Spiritual Care When You Are Not Religious

This page is for people with cancer, and their families, who are not religious but are struggling with fear, meaning, or what matters now. It explains what spiritual care is, what the research shows, and what you can ask for.

"Spiritual care" sounds like something for religious people. That is why a great many patients who would benefit from it never ask. What it actually covers is the set of questions cancer raises that medicine has no answer to. What is this for? Have you done enough? What are you frightened of? What do you want the remaining time to look like? And who are you now that you cannot do what you used to?

None of that has to involve religion. The National Cancer Institute's summary says hospital chaplains are trained "to work with a wide range of issues as they arise for patients and to be sensitive to patients' diverse beliefs and concerns."

This is the part most likely to surprise a skeptical reader.

The most widely used tool in this field is the FACIT-Sp. The NCI's own description makes the design choice explicit: "the wording of items does not assume a belief in God. Therefore, it can be comfortably completed by an atheist or agnostic."

NCI reports that people who score high on it are much more likely to report enjoying life despite fatigue or pain, are less likely to desire a hastened death at the end of life, and report better disease-specific and psychosocial adjustment.

A study of breast cancer patients cited by the NCI found that a higher level of meaning and peace went with a decline in depression over twelve months.

NCI's summary reports a study that put patients into three groups: religious, existential, and non-spiritual. It found that "individuals in the third group were far more distressed about their illness and experienced worse adjustment than the other two groups."

NCI reports this finding from one study. It does not say you should acquire a religion. It is a reason to take the questions seriously, and to ask your care team for support if you are struggling.

Here are the options, from talking with someone to choosing nothing at all.

• A chaplain, on your own terms. Open with what you want: that you are not religious, that you would rather not pray, and what you do want to talk about.
• Counseling. If what you are dealing with feels like depression or anxiety, tell your care team and ask what mental health support is available. If you ever feel you might harm yourself, call or text 988 (Suicide and Crisis Lifeline) or call 911 right away.
• Mindfulness or meditation programs. The NCI's patient summary names mindfulness relaxation, such as yoga or meditation, among therapies that have been shown to increase spiritual well-being.
• Creative arts. The same summary names creative arts programs, such as writing, drawing, or music therapy.
• Nothing at all. The summary is unambiguous: "Patients who do not want to discuss spirituality during cancer care should also be able to count on the health care team to respect their wishes." If you want it noted in your record that you do not want religious visitors, ask.

The NCI summary says chaplains are generally available in large medical centers but may not be reliably available in smaller hospitals, and are rarely available in outpatient settings where most cancer care is now delivered. Ask what your center offers.

In an NCI-cited survey of cancer outpatients, a slight majority felt it was appropriate for a doctor to ask about their beliefs and needs. Only one percent reported that this had happened.

Asking is not a sign that things are worse than you thought. It is a common request, and it is often how the conversation starts.

Say someone you love is not religious. Do not arrange religious visitors on their behalf as a kindness. It is a common instinct and it lands badly. That is especially true when the person is too unwell to decline politely.

What tends to help instead is asking what they want the time to be about, and then protecting it. Who do they want to see? What do they want said? What do they want done afterwards? Those are the same questions a chaplain would ask. And you do not need anyone's permission to ask them.