ANALISIS JURNAL

Palliative Professionals’ Views on the Importance of Religion,

Belief, and Spiritual Identities toward the End of Life

DISUSUN OLEH :

Said Abdul Jalil

Tedi Firmansyah

PROGRAM STUDI SARJANA KEPERAWATAN

STIKES HORIZON KARAWANG

Jl. Pangkal Perjuangan Km 1 Bypass Karawang 41316

Belief, and Spiritual Identities toward the End of Life

1. Resume

Abundant literature has argued the significance of religion, belief, and spirituality at the end of life.
This study aims to add to this literature by exploring palliative professionals’ views in this area.
By means of an in-depth interviewing method, this paper reports data from 15 hospice and
palliative care professionals. Participants were recruited from five hospice and palliative care
organisations, and the data were managed and analysed with thematic analysis and NVivo (version
11). This study found three main reasons that make religion, belief, and spirituality important for
patients and their loved ones when facing imminent death: the sense of comfort and security,
meaning making, and closure. These reasons are not independent from one another, but
complementary. This paper offers some implications for practice and concludes with a call for
further research A terminal diagnosis can potentially evoke death anxiety, which in turn generates
a reduced sense of safety [1]. The ambivalence between the “universal fear of death” and
“universal denial of death” brought to the fore by Malinowski [2] dissolves with the news of
impending death and is taken over by a surge of worry and anxiety. The instinctual reaction to the
fear generated is then often mediated by religion [2]. Religion and spirituality help individuals
make sense of what awaits them near the end of life [3] and help the dying cope with their terminal
condition [4]. Given the importance of religion and spirituality at the end of life, palliative care
aims to improve the quality of life of the patient and their family and friends through a holistic
approach by addressing not just the physical, psychological, emotional, and social needs but also
the spiritual and religious needs, making it multidimensional in nature [5,6]. After terminal
diagnosis, it is vital to understand the entire patient and not just the illness, which is why it become
imperative to address patients’ spiritual and religious needs [5]. After a review of 26 articles
published between August 2013 and August 2014 on the role of religion and spirituality at the end
of life, Lópes-Síerra and Rodríguez-Sánchez [7] (p. 87) concluded that “religion/spirituality
evokes in patients the sources to find the necessary inner strengths, which includes perspective
thinking, rituals for transcending immediate physical condition and modalities of coping with their
oncological illnesses”. Koenig [8] reported that with the support of the spiritual community and
religious faith, individuals at the end of life are able to leave it to God to control their circumstances
with love and wisdom. A total of approximately 120 prospective participants received the
information and 15 palliative care professionals in hospice and hospital care in England, UK were
interviewed (see Table 1 for main characteristics). The number of the total palliative care
professionals in the UK is not recognizable due to diverse policy and professional perceptions of
who is considered as a palliative care professional. The interviews lasted between 45–60 min. The
data were collected between April 2015 and January 2016, following ethical approval by a
University Research Ethics Committee and the mapping of ethical standards indicated by the
varied organisations/institutions where the participants were employed at the time. The data were
processed in 2016 and initial outputs directed at hospices and palliative care units were released in
2017–2018. To increase validity of the data in the present day, a more recent study [15] confirmed
the relevance and currency of the information. A participant information sheet and an invitation
letter were circulated among palliative care professionals via their wards in hospices and hospitals.
Those interested contacted the researcher (PP), conversed with them for further clarity about the
research study, signed a consent form, and finally, took part in face-to-face interviews. Prior
acquaintance between the researcher and the participants automatically disqualified them from
partaking. The interviews took place in a private space in the respondents’ place of employment
at a time most convenient to them, and participants were asked open-ended questions about their
views on the significance of religion and belief in society, the role these play in illness and health,
as well as how religion, belief, and spirituality influence the experiences of those dying or grieving.

METODOLOGI ARTIKEL

This was a qualitative study that employed semi-structured in-depth interviewing as its main
method of data collection. Such a tool gives the researcher the flexibility to navigate the topic
under investigation with the respondents, and the participants the authority toinfluence the
exploration [26]. Such methods ensure a higher degree of coproduction with research participants
[27]. A total of approximately 120 prospective participants received the information and 15
palliative care professionals in hospice and hospital care in England, UK were interviewed (see
Table 1 for main characteristics). The number of the total palliative care professionals in the UK
is not recognizable due to diverse policy and professional perceptions of who is considered as a
palliative care professional. The interviews lasted between 45–60 min. The data were collected
between April 2015 and January 2016, following ethical approval by a University Research Ethics
Committee and the mapping of ethical standards indicated by the varied organisations/institutions
where the participants were employed at the time. The data were processed in 2016 and initial
outputs directed at hospices and palliative care units were released in 2017–2018. To increase
validity of the data in the present day, a more recent study [15] confirmed the relevance and
currency of the information. A participant information sheet and an invitation letter were circulated
among palliative care professionals via their wards in hospices and hospitals. Those interested
contacted the researcher (PP), conversed with them for further clarity about the research study,
signed a consent form, and finally, took part in face-to-face interviews. Prior acquaintance between
the researcher and the participants automatically disqualified them from partaking. The interviews
took place in a private space in the respondents’ place of employment at a time most convenient
to them, and participants were asked open-ended questions about thei views on the significance of
religion and belief in society, the role these play in illness and health, as well as how religion,
belief, and spirituality influence the experiences of those dying or grieving.

P:

Omfort and Sense of Security Participants with more than 10 years of experience in the palliative
and hospice care sector, as well as those aged 41 and above shared the view that religion, belief,
and spiritual identities are of utmost importance when someone is near the end of their lives,
experiencing an advanced illness, or is caring for someone in either of the former situations.
Specifically, participants stated that religion and spirituality, both as frameworks and inner
beliefs—also noted elsewhere [15]—provide comfort to patients, family, and friends. This is
regardless of whether they have maintained their faith throughout their lifespan, are returning to it,
or are developing it at the end of life. “Other patients get comfort from a spiritual or religious belief
that they have had all the way through their life” (social worker). “They [patients] are comforted
that they will be with god. Even if they did not believe throughout their lives, they are drawn to
their spirituality and faith where they find safety and trust” (nurse). “When people are poorly, their
belief or spiritual thinking is magnified, and they find comfort and feel secure from it” (counsellor).
Furthermore, participants, particularly nurses and social workers, suggested that such comfort is
primarily developing a sense of security for patients and their support system. “If they have
already got some belief system, sometimes, again, they can get comfort from that and support from
the community in their part of that religious community” (nurse). “It gives patients something to
feel secure with. Their situation is already upsetting and having something to believe in helps them
feel safe” (social worker).

I:

This paper reports primary evidence collected from palliative care professionals in England, and
it aims to examine the importance that professionals assign to religion, belief, and spiritual
identities of patients and their family members/friends when the patient is near the end of their life.
This will further add to the literature that seeks to develop a deeper understanding of professionals’
views and attitudes towards these identities, when westernised medicine, care, and service
provisions are underpinned by a medical model that does not emphasise religion/spirituality
equally with physical needs. Developing more knowledge in this area will help facilitate the
arguments about the need for further training where necessary, or foreseeing future needs in
palliative care. In the present study, the concept of spirituality and religion have been used
inclusively.
C:

Research has found that there is a positive relationship between meaning making and quality of
life [37,38]. In the context of the bereaved, Neimeyer et al. [39] noted that the stronger the bond
of the bereaved with the deceased, the greater the psychological distress experienced “when the
survivor was unable to make sense of the loss in personal, practical, existential, or spiritual terms”
(p. 715). Neimeyer [40] also explained that the inability to find meaning in the loss also
complicates the grieving process, which could be deal with by “reconstructing meaning”.

O:

3. Results All participants to this study shared the view that people who either face their own death
or are experiencing the imminent death of a loved one are often drawn t spirituality and religion
as coping strategies. This finding is not surprising or new; previous studies have shown similar or
the same results [31,32] but not always drawing from palliative care professionals and in a period
politically and religiously charged in the UK [33]. “I think sometimes when people . . . face the
fact that they are dying, their life comes towards an end, that can sometimes make them focus on
their spirituality in a way that they might not have done previously” (nurse). Specifically,
participants stated that those they work with, regardless of if they are religious or not, or have been
in their lives, will always turn to a higher power to seek support, bargain for more time or a cure,
and find answers where science and medicine may be failing them. Of the participants, nurses and
doctors/consultants expressed this finding more, going further to opine that non-religious
individuals are likely to be more scared of their circumstances and thus find solace in spirituality
or religion. “Their illness and prognosis make them scared [patients]. Even when they do not
believe, they will turn to anything else to find comfort. There is definitely spirituality even if the
person is not religious” (doctor). The thematic analysis of the data generated three main themes
which address palliative professionals’ views about the importance of religion, belief, and spiritual
identities near the end of life. All themes have been contextualised in grief and dying. In other
words, participants suggested same thoughts between exploring the importance of religion, belief,
and spiritual identities in grieving, and in dying. The three main themes are comfort and sense of
security, meaning making, and closure