Table 3.

Thematic matrix: views of the GPs interviewed concerning spiritual care in palliative care

	Definition of spirituality	Role of religion	Spirituality as a dynamic process
What is spirituality?	Broad vision of spirituality Affirmation of US definition1 Questions about meaning, life after death	Religion is a potential, but not mandatory component of spirituality	Spirituality is variable Older and younger people have different spiritual experiences

	Initiation of spiritual conversations	How?	Setting	Why?
Spiritual history-taking	Initiative taken by GP Initiative taken by patients Making spirituality negotiable by responding to hints from patients Planning end-of-life care as opener of spiritual conversations	Patients determine the conversations Spontaneous timing and course of conversations	Being alone with patients Home visits Spiritual conversations can be initiated anywhere Conversations in terminal care	Is a value Can be a value

	Physician factors	Patient factors	GP–patient relationship factors	Contextual factors
Barriers in spiritual history-taking	Emotions Rational arguments	Emotions Closed attitude Not accepting palliative diagnosis	Role attributed to GP Lack of privacy or intimacy Lack of spiritual language	Western society not familiar with spirituality Superficial society

	Physician factors	Patient factors	GP–patient relationship factors	Contextual factors
Facilitating factors in spiritual history-taking	Practice experience Being receptive for patients spirituality Mental preparation for a spiritual conversation	Accepting palliative diagnosis Symptom control	Trusting relationship Respect for unique person GP showing human side	Positive influence of family

	GP as spiritual care giver	Threats in spiritual care	Influence on GP
Spiritual care	GP should be a spiritual care giver GP is not required to be a education spiritual care giver Referral to patient’s relatives or professional spiritual care giver	Lack of time Lack of formal spiritual	Rewarding experience Stressful experience