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Healthcare Professionals’ Learning from Patients as Teachers in Spiritual Care: A Grounded Theory Study in TaiwanA
Hsiao-Fen Lo, PhD student1; Jaw-Shiun Tsai, MD, PhD2; Chen-Yin Tung, PhD1; Chia-Chen Chang*, PhD1Running Title: Patients as Teachers in Spiritual Care
1 Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan, ROC.
No. 162, Section 1, Heping E. Rd., Taipei City 106, Taiwan, ROC
2 Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan; Center for Complementary and Integrated Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Family Medicine, Jin-Shan Branch, National Taiwan University Hospital, New Taipei City, Taiwan, ROC.
No. 1, Changteh St., Zhongzheng Dist., Taipei City 100, Taiwan, ROC
*Corresponding author: Chia-Chen Chang, PhD
Address: Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan, ROC; No. 162, Section 1, Heping E. Rd., Taipei City 106, Taiwan
Tel: 886-02-77491709
Fax: 886-02-23630326
E-mail: juliachang1@gapps.ntnu.edu.tw
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Healthcare Professionals’ Learning from Patients as Teachers in Spiritual Care: A Grounded Theory Study in TaiwanAbstract
Background
Spiritual care is a core dimension of holistic palliative practice, but its delivery in Taiwan remains inconsistent because of cultural, educational, and institutional barriers. This study explored healthcare professionals’ experiences in providing spiritual care and developed a culturally relevant model to inform practice.
Methods
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We conducted focus groups with 15 physicians and nurses in northern Taiwan and analyzed data using grounded theory.Results
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Participants described a four-stage trajectory: (1) recognizing spiritual distress, (2) confirming needs and building trust, (3) providing spiritual interventions and reconstructing meaning, and (4) reflecting on their role and integrating insights into professional practice. Based on these findings, we developed the Patients as Teachers Professional Mastery Cycle Model, which positions patients as active contributors to caregivers’ professional growth.Conclusions
Spiritual care functions as a reciprocal process that promotes patient well-being and supports caregiver transformation. The model highlights the importance of culturally sensitive education, institutional support, and reflective practice for strengthening spiritual care in clinical settings.
Keywords:
Spiritual Care
Grounded Theory
Cultural Sensitivity
Spiritual Care
Patient-as-Teacher
Healthcare Professionals
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Background
Spiritual care is increasingly recognized as a crucial component of holistic health care(1, 2), addressing patients’ needs for meaning, connection, and peace alongside their physical, emotional, and social concerns (3, 4). The World Health Organization’s 2023 vision for integrated health also highlights spirituality as central to well-being in the context of serious illness and end-of-life (5). Evidence shows that spiritual support can improve quality of life, enhance emotional adjustment, and facilitate decision-making in patients and their families (6–9). Despite this recognition, integration of spiritual care into clinical practice remains inconsistent. Common barriers include unclear definitions, lack of formal training, insufficient institutional support, and systemic factors such as time pressure, workload, and hospital ethical climate (7, 10–12).
Previous reviews have underscored that although healthcare providers generally acknowledge the importance of spirituality(13), they often report low competence and confidence in addressing spiritual needs(7, 13, 14). Spiritual distress is frequently subtly, vaguely, or ambiguously expressed(15) and, therefore, difficult to detect without specific training. The absence of structured procedures and limited opportunities for reflection further reduce clinic professionals’ readiness to respond (13, 16).
Cultural context adds further complexity. In many cultures, including in Chinese-speaking communities like Taiwan, traditional values often frame topics as spirituality, particularly regarding death, which is considered an evil omen or taboo, leading patients and their families to remain silent or choose to avoid discussing existential struggles(15). At the same time, clinicians may hesitate to raise spiritual issues for fear of intruding or offending (15, 17, 18). The spiritual needs are often interpreted through family responsibility, ancestral beliefs, or moral obligation, which differ from Western models that emphasize individual autonomy. However, such cultural dynamics also happened to remind us that the delivery of spiritual care cannot be understood without attending to locally embedded meanings.
Existing research has mainly described knowledge, attitudes, and behaviors related to spiritual care(19–21). Additionally, he benefits of spiritual care for patients are well-documented; some studies indicate that spiritual care may foster resilience, empathy, and a professional identity among clinicians(19–22). However, the professional and personal impact on healthcare providers has been less systematically examined. There is a limited understanding of how clinicians actually recognize, interpret, and respond to patients’ concerns in daily practice. Thus, systematic exploration of these transformative processes remains scarce.
Grounded theory provides a suitable methodology for addressing these gaps, as it enables theory development from practitioners’ lived experiences while remaining sensitive to socio-cultural context (23). By capturing the processes through which clinicians identify spiritual distress, engage in dialogue, and integrate reflections into their professional roles, grounded theory can illuminate both the relational and transformative aspects of care.
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The present study, therefore, aims to explore how physicians and nurses in Taiwan experience, interpret, and practice spiritual care, and to develop a conceptual model that reflects the cultural and clinical realities of this setting. In doing so, the study seeks not only to clarify how spiritual care is enacted but also to examine its reciprocal impact on the professional growth of healthcare providers.Methods
Study Design
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This qualitative study adopted a constructivist grounded theory (GT) approach (Charmaz, 2024) to explore how Taiwanese healthcare professionals perceive, practice, and reflect on spiritual care. GT was selected because it enables theory to develop directly from participants’ descriptions, making it particularly suitable for examining complex, relational, and culturally embedded practices such as spiritual care.Participants
Physicians and nurses with at least two years of experience in providing spiritual care were purposefully recruited from hospitals and clinics in northern Taiwan (including four major cities: Taipei, New Taipei, Keelung, and Taoyuan). Two profession-specific focus groups were conducted: one with physicians (n = 9) and one with nurses (n = 6). The sample included participants from diverse clinical specialties, genders, and institutional backgrounds to ensure a range of perspectives.
Data Collection
Data were collected in August 2024 through semi-structured focus group interviews, each lasting approximately 120 minutes. The interview guide (Appendix 1) elicited detailed accounts of: (1) situations where participants recognized or responded to spiritual distress; (2) strategies and interventions employed; (3) challenges encountered and facilitating factors; and (4) personal and professional reflections.
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All interviews were audio-recorded with consent, transcribed verbatim, anonymized, and cross-checked for accuracy. Follow-up phone calls were used when clarification was required.Data Analysis
Data were analyzed using Charmaz’s constructivist grounded theory approach, which involved three iterative stages: initial line-by-line coding, focused coding to refine core categories, and theoretical coding to integrate categories into a coherent framework. Constant comparison across and within transcripts, along with memo writing, was employed to support analytic insight and theory development until theoretical saturation was achieved.
During theoretical coding, we observed that participants’ accounts followed a pattern resonant with the culturally familiar Qi-Cheng-Zhuan-He sequence. To capture this cultural grounding, we articulated the emergent model through the Beginning–Continuing–Transitioning–Concluding (BCTC) framework. For analytic purposes, this framework was paralleled with the SOAPIE documentation method widely used in Taiwanese clinical practice. We adapted SOAPIE into SOAPIE(R): Subjective data, Objective data, Assessment, Plan, Implementation, Evaluation, and Reflection, explicitly adding “R” for Reflection. This adaptation was used only during the analytic process as a coding guide to align participants’ narratives with clinical reasoning steps, and it was not intended as a conceptual model for practice.
This culturally grounded articulation was derived inductively from the data and highlighted “Reflection” as a critical final stage. In doing so, our analysis demonstrated that participants’ narratives could be structured as an educational cycle of professional learning. Patients were positioned as teachers within this cycle, shaping caregivers’ reflective practice and professional growth, and thereby linking clinical encounters with implications for medical and nursing education.
Rigor and Ethics
To ensure rigor, multiple strategies were employed. Credibility was enhanced through triangulation of data sources (e.g., comparing physicians’ and nurses’ perspectives), peer debriefing within the research team, and member checking by returning preliminary themes to several participants for feedback. Dependability was supported by maintaining a transparent audit trail, including coded transcripts and analytic memos, which allowed for the review of analytic decisions. Transferability was facilitated by providing a thick description of participants’ demographics, clinical settings, and cultural context, enabling readers to assess the applicability of findings to other educational or clinical environments. Confirmability was strengthened through reflexive memo-writing and regular team discussions; for example, the team compared alternative interpretations of sensitive quotations to minimize individual bias.
Ethical approval
was obtained from the Institutional Review Board of National Taiwan Normal University (IRB No. 202312HS022).
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Written informed consent was secured from all participants, who were assured of confidentiality, anonymity, and the voluntary nature of their participation.Results
Participant Characteristics
A total of 15 healthcare professionals participated in two focus groups: nine physicians (five male, four female) and six nurses (all female). The mean age was 39.7 years (range, 31–58), with an average of 16.6 years of clinical experience (range, 10–30). Physicians were mainly from family medicine and palliative care, with additional representation from emergency medicine, traditional Chinese medicine, obstetrics and gynecology, general internal medicine, and surgery. Nurses, with an average of 15 years of experience, represented diverse settings including home-based palliative care and inpatient wards across obstetrics and gynecology, orthopedics, cardiology, and neuro-intensive care. Demographic details are summarized in Table 1.
Table 1. Demographic Characteristics | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Items | Physician | Nurse | Total | |||||||||
(n = 9) | (n = 6) | (N = 15) | ||||||||||
Mean | Range | Mean | Range | Mean | Range | |||||||
Gender | ||||||||||||
Male | 4 | (-) | 0 | (-) | 4 | (-) | ||||||
Female | 5 | (-) | 6 | (-) | 11 | (-) | ||||||
Age (years old) | 47.5 | 35–58 | 36.4 | 31–47 | 39.7 | 31–58 | ||||||
Work experience | 20.5 | 10–30 | 15 | 10–27 | 16.6 | 10–30 | ||||||
(years) | ||||||||||||
Specialty* | FM/PC: 4 | O&G: 1 | PC:2 | O&G: 1 | FM/PC: 6 | O&G: 2 | ||||||
GM: 1 | GS: 1 | GM: 1 | GS:1 | GM: 2 | GS: 2 | |||||||
ER:1 | TCM:1 | ICU:1 | ER:1 | TCM:1 | ||||||||
ICU:1 | ||||||||||||
*: FM: Family Medicine; PC: Palliative Care Unit; O&G: Obstetrics and Gynecology; ER: Emergency Room; | ||||||||||||
ICU: Intensive Care Unit; TCM: Traditional Chinese Medicine; GS: General Surgery; GM: General Medicine | ||||||||||||
Thematic Findings
Guided by the BCTC narrative framework, analysis revealed a four-stage trajectory in participants’ reflections on providing spiritual care: (1) Recognizing Spiritual Distress with Clinical Sensitivity, (2) Building Trust as a Foundation for Spiritual Dialogue, (3) Facilitating Meaning Reconstruction through Spiritual Interventions, and (4) Reflection and Integration into Professional Learning. These stages, elaborated below with subthemes and illustrative quotations, demonstrate how clinicians perceived spiritual care and how these encounters contributed to their professional learning and development.
Stage 1. Beginning: Recognizing Spiritual Distress with Clinical Sensitivity
Spiritual distress often manifests in subtle ways that are not easily captured by standard clinical tools.
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Patients’ words and behaviors may conceal deep existential anxiety, requiring caregivers to draw on observation, clinical experience, and intuitive judgment to recognize these needs.1.1
Uncontrolled symptoms with unclear etiology
Some patients presented with poorly explained symptoms, prompting suspicion of non-physical distress. As one physician noted, “The patient was emotionally unstable… often saying the wrong things, making mistakes, and even falling when walking” (M2, p.19). Despite pharmacological and counselling interventions, “nothing really worked… it felt like something beyond the physical was happening” (M9, p.17).
1.2
Emotional instability and disorganized language
Fragmented expressions often revealed inner chaos: “He could not get to the point—deep down he just did not know how to face his situation” (N3, p.61). Existential concerns also surfaced: “Why am I still alive? It would be better if I were dead” (N1, p.59); “What is the meaning of life?” (M6, p.6).
1.3
Illness interpreted as punishment, guilt, or burden
Patients sometimes framed illness in moral or relational terms: “I got this disease because God wants to punish me… because I’m a gay” (N6, p.69). Others avoided treatment to reduce family burden: “My wife has to take leave to care for me. I don’t want to drag them down” (M7, p.22).
1.4
Ambivalent interpersonal interactions
Some patients alternated between rejecting and seeking connection: “She told her families not to visit anymore… but when her family needed to go out, then she said, Don’t bother if you are so busy, I know I’m just a burden for you” (M7, p.22). Another physician described repeated consultations as a signal of unresolved distress: “The patient refused treatment at times but continued to seek consultations again and again” (M8, p.48).
These accounts illustrate that spiritual distress often emerges in nuanced and culturally mediated ways, underscoring the importance for clinicians to cultivate sensitivity and reflective skills in practice.
Stage 2. Continuing: Building Trust as a Foundation for Spiritual Dialogue
Spiritual care develops gradually through ongoing interactions. Once caregivers identify possible distress, their openness and consistent presence can promote deeper dialogue and build trust.
2.1 Expressing needs in informal conversations
Existential concerns often surfaced in casual exchanges. For example, one patient asked, “After I die, who will remember me? Will I just disappear?” (N2, p.61). Such informal questions provided an entry point for spiritual dialogue, highlighting the importance of clinicians’ attentiveness beyond formal assessments.
2.2 Continuing: Building Trust as a Foundation for Spiritual Dialogue
Trust was cultivated through continuity of care. A physician reflected, “At first she said nothing… After I visited every day, she finally asked, ‘Where do you think people go when they die?’” (M5, p.41). This illustrates how longitudinal presence, even in brief interactions, can encourage patients to disclose profound concerns.
2.3 Patients initiate dialogue when they feel safe
Once trust was established, patients were more willing to share fears and beliefs. As one patient expressed, “I want someone to pray with me—not because I’m religious, but because I’m afraid of dying alone” (N4, p.65). These examples show how relational safety creates opportunities for meaning-making and emotional support.
2.4 Caregivers’ responses shape the depth of dialogue
The quality of caregivers’ responses influenced how deeply patients engaged. One nurse recalled asking a patient, “What do you hope to leave behind?” which led him to affirm, “I want someone to remember I tried my best to live” (N6, p.84). Such reflective questioning demonstrates the role of clinical communication skills in facilitating patients’ exploration of meaning and value.
These findings indicate that trust in spiritual care is built incrementally, requiring continuity, relational safety, and reflective responses. For medical education, this underscores the need to train clinicians not only in technical communication skills but also in sustained presence and reflective dialogue, which are crucial for addressing patients’ spiritual concerns.
Stage 3. Transitioning: Facilitating Meaning Reconstruction through Spiritual Interventions
Once patients entered spiritual dialogue, caregivers supported the reconstruction of meaning through reflective listening, symbolic practices, and life review. These approaches enabled patients to reconnect with themselves, others, and life, while also providing clinicians with opportunities to develop skills in facilitating meaning-making.
3.1 Listening and presence as the foundation
Attentive listening and empathic presence allowed patients to reframe difficult experiences. One physician recalled, “I didn’t give advice, just listened to him talk about his father. Later he said, ‘I think I can forgive him now’” (M5, p.43). Similarly, a nurse described encouraging a patient to keep a diary, which led him to recognize, “I still have something worth recording” (N3, p.61). These accounts highlight how non-directive listening fosters patient-driven meaning-making and demonstrates the educational value of reflective communication.
3.2 Symbolic actions and rituals enable expression
Symbolic acts offered tangible ways for patients to externalize emotions and affirm continuity of self. Examples included writing a letter to a deceased parent (“I wanted her to know I’m doing okay”, N4, p.62) and planting a tree as a legacy for children (“This will be my sign for my children”, M7, p.35). Such practices illustrate the importance of clinicians being open to creative and culturally sensitive interventions.
3.3 Life review fosters integration and value reconstruction
Guided reflection on past experiences helped patients recognize personal worth and meaning. One physician remarked, “Some of my students visited me after I got sick. Now I realize that those days my companionship was meaningful” (M9, p.38). A nurse noted a similar shift when a patient affirmed, “I’m a useful person” after reflecting on a lifetime of caregiving (N5, p.72). These narratives demonstrate how life review can facilitate identity integration and provide educators with examples of structured reflective practice.
3.4 Reconnection with others as evidence of transformation
Reconciliation with family members reflected a more profound transformation. A patient expressed, “I want to apologize to my son for being too strict” (M9, p.19). Another patient, initially resistant to visits, later told his wife, “I want you to know I’m trying very hard to live” (N1, p.84). Such examples highlight the relational outcomes of spiritual care and the role of clinicians in supporting these processes.
These findings indicate that meaning reconstruction is facilitated through listening, symbolic acts, and life review, ultimately leading to renewed relationships. For medical education, this highlights the importance of training clinicians in reflective listening, culturally sensitive care, and life review techniques as part of holistic, patient-centered practice. Integrating these skills into curricula can better prepare healthcare professionals to address the spiritual and existential dimensions of patient care.
Stage 4. Concluding: Reflection and Integration into Professional Learning
The process of providing spiritual care not only transformed patients but also profoundly shaped caregivers’ professional learning. Patients acted as teachers, inspiring reflection, reshaping clinicians’ understanding of care, and reinforcing their professional mission. At the same time, participants identified systemic challenges and articulated the need for education, institutional support, and self-care to advance their practice.
4.1 Patients as teachers and professional growth
Clinical encounters often became powerful lessons. One physician reflected, “He taught me what it means to face life bravely. I wasn’t just his doctor—I was his student” (M6, p.38). A nurse recalled, “That night, after hearing a patient’s regret, I hugged my mom and said ‘I love you’” (N3, p.79). Such reflections illustrate the educational value of patients as co-educators in professional learning.
4.2 Redefining professional roles and mission
Spiritual care prompted clinicians to broaden their roles from disease treatment to holistic presence. One physician noted, “I realized that what truly matters is presence and listening” (M5, p.7). Another added, “Medical care is not only about treatment but also about connection and companionship” (N3, p.70). These insights deepened their professional mission and commitment to patient-centered care.
4.3 Challenges to implementation
Participants also highlighted cultural sensitivity as a key barrier. In Taiwanese society, spirituality is often considered a private or sensitive topic, leaving clinicians uncertain about how to respond. One nurse admitted, “When patients talk about their beliefs, I worry my response might offend them” (N2, p.73). Others noted that “different families interpret spirituality in very different ways, complicating interventions (M9, p.42). These findings emphasize that cultural context shapes how spiritual care is understood and practiced, underscoring the need for education in culturally sensitive communication.
4.4 Educational and institutional needs
To address these challenges, participants called for structured education that integrates cultural awareness. As one physician suggested, “If we could practice through case simulations or role models during on-the-job training or even earlier in school, it would give us more confidence” (M4, p.39). Incorporating culturally grounded scenarios into training—such as end-of-life family discussions in Taiwanese contexts—was deemed essential for preparing clinicians to address diverse spiritual concerns.
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Reflections on spiritual care reinforced clinicians’ professional mission while exposing systemic and cultural challenges. For medical education, these findings highlight the importance of integrating patient narratives into curricula, providing structured training in spiritual care, and incorporating cultural sensitivity into teaching so that future clinicians can navigate both institutional and sociocultural complexities.Discussion
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This study explored the clinical experiences and reflections of physicians and nurses in Taiwan regarding spiritual care through focus group interviews. Compared with previous studies, our findings not only confirm the diversity and subtlety of patients’ spiritual needs but also highlight the cultural tendency within Chinese societies to avoid open discussions of death and spirituality. This cultural characteristic significantly influences both recognition and intervention strategies. Four key areas emerged from the findings: recognition of spiritual distress, cultural challenges, bidirectional transformation, and educational needs.Our findings highlight that spiritual distress often manifests in subtle and non-verbal ways, such as anxiety, hopelessness, or guilt. These cues may go unnoticed without heightened sensitivity, which supports earlier evidence showing that most healthcare providers receive limited training in recognizing such signs and are often underprepared to respond effectively (8, 20, 24).
Beyond these clinical observations, the cultural context further complicates recognition and response. In Taiwanese society, hesitation to discuss death and spirituality often prevents patients from expressing their needs openly. At the same time, the lack of culturally grounded training leaves caregivers uncertain and underconfident (25, 26). Similar barriers have also been documented internationally, where institutional constraints and limited time for spiritual dialogue create additional challenges(11, 27–30). These findings underscore the importance of context-sensitive approaches that incorporate cultural humility into clinical training.
Spiritual care was also shown to be transformative for both patients and caregivers. By responding to patients’ spiritual needs, clinicians simultaneously engaged in self-reflection and professional growth, reinforcing resilience and a sense of professional mission. This dual process is consistent with previous studies that emphasize the reciprocal and bidirectional nature of spiritual care(21, 31–33).
The study further reveals important educational implications.
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Participants consistently expressed a preference for experiential and reflective learning methods, including role-playing, case-based discussions, mentorship, and team-based support. Such approaches align with the findings of Sekse et al. (34), who reported that experiential learning significantly enhances providers’ spiritual competence and clinical communication skills.Taken together, these results underscore that spiritual care should be viewed as an ongoing process of reflection and transformation for both patients and healthcare professionals. Future education and policy efforts should prioritize authenticity, cultural relevance, and reflective practice to cultivate context-specific competencies. Spiritual care is not merely a technical intervention but a form of clinical practice rooted in humanistic engagement. Only through the integration of structured education, institutional support, and cultural sensitivity can the full significance of spiritual care be realized.
Building on these insights, this study introduces the Patients-as-Teachers Professional Mastery Cycle Model (Fig. 1). The model conceptualizes patients not only as recipients of care but also as catalysts for professional growth. It outlines four stages: recognition of spiritual distress (Beginning), trust-building and clarification of needs (Continuing), spiritual intervention and reconstruction of meaning (Transitioning), and caregiver reflection and professional integration (Concluding). This framework expands existing models by presenting spiritual care as a mutual, cyclical process that integrates clinical sensitivity, relational depth, and reflective practice into professional learning.
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By emphasizing mutuality and cultural grounding, this study provides an empirically based framework that contributes to advancing both spiritual care education and policy.Fig. 1
Patient-as-Teacher Professional Mastery Cycle Model
This study also has limitations. The participants were recruited from healthcare institutions in northern Taiwan, comprising a total of 15 physicians and nurses, which may limit the transferability of the findings to other regions or healthcare systems. Most participants were mid- to senior-level professionals, and their perspectives may differ from those of junior staff, trainees, or students who are still developing their competencies. Although focus group interviews encouraged interaction and reflection, they may also have introduced group dynamics that limited the expression of personal views. Finally, the study focused solely on healthcare professionals and did not include the voices of patients or family members. Future research should involve multiple stakeholders, including learners in medical education, to provide a more comprehensive and culturally grounded understanding of spiritual care practices.
Conclusion
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Using the BCTC narrative framework, this study examined the clinical experiences, interventions, and reflections of healthcare providers in Taiwan regarding spiritual care. The findings show that spiritual distress often manifests through subtle or atypical symptoms and emotional expressions, requiring high levels of clinical sensitivity and cultural awareness to recognize. Spiritual health was understood not only in religious terms but also in relation to meaning, value, connectedness, and peace, which is consistent with multidimensional definitions in the international literature.This study also introduces the Patients-as-Teachers Professional Mastery Cycle Model, which conceptualizes patients as both recipients of care and catalysts for caregivers’ professional development.
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The model presents spiritual care as a mutually transformative and cyclical process—encompassing recognition, trust-building, intervention, and reflection—that addresses both cultural and clinical challenges.The findings further demonstrate that spiritual care contributes not only to patient well-being and quality of life but also to caregivers’ self-awareness, resilience, and integration into their professional roles. Spiritual encounters provided clinicians with opportunities to re-examine their values and professional mission, underscoring the bidirectional nature of spiritual care.
Despite these benefits, challenges remain in Taiwan, including limited educational resources, insufficient institutional support, cultural hesitation in discussing spirituality, and the lack of standardized procedures.
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Participants emphasized the need for structured training through simulation, role-play, case-based learning, and team-based approaches to strengthen communication skills and confidence in providing support.In conclusion, spiritual care should be regarded not merely as a technical intervention but as a culturally sensitive and humanistic clinical practice. Future educational programs and healthcare policies should prioritize authenticity, cultural relevance, and reflective practice in order to develop localized competencies. Only through the integration of education, institutional frameworks, and cultural sensitivity can spiritual care achieve its deeper purpose and promote mutual growth and healing for both patients and caregivers.
Abbreviations
BCTC
Beginning
Continuing
Transitioning
and Concluding
SOAPIE(R): Subjective data, Objective data, Assessment, Plan, Implementation, Evaluation, and Reflection
Declarations
Ethics Approval and Consent to Participate
A
A
The study protocol was reviewed and approved by the Research Ethics Committee of National Taiwan Normal University on June 14, 2024 (approval number: 202312HS022). A
All procedures were conducted in accordance with the principles of the Declaration of Helsinki. A
All participants invited to the focus group interviews were fully informed about the purpose of the study, and written informed consent was obtained prior to participation.Clinical trial number
Not applicable.
Consent to Publish:
Not applicable.
A
Data Availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Conflict of Interest
The authors declare no financial or non-financial conflicts of interest.
A
Funding
This work was supported by the National Science Council (NSC) of Taiwan under grant number 113-2410-H-003-106.
A
Author Contribution
Lo H.F., Tsai J.S., Tung C.Y., and Chang C.C. conceptualized and designed the study. Lo H.F. was responsible for data curation, visualization, and editing. Tung C.Y. and Tsai J.S. assessed the methodology and validation. Chang C.C. supervised the project and performed the final review and editing. All authors participated in the critical drafting and revision of the article for its intellectual content, and all authors gave final approval of the submitted version.
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Acknowledgement
We sincerely thank all the healthcare professionals who participated in the interviews; their invaluable insights made this study possible. We are also grateful to the National Science and Technology Council, Taiwan, for financial support under project number 113-2410-H-003-106.
Authors' information:
The authors form a multidisciplinary team. Hsiao-Fen Lo, PhD student, actively studying the intersection of spirituality and life and death. Jaw-Shiun Tsai, MD, PhD, is a hospital director with extensive experience in palliative care. Chen-Yin Tung, PhD, is a leading expert in medical education in Taiwan. Chia-Chen Chang, PhD, focuses on spiritual education, offering fresh insights into human knowledge and learning.
Electronic Supplementary Material
Below is the link to the electronic supplementary material
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