During the last year, the Park Ridge Center has taken a fresh look at the spiritual needs of people with life-threatening illness and the appropriate role of clergy in providing spiritual care in the hospital, hospice, and congregation.

Researchers are exploring what spiritual care means at the end of life; what the spiritual needs, concerns, and issues of the terminally ill are; and what spiritual needs are unmet. Drawing upon hospital and hospice observations and interviews (congregational research is in progress), we have early results of the project "Spiritual Care at the End of Life: Challenges for Hospital, Hospice, and Congregational Clergy."

In much of the literature on health care and spirituality, there is an obsession with defining spirituality or spiritual care. There may be as many definitions as there are people who use the words. At this point, we can characterize how clergy and patient participants understand spirituality in the context of end of life care. The worlds of patients with a life-threatening illness and their families have been turned upside down. To paraphrase sociologist Arthur Frank, the illness has called their name and has broken their normal routines and assumptions. They are in the foreign land of serious illness. Whether in home-based hospice care or in the hospital, with its alien language and strange customs, dying people we have interviewed seek some connection with a transcendent meaning, to make sense of their experience and to regain some control over their lives and perhaps their deaths. These patients and families need acceptance, compassion, and understanding, someone to walk with them, even to their death.

To the clergy, spiritual care means providing that companionship, being attentive to the needs of dying people and their families. Handling paperwork, being entrusted with valuables, giving the dying permission to talk about both mundane and ultimate concerns, translating medical terminology—these are expressions of spiritual care.

So far, at least four overlapping themes are emerging. First, ritual—baptism, prayer, hand holding, and more—appears to be a powerful means of spiritual care.

Second, differences in cultural, socio-economic, religious, or ethnic situations between patients and chaplains affect spiritual care. Opportunities for spiritual care giving are enhanced when clergy's access to the dying person rests on trust and intimacy developed over time.

Third, non-clergy spiritual caregivers are important. Corroborating 1997 Gallup findings, most patients turn to family and friends for spiritual support. These findings confirm that the dying naturally turn to those in their lives with whom they have long-standing, intimate relationships. The dying person may perceive an unknown clergy person as an "outsider."

Fourth, although our observations of congregations are not complete, differences among hospital, hospice, and congregational care are emerging. Congregational clergy, for example, seem to have an advantage because they know their congregants. Although a chaplain might have met a patient during a previous hospitalization, patients typically leave the hospital before a relationship can be well established. A hospice chaplain may come to know patients, sometimes intimately, in the course of their dying, but clearly this relationship exists because of the circumstances.

Death seems to be construed more as an enemy in the hospital and congregation and more as a friend in the hospice. Hospitals are largely devoted to aggressive attempts to cure illness or restore function, and the difficulties in shifting from cure to care were apparent in the hospital we studied. Hospital chaplains are in the center of this shift, because of their role as religious representatives and their occupational/institutional role assignments. Hospice chaplains, on the other hand, operate in an atmosphere in which the patient knows he or she is dying. In our observation, congregational clergy seem least prepared by training or personal reflection to offer intense, sustained support to congregants facing death. Although death may be perceived as an inescapable aspect of members' lives, clergy's attention is more immediately directed to congregational and religious "life."

Midway through the study, clearly the clergy in all three settings can be significant figures in the care of dying people. The project report is due in mid 2001.