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Grounded theory is a qualitative research method that allows a situation or phenomenon to be examined in order to understand how key players manage their roles and then, through inductive reasoning, develops a theory or framework in order to convey an understanding about the situation or phenomenon.In this study, data collection and analysis follow the grounded theory constant comparative approach [18, 19], viewing data collection and analysis as a single concurrent process in which the method is fluid and evolves as the understanding unfolds from the data.
Over the course of several months in 2014, the authors visited four hospice organizations, each informed by an explicit religious context: the Catholic Hospice in Miami, Florida; the Zen Hospice Project in San Francisco, California; the Salvation Army Agapé Hospice in Calgary, Alberta; and, the Jewish Hospice Program of Jewish Family & Child in Toronto, Ontario.
Though framed and informed by religious traditions, each of these hospice programs is inclusive, serving a diverse range of persons.
At the level of patient and family experience, a recent assessment of palliative care in Nova Scotia demonstrated that ‘[c]ommunication in various forms and family emotional and spiritual support were consistently viewed [by next of kin] as lacking in all locations and identified as targeted areas for impacting quality care at end of life.’  These findings are representative of an issue that has emerged in hospice palliative care planning, delivery, and research: there is need to improve the spiritual dimension of care, but historical, cultural, educational, political, and other contexts surrounding and informing the delivery of care inhibit integrating the spiritual into end of life care [7–13].
The disjunction between acknowledged need for spiritual care and on-the-ground organization and practice generated the central question driving this study: How can hospice palliative care – which recognizes the importance of spiritual care at the end of life and beyond, yet which is chiefly framed and informed by secular ideas, contexts, and practices – better meet the religious, spiritual, and existential questions and needs often present at end of life?
The interviews were analyzed iteratively using the constant comparison method within a grounded theory approach.
Nine Principles for organizational support for spiritual care emerged from the interviews.Three Principles identify where and how spiritual care fits with the other aspects of palliative care; three Principles guide the organizational approach to spiritual care, including considerations of assessment and of sacred places; and three Principles support the spiritual practice of care providers within the organizations.Organizational practices that illustrate each of the principles were provided by interviewees.General readers will be moved by the persuasive call for greater religious and spiritual literacy at every level of health care in order to respond to the full spectrum of human needs in life and in death. addresses a very important issue—how can we best manage spiritual distress in patients who have no religious attachments or beliefs?” — is a welcome and highly recommended contribution to professional and academic library Religious/Spirituality Studies and Health/Medicine Hospice Care reference collections and supplemental reading lists.” — provides a great deal of information about the topic from the perspectives of several disciplines, most strongly nursing and pastoral care/chaplaincy within Western culture.Since, practically speaking, most hospice palliative care in the foreseeable future will continue to be organized and practiced chiefly within or connected to health care organizations not founded and operated on specific spiritual foundations in Canada and other countries, there is a need to find ways to incorporate religion and spirituality into the organization and delivery of care offered in these secular settings.This will help to meet the needs of people who are dying, their family members, and, often, their care providers live up to the intentions informing statements of best practice in hospice palliative care.The ‘holistic’ model inaugurated by Saunders explicitly or implicitly shapes much of the current discussions and conceptions of hospice palliative care —and yet there remains a significant gap between theory and practice, between acknowledged need and delivered care.The medical model has been the dominant paradigm in health care for over a century.Another way to reflect on reorienting hospice palliative care in chiefly secular settings is to explore whether valuable lessons may be learned from the organization and delivery of care practiced at hospice organizations that have an explicit religious or spiritual orientation, committed as they are to the spiritual dimensions of end of life care.This is the approach taken in this study, with a focus on organizational level practices and approaches that could support and complement the efforts of individual care providers.