Critical appraise of inter-professional clinical practice guidelines for the spiritual care of patients with chronic illness: a systematic review.

backgroundClinical guidelines for spiritual care play a crucial role in ensuring standardized care for patients with chronic illnesses. The development of these guidelines is complex and necessitates comprehensive evidence; therefore, a critical appraisal of existing guidelines is instrumental in summarizing and aiding the integration of evidence-based knowledge for healthcare providers, as well as in adapting clinical guidelines to local contexts. This study was designed and executed to address the question: "What constitutes the structure and content of an appropriate guideline for inter-professional spiritual care for patients with chronic illness?"

methodThis systematic review involved searching the databases of esteemed guideline developers and registrants, including the Agency for Healthcare Research and Quality, the International Guidelines Network, the National Institute for Health and Care Excellence, the National Guidelines Clearinghouse, the New Zealand Department of Health, the Scottish Inter-University Guidelines Network, the National Health Service, the Royal Flying Doctor Service, the National Consensus Project, the Comprehensive Cancer Centre/Netherlands, and various international databases such as Science Direct, PubMed, ProQuest, CINAHL, the Cochrane Library, Elsevier, and MEDLINE, covering the period from 2007 to 2024. The primary outcome of this research is the evaluated quality of the clinical guidelines. The quality of the guidelines that satisfied the inclusion criteria was evaluated using the Assessment of Guidelines, Research, and Evaluation II (AGREE II) tool by two teams of five inter-professional experts from fields including medicine, nursing, psychology, and spiritual counseling, along with two independent raters. Descriptive statistics were employed to quantify the quality of the guidelines. The secondary outcomes of this study included the titles of the clinical recommendations provided. Any contradictory or duplicate recommendations across the guidelines were compared. A narrative synthesis was also provided to elucidate the findings associated with each guideline.

resultsThis study critically evaluated 8 clinical guidelines. Utilizing the AGREE tool for the assessment, the guidelines titled Spiritual Care Matters, Spiritual Care guideline, and Religious and Spiritual Care of Patients achieved acceptable scores across all 6 domains of the tool and are strongly endorsed. The content review of these guidelines highlighted similar care practices, including methods for gathering a spiritual history, ways to offer spiritual support to patients through family and healthcare teams, effective communication principles with patients, and assisting patients in coping with grief and loss, emphasizing the importance of collaboration among medical, nursing, psychological, and spiritual professionals. The differing care approaches primarily focused on the religious aspects of patient care.

conclusionThe existing guidelines for inter-professional spiritual care for patients with chronic illnesses exhibited variability in methodological quality and fell short of the required standards for rigor in their formulation. Additionally, there was a lack of cohesive guidance on various aspects of spiritual care. There is a pressing need for enhanced efforts to deliver clear, high-quality evidence and greater transparency among guideline developers, particularly regarding the intricate and abstract nature of spiritual care.