ScholarPubMed
de Oliveira e Oliveira, F. H. A., Peteet, J. R. and Moreira-Almeida, A. (2020) Religiosity and spirituality in psychiatry residency programs: why, what, and how to teach? Brazilian Journal of Psychiatry, 43, 424429.Google Scholar
Eagger, S. and Ferdenando, S. (2018) Exploring Spirituality with People Who Use Mental Health Services. Royal College of Psychiatrists Online CPD module. https://elearning.rcpsych.ac.uk/learningmodules/exploringspiritualitywithpe.aspx (accessed 15 December 2020).Google Scholar
Eagger, S. and McSherry, W. (2011) Assessing a person’s spiritual needs in a healthcare setting. In Gilbert, P., ed., Spirituality and Mental Health. Brighton: Pavilion Publishing, pp. 193215.Google Scholar
European Commission (2010) EUROPE 2020: A Strategy for Smart, Sustainable and Inclusive Growth. Brussels: European Commission.Google Scholar
Fetzer Institute (1999) Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research. Kalamazoo, MI: Fetzer Institute and National Institute on Aging Working Group.Google Scholar
Fitchett, G. (2012) Next steps for spiritual assessment in healthcare. In Cobb, M., Puchalski, C. and Rumbold, B., eds., Oxford Textbook of Spirituality in Healthcare. Oxford: Oxford University Press, pp. 299305.Google Scholar
Fitchett, G. and Risk, J. (2009) Screening for spiritual struggle. Journal of Pastoral Care & Counseling, 63, 112.Google Scholar
Fowler, J. (1981) Stages of Faith. San Francisco, CA: Harper and Row.Google Scholar
Frick, E. (2020) Charting spiritual care: psychiatric and psychotherapeutic aspects. In Peng-Keller, S. and Neuhold, D., eds., Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care. Cham: Springer, pp. 171180.CrossRefGoogle Scholar
General Medical Council (2013a) Good Medical Practice. London: General Medical Council.Google Scholar
General Medical Council (2013b) Personal Beliefs and Medical Practice; www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/personal-beliefs-and-medical-practice/personal-beliefs-and-medical-practice (accessed 15 December 2020).Google Scholar
Gibbon, A. and Baldie, D. (2019) Community Chaplaincy Listening in a community mental health group. Health and Social Care Chaplaincy, 7, 5774.Google Scholar
Griffith, J. L. (2012) Psychiatry and mental health treatment. In Cobb, M., Puchalski, C and Rumbold, B., eds., Oxford Textbook of Spirituality in Healthcare. Oxford: Oxford University Press, pp. 227233.Google Scholar
Grimwade, L. and Cook, C. (2019) The clinician’s view of spirituality in mental health care. In Fletcher, J., ed., Chaplaincy and Spiritual Care in Mental Health Settings. London: Jessica Kingsley Publishers, pp 3143.Google Scholar
Harrington, A. (2016) The importance of spiritual assessment when caring for older adults. Ageing & Society, 36, 116.Google Scholar
Higginson, I., Evans, C., Grande, G. et al. (2013) Evaluating complex interventions in end of life care: the MORECare statement on good practice generated by a synthesis of transparent expert consultations and systematic reviews. BMC Medicine, 11, 111.Google Scholar
Hodge, D. R. (2005) Spiritual lifemaps: a client-centered pictorial instrument for spiritual assessment, planning, and intervention. Social Work, 50, 7787.Google Scholar
Huguelet, P., Mohr, S., Betrisey, C. et al. (2011) A randomized trial of spiritual assessment of outpatients with schizophrenia: patients’ and clinicians’ experience. Psychiatric Services, 62, 7986.Google Scholar
Hui, D., de la Cruz, M., Thorney, S. et al. (2011) The frequency and correlates of spiritual distress among patients with advanced cancer admitted to an acute palliative care unit. American Journal of Hospice and Palliative Medicine®, 28, 264270.Google Scholar
International Council of Nurses (2012) The ICN Code of Ethics for Nurses. Geneva: International Council of Nurses.Google Scholar
Jobin, G. (2020) Charting spiritual care: ethical perspectives. In Peng-Keller, S. and Neubold, D., eds., Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care. Cham: Springer, pp. 199212.Google Scholar
Johnstone, E. C., Owens, D. C. and Lawrie, S. M. (2010) Companion to Psychiatric Studies. Edinburgh: Churchill Livingstone.Google Scholar
Kao, L. E., Peteet, J. R. and Cook, C. C. H. (2020) Spirituality and mental health. Journal for the Study of Spirituality, 10, 4254.Google Scholar
Kevern, P. and Hill, L. (2015) ‘Chaplains for well-being’ in primary care: analysis of the results of a retrospective study. Primary Health Care Research & Development, 16, 8799.CrossRefGoogle ScholarPubMed
Koenig, H. G. (2011) Spirituality and Health Research: Methods, Measurement, Statistics, and Resources. West Conshohocken, PA: Templeton Press.Google Scholar
Koenig, H. G. (2012) Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry. DOI: https://doi.org/10.5402/2012/278730Google Scholar
Koenig, H. G. (2013) Spirituality in Patient Care: Why, How, When, and What. West Conshohocken, PA: Templeton Foundation Press.Google Scholar
Koenig, H. G. (2015) Religion, spirituality, and health: a review and update. Advances in Mind-Body Medicine, 29, 1926.Google Scholar
Koenig, H. (2018) Religion and Mental Health: Research and Clinical Applications. San Diego, CA: Academic Press.Google Scholar
Koenig, H. G. and Al Zaben, F. (2017) Integrating religious faith into patient care: Commentary On… The Role of Faith in Mental Health Care. BJPsych Advances, 23, 426427.Google Scholar
Koenig, H. G., King, D. E. and Carson, V. B., eds. (2012) Handbook of Religion and Health. New York: Oxford University Press.Google Scholar
Koenig, H. G., Peteet, J. R. and VanderWeele, T. J. (2020a) Religion and psychiatry: clinical applications. BJPsych Advances, 26, 273281.CrossRefGoogle Scholar
Koenig, H. G., Al-Zaben, F. and VanderWeele, T. J. (2020b) Religion and psychiatry: recent developments in research. BJPsych Advances, 26, 262272.Google Scholar
LaRocca-Pitts, M. A. (2009) FACT: taking a spiritual history in a clinical setting. Journal of Health Care Chaplaincy, 15, 112.Google Scholar
Lewis-Fernandez, R., Krishan Aggarwal, N., Hinton, L. et al. (2016) DSM-5 Handbook on the Cultural Formulation Interview. Washington, DC: American Psychiatric Publishing.Google Scholar
Loynes, B. and O’Hara, J. (2015) How can mental health clinicians, working in intellectual disability services, meet the spiritual needs of their service users? Advances in Mental Health and Intellectual Disabilities. 9, 918.CrossRefGoogle Scholar
Lucas, A. M. (2001) Introduction to the discipline for pastoral care giving. Journal of Health Care Chaplaincy, 10, 133.Google Scholar
Lucchetti, G., Lucchetti, A. L. G. and Vallada, H. (2013) Measuring spirituality and religiosity in clinical research: a systematic review of instruments available in the Portuguese language. São Paulo Medical Journal, 131, 112122.Google Scholar
Macdonald, G. (2017) The efficacy of primary care chaplaincy compared with antidepressants: a retrospective study comparing chaplaincy with antidepressants. Primary Health Care Research & Development, 18, 354365.Google Scholar
McSherry, W., Ross, L., Balthip, K., Ross, N. and Young, S. (2019) Spiritual assessment in healthcare: an overview of comprehensive, sensitive approaches to spiritual assessment for use within the interdisciplinary healthcare team. In Timmins, F. and Caldeira, S., eds., Spirituality in Healthcare: Perspectives for Innovative Practice. Cham: Springer, pp. 3954.Google Scholar
McSherry, W., Ross, L., Attard, J. et al. (2020) Preparing undergraduate nurses and midwives for spiritual care: some developments in European education over the last decade. Journal for the Study of Spirituality, 10, 5571.Google Scholar
Mako, C., Galek, K. and Poppito, S. R. (2006) Spiritual pain among patients with advanced cancer in palliative care. Journal of Palliative Medicine, 9, 11061113.Google Scholar
Maugans, T. A. (1996) The spiritual history. Archives of Family Medicine, 5, 1116.CrossRefGoogle ScholarPubMed
Mohr, S. and Huguelet, P. (2014) The wishes of outpatients with severe mental disorders to discuss spiritual and religious issues in their psychiatric care. International Journal of Psychiatry in Clinical Practice, 18, 304307.CrossRefGoogle ScholarPubMed
Monod, S., Brennan, M., Rochat, E. et al. (2011) Instruments measuring spirituality in clinical research: a systematic review. Journal of General Internal Medicine, 26, 13451357.Google Scholar
Monod, S., Lécureux, M. E., Spencer, B. and Büla, C. (2012) Validation of the Spiritual Distress Assessment Tool in older hospitalized patients. BMC Geriatrics, 12, 13.Google Scholar
Moreira-Almeida, A., Koenig, H. G. and Lucchetti, G. (2014) Clinical implications of spirituality to mental health: review of evidence and practical guidelines. Brazilian Journal of Psychiatry, 36, 176182.Google Scholar
Moreira-Almeida, A., Sharma, A., Janse van Rensburg, B., Verhagen, P. and Cook, C. C. H. (2016) WPA Position Statement on Spirituality and Religion in Psychiatry. World Psychiatry, 15, 7778.Google Scholar
Murgia, C., Notarnicola, I., Rocco, G. and Stievano, A. (2020) Spirituality in nursing: a concept analysis. Nursing Ethics, 27, 11711173.CrossRefGoogle Scholar
National Institute for Health and Care Excellence (NICE) (2020) Depression in Children and Young People: Identification and Management. NG134. www.nice.org.uk/guidance/ng134/resources/depression-in-children-and-young-people-identification-and-management-pdf-66141719350981 (accessed 24 November 2020).Google Scholar
Nolan, S., Saltmarsh, P. and Leget, C. (2011) Spiritual care in palliative care: working towards an EAPC task force. European Journal of Palliative Care. 18, 8689.Google Scholar
Nursing and Midwifery Council (2018) Future Nurse: Standards of Proficiency for Registered Nurses. London: Nursing and Midwifery Council.Google Scholar
Nye, R. (2011) Children and young people’s well-being. In Gilbert, P., ed., Spirituality and Mental Health. Hove: Pavilion, pp. 217230.Google Scholar
Owen, G., Wessely, S. and Murray, R., eds. (2014) The Maudsley Handbook of Practical Psychiatry. Oxford: Oxford University Press.Google Scholar
Pargament, K. I. and Lomax, J. W. (2013) Understanding and addressing religion among people with mental illness. World Psychiatry, 12, 2632.CrossRefGoogle ScholarPubMed
Payman, V. (2016) The importance of taking a religious and spiritual history. Australasian Psychiatry, 24, 434436.CrossRefGoogle ScholarPubMed
Peery, B. (2020) Chaplaincy documentation in a large US health system. In Peng-Keller, S. and Neubold, D., eds., Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care. Cham: Springer, pp. 2152CrossRefGoogle Scholar
Peng-Keller, S. and Neubold, D., eds. (2020) Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care. Cham: Springer.Google Scholar
Piedmont, R. L. (2012) Overview and development of a trait-based measure of numinous constructs: the Assessment of Spirituality and Religious Sentiments (ASPIRES) Scale. In Miller, L. J., ed., The Oxford Handbook of Psychology and Spirituality. Oxford: Oxford University Press, pp. 104122.Google Scholar
Pruyser, P. W. (1976) The Minister as Diagnostician. Philadelphia, PA: The Westminster Press.Google Scholar
Puchalski, C. and Romer, A. L. (2000) Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3, 129137.CrossRefGoogle ScholarPubMed
Puchalski, C. M., Vitillo, R., Hull, S. K. and Reller, N. (2014) Improving the spiritual dimension of whole person care: reaching national and international consensus. Journal of Palliative Medicine, 17, 642656.Google Scholar
Pujol, N., Leboul, D., Prodhomme, C. and Guirimand, F. (2018) Is spiritual care the hospital’s business? A qualitative study on patients’ preferences about the integration of spirituality in palliative care units (PCU). Journal of Pain and Symptom Management, 56, E47E48.Google Scholar
Raffay, J. (2014) How staff and patient experience shapes our perception of spiritual care in a psychiatric setting. Journal of Nursing Management, 22, 940950.Google Scholar
Rosmarin, D. H., Pirutinsky, S. and Pargament, K. I. (2011) A brief measure of core religious beliefs for use in psychiatric settings. International Journal of Psychiatry in Medicine, 41, 253261.Google Scholar
Ross, L. A. (1997) Nurses’ Perceptions of Spiritual Care. Aldershot: Avebury.Google Scholar
Ross, L. and McSherry, W. (2018) The power of two simple questions. Nursing Standard. 33, 7880.Google Scholar
Ross, L. and McSherry, W. (2020) Spiritual care charting/documenting/recording/assessment: a perspective from the United Kingdom. In Peng-Keller, S. and Neubold, D., eds., Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care. Cham: Springer, pp. 97116.Google Scholar
Ross, L. and McSherry, W. (2021) Relevance of addressing spiritual needs for clinical support: nursing perspective. In Bussing, A., ed., Spiritual Needs in Research and Practice: The Spiritual Needs Questionnaire as a Global Resource for Health and Social Care. Cham: Springer Nature, pp. 419436.Google Scholar
Ross, L. and Miles, J. (2020) Spirituality in heart failure: a review of the literature from 2014 to 2019 to identify spiritual care needs and spiritual interventions. Current Opinion in Supportive and Palliative Care, 14, 918.Google Scholar
Royal College of Psychiatrists (2020) Core Psychiatry Curriculum 2021. London: Royal College of Psychiatrists.Google Scholar
Sadock, B., Sadock, V. and Ruiz, P., eds. (2017) Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, 10th edition. Philadelphia, PA: Wolters Kluwer.Google Scholar
Saunders, C. (1996) A personal therapeutic journey. British Medical Journal, 313, 15991601.Google Scholar
Selman, L., Siegert, R., Harding, R. et al. (2011) A psychometric evaluation of measures of spirituality validated in culturally diverse palliative care populations. Journal of Pain and Symptom Management, 42, 604622.Google Scholar
Selman, L.E., Brighton, L. J., Sinclair, S. et al. (2017) Patients’ and caregivers’ needs, experiences, preferences and research priorities in spiritual care: a focus group study across nine countries. Palliative Medicine, 32, 216230.Google Scholar
Sexson, S. B. (2004) Religious and spiritual assessment of the child and adolescent. Child and Adolescent Psychiatric Clinics of North America, 13, 3547.Google Scholar
Shields, M., Kestenbaum, A. and Dunn, L. B. (2015) Spiritual AIM and the work of the chaplain: a model for assessing spiritual needs and outcomes in relationship. Palliative & Supportive Care, 13, 7589.Google Scholar
Slade, N. and Culliford, L. (2004) Heavenbound. In Barker, P. J. and Buchanan-Barker, P., eds., Spirituality and Mental Health: Breakthrough. London: Whurr Publishers, pp. 167190.Google Scholar
Snowden, A. and Telfer, I. (2020) The story of the Scottish PROM. In Kelly, E. and Swinton, J., eds., Chaplaincy and the Soul of Health and Social Care: Fostering Wellbeing in Emerging Paradigms of Care. London: Jessica Kingsley Publishers, pp. 6789.Google Scholar
Snowden, A., Gibbon, A. and Grant, R. (2018) What is the impact of chaplaincy in primary care? The GP perspective. Health and Social Care Chaplaincy, 6, 200214.Google Scholar
Snowden, A., Enang, I., Kernohan, W. G. et al. (2020) Why are some healthcare chaplains registered professionals and some are not? A survey of healthcare chaplains in Scotland. Health and Social Care Chaplaincy. 8, 4569.Google Scholar
Stanley, M. A., Bush, A. L., Camp, M. E. et al. (2011) Older adults’ preferences for religion/spirituality in treatment for anxiety and depression. Aging & Mental Health, 15, 334343.Google Scholar
Starnino, V. R., Gomi, S. and Canda, E. R. (2014) Spiritual strengths assessment in mental health practice. British Journal of Social Work, 44, 849867.Google Scholar
Steinhauser, K. E., Fitchett, G., Handzo, G. F. et al. (2017) State of the Science of Spirituality and Palliative Care Research Part I: definitions, measurement, and outcomes. Journal of Pain and Symptom Management, 54, 428440.Google Scholar
Swinton, J. (2010) The meanings of spirituality: a multi-perspective approach to the spiritual. In McSherry, W. and Ross, L., eds., Spiritual Assessment in Healthcare Practice. Keswick: M&K Publishing, pp. 1735.Google Scholar
Swinton, J. (2020) BASS ten years on: a personal reflection. Journal for the Study of Spirituality, 10, 614.Google Scholar
Tanyi, R. A. (2002) Towards clarification of the meaning of spirituality. Journal of Advanced Nursing, 39, 500509.Google Scholar
UK Board of Healthcare Chaplaincy (2015) Spiritual and Religious Care Capabilities and Competences for Chaplaincy Support 2015. Cambridge: UK Board of Healthcare Chaplaincy.Google Scholar
UK Board of Healthcare Chaplaincy (2020) Spiritual Care Competences for Healthcare Chaplains (2020). Cambridge: UK Board of Healthcare Chaplaincy and NHS Education Scotland. Available at www.ukbhc.org.uk/wp-content/uploads/2020/10/UKBHC-CCs-180220.pdf (accessed 20 December 2020)Google Scholar
Vandenhoeck, A. (2020) The spiritual care giver as a bearer of stories: a Belgian exploration of the best possible spiritual care. In Peng-Keller, S. and Neubold, D., eds., Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care. Cham: Springer, pp. 129142.Google Scholar
van Leeuwen, R., Attard, J., Ross, L. et al. (2021) The development of a consensus‐based spiritual care education standard for undergraduate nursing and midwifery students: an educational mixed methods study. Journal of Advanced Nursing, 77, 973986.Google Scholar
Weathers, E., McCarthy, G. and Coffey, A. (2015) Concept analysis of spirituality: an evolutionary approach. Nursing Forum. 51, 7996.Google Scholar
Welsh Government (2015) Health and Care Standards. Cardiff: Welsh Government. Available at https://gov.wales/health-and-care-standards. (accessed 20 December 2020).Google Scholar
World Health Organization (2002) WHOQOL Spirituality, Religiousness and Personal Beliefs (SRPB) Field-Test Instrument. Geneva: World Health Organization.Google Scholar
World Health Organization (2006) The World Health Report 2006: Working Together for Health. Geneva: World Health Organization. Available at www.who.int/whr/2006/whr06_en.pdf (accessed 15 December 2020).Google Scholar
World Psychiatric Association (2002) World Psychiatric Association Institutional Program on the Core Training Curriculum for Psychiatry. Yokohama: World Psychiatric Association.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×