Background Guidance suggests that spiritual care is vital to a holistic approach to end of life care and we wanted to assess whether our local palliative care team were able to have these conversations as part of a wider project into spiritual care in our hospital.

Aim To review whether spiritual care is being offered to patients recognised to be coming to the end of their life.

Method We reviewed the notes of patients who died over a two month period and the subsequent month following implementation of a ‘Unified Holistic Needs Assessment (uHNA) proforma within our casenotes, utilised by the palliative care team on each interaction. This had a section for spiritual/religious needs as an aide-memoire.

Results 75 patients were included in the initial cycle and 28% of these patients had no documented discussion of their spiritual care needs. 39 patients were included in the subsequent cycle and 28% of patients had no documented discussion of their spiritual care needs, showing no improvement following intervention.

Discussion Almost one third of patients did not have their spiritual care needs addressed and this didn’t improve with a change in documentation format to include a prompt. This may reflect an unexpected level of discomfort with the subject even amongst specialist clinicians although individual variation in what we document of our discussions could confound this result. It is also important to acknowledge that in a first meeting it may not be appropriate to discuss more personal matters without adequate rapport and that each patient encounter progresses differently. Part of an ongoing quality improvement project aims to identify education needs and empower clinicians to engage in these conversations and improve patient experience.