Conversation as a Bridging Tool in End of Life Spiritual Care

The Case of Hong Kong


  • Caroline Yih University of Aberdeen



end of life, spiritual care, holistic end of life care, Hong Kong chaplaincy


End of life care is a holistic approach to the provision of treatment and support for dying patients and families. It focuses on four dimensions: the physical, social, psychological and spiritual. In relation to the latter dimension, healthcare professionals are joined by spiritual care specialists, namely, chaplains. Even though great strides have been made towards holistic provision, chaplains remain marginalized. This article focuses on one essential yet often overlooked tool utilized by chaplains in spiritual care, and it showcases the fundamental importance of the practice in holistic end of life delivery, using Hong Kong chaplaincy as a case study: conversation as a bridging tool. Specifically, I focus on three distinctive aspects: conversation to overcome the challenges created by the chaplain’s role ambiguity, conversation to bridge cultural and linguistic limitations, and conversation to address death anxieties through narrational encounters, including conversations about dreams. Despite the value of conversation in end of life care, this article illustrates that the wider hospital care team has a strong negative perception of chaplains’ use of conversation, contributing to the marginalized status of chaplains.

Author Biography

  • Caroline Yih, University of Aberdeen

    Caroline Yih completed her PhD at the University of Aberdeen. The title of her thesis is “Practising in an inhospitable land: The lived experience of Chaplains in Hong Kong hospitals”. Caroline was a hospital pharmacist before completing her MDiv and has been working as a Palliative Care Chaplain for five years. Her ongoing post-doctoral research focuses on trauma and disenfranchisement. 


Baugher, J. E. (2008). Facing death: Buddhist and Western hospice approaches. Symbolic Interaction, 31(3), 259–284.

Beckstrand, R. L., Callister, L. C., & Kirchhoff, K. T. (2006). Providing a “good death”: Critical care nurses’ suggestions for improving end-of-life care. American Journal of Critical Care, 15(1), 38–45.

Bond, M. H. (1993). Emotions and their expression in Chinese culture. Journal of Nonverbal Behavior, 17(4), 245–262.

Boulay, S. du (1984). Cicely Saunders: The founder of the modern hospice movement. New York: Amaryllis Press.

Brennan, F. (2013). Holistic palliative care approach – physical, spiritual, religious and psychological needs. Nephrology (Carlton).

Bruce, A., Schreiber, R., Petrovskaya, O., & Boston, P. (2011). Longing for ground in a ground (less) world: A qualitative inquiry of existential suffering. BMC Nursing, 10(1), 1–9.

Bulkeley, K. (2000). Dream interpretation: Practical methods for pastoral care and counselling. Pastoral Psychology, 49(2), 95–104.

Callanan, M., & Kelley, P. (1992). Final gifts: Understanding the special awareness, needs and communications of the dying. New York: Poseidon Press.

Charon, R. (2008). Narrative medicine: Honoring the stories of illness. Oxford: Oxford University Press.

Chen, S. X., Cheung, F. M., Bond, M. H., & Leung, J. P. (2005). Decomposing the construct of ambivalence over emotional expression in a Chinese cultural context. European Journal of Personality, 19(3), 185–204.

Cheung, W. S., & Ho, S. (2006). Death metaphors in Chinese. In C. L. W. Chan & A. Y. M. Chow (Eds.), Death, dying and bereavement: A Hong Kong Chinese experience (pp. 117–126). Hong Kong: Hong Kong University Press.

Chow, A. Y. M., Lo, J. S. F., & Li, W. W. Y. (2006). Care for Chinese families with patients facing impending death. In C. L. W. Chan & A. Y. M. Chow (Eds.), Death, dying and bereavement: A Hong Kong Chinese experience (pp. 225–240). Hong Kong: Hong Kong University Press.

Chow, M. L. (2015). The influence of clinical pastoral education on Christian seminarians in Hong Kong (publication no. 1224181220). Doctoral dissertation, Acadia University.

Cohen, J. (2018). How is chaplaincy marginalized – by our faith communities and by our institutions and can we change it? Religions, 9(1), 24.

Cohen, S. R., Mount, B. M., Tomas, J. J., & Mount, L. F. (1996). Existential well-being is an important determinant of quality of life: Evidence from the McGill quality of life questionnaire. Cancer: Interdisciplinary International Journal of the American Cancer Society, 77(3), 576–586.<576::AID-CNCR22>3.0.CO;2-0

Cohen, S. R., Boston, P., Mount, B. M., & Porterfield, P. (2001). Changes in quality of life following admission to palliative care units. Palliative Medicine, 15(5), 363–371.

DasGupta, S., Irvine, C., & Spiegel, M. (2009). The possibilities of narrative palliative care medicine: “Giving sorrow words”. In Y. Gunaratnam and D. Oliviere (Eds.), Narrative and stories in health care: Illness, dying and bereavement (pp. 33–46). Oxford: Oxford University Press.

Eatough, V., & Smith, J. A. (2008). Interpretative phenomenological analysis. In C. Willig & W. Stainton Rogers (Eds.), The Sage handbook of qualitative research in psychology (pp. 179–194). London: Sage Publications.

Eisenberg, L. (1981). The physician as interpreter: Ascribing meaning to the illness experience. Comprehensive Psychiatry, 22(3), 239–248.

Ellis, C. (2000). Negotiating terminal illness: Communication, collusion, and coalition in caregiving. In J. H. Harvey & E. D. Miller (Eds.), Loss and trauma: General and close relationship perspectives (1st ed., pp. 296–306). Philadelphia: Brunner-Routledge.

Florian, V., & Snowden, L. R. (1989). Fear of personal death and positive life regard: A study of different ethnic and religious-affiliated American college students. Journal of Cross-Cultural Psychology, 20(1), 64–79.

Foster, E. (2014). Communicating at the end of life: Finding magic in the mundane. New York: Routledge.

Foucault, M. (1973). The birth of the clinic: An archaeology of medical perception (trans. A. M. Sheridan Smith). New York: Pantheon Books.

Frank, A. W. (2013). The wounded storyteller: Body, illness, and ethics. Chicago: University of Chicago Press. doi:10.7208/Chicago/978022606.001.0001

Gao, G., & Ting-Toomey, S. (1998). Communicating effectively with the Chinese. Thousand Oaks: Sage Publications.

George, H. Gallup International Institute (1997). Spiritual beliefs and the dying process: A report on a national survey. Princeton: George H. Gallup International Institute.

Henoch, I., & Danielson, E. (2009). Existential concerns among patients with cancer and interventions to meet them: An integrative literature review. Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 18(3), 225–236.

Hermann, C. P. (2007). The degree to which spiritual needs of patients near the end of life are met. Oncology Nursing Forum, 34(1), 70–78.

Hirst, S. P., & McKiel, E. (1997). “As a young girl, I …” The benefits of narrational relationships in the lives of older residents. Journal of Psychosocial Nursing and Mental Health Services, 35(5), 40–43.

Ho, R. T., Chan, C. L., & Ho, S. M. (2004). Emotional control in Chinese female cancer survivors. Psycho-Oncology, 13(11), 808–817.

Ho, S. M., Chow, A. Y., Chan, C. L., & Tsui, Y. K. (2002). The assessment of grief among Hong Kong Chinese: A preliminary report. Death Studies, 26(2), 91–98.

Ho, S. M., Ho, J. W., Chan, C. L., Kwan, K., & Tsui, Y. K. (2003). Decisional consideration of hereditary colon cancer genetic test results among Hong Kong Chinese adults. Cancer Epidemiology and Prevention Biomarkers, 12(5), 426–432. PMID: 12750237.

Hong Kong SAR Government Hospital Authority (2017). Strategic service framework for palliative care.

Keeley, M. P. (2007). Turning toward death together: The functions of messages during final conversations in close relationships. Journal of Social and Personal Relationships, 24(2), 225–253.

Keeley, M. P., & Yingling, J. (2007). Final conversations: Helping the living and the dying talk to each other. Acton: VanderWyk & Burnham.

Kleinman, A. (2012). Caregiving as moral experience. Lancet, 380(9853), 1550–1551.

Koltko-Rivera, M. E. (2006). Rediscovering the later version of Maslow’s hierarchy of needs: Self-transcendence and opportunities for theory, research, and unification. Review of General Psychology. 10(4), 302–317.

Kübler-Ross, E. (1986). Death: The final stage of growth. New York: Simon & Schuster.

Leung, J. P. (1998). Emotions and mental health in Chinese people. Journal of Child and Family Studies, 7(2), 115–118.

Luk, L. A. (2019). Are hospital chaplains under stress in Hong Kong? Preliminary results from a pilot study. Religions, 10(5), 325.

McGrath, P. (1997). Putting spirituality on the agenda: Hospice research findings on the “ignored” dimension. Hospice Journal, 12(4), 1–14.

McGrath, P. (2002). Creating a language for “spiritual pain” through research: A beginning. Supportive Care in Cancer, 10(8), 637–664.

McLennan, J., Stewart, C. A., Pollard, A. C., Anastasios, J., Akande, A., & McLennan, L. J. (1997). Using metaphors to assess anticipatory perceptions of personal death. Journal of Psychology, 131(3), 333–342.

McQuellon, R. P., & Cowan, M. A. (2000). Turning toward death together: Conversation in mortal time. American Journal of Hospice and Palliative Medicine, 17(5), 312–318.

Moustakas, C. (1994). Phenomenological research methods. Thousand Oaks: Sage Publications.

Myers, G. E. (2003). Restoration or transformation? Choosing ritual strategies for end-of-life care. Mortality, 8(4), 372–387.

Nussbaum, J. F., Pecchioni, L. L., Robinson, J. D., & Thompson, T. L. (2000). Communication and aging. New York: Routledge.

O’Connor, M., Davis, M. P., & Abernethy, A. (2010). Language, discourse and meaning in palliative medicine. Progress in Palliative Care, 18(2), 66–71.

Pattison, S. (2020). Conversations in practical theology. Practical Theology, 13(1–2), 87–94.

Peat, G., Rodriguez, A., & Smith, J. (2019). Interpretive phenomenological analysis applied to healthcare research. Evidence-Based Nursing, 22(1), 7–9.

Pennebaker, J. W. (1985). Traumatic experience and psychosomatic disease: Exploring the roles of behavioural inhibition, obsession, and confiding. Canadian Psychology/Psychologie Canadienne, 26(2), 82–95.

Puchalski, C. M. (2001). The role of spirituality in health care. Baylor University Medical Center Proceedings, 14(4), 352–357.

Puchalski, C. M. (2002). Spirituality and end-of-life care: a time for listening and caring. Journal of Palliative Medicine, 5(2), 289–294.

Saunders, C. M. (1978). The management of terminal disease. London: Edward Arnold.

Schuhmann, C., & Damen, A. (2018). Representing the good: Pastoral care in a secular age. Pastoral Psychology, 67(4), 405–417.

Schumaker, J. F., Barraclough, R. A., & Vagg, L. M. (1988). Death anxiety in Malaysian and Australian university students. Journal of Social Psychology, 128(1), 41–47.

Shames, L., & Barton, P. (2003). Not fade away: A short life well lived. Emmaus: Rodale.

Soeken, K. L., & Carson, V. J. (1986). Study measures nurses’ attitudes about providing spiritual care. Health Progress, 67(3), 52–55. PMID: 10275908

Stranahan, S. (2011). The use of dreams in spiritual care. Journal of Health Care Chaplaincy, 18, 87–94.

Sulmasy, D. P. (2002). A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist, 42, 24–33.

Wilson, B., & Ryan, A. S. (1990). Working with the terminally ill Chinese-American patient. In J. K. Parry (Ed.), Social working practice with the terminally ill: A transcultural perspective (pp. 145–158). Charles C. Thomas.

Wong, E. L. Y., Kiang, N., Chung, R. Y. N., Lau, J., Chau, P. Y. K., Wong, S. Y. S., … & Yeoh, E. K. (2020). Quality of palliative and end-of-life care in Hong Kong: Perspectives of healthcare providers. International Journal of Environmental Research and Public Health, 17(14), 5130.

Wu, A. M., Tang, C. S., & Kwok, T. C. (2002). Death anxiety among Chinese elderly people in Hong Kong. Journal of Aging and Health, 14(1), 42–56.

Yih, C. (2021). The practice of chaplaincy within the delivery of end of life care in Hong Kong public hospitals. Doctoral dissertation, University of Aberdeen.

Youngblood, P. W. (2018). The problem of global interfaith chaplaincy: The case of Hong Kong. International Journal of Asian Christianity, 1(2), 329–345.

Zhou, L. (2018). Study on medical colonization in “People like that are the only people here: Canonical babbling in peed onk”. In Irinia Solovjeva & Yong Zhang (Eds.), International Conference on Contemporary Education, Social Sciences and Ecological Studies (pp. 447–450). Dordrecht: Atlantis Press.



How to Cite

Yih, C. (2022). Conversation as a Bridging Tool in End of Life Spiritual Care: The Case of Hong Kong. Health and Social Care Chaplaincy, 11(1), 8–23.