Spirituality is a universal human expression. It 'is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.'  It is different from religion, though this provides a spiritual expression and spiritual community for some people. Spirituality can help people make sense of their lives.
Spirituality is individual and subjective and means different things to different people. Some people may not call it by name or know how to identify it. It is just part of what makes them who they are. Others have a more conscious awareness of and connection with their spirit and with what nurtures it. The human spirit can be seen and named in different ways, including dignity, hope, joy, love and humour. This means that people will express their spirituality in different ways.
When someone is nearing the end of their life they may start to question their beliefs, reflect on their life or wonder at the meaning of life. This is a normal process. However, if there is ongoing inner conflict then spiritual pain or distress may become an issue for some people. Spiritual distress can sometimes be communicated in physical symptoms.
To ensure a holistic approach to care, it is important to address spirituality and to assess this dimension of care, just as for pain or sexuality. Not everyone will know what 'spirituality' means. Asking the question 'Are you at peace?' or 'where do you find strength in difficult times?' are ways in which to start to explore spiritual issues. [2,3]
Sometimes all an individual needs is not to be alone; a supportive, listening presence or 'being there' can help. All members of the palliative care team can provide this form of caring for the spirit. Sometimes people need more than this and referral is also needed to a member of the team trained specifically in spiritual care at the end of life, or another spiritual resource such as someone from the person’s own spiritual community or tradition.
A systematic review of the literature in the UK made recommendations that include the need to strengthen the evidence base, including evaluation of practice models, and improve education and training.