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Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses

Published online by Cambridge University Press:  06 September 2018

Gil Bar-Sela*
Division of Oncology, Rambam Health Care Campus, Haifa, Israel
Michael J. Schultz
Division of Oncology, Rambam Health Care Campus, Haifa, Israel
Karima Elshamy
Faculty of Nursing, Mansoura University, Mansoura, Egypt
Maryam Rassouli
Cancer Research Center, Shahid Beheshti University of Medical Sciences, Teheran, Islamic Republic of Iran
Eran Ben-Arye
The Oncology Service, Lin Medical Center, Haifa, Israel
Myrna Doumit
Alice Ramez Chagoury School of Nursing, Lebanese American University, Beirut, Lebanon
Nahla Gafer
Radiation and Isotope Center, Khartoum, Sudan
Alaa Albashayreh
College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
Ibtisam Ghrayeb
Makassed Charitable Hospital, East Jerusalem
Ibrahim Turker
Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
Gulcin Ozalp
Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
Sultan Kav
Faculty of Health Sciences, Department of Nursing, Baskent University, Ankara, Turkey
Rasha Fahmi
El-Salam Oncology Center, Cairo, Egypt
Sophia Nestoros
Cyprus Anti-Cancer Society, Avodaphnousa Hospice, Nicosia, Cyprus
Hasanein Ghali
Children’s Welfare Teaching Hospital, Medical City, Baghdad, Iraq
Layth Mula-Hussain
Cross Cancer Institute - University of Alberta, Edmonton, Canada
Ilana Shazar
Department of Hematology, Rambam Health Care Campus, Haifa, Israel
Rana Obeidat
Faculty of Nursing, Zarqa University, Zarqa, Jordan
Rehana Punjwani
Children Cancer Hospital, Karachi, Pakistan
Mohamad Khleif
Al-Sadeel Society for Palliative Care, Bethlehem, West Bank, Palestinian Authority
Gulbeyaz Can
Florence Nightingale Faculty of Nursing, Istanbul University, Istanbul, Turkey
Gonca Tuncel
Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
Haris Charalambous
Bank of Cyprus Oncology Center, Nicosia, Cyprus
Safa Faraj
Children’s Welfare Teaching Hospital, Medical City, Baghdad, Iraq
Neophyta Keoppi
Cyprus Anti-Cancer Society, Nicosia, Cyprus
Mazin Al-Jadiry
Children’s Welfare Teaching Hospital, Medical City, Baghdad, Iraq
Sergey Postovsky
Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
Ma'an Al-Omari
King Abdullah University Hospital, Irbid, Jordan
Samaher Razzaq
Children’s Welfare Teaching Hospital, Medical City, Baghdad, Iraq
Hani Ayyash
European Khan Yunis Hospital, Khan Yunis, Gaza Strip, Palestine
Khaled Khader
Taif University, Taif, Saudi Arabia
Rejin Kebudi
Cerrahpaşa Medical Faculty & Oncology Institute, Istanbul University, Istanbul, Turkey
Suha Omran
Faculty of Nursing, Jordan University for Science and Technology, Irbid, Jordan
Osaid Rasheed
Al Quds University, Abu Dis and Al-Ahli Hospital, Hebron, West Bank, Palestinian Authority
Mohammed Qadire
Faculty of Nursing, Al-Bayt University, Mafraq, Jordan
Ahmet Ozet
Gazi Universitesi Tip Fakultesi, Tibbi Onkoloji Bilim Dali, Ankara, Turkey
Michael Silbermann
Middle East Cancer Consortium and Technion–Israel Institute of Technology, Haifa, Israel
Author for correspondence: Gil Bar-Sela, Integrated Oncology and Palliative Care Unit, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel. Email:



When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with “unrealized potential” for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it.


We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.


We had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How “developed” a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.

Significance of results

Despite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

Original Article
Copyright © Cambridge University Press 2018 

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