Attending to the spiritual struggles and needs of patients and families is part of palliative care philosophy and practice. Clearly, you have spirituality on your radar as you care for patients and have integrated it into your practice. Your comfort in opening up conversations with patients about their spiritual perspectives and religious beliefs enlarges and deepens the care you and the health care team provide. Your prayers with patients can be a meaningful way of supporting their religious faith and affirming a divine presence in their suffering.

Because spirituality is part of palliative care practice, cross-cultural issues and the need for spiritual sensitivity do arise. Health care providers may feel uncertain when trying to respond to the spiritual needs of patients from traditions other than their own. It is tempting in such situations to avoid the spiritual domain of care or to leave it to the patient or family to make their needs or expectations known. However, a better option is to approach these patients with a readiness to learn how the health care team can support them in meeting their spiritual needs during their illness.

A conversation about patients’ spiritual needs or expectations may reveal how you or other team members can act as spiritual resources for them. If necessary, you can clarify with the patient or family what your role might be in supporting him or her. It may be helpful to acknowledge that your faith background is different and to ask the patient how he or she would like to be prayed for. Many religious patients or families feel comfortable and supported if familiar prayers, rituals and symbols are offered to them by representatives of their own tradition. You or the team’s spiritual care provider may play a key role in arranging this.

Some patients have inclusive spirits and inquisitive minds that cut across religious boundaries. These patients may welcome opportunities to talk about spiritual issues with a health care worker from a different spiritual tradition. They experience this exchange of perspective and shared exploration of spiritual questions as an enrichment of their spirituality. They are open to including people from other traditions in their personal spiritual community. If respect and trust grow in these relationships, praying together may arise naturally.

Even when mutual trust and respect have been established, a health care worker needs to carefully explore how prayer could be shared meaningfully when the possibility arises. There is no one right way to share prayer across faith boundaries. The important thing is to find a way that works for both the patient or family and the health care worker. You may find some of the following suggestions helpful:

• Offer a prayer that is familiar to you and invite the patient or family to do the same.
• Be a respectful presence and witness as the patient or family prays.
• Invite the patient or family to begin the prayer, then close the prayer yourself. That way you will be able to get a feel for the “prayer language” of the patient and to tailor your closing as appropriate.
• Pray in a generic way that uses language not specific to any tradition. For example, “Holy One,” “Creator,” or “Living Spirit” may be addressed rather than “God” or “Jesus” or “Allah.” Prayers could simply end with “Amen” or “Peace,” or “May you be blest,” rather than with “In the name of the Father, Son, and Holy Spirit.” (Do not use words that are part of the patient’s tradition but not part of yours to avoid being seen as insincere or presumptuous.)
• Use a blessing that is not strongly attached to any particular religious tradition. This may be as simple as “God be with you” or “God bless you.” However, depending on the situation and relationship, longer blessings may be appropriate. Here are two examples:
  • The loving-kindness meditation, which has been adapted from the Buddhist tradition and is used widely. There are various forms of this blessing, but for health care crises, the following may be particularly helpful:
    May you be at peace. May your heart remain open.
    May you awaken to the light of your own true nature.
    May you be healed. May you be a source of healing for all beings.
  • The old Gaelic blessing:
    Deep peace of the running wave to you.
    Deep peace of the flowing air to you.
    Deep peace of the quiet earth to you.
    Deep peace of the shining stars to you.
    Deep peace of the infinite peace to you.
• Offer to arrange for a spiritual leader from the patient’s tradition to pray with him or her. You might explore whether the patient or family would like you to be present when the spiritual leader offers prayers.
• Read a prayer from the patient’s tradition. This could be especially appropriate if the patient has cognitive or communication impairment.

In no case should prayer be imposed on the patient or family, or offered without their consent. In the same vein, health care professionals should not engage in prayer if they feel uncomfortable, insincere or conflicted. Your prayer support of patients and families does not need to involve actually praying together. You can simply let them know that you are remembering them in prayer.