Barriers and enablers of implementing spiritual care at the end of life: a mixed-methods systematic review using the theoretical domains framework

This systematic review identified barriers and enablers of implementing spiritual care in palliative care to end-of-life patients. Successful implementation requires a paradigm shift from "end-of-life spiritual rescue" toward longitudinal spiritual integration. Clinicians must recognize their role as behavioral catalysts who bridge the gap between patient latent needs and perceived professional boundaries. Policy efforts should focus on multidisciplinary training, the structural normalization of spiritual metrics in clinical systems, and fostering relational continuity within healthcare delivery models.