Attitudes, Practices, and Barriers to Spiritual Care for Patients With Cancer: An International Survey

Purpose: Spiritual care is recognized by the WHO and consensus frameworks as integral to whole-person oncology care, yet its integration into practice remains limited. Global data on clinician beliefs, practices, and barriers are limited. The aim was to characterize oncology and palliative care clinicians' attitudes, practices, and barriers regarding spiritual care and to examine variation by characteristics such as role, region, age, sex, years of experience, setting, and place of clinical practice. Methods: This was an international cross-sectional online survey (December 23, 2024-February 7, 2025) disseminated through oncology, hematology, and palliative care societies across 55 countries. Eligible participants were health care professionals involved in cancer care (N = 670). Attitudes toward spiritual care, perceived role, frequency of screening and history-taking, preparedness and training, and barriers were examined. Logistic regression models examined associations by discipline and region. Results: Among 670 respondents (mean age, 47.8 years; 432 [64%] women), 380 (57%) practiced in Europe, and 228 (34%) in North America. Most endorsed spiritual care as essential (587 [90%]) and agreed that spiritual distress impairs outcomes (599 [92%]). Yet, only 87 (13%) always conducted screening and 56 (9%) always took a history. Nearly half of oncologists never did either. Compared with palliative care physicians, oncologists had lower odds of endorsing spiritual care as their role (adjusted odds ratio [aOR], 0.27 [95% CI, 0.12 to 0.59]) and performing screening (aOR, 0.44 [95% CI, 0.21 to 0.95]). Training preparedness was lowest among oncologists (mean, 2.7/10) although 86% sought further training. Key barriers were the lack of time (49%) and role ambiguity (46%). Conclusion: Clinicians worldwide affirm the importance of spiritual care, yet systematic provision is limited. Embedding role-appropriate competencies and integrating screening into routine workflows are needed to advance whole-person cancer care.