Survey Reveals Gap: 90% of Clinicians Say Spiritual Care Is Essential in Cancer, Yet Few Routinely Screen for It
Key Insights
More than 90% of surveyed oncologists, hematologists, and palliative care clinicians agree spiritual care is essential in cancer (search) care and that spiritual distress negatively impacts outcomes.
Only 13% of clinicians report always screening patients for spiritual needs, while 25% never screen; among hematologists/oncologists, 47% never take a spiritual history.
Lack of time (49%) and the perception that spiritual care is not part of their responsibilities (46%) were the most common barriers cited.
A large international survey of nearly 700 cancer (search) clinicians reveals a striking disconnect: while the overwhelming majority believe spiritual care is essential to oncology practice, only a small fraction routinely address it with their patients.
The cross-sectional study, conducted by researchers led by Carla I. Ripamonti, MD, of the University of Brescia in Italy, surveyed 670 oncologists, hematologists, and palliative care clinicians from 55 countries between December 2024 and February 2025. The findings paint a picture of widespread agreement on the importance of spiritual care alongside persistent failure to integrate it into routine clinical practice.
Strong Consensus on Importance
More than 90% of respondents agreed that spiritual care is an "essential" part of cancer (search) care, and 92% acknowledged that spiritual distress can negatively impact a patient's quality of life. Furthermore, 93% agreed that taking a spiritual history shows respect to patients, even when clinicians do not share the same beliefs, and 75% endorsed the idea that all clinicians caring for patients should take a spiritual history as part of a whole-person assessment.
"These data positively surprised us," Ripamonti told Healio.
A Widening Gap Between Belief and Practice
Despite this broad consensus, implementation lags dramatically. Only 13% of respondents reported they "always" screened patients for spiritual needs, while 25% said they never did so. The gap was even more pronounced when it came to taking a spiritual history: 28% of clinicians reported never conducting one, compared with just 9% who always did.
Among hematologists and oncologists specifically, 47% reported never conducting a spiritual history assessment. Palliative care nurses had the highest rates of always screening at 38%, followed by psychosocial practitioners at 28% and palliative care physicians at 22%. Less than 10% of hematologists/oncologists reported always screening patients.
Compared with palliative care physicians, oncologists had a significantly lower likelihood of reporting spiritual care as part of their professional role (adjusted OR = 0.27; 95% CI, 0.12-0.59), that they screened for spiritual distress (aOR = 0.44; 95% CI, 0.21-0.95), and that discussions about spiritual history should be part of their role (aOR = 0.37; 95% CI, 0.16-0.87).
Barriers and Professional Identity
The most commonly cited barriers to providing spiritual care were lack of time (49%) and the belief that it was not part of the respondent's responsibilities (46%). Overall, 57% of hematologists/oncologists agreed that spiritual care was not part of their job.
When discussing their own professional roles, only 72% of respondents agreed they should discuss spirituality with patients, 65% reported they should be the ones conducting spiritual screening, and 62% said taking a spiritual history constituted part of their job — notably lower than the 90% who endorsed spiritual care as essential in principle.
Clinical Implications and the Path Forward
Between 20% and 30% of patients with cancer (search) experience spiritual distress, Ripamonti noted. Although spiritual needs are studied mainly in the context of advanced cancer and end of life, patients often develop such needs upon diagnosis, with an increase in the first six months following diagnosis regardless of cancer severity, as well as during treatment and remission.
"In clinical practice, there is a gap between the spiritual needs of patients with cancer (search) at every stage of their illness and the clinician consideration and response," Ripamonti said.
Multiple guidelines, including the WHO palliative care framework, acknowledge spiritual health as a critical component of care. Unaddressed spiritual needs have been associated with poorer patient quality of life, while provision of spiritual care in medical settings has been linked to better end-of-life outcomes.
Most respondents reported not being trained in spiritual care, but agreed such training was "necessary" and expressed interest in improving their spiritual competencies. Ripamonti emphasized that research should explore different training methods, beginning in degree programs for all medical professions and continuing through specialization schools, with healthcare facilities organizing on-site refresher courses.
"These unmet needs are not of secondary importance if we consider that the literature data show that spiritual health also corresponds to improved health-related quality of life and outcomes," Ripamonti said. "This is becoming a public health problem."
The researchers acknowledged study limitations, including distribution of the survey through professional societies and social media, which may have limited the number of clinicians who received it.