Background Assessment of patients' spiritual needs and appropriate spiritual support is fundamental to holistic care, particularly towards end of life. Merseyside & Cheshire Cancer Network (MCCN) implemented spiritual awareness education in response to a spiritual care audit (2006), which demonstrated that staff felt under-skilled in this area. The results of the second cycle of this super regional audit are presented.

Method The audit consisted of three parts a) telephone survey of spiritual care resources within specialist palliative care services (SPCS), b) web-based survey determining healthcare professionals (HCPs) perceptions of practice, c) case note audit determining actual practice.

Results (A) The majority of SPCS inpatient units have a spiritual care policy; this is not the case for community services. All inpatient settings provided multi-faith quiet spaces; directories of spiritual care resources were mainly available. Inpatients had access to suitably qualified spiritual care givers more often than community settings. (B) 138 HCPs completed the survey. More than 85% assessed spiritual needs and 80% assessed religious needs some or all of the time. Less than 10% use specific assessment tools. Over 50% had undertaken specific spiritual support training. Confidence in assessment and provision of spiritual care had increased, but religious support less so. There was improvement in confidence levels of those who had undergone spiritual care training compared to those who had not. c) The case note audit revealed fewer staff recorded religious affiliation (78%) than in 2006 (91%); the recording of spiritual needs (72%) had increased (60%).

Conclusion Community services are under-resourced with respect to spiritual care support. Confidence in spiritual assessment and support has improved since 2006 and appears to be greater in those who have undergone training. The poorest area of documentation is of religious need and on-going religious care. MCCN guidelines for assessment and provision of spiritual care have subsequently been revised.