Background The National Institute for Health and Care Excellence (2015) states that end of life patients should receive a holistic, tailored care plan, encompassing physical and psychological treatment, alongside social, emotional, spiritual and religious support. Spiritual and religious support has proven to be an important facet of palliative care.

Objectives To investigate whether the anticipation and recognition of death during hospital inpatients’ final admission increases the likelihood of these patients receiving spiritual or religious care at the end of life.

Methods Anticipation of death was measured using three markers: (1) initiation of comfort observations (CO), (2) completion of a DNA CPR form, (3) visit from the palliative care team. Records of patients‘ final admission were scrutinised for evidence of anticipation of death and spiritual or religious care. Documented chaplaincy visits were utilised as surrogate markers of spiritual or religious care.

Results The sample population comprised patients who died in hospital in August 2019; 116 patients were included. Only 18.1% of the total population received a chaplaincy visit. This percentage increased when death was anticipated using the three markers. If seen by the palliative team, the percentage visited by a chaplain increased to 38.3%, if CO were initiated, 21.8%, and with a DNA CPR in place, 20.2%

Conclusions Current efforts in providing spiritual and religious care are poor; under a quarter of end of life hospital inpatients received spiritual or religious care in the form of chaplaincy. Anticipation of death increased the likelihood of end of life patients receiving spiritual or religious care, particularly palliative care involvement, and this represents an important opportunity to improve provision of this care.