P-154 The value of silence in end-of-life spiritual care: connexion, companionship, potential for change

Abstract

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.

Toward a psychology of silence.

“…In a phenomenological study of the experience of “embodied transcendental empathy” of therapists with their clients, Macecevic (2008) found results consistent with those of Siegel (2013) including an essential breakthrough or transformation for clients as well as the occurrence of extraordinary, sacred, and/or transcendent experiences in the therapeutic encounter. Bassett, Bingley, and Brearly (2017) investigated the use of silence by expressively compassionate counselors and palliative care chaplains in the context of end-of-life spiritual care. They found that silence has the potential to enable change by creating opportunities for the acknowledgment, expression, and articulation of truth, and that this led to greater acceptance, restoration of emotional stability, and peace in the patients served in this way.…”