The purpose of this paper is to illustrate the role of spirituality in coping among women with breast cancer and their families. This phenomenological study was guided by family systems theory and the recognition that a family is a complex system whereby family members interact with one another as well as with the outside world. A change in any of these interactions/relationships can affect the rest of the system, and the diagnosis of breast cancer in mothers within the family system is no exception. Five families (five women, five men and six children) comprising a total of 16 participants took part in this study. The women in this study reported using a number of methods to cope with their illness, one of which was utilising their spiritual beliefs. Although they placed a great deal of importance upon their spiritual beliefs, their families did not. The implications of this reality upon nursing practice will be discussed here.

Critical junctures in patients' lives such as chronic illnesses and advanced diseases may leave the persons in a state of imbalance or disharmony of body, mind and spirit. With regard to spirituality and healing, there is a consensus in literature about the influence of spirituality on recovery and the ability to cope with and adjust to the varying and demanding states of health and illness. Empirical evidence suggests that spiritual support may act as an adjunct to the palliative care of those facing advanced diseases and end of life. In this article, the author draws from his empirical work on spirituality and culture to develop a discourse on palliative care and spirituality in both secular and non-secular settings. In doing so, this paper offers some understanding into the concept of spirituality, spiritual needs and spiritual care interventions in palliative care in terms of empirical evidence. Responding to spiritual needs could be challenging, but at the same time it could be rewarding to both healthcare practitioner (HCP) and patient in that they may experience spiritual growth and development. Patients may derive great health benefits with improvements in their quality of life, resolutions and meaning and purpose in life. It is hoped that the strategies for spiritual support outlined in this paper serve as practical guidelines to HCPs for development of palliative care in South Asia.

Spirit and spirituality are human universals, which are understood, expressed and lived out in different ways. Care of the spirit is an integral component of holistic palliative care, respecting the individual spirituality and experience of the person for whom we care. Whatever be the religious, ideological or philosophical background of the patient and the clinician/carer, certain skills, knowledge and attitudes are essential in providing effective care of the spirit. Rather than using a single perspective, such as either a secular or a religious approach, to meet the needs of all in a pluralistic setting, effective, patient-centered spiritual care draws on the (often shared) wisdoms of the great spiritual and philosophical traditions and of the evolving understandings of these, science and art. Carers need both an awareness of their own spirituality and spiritual practice and an ability to 'bracket' this in focusing on the needs and care of the patient's spirit.

Spirituality is multifaceted. The various beliefs regarding the concept of spirituality, spiritual needs of terminally ill patients and the methods of spiritual assessment are discussed here. There is a close association between demoralization, distress, spiritual pain and spiritual distress. Standardised clinical methods to assess spiritual distress and provide spiritual care and healing are available. Spiritual well-being is a significant dimension of overall health-related quality of life. Although there seems to be traditional and natural spiritual care in our society and especially in palliative care settings, hardly any formal training or interventions are available. This paper aims to encourage soul searching in the end-of-life care.

Palliative care professionals promote well-being and ease suffering at the end-of-life through holistic care that addresses physical, emotional, social and spiritual needs. The ways that individuals cope with serious illness and prepare for death are often done so within a religious context. Therefore, it is essential that palliative care practitioners are sensitive to and have an appreciation of different religious perspectives and rituals to meet the unique needs of their patients and families. This paper provides a brief overview of the five major world religions - Buddhism, Christianity, Hinduism, Islam and Judaism - with particular emphasis of the respective perspectives on suffering, death and afterlife. Despite wide variation in these traditions, an understanding of common rituals surrounding death, funerals and bereavement can improve care for patients, families and communities facing the end-of-life.

End-of-life care requires dealing with challenging issues along various dimensions - physical, psychological, social and cultural. In addition to physical care, the importance of mental healthcare for patients at the end of life is now clearly recognised. However, there is much less awareness about the cultural factors that are involved in end-of-life care. Sensitivity to these factors is essential to providing high quality care and satisfaction to patients. In India, patients come from varied backgrounds. Their end-of-life needs differ according to their belief systems and values relating to life and death in general. In turn, these are influenced by the position they occupy along various dimensions, such as class, religion, caste, community, language, gender, to name a few. Moreover, cultural variations in attitudes and values have important practical implications for individuals making crucial medical decisions. It is therefore important for medical, paramedical and mental health professionals to be cognizant of these factors so as to provide effective and satisfying end-of-life care to patients. This paper discusses some of the issues in providing culture-sensitive care, using examples from the Indian context.

Providing relevant spiritual support to individuals at the end-of-life often raises ethical and practical dilemmas. A little forethought and access to guidelines already in vogue can provide useful hints to many situations commonly faced in everyday practice. The author's experiences and some guidelines are discussed here.