II. Spirituality

This section includes City of Hope publications and other resources relating to spirituality in health care including articles relating to cross-cultural topics. There is a listing of tools for assessing spirituality and spiritual concerns, links to organizational position statements relating to spirituality, and recommended publications.

      City of Hope Publications

  1. Ellington, L., Reblin, M., Ferrel, B., Puchalski, C., Otis-Green, S., Handzo, G., Doyon, K. & Clayton, M. F.  (in press). The religion of ‘I don’t know’: Naturalistic observation of spiritual conversations occurring during cancer home hospice nurse visits. Omega: Journal of Death and Dying.

  2. Skalla, K., Ferrell, B. (2015) Challenges in assessing spiritual distress in survivors of cancer.  Clinical Journal of Oncology Nursing, 19(1): 99-104.  DOI: 

  3. Wittenberg, E., Ferrell, B., Goldsmith, J., & Buller, H. (2015). Provider Difficulties With Spiritual and Forgiveness Communication at the End of Life. American Journal of Hospice and PalliativeMedicine, 1-6.  DOI:10.1177/1049909115591811

  4. Puchalski, C. Ferrell, B., Otis-Green, S., Handzo, G. (2014)  Overview of spirituality in palliative care.  UpToDate.

  5. Ferrell, B., Otis-Green, S., Baird, P., & Garcia, A., (2014). Nurses’ responses to requests for forgiveness at the end of life. Journal of Pain and Symptom Management, 46(2), 631-641.  DOI: 10.1016/j.painsymman.2013.05.009

  6. Bulkley, J., McMullen, C. K., Hornbrook, M. C., Grant, M., Altschuler, A., Wendel, C. S. & Krouse, R. S. (2013).Spiritual well-being in long-term colorectal cancer survivors with ostomies. Psycho-Oncology, 22(11), 2513-2521.   DOI: 10.1002/pon.3318. 

  7. Ferrell, B., Otis-Green, S., & Economou, D. (2013). Spirituality in cancer care at the end of life. The Cancer Journal: The Journal of Principles and Practice of Oncology, 19(5), 431-437. DOI: 10.1097/PPO.0b013e3182a5baa5.

  8. Borneman, T., Bluman, O., Klein, L., Thomas, J., Ferrell, B. (2013) Spiritual care for Jewish patients facing a life threatening illness.  Journal of Palliative Care, 29(1) 58-62

  9. Ferrell, B. R., & Munevar. C. (2012). Domain of spiritual care. Progress in Palliative Care, 20(2), 66-71. 

  10. Ferrell, B., & Baird, P. (2012). Deriving meaning and faith in caregiving. Seminars in Oncology Nursing, 28(4), 256-261. DOI: 10.1016/j.soncn.2012.09.008. 

  11. Otis-Green, S., Ferrell, B. R., Borneman, T., Puchalski, C., Uman, G., & Garcia, A. (2012). Integrating spiritual care within palliative care: An overview of nine demonstration projects. Journal of Palliative Medicine, 15(2), 154-163.
    DOI: 10.1089/jpm.2011.0211.

  12. Borneman, T., Ferrell, B. R., & Puchalski, C. M. (2010). Evaluation of the FICA tool for spiritual assessment. Journal of Pain and Symptom Management, 40(20), 163-173. DOI: 10.1016/j.jpainsymman.2009.12.019.

  13. Wong, F. L., Fransisco, L., Togawa, K., Bosworth, A., Golzales, M., Hanby, C., Sabado, M., Grant, M., Forman, S. J., & Bhatia, S., (2010).  Long-term recovery after hematopoietic cell transplantation: Predictors of quality-of-life concerns. Blood, 115(12), 2508-2519. DOI: 10.1182/blood-2009-06-225631. 

  14. Puchalski, C., Ferrell, B. R., Virani, R., Otis-Green, S., Baird, P., Bull, J. et al., (2009).  Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. Journal of Palliative Medicine, 12(10), 885-904.             DOI: 10.1089=jpm.2009.0142.  

  15. Baldwin, C. M., Grant, M., Wendel, C. Rawl, S., Schmidt, C. M., Ko, C., & Krouse, R. S. (2008). Influence of intestinal stomal on spiritual quality of life of U.S. veterans. Journal of Holistic Nursing, 26(3), 185-194. DOI:10.1177/0898010108315185.

  16. Crane-Okada, R. (2007). A compass for the cancer journey: Scientific, spiritual, and practical directives. Oncology Nursing Forum, 34(5), 945-954. DOI: 10.1188/07.ONF.945-955.

  17. Ferrell, B. R. (2007). Meeting spiritual needs: What is an oncologist to do? Journal of Clinical Oncology, 25(5), 467-468.       DOI: 10.1200/JCO.2006.09.3724.

  18. Otis-Green, S. (2006). Spiritual palliative care. Journal of Palliative Medicine, 9, 1477-1478.

  19. Ferrell, B. R., Smith, S. L., Juarez, G., & Melancon, C. H. (2003). Meaning of illness and spirituality in ovarian cancer survivors. Oncology Nursing Forum, 30(2), 249-257.  DOI: 10.1188/03.ONF.249-257.

  20. Otis-Green, S., Sherman, R., Perez, M., & Baird, P. (2002). An integrated psychosocial spiritual model for cancer pain management. Cancer Practice, Special Issue: Issues in Cancer Pain Management: Models of Success, 10(Supp. s1), 58-65.
    DOI: 10.1046/j.1523-5394.10.s.1.13.x.

      Recommended Publications

  1. Spirituality in Healthcare
    - Cobb, M. R., Puchalski, C. M., & Rumbold. B. R. (2012). NY: Oxford University Press. ISBN: 978-0199571390.

  2. Principles and Practice of Palliative Care and Supportive Oncology, 4th Edition, esp. Section II: #54 Spirituality
    - Berger, A. M., Shuster Jr., J. L., Von Roenn, J. H. (2012). MA: Lippincott Williams & Wilkins. ISBN: 978-1451121278.

  3. Selman, L., Siegert, R., Harding, R., Harding, R., Gysels, M., Speck, P., & Higginson, I. J. (2011). A psychometric
    evaluation of measures of spirituality validated in culturally diverse palliative care populations. Journal of Pain and
    Symptom Management, 4
    2(4), 604-622. DOI: 10.1016/j.jpainsymman.2011.01.015.

  4. Oxford American Handbook of Hospice and Palliative Medicine, esp. Chapter 21: Spiritual Issues in Palliative Care
    - Bruera, E. & Yennarajalingam, S. (Eds). (2011). Oxford University Press. ISBN: 978-0195380156.

  5. Making Health Care Whole: Integrating Spirituality into Patient Care
    -  Puchalski, C, M., & Ferrell, B. R. (2010). PA: Templeton Press. ISBN: 9781599473505.        

  6. Oxford Textbook of Palliative Nursing, esp. Section III. Psychosocial Support
    - Ferrell, B. R., Coyle, N., & Paice, J.,  (2015). NY: Oxford University Press. ISBN: 9780199332342

  7. Alcorn, S. R., Balboni, M. J., Prigerson, H. G., Reynolds, A., Phelps, A. C., Wright, A. A., et al., (2010).  If God wanted me yesterday, I wouldn’t be here today: Religious and spiritual themes in patients’ experiences of advanced cancer. Journal of Palliative Medicine, 13(5), 581-588.  DOI: 10.1089/jpm.2009.0343.

  8. Patterson, M. (2010).  Prayer shawls: A blessing in every stitch.  Health Progress, 91(3), 49-51.

  9. Abu-Ras, W., & Laird, L. (2010).  How Muslim and non-Muslim chaplains serve Muslim patients? Does the interfaith chaplaincy model have room for Muslims’ experiences?  Journal of Religious Health, 50(1), 46-61.  DOI: 10.1007/s10943-010-9357-4.
  10. Salman, K., & Zoucha, R. (2010). Considering faith within culture when caring for the terminally ill Muslim patient and 
    family.  Journal of Hospice and Palliative Nursing, 12(3), 156-163. DOI: 10.1097/NJH.0b013e3181e24a52.
  11. Albers, G., Echteld, M. A., de Vet,  H. C. W., Onwuteaka, Philipsen, B. D., van der Linden, M. H. M., & Deliens, L.  (2010). Content and spiritual items of quality-of-life instruments appropriate for use in palliative care: A reviewJournal of Pain and Symptom Management, 40(2), 290-300. DOI: 10.1016/j.jpainsymman.2009.12.012.
  12. Psychology, Religion, and Spirituality
    - Nelson, J. M. (2009). NY: Springer. ISBN: 978-0-387-87572-9 (Print) 978-0-387-87573-6 (E-book). 
      DOI: 10.1007/978-0-387-87573-6.

  13. The Medical Manual for Religio-Cultural Competence: Caring for Religiously Diverse Populations
          - Tanenbaum. (2009). 
    Tanenbaum Center for     
                Interreligious Understanding.
               ASIN: B0033T7O8Q.
  14. Kreitzer, M.J., Gross, C. R., Waleekhachonloet, O., Reilly-Spong, M., & Byrd, M., (2009). The brief serenity scale: a  psychometric analysis of a measure of spirituality and well-being.  Journal of Holistic Nursing (0898-0101), 27 (1), 7-16.  Describes a 22-item Serenity Scale, a tool that measures serenity as a dimension of spirituality and well-being.
  15. Phelps, A. C., Maciejewski, P. K., Nilsson, M., Balboni, T. A., Wright, A. A., & Paulk, M. E. (2009).  Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer.  Journal of the American Medical  Association, 301(11), 1140-1147. DOI: 10.1001/jama.2009.341.  
  16. Yardley, S.J., Walshe, C. E., & Parr, A. (2009).  Improving training in spiritual care: A qualitative study exploring patient perceptions of professional educational requirements.  Palliative Medicine, 23(7), 601-607.   DOI: 10.1177/0269216309105726.
  17. Vachon, M., Fillion, L., & Achille, M. (2009).  A conceptual analysis of spirituality at end of life.  Journal of Palliative  Medicine, 12(1), 53-59. DOI: 10.1089/jpm.2008.0189.
  18. The Nature of Suffering and the Goals of Nursing
    - Ferrell, B., & Coyle, N. (2008). NY: Oxford University Press.  ISBN #: 
  19. Ando, M., Morita, T., Okamoto, T., & Ninosaka, Y. (2008).  One-week Short-Term Life Review interview can improve spiritual well-being of terminally ill cancer patients. Psycho-oncology, 17(9),  885-890. DOI: 10.1002/pon.1299.
  20. Edmondson, D., Park, C. L., Chaudoir, S. R., & Wortmann, J. H. (2008).  Death without God: Religious struggle, death concerns, and depression in the terminally ill.  Psychological Science, 19(8), 754-758. DOI: 10.1111/j.14679280.2008.02152.x

  21. Daaleman, T. P., Usher, B. M., Williams, S. W., Rawlings, J., & Hanson, L. C. (2008).  An exploratory study of spiritual 
    care at the end of life.  Annals of Family Medicine, 6(5), 406-411. DOI: 10.1370/afm.883. 

  22. Timmins, F., & Kelly, J., (2008). Spiritual assessment in intensive and cardiac care nursing.  Nursing in Critical Care,  13(3),  124-131. DOI: 10.1111/j.1478-5153.2008.00276.x.

  23. Vivat, B. (2008).  Measures of spiritual issues for palliative care patients: A literature review. Palliative Medicine, (0269-2163), 22 (7), 859. A literature review of 29 tools for measuring spirituality. DOI: 10.1177/0269216308095990.

  24. Vachon, M. L. (2008). Meaning, spirituality, and wellness in cancer survivors.  Seminars in Oncology Nursing, 24(3), 218-225.  DOI: 10.1016/j.soncn.2008.05.010.

  25. Carpenter, K., Girvin, L., Kitner, W., & Ruth-Sahd, L. A., (2008). Spirituality: A dimension of holistic critical care nursing.  Dimensions of Critical Care Nursing, 27(1), 16-20. DOI: 10.1097/01.DCC.0000304668.99121.b2.

  26. What Do I Say? Talking with Patients about Spirituality (Book & DVD)
         - Taylor-Johnston, E. (2007). PA: Templeton
    ISBN#: 1599471175.        

  27. Goldstein, E. D., (2007). Sacred moments: Implications on well-being and stress. Journal of Clinical Psychology, 63(10), 1001-1019. 
    DOI: 10.1002/jclp.20402.

  28. Smith-Stoner, M. (2007). End-of-life preferences for atheists.  Journal of Palliative Medicine, 10(4), 923-928. DOI: 10.1089/jpm.2006.0197.

  29. Chaturvedi, S. K. (2007). Spiritual issues at end of life.  Indian Journal of Palliative Care, 13(2), 48.                   DOI: 10.4103/0973-1075.38899.   

  30. Puchalski, C. M., Lunsford, B., Harris, M. H., & Miller, T. (2006). Interdisciplinary spiritual care for seriously ill and  dying patients: A collaborative model.  Cancer Journal, 12(5), 398-416. 

  31. Taylor, E. J. (2006).  Prevalence and associated factors of spiritual needs among patients with cancer and family caregivers. Oncology Nursing Forum, 33(4), 729-735. DOI: 10.1188/06.ONF.729-735.

  32. King, M., Jones, L., Barnes, K, Low, J., Walker, C., Wilkinson, S., Mason, C., Sutherland, J., & Tookman, A. (2006).  Measuring spiritual belief: Development and standardization of a beliefs and values scale. Psychological Medicine  (0033-2917), 36 (3), 417.  Development of a 20-item questionnaire that measures spirituality from both a religious 
    and non-religious perspectives. DOI: 

  33. Quest, T. E., & Franks, N.  M., (2006). Vulnerable populations: Cultural and spiritual direction.  Emergency Medicine  Clinics of North America, 24(3), 687-702. DOI: 10.1016/j.emc.2006.05.010.

  34. Sinclair, S., Pereira, J., & Raffin, S., (2006).  A thematic review of the spirituality literature within palliative care.   Journal  of Palliative Medicine, 9(2), 464-479. DOI: 10.1089/jpm.2006.9.464.

  35. Sinclair, S., Raffin, S., Pereira, J., & Guebert, N., (2006). Collective soul: The spirituality of an interdisciplinary palliative care team.  Palliative and Supportive Care, 4(2), 13-24.
    DOI: 10.1017/S14789515060032. 

  36. Brown, A. E., Whitney, S. N., & Duffy, J. D., (2006). The physician's role in the assessment and treatment of spiritual distress at the end of life. Palliative & Supportive Care, 4(1), 81-86. DOI: 10.10170S1478951506060093.

  37. Hills, J., Paice, J. A., Cameron, J. R., & Shott, S., (2005). Spirituality and distress in palliative care consultation. Journal  of  Palliative Medicine (1096-6218), 8 (4), 782. Pilot study measuring facets of spirituality with several scales including RCOPE, FACIT-Sp, FICA, and POMS-SF.  DOI: 10.1089/jpm.2005.8.782

  38. Baggini, J., & Pym, M. (2005). End-of-life: The humanist view. The Lancet, 366(9492), 1235-1237. 

  39. Markwell, H. (2005). End-of-life: A Catholic view. The Lancet, 366(9491), 1132-1135. DOI: 10.1016/S0140-6736(05)67425-9. 

  40. Engelhardt, H. T., & Iltis, A. S., (2005). End-of-life: The traditional Christian view.  The Lancet, 366(9490), 1045- 1049.         
    DOI: 10.1016/S0140-6736(05)67383-7

  41. Keown, D. (2005).  End-of-life: The Buddhist view. The Lancet, 366(9489), 952-955. DOI: 10.1016/S0140-6736(05)67323-0.

  42. Dorff, E. N. (2005).  End-of-life: Jewish perspectives. The Lancet, 366(9488), 862-865. DOI: 10.1016/S0140-6736(05)67219-4.

  43. Sachedina, A. (2005).  End-of-life: The Islamic view.  The Lancet, 366(9487), 774-779. DOI: 10.1016/S0140-6736(05)67183-8.

  44. Firth, S. (2005).  End-of-life: A Hindu view.  The Lancet, 366(9486), 682-685.  DOI: 10.1016/S0140-6736(05)67141-3.

  45. Puchalski, C., & Romer, A. L., (2000). Taking a spiritual history allows clinicians to understand patients more fully.  Journal of Palliative Medicine (1096-6218), 3 (1), 129.  FICA tool.

Educational Materials/Curriculum


  1. Completing a Life: A Resource for Taking Charge, Finding Comfort, Reaching Closure
     An interactive CD inviting patients and families to learn about the practical, emotional, spiritual, and medical  issues faced by those dealing with advanced illness. The CD is available through the Instructional Media Center at Michigan State University. 

  2. Core Curriculum for Holistic Nursing - American Holistic Nurses Association
     Nurses are increasingly aware of the need to blend technology, mind, and spirit in creating optimal circumstances for healing. Barbara Dossey, a pioneer and leader in the field, has created a core curriculum that will provide a blueprint for what it means to be a holistic nurse. Order online at.

  3. FACIT Questionnaires
     Functional Assessment of Chronic Illness Therapy, (FACIT), manages questionnaires that measure health-related quality of life for people with chronic illnesses. The first questionnaire, The Functional Assessment of Cancer Therapy-General (FACT-G), was developed and validated over 10 years ago, and has been used in hundreds of studies worldwide. Since then over 40 questionnaires have been developed and selected questionnaires translated into over 45 different languages. There are three questionnaires relating to spirituality: the FACIT-Sp (Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being), FACIT-Sp-12 (12-item Spiritual Well- Being Scale), FACIT-Sp-Ex (Spiritual Well-Being, Expanded version). 

  4. Fast Facts and Concepts – Palliative Care Network of Wisconsin (PCNOW)
     -     Taking a Spiritual History  #019                          
         Music Therapy  #108                                       
         Physicians and Prayer Requests  #120             

  5. Interfaith Care for the Ill – Mobile App 
      This app is for healthcare professionals looking for the right words of spiritual comfort in difficult circumstances relating to death or illness. It offers overviews of central beliefs, traditional prayers, and descriptions of common practices relating to illness and end-of-life care for Buddhism, Christianity, Hinduism, Islam, and Judaism.            

  6. GWish SOERCE:  Educational and clinical resources in spirituality, religion, and health 
    -  An amazing array of resources on spirituality, religion, and health. Supported by a grant from The JohnTempleton Foundation, GWish created SORECE to build the online infrastructure to support medical educators and  other health professionals in their quest to teach about spirituality and health by providing educational materials and resources.  SOERCE covers an array of topics including spiritual assessment, end of life care, palliative care, spiritual distress management and interventions, articles on major faith traditions, educational modules, presentations, and videos.  

  7. Marie Curie Cancer Care - London: Marie Curie Cancer Care
       Spiritual & religious care competencies assessment tools for specialists in palliative care.        

  8. Pain Care Fast Facts: 5-Minute Clinical Inservice - UW Health, University of Wisconsin Hospital & Clinics, Madison, WI 
    Pain, Suffering and Spiritual Assessment   

  9. Passport to Comfort: Reducing Barriers to Pain & Fatigue Management, #17 – City of Hope, Duarte, CA
    This model addresses patient, professional and system barriers to the relief of pain and fatigue and is based on established guidelines developed by the National Comprehensive Cancer Network (NCCN). An NCI supported program.  Most available 
             in English and Spanish. 
          Patient Spiritual Care Card
          Spirituality Card

  10. The Clinical Social Work Spiritual Care Lecture Series – City of Hope, Duarte, CA
              - Lecture series designed with the overall goal of
                  providing training to clinical oncology social
                  workers to develop their skills in identifying and
                  responding to various spiritual care concerns in
                  the cancer and palliative care population.


         Other Organizational Links   

         American Holistic Medical Association                                                  

         American Holistic Nurses Association                                                     

         Association of Professional Chaplains                                                    

         Canadian Society for Spirituality & Social Work                                

         National Center for Complementary & Alternative

         Can’t Believe I Have Cancer

         HealthCare Chaplaincy Network - Helps people faced
        with the distress of illness and suffering to find comfort
        and meaning

         National Center for Complementary & Alternative

         Strengthening the Spirit

         Tanenbaum Center for Interreligious Understanding

         The Importance of Spirituality in Cancer Care

      Position Statements/Standards

  1. American Holistic Nurses Association (AHNA) Position Statements      
  2. Hospice and Palliative Nurses Association (HPNA)  Position Statements
    -     Spiritual Care
  3. National Comprehensive Cancer Network (NCCN)
     You must log in to access these documents. Registration is free.
      -      Palliative Care
      -      Distress Management

  4. National Consensus Project (NCP) for Quality Palliative Care   
    -      Clinical Practice Guidelines for Quality
             Palliative Care


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