Spirituality and spiritual care in palliative and terminal illness: a systematic review and epistemic meta-analysis from physicians' hermeneutic and bioethical perspective.

BACKGROUND: Spirituality is a fundamental aspect of palliative care; however, it remains insufficiently addressed by physicians, despite patient’s expressed preferences and substantial evidence supporting its benefits. This systematic review explores the reason behind this persistent gap, focusing on the sociological and axiological factors influencing physician engagement with spiritual care. AIM: To develop a spirituality operative definition in the frame of healthcare and simultaneously identify and analyze the (value—based) axiological and sociocultural factors that influence physicians’ engagement with spiritual care to terminally ill patients. METHOD: A systematic review was conducted according to PRISMA guidelines. Three databases (PubMed, Web of Science, BIREME) were searched up to September 2023. Studies were included based on their examination of physicians’ perspectives on spiritual care in palliative settings. Thematic synthesis was performed using Atlas.ti guided by Paul Ricoeur’s hermeneutic framework and Echeverría’s axiology or values system. Quality appraisal was conducted using cross functional approach. RESULTS: Physicians’ engagement with spiritual care is shaped by their own spirituality, including encompassing personal values (e.g., compassion, respect), individual beliefs and self-awareness regarding their own well-being and transcendent dimension of clinical practice. Additional factors include communication skills, established clinical routines and the nature of the care they provide their patients. The key barriers identified include insufficient training, ambiguity regarding the physician’s role in spiritual care and personal discomfort addressing spiritual matters. Cultural contexts and institutional dynamics, such as wether care is primarily nurse-led or physician-led care – also impact physician’s involvement. CONCLUSION: Effectively integrating spiritual care into palliative practice requires not only technical competences grounded in evidence and values-based medicine but also reflective engagement with one’s own core values and beliefs. Understanding physicians’ perspectives highlights opportunities to embed spirituality and improve spiritual care provision by doctors within holistic care frameworks.