Spiritual care training needs in hospice palliative care settings in South Africa: Chorused national, provincial and local voices

ABSTRACT

Globally, spiritual care is recognized as an important component of palliative care. In the Global North spiritual care training is gaining momentum and being prioritized, but not so in the Global South. This study seeks to establish what the national spiritual care training needs are in hospice palliative care settings with formalized spiritual care services in a middle-income country in the Global South. This was a three-part study: a quantitative national online survey of hospices in South Africa establishing what their spiritual care training needs were – survey results were collated, analyzed and filtered for key issues and overarching themes; a qualitative study consisting of focus group discussions with hospices in the Western Cape Province, South Africa, who have formalized spiritual care services, with the aim of understanding their spiritual care practices and workforce needs – the discussions were analyzed using thematic analysis; and a qualitative study drawing on the experiences of a cohort of spiritual care workers from an established hospice in Cape Town to understand their training needs in spiritual care and explore their workforce issues. Results revealed a chorused need for the development of a national training curriculum in spiritual care for hospices providing palliative care in South Africa and a chorused recognition that spiritual care services are nuanced and require both formalization and flexibility for spiritual care workers to be led by patient needs. Two elements – finance and human capital – were identified as key barriers to developing a spiritual care curriculum.

KEYWORDS:

• Spiritual care
• palliative care
• training curriculum
• hospice
• South Africa
• training barriers

Acknowledgements

The authors thank the passionate and dedicated participants of this three-part study; Varkey George for co-facilitating; and Prof. Dianne Yach, Chairperson of The Mauerberger Foundation Trust, for the financial funding of this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 There are many debates about how to classify countries. The ‘Global North’ generally corresponds to countries categorised by the World Bank (World Bank Blog 2021/2022 Atlas) as high-income countries (HICs) – so, for example, Australia, which is a high-income country is commonly viewed as part of the Global North, despite it being in the southern hemisphere. Countries in the ‘Global South’ generally correspond to the World Bank low and middle-income countries (LMICs) (World Bank Blog 2021/2022 Atlas). South Africa is a middle-income country. The distinction here is based largely on financial resources, though of course other factors are associated with relative wealth.

2 HPCA is a national association operating in all nine provinces in SA, including 51 health districts. Some of its voluntary member organizations offer hospice palliative care, some home-based care, and others both services.

3 We use the term ‘member organizations’ rather than ‘hospices’ because all organizations offer palliative care, but not all call themselves hospices.

4 In South Africa, as elsewhere, the use of ‘racial’ terminology is complex and contested, and certainly still a source of debate and great pain. We make no claim for the scientific validity of the different ‘racial’ categories, but the labels used still have social significance (Swartz et al. 2020). In the South African context, the term ‘Coloured’, which may well be the most contested, is an official term still used in government documents, refers to a very diverse group of people of mixed and diverse origin, with Afrikaans being the predominant language spoken (Swartz et al. 2020). By contrast, the term ‘Black African’ commonly refers to people who speak indigenous languages such as isiXhosa, spoken in the Western Cape. Under apartheid, the Western Cape was viewed as a preferential area in which ‘Coloured’ people could live and work, whereas ‘Black Africans’ were viewed as not being citizens of South Africa, but of racially defined ‘homelands’.

5 The interdisciplinary team at SLCH consists of a clinical palliative care staff such as a medical nurse, doctor, social worker, spiritual care worker and bereavement care worker.

Additional information

Funding

This work was supported by The Mauerberger Foundation Fund.

Notes on contributors

Ronita Mahilall

Ronita Mahilall is a PhD candidate at Stellenbosch University, South Africa. She is a social worker with a Master’s degree in social work. She is also the CEO of St Luke’s Combined Hospices in Cape Town, South Africa.

Leslie Swartz

Leslie Swartz is a clinical psychologist and professor of psychology at Stellenbosch University, South Africa. He publishes widely in the mental health, disability, and care fields; and he is the Editor-in-chief of the South African Journal of Science. His most recently published book is How I Lost My Mother (a memoir dealing with care issues in context, Wits University Press 2021).