EAPC white paper on spiritual care education in palliative care     


Piret Paal is an anthropologist who works as a researcher and coordinator of the WHO Collaborating Centre at the Institute of Nursing Science and Practice, Paracelsus Medical Private University, Salzburg, Austria. With comments from co-authors, Andrew Goodhead, Carlo Leget and Megan Best, Piret explains the background to a new EAPC white paper that addresses the issue of spiritual care education for all palliative care professionals. And it’s free to download…

Dr Piret Paal.

For my doctoral thesis I explored more than 6,000 pages of written text on cancer patients’ experiences, emotions and thoughts. As I had no exposure to clinical practice at this time, I did not understand why it was so difficult for healthcare professionals to engage in patients’ concerns and lives. I felt for patients and their caregivers, who sought for connectedness, and did not really know what to do about it. For the past ten years, I have worked closely with palliative care professionals, and I have come to understand their heavy workloads, permanent lack of time, and hesitance when it comes to spirituality and spiritual care.

When thinking of integrating spiritual care into health care many healthcare professionals ask: Who should provide spiritual care? What is the role of caregivers’ spirituality when providing spiritual care? (Liefbroer et al. 2019).The European Association for Palliative Care (EAPC) white paper on spiritual care education in palliative care is to operationalise spiritual care education in palliative care.

Like all statement papers, the white paper should be seen as a recommendation. But how did all this work begin?

In 2011 the Spiritual Care Task Force published its working definition for spirituality and spiritual care in palliative care (Nolan et al. 2011). Today, this EAPC definition is widely accepted as a guide to spiritual care provision, education and research in palliative care and beyond. To apply the term ‘spirituality’ is useful as it is consistent with the World Health Organization (WHO) definition of palliative care (2002).

In July 2014, together with Rev’d Dr Andrew Goodhead, we wrote an EAPC blog post titled: ‘Spiritual care education: Step by step towards curriculum guidelines’,where we briefly reported on a survey that was later published in the European Journal of Palliative Care (Paal et al. 2015). This study revealed that theoretical input, self-reflection, discussion rounds, developing communication and listening strategies are of great importance in spiritual care education. Shortly after, Professor Dr Carlo Leget came up with the white paper idea. Today he says, I think this white paper is needed for a number of reasons: 

  • It gives an overview of the state of the art in Europe and beyond.
  • It is an inspiration for people who develop teaching programmes
  • It contributes to building a shared framework of reference for this area. (Carlo Leget, 2020).

Sweeping through our old email threads, there are discussions about choosing the appropriate methodology: e-focus groups v. systematic review as well as many questions about time management, resources (and the lack of them), and personal struggles to commit.

In March 2016, Dr Megan Best joined the educational subgroup. In her work in palliative care she had seen how existential questions arise for patients as they face their own death, and their need for support to resolve those questions if they are to die in peace. She suggested we look at multidisciplinary spiritual care to recognize the value of palliative care professionals learning from each other.

Andrew Goodhead seconds this:

“We need to have awareness about the spiritual issues of the end of life. Suffering and spiritual pain are not met by nursing and medicine alone, but through a complex network of colleagues working together to understand the whole person – not simply as a patient.” (Andrew Goodhead, 2020).

Around the same time, Carlo Leget suggested we explore the spiritual care competencies proposed by Gamondi et al. (2013). The following steps and selected methods are fully described in the white paper, which as an official statement paper of the EAPC, was recently published as an open access article in BMC Palliative Care. As a group, we believe that step-by-step we have managed to work out a framework that integrates the voices of different levels of expertise from different regions.

Download your free copy of the EAPC white paper on spiritual care and education.

The EAPC white paper points out the importance of spiritual care as an integral part of palliative care and suggests incorporating it accordingly into educational activities and training models in palliative care. Spiritual care is seen as the responsibility of all staff members according to the interprofessional model of spiritual care. Self-reflection on spiritual issues in the individual’s own life should be a standard part of spiritual care training, as a professional requirement. Self-awareness can help the healthcare practitioner to avoid being distracted by their own fears, prejudices and restraints and attend to the patient. However, not all changes will be possible merely through spiritual care education.


Liefbroer AI, Ganzevoort RR, Olsman E. Addressing the spiritual domain in a plural society: What is the best mode of integrating spiritual care into healthcare? Ment Health Relig Cult 2019. doi: 10.1080/13674676.2019.1590806

Nolan S, Saltmarsh P, Leget C. Spiritual care in palliative care: working towards an EAPC task force. Eur J Palliat Care. 2011;18(2):86–9.

World Health Organization. WHO Definition of Palliative Care 2002 [Available from: http://www.who.int/cancer/palliative/definition/en/].

Paal, P, Leget, C, Goodhead, A.Spiritual care education: Results from an EAPC survey. Eur J of Palliat Care 2015; 22(2):91-95

Best, M, Leget, C, Goodhead, A, Paal, P. An EAPC white paper on multi-disciplinary education for spiritual care in palliative care. BMC Palliat Care 19, 9 (2020). https://doi.org/10.1186/s12904-019-0508-4.


The EAPC Spiritual Care Reference Group. Includes several publications to download incuding the new white paper.

Read more posts in the Spirituality and Palliative Care series on the EAPC blog

Following much interest in this series, we are delighted to announce that a new Spirituality and Palliative Care series will launch in the summer. We already have  contributions lined up from the EAPC Spiritual Care Reference Group and Dr Catherine Pilbeam. If you’d like to contribute please email the editor.

This entry was posted in EAPC Task Forces/Reference Groups, EAPC White Papers, Guidelines & Recommendations, SPIRITUAL CARE and tagged . Bookmark the permalink.

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