Background Since the foundation of the modern hospice movement, spiritual care has been regarded as a vital part of patient care, alongside physical, psychological and social considerations. This holistic approach to Palliative Care is upheld by and reflected in the NICE Guidance on Supportive and Palliative Care (2004) and the DOH End of Life Strategy (2008). One of the Quality Markers for Spiritual Support in End of Life Care proposed as part of the 2008 EOL Strategy was: ‘People approaching the end of life... have the opportunity to explore their spiritual beliefs and values with staff at regular points throughout the illness trajectory and these are recorded and regularly reviewed.’

Objectives and standards To assess whether some of the essential, basic elements of assessing and facilitating spiritual care for patients, were part of the standard practice of clinical teams at the Hospice. The following criteria were selected: Record of religiousaffiliation, Exploration of spiritual needs (either conducted or considered), Consideration given to potential chaplaincy involvement.

Methods 45 patients electronic records reviewed in total -15 each from inpatients- (IPU), Home care (HCT) and Day therapy (DTU).

Results The recording of religious affiliation was more consistent on IPU (93%) than either the DTU or HCT (both 73%). Performance in each of the 3 categories considered by this audit fell short of the set-targets: Religious was recorded in 80% of cases compared to the goal of 95%. Spiritual Care Needs were assessed or considered in 41.5% of patient assessments compared to the target of 80%. Chaplaincy Referral was offered or thought of in 20% of instances, against the aim of 67%.

Discussion Reflection on the demographic mix of the audit population and the potential effect on results suggest a number of interesting questions for future research regarding factors that might affect the assessment of spiritual care needs. We plan to reaudit further to this.