SynthesisBMC palliative care2026
Barriers and enablers of implementing spiritual care at the end of life: a mixed-methods systematic review using the theoretical domains framework.
Synthesis in BMC palliative care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThis systematic review aims to identify and synthesize current evidence on perceived barriers and enablers of implementing spiritual care in palliative care to end-of-life patients using the Theoretical Domains Framework (TDF).
methodsReviewer screened records identified from six electronic databases—PubMed, Embase, CLNAHL, Web of Science, ProQuest and Cochrane library-and published before July 2025. Qualitative and quantitative records reporting data on the perspectives of patients, and healthcare providers towards implementing Spiritual Care at the end of life were included. Using a mixed methods appraisal tool, the quality of the included studies was assessed. Barriers and enablers were identified and then coded into domains of the theoretical domains framework (TDF) using a combination of deductive and inductive qualitative analysis.
resultsTwenty-seven studies were included 13 quantitative, 7 qualitative and 7mixed-method studies. Patient perspectives were reported in 7 studies, while healthcare providers’ viewpoints were documented in 23 studies. We identified barriers and enablers in the majority of TDF domains and two other themes that did not fit into the TDF: “Providers’ Spiritual Self-Care and Reflection” and “Provider-patient’ Longitudinal relationships”. There are 16 sub-themes related to barrier factors and 16 sub-themes related to enabler factors. No relevant barriers or enablers were identified in two of the 14 TDF domains-Memory, Attention and Decision Process, and Behavior Regulation, respectively.
conclusionsThis systematic review identified barriers and enablers of implementing spiritual care in palliative care to end-of-life patients. Successful implementation requires a paradigm shift from "end-of-life spiritual rescue" toward longitudinal spiritual integration. Clinicians must recognize their role as behavioral catalysts who bridge the gap between patient latent needs and perceived professional boundaries. Policy efforts should focus on multidisciplinary training, the structural normalization of spiritual metrics in clinical systems, and fostering relational continuity within healthcare delivery models.
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