Communicating with patients about existential and spiritual issues: SACR-D work

Abstract

Communicating with patients about their spiritual and existential issues is a core element of comprehensive palliative care. Spiritual and existential issues are conceptually problematic and can be difficult to delineate from other health domains. Patients and families facing the end of life identify spiritual and existential needs as vital to their experience at the end of life and want their health care professionals to address them. This essay discusses the relevance of assessing and supporting patients as they deal with existential and spiritual issues at the end of life, while also providing clinical guidance for their health care professionals. Implicit and explicit means for communicating with patients about their existential and spiritual issues are discussed. The pneumonic SACR-D: S – self-awareness, A – assessing the patient, C – compassionate presence, R – referring for additional spiritual support, and D – dialogue, is presented as a clinical framework to effectively communicate with patients about their existential and spiritual needs.