Exploring the hidden before the end: A phenomenological analysis of forgiveness at the end of life among spiritual caregivers.

Abstract

While forgiveness is linked to emotional and physical benefits at the end of life, little is known about how it is understood or addressed by palliative care professionals. Spiritual caregivers, especially in the Netherlands where formal training is growing, may be well-placed to support such conversations, yet their experiences remain underexplored. To explore how Dutch spiritual caregivers perceive and engage with forgiveness at the end of life, including their potential role in facilitating it. This qualitative study used interpretative phenomenological analysis. In-person, semi-structured interviews were analyzed through reflexive thematic analysis. Eleven interviews were conducted with spiritual caregivers from various hospitals across the Netherlands. Interviews took place in hospitals (<i>n</i> = 6), caregivers' homes (<i>n</i> = 2), via Zoom (<i>n</i> = 2), and by phone (<i>n</i> = 1). Due to conceptual differences related to religious and existential backgrounds, nine interviews were finally selected, focusing on the Christian (Catholic <i>n</i> = 4, Protestant <i>n</i> = 4) and non-affiliated (<i>n</i> = 1) ones. Four main themes emerged: (1) concept of forgiveness according to spiritual caregivers; (2) forgiveness as a theme in the conversation between spiritual caregivers and patients, (3) barriers to talking about forgiveness, and (4) the role of spiritual caregivers in addressing forgiveness. Spiritual caregivers acknowledged forgiveness as beneficial but noted challenges-logistical, cultural, and personal-that make direct conversations difficult. As a result, they often adopt a subtle, indirect approach, using rituals and attentive listening to address forgiveness with patients nearing the end of life.