In our study, 12% to 14% of medical professionals received SC training. This finding is congruent with a national physician survey but was surprisingly low for nurses given the presence of SC as part of nursing education guidelines. The availability of SC training has increased recently for physicians,but largely remains voluntary,
self-selecting,and, consequently, infrequent. SC guidelines indicate that nurses and physicians play a necessary role by taking spiritual histories and involving chaplaincy/clergy in patient care when needed. Hence SC training prepares nurses and physicians in taking a spiritual history, prioritizing referral to chaplaincy/clergy when there are spiritual needs, and equipping practitioners in navigating R/S when it intersects with medical decision making. The time required to provide SC is resultantly largely limited to taking a spiritual history, such as Pulchaski’s four-item FICA assessment—a simple R/S screening tool developed for medical professionals.This critical but time limited role is possibly why SC training, and not adequacy of time, strongly predicted SC provision. Consider the example of a highly religious, terminally ill patient with advanced cancer who wishes to continue aggressive therapies because of a belief in miracles. If the clinician does not take a spiritual history, the clinician may never recognize the underlying religious convictions that can impact EOL decision making and hence never incorporate the patient’s R/S beliefs and supporters in care, including EOL discussions. Studies suggest that inclusion of spiritual support in EOL care is associated with better patient QOL, less aggressive interventions, and increased hospice use. Our study suggests that SC training is necessary to advance the inclusion of SC into the care of patients with serious illness and to improve EOL outcomes