Maeva CUNIAH

The notions of "spiritual needs", "spiritual suffering" or "spiritual well-being" are increasingly being introduced into the field of healthcare, notably through palliative care, which claims a holistic approach to the person. A great deal of research has shown that patients with life-threatening illnesses have expectations that transcend the physical, psychic and social spheres. Indeed, the encounter with these patients faced with serious illness, suffering and death cannot take place without a permanent openness to questioning the meaning of existence. Often equated with religion, spirituality has long been neglected in medical practice, giving rise to a feeling of incompetence on the part of caregivers (a notion opposed to the biomedical model and the technical nature of care, fear of proselytizing, secularization of society, etc.).in recent years, however, there has been a real shift in the way in which the spiritual needs of people with incurable illnesses are taken into account, thanks in part to the humanistic approach of palliative care, which aims to relieve physical pain, but also to take account of psychological, social and spiritual suffering. The aim of this doctoral project is to promote the dissemination and sharing of this palliative culture. Four studies were carried out, highlighting: 1) the value of spirituality and its potential effects on the quality of life of palliative care patients in a systematic review (Study 1), which showed a positive effect between spirituality and the quality of life of palliative care patients. The majority of included studies (8 out of 10) reported that spirituality enabled patients to cope with their illness, preserve social relationships, maintain hope and find meaning in their lives. Nevertheless, the benefits observed must be viewed with caution, and further research is needed to verify our findings; 2) professionals' representations of spirituality (meaning of life, transcendence, identity, values) working in palliative care and the value of this dimension in accompaniment (Study 2). Focus group data indicate that integrating the spiritual dimension into the overall approach to care seems to be recommended by professionals, and requires training, interdisciplinary collaboration, respect for the singularity of others, openness, presence, listening and commitment; 4 3) palliative care patients' views on taking their spiritual dimension into account and integrating it into support (Study 3). The results show that patients are in favor of specific, professional support that recognizes their spiritual needs and expectations. The interviews revealed that spirituality is a complex issue, generally defined as a search for meaning, recognition and social interaction; 4) validation in French of a scale measuring fear of death (CL-FODS révisée) with 590 participants (Study 4). The French version has satisfactory psychometric qualities (construct validity, convergent, concurrent, internal reliability) and could in future be used in specific clinical contexts such as palliative care. If spirituality remains a difficult concept for professionals and patients to elaborate and address, the data obtained invite us to include this dimension in the field of care to facilitate a better overall approach to patients by proposing tools to accompany spirituality in the context of the end of life.