Spirituality Has Entered the Conversation–Are We Ready to Listen?
BY HEATHER R. KELLY, MSN, RN, BCPA, CPC
As a hospice case manager, I often found myself navigating spiritual and religious conversations—it was simply part of the journey.
In many ways, those discussions felt natural. I had grown comfortable sitting with patients and families in those moments, listening, supporting, and helping them make sense of what they were experiencing. But there was one encounter that stayed with me differently.
It was a middle-aged man nearing the end of life who was not ready to accept it. He spoke with deep conviction, believing that a miracle was going to save him. He wanted every life-saving measure possible, while across the room stood his wife and two adult children, quietly holding a very different understanding of what was happening. I remember feeling a shift within myself, realizing that while I had been comfortable with these conversations before, something was missing in this situation.
What if that missing piece is spirituality?
That moment stayed with me, because it was a powerful reminder that spirituality isn’t just a concept in care; it’s something our patients are already carrying with them, shaping how they understand illness, hope, and even the meaning of letting go.
Recent research published in Health Affairs highlights a growing recognition that spirituality, defined as a sense of meaning, purpose, connection, and transcendence functions as a meaningful determinant of health (Long et al., 2024). While this may feel like a deeply personal or even abstract concept, the evidence suggests it plays a real and measurable role in health outcomes, particularly for individuals facing serious or chronic illness.
MORE THAN BELIEF, IT IS A FOUNDATION FOR RESILIENCE
For many patients, spirituality is not separate from their health journey; it is central to how they make sense of illness, suffering, healing, and hope.
The article emphasizes that spirituality can influence not only emotional well-being but also how individuals engage with care, cope with disease, and connect with their communities (Long et al., 2024).
And if we pause for a moment, we’ve all seen this in practice.
It’s the patient who finds strength in faith during chemotherapy.
The caregiver who leans on a sense of purpose to push through exhaustion.
The individual who simply wants someone to acknowledge their fears, their values, and what matters most to them.
These aren’t “soft” elements of care—they are powerful drivers of resilience. In fact, research in oncology populations demonstrates that spirituality and religious coping are associated with improved quality of life and emotional outcomes (Vallurupalli et al., 2012).
WHERE CASE MANAGEMENT FITS IN
Case managers sit at a unique intersection in healthcare, clinical, social, and deeply human. That position creates an opportunity, and perhaps a responsibility, to recognize spirituality as part of the broader care experience.
The research suggests that healthcare systems are beginning to explore ways to incorporate spiritual considerations into policy and practice, though adoption remains inconsistent (Long et al., 2024).
For case managers, this doesn’t mean becoming spiritual counselors. Instead, it means:
- Creating space for patients to express what matters most to them
- Recognizing when spiritual distress may impact engagement or decision-making
- Partnering with interdisciplinary teams—including chaplaincy or community support when appropriate
- Approaching care with curiosity, respect, and cultural humility
In many ways, this aligns with what case managers already do best, listening beyond the diagnosis.
THE CHALLENGE: BALANCING INCLUSION AND SENSITIVITY
Integrating spirituality into care is not without complexity.
Spirituality is deeply personal, shaped by culture, respecting diversity, belief systems, and lived experience. For some, it may be tied to faith. For others, it may center on relationships, purpose, or connection to something greater.
There are also ethical considerations:
- Ensuring that discussions are patient-led, not provider-driven
- Avoiding assumptions or bias
- Maintaining professional boundaries
This is where case managers’ training in patient advocacy and person-centered care become essential (Bruner, 2024).
REFRAMING “WHOLE-PERSON CARE”
We often talk about integrating physical, behavioral, and social health, but perhaps “whole-person care” isn’t fully complete without acknowledging the role of meaning and purpose in a person’s life.
Integrating spirituality doesn’t require new systems as much as it requires a shift in awareness.
It may look like:
- Asking one additional question
- Pausing long enough to hear what isn’t being said
- Recognizing that healing is not always just clinical
And in doing so, we create a space where patients feel seen, not just as cases to manage, but as people with values, beliefs, and stories that matter.
For case managers who may feel uncertain or uncomfortable navigating conversations around spirituality, it’s important to remember that this is not about having the right answers, or even sharing similar beliefs, it’s about creating space for the patient’s voice. You don’t need to be an expert in spirituality to be present, curious, and respectful. Often, simple, open-ended questions like “What gives you strength right now?” or “What matters most to you as you navigate this?” can gently invite patients to share what is meaningful to them without placing pressure on the interaction.
A CALL TO THE PROFESSION
As healthcare continues to evolve toward more personalized, value-based care, the integration of spirituality presents both an opportunity and a challenge.
It asks us to step outside traditional clinical frameworks and lean into the human side of care. It reminds us that outcomes are not defined solely by utilization or metrics, but also by dignity, understanding, and connection.
For case managers, this is not a departure from our role. It is an extension of it.
Because at its core, case management has always been about more than coordinating care. It has been about walking alongside people, especially in their most vulnerable moments and helping them navigate not just the system, but their experience within it.
REFERENCES
Bruner, E. (2024). Spirituality in healthcare: A primer for case managers. CareManagement, 30 (6): 9-12. December 2024-January 2025.
Long, K. N. G., Symons, X., VanderWeele, T. J., Balboni, T. A., Rosmarin, D. H., Puchalski, C., Cutts, T., Gunderson, G. R., Idler, E., Oman, D., Balboni, M. J., Tuach, L. S., & Koh, H. K. (2024). Spirituality as a determinant of health: Emerging policies, practices, and systems. Health Affairs, 43(6). https://doi.org/10.1377/hlthaff.2023.01643.
Vallurupalli, M., Lauderdale, K., Balboni, M. J., Phelps, A. C., Block, S. D., Ng, A. K., Kachnic, L. A., VanderWeele, T. J., & Balboni, T. A. (2012). The role of spirituality and religious coping in the quality of life of patients with advanced cancer receiving palliative radiation therapy. Journal of Supportive Oncology, 10(2), 81–87.
, MSN, RN, BCPA, CPC, is a registered nurse with more than 30 years of healthcare experience, including oncology, hospice and palliative care, and healthcare administration. She brings a strong background in care coordination, medical policy, and clinical program strategy, with a focus on improving access, quality, and patient-centered outcomes. Heather currently serves as a senior clinical strategist, collaborating with multidisciplinary teams to support effective care management and program development. She is a frequent community speaker on cancer survivorship and end-of-life planning and is deeply committed to patient advocacy and professional mentorship.
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