Experience of silence as an element of care was found in palliative and spiritual care, psychotherapy and counselling supporting existing recognition of the value of silence as a skill and practice. Because silence can present challenges for caregivers, greater understanding may offer benefits for clinical practice.

At the end of life, silence often takes increasing prominence in caregiving encounters. Valued in spiritual and religious traditions, silence lends itself to the spiritual and existential dimensions of healthcare but lack of familiarity with the phenomenon can lead to anxiety or avoidance. Greater understanding of the contribution of silence to care may support professional caregiving practice. This paper reports research that explored the nature, meaning and value of silence in palliative spiritual care. In a two-phase phenomenological approach, data were gathered through self-inquiry and unstructured interviews with 15 palliative care chaplains. A descriptive and hermeneutic analysis facilitated explication of the lived experience to produce an interpretation of essential qualities of silence in this context. 'Spiritual caregiving silence' emerged as a person-centred phenomenon that supports patients and their relatives. It is described as a way of being with another person, complementary to speech and non-verbal communication, which evokes a sense of companionship and connection. The caregiver takes both active and participative roles in the silence to create an accompanied space that allows the other person in the relationship to be with her or himself in a way that may not be possible when alone. This demands engagement and commitment. Silence provides a means of, and a medium for, communication that is beyond the capacity of words and has the potential to enable change. This insight into the specialist experience of chaplains may resonate with the experience of other professional caregivers to stimulate reflection and discussion, and to benefit patient care. KEYWORDSSilence; spiritual care; palliative care; end of life; caregiver

BackgroundAt the end of life silence seems to take increasing prominence in encounters between professional caregivers, patients and their family members but its value as an element of spiritual care has been little explored. Whilst silence lends itself to spiritual and existential dimensions of care, unfamiliarity with the phenomenon can lead to anxiety or avoidance. Greater understanding could support caregiving practice.AimTo gain deeper understanding of silence as an element of palliative spiritual caregiving.MethodsA two-phase phenomenological approach, using heuristic inquiry and hermeneutic phenomenology. Data were gathered through self-inquiry and unstructured interviews with 15 palliative care chaplains. A descriptive and hermeneutic analysis facilitated explication of the lived experience to produce an interpretation of the nature, meaning and value of silence in end-of-life care.Results‘Spiritual caregiving silence’ emerged as a way of being with another person, complementary to speech and non-verbal communication, in which the caregiver takes both an active and participative role. This demands engagement and commitment. It evokes a sense of companionship and connexion and creates accompanied space that allows the other person to be with themselves in a way that they may not be able to be alone. It provides a means of and a medium for communication that is beyond the capacity of words and a supportive environment when words fail. Silence has the potential to enable change by creating opportunity for acknowledgment, expression and articulation of truth. Chaplains observed outcomes of acceptance, restoration and peace.ConclusionsSpiritual caregiving silence is a person-centred phenomenon that supports the wellbeing of patients at the end of life and their family members. Understanding has been deepened through the interpretive and reflexive phenomenological process drawing upon cross-disciplinary knowledge and specialist experience. Findings may find resonance with other caregivers, to stimulate further reflection and discussion and support clinical practice.

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