Table 2 Interview categories, themes, and quotations

1. Definitions of spiritual care.

Patient beliefs and values

“You have to go get to know a person. What is his/her value in life? What is his faith? Or are there things that he is afraid of?”

Providing presence

“A lot of patients see that your care is always there, no matter what state he’s in. if he feels this power of warmth, he can ride the wave of this strength.”

Addressing physical symptoms refractory to medical management

“The first thing would be when there are a lot of physical symptoms and after looking at test results or blood results, he shouldn’t be that uncomfortable. However, he expresses discomfort a lot with a lot of symptoms. This hints to me as spiritual troubles.”

Addressing psychological or emotional needs

“To me, it’s very difficult to differentiate between spirituality and psychology…I think it’s a psychological and emotional thing, and towards walking to this stage of life, where are we going then?”

2. Sources of spiritual distress.

The afterlife

“Some Buddhists may worry that they won’t be able to go to a better world after they pass away and may go to hell. Family members would also worry about this sometimes.”

Burdening one’s family

“Some people may think that when they were young, they were irresponsible to their families, so their children are not visiting them now.”

Communication

“…because we always discuss the issue of death very vaguely and discreetly, a lot of people don’t know that they are in the final stage of life. This type of uncertainty makes them not know how to react and adjust to themselves losing bodily functions, and don’t know how to do the following preparations.”

3. Challenges in providing spiritual care.

The state of the patient

“…when the symptoms worsen, the physical discomfort would affect the practicality of him [chanting prayers]. It’d end up becoming that he isn’t able to change anymore…these physical symptoms would affect the feasibility of us performing spiritual care.”

Providers’ lack of preparedness

“I think the biggest problem is still the inability to notice, or sometimes when you’re working, you may not be mature enough to explore this area…or the worries of noticing things that you’re unable to help with.”

Providers’ lack of time

“Everybody’s too busy.”