Rituals in palliative care: an integrative review

Rituals are a universal phenomenon in human culture, which act to support and process transitions and challenges. The objective of this integrative review was to synthesise the evidence for the types of rituals, whether traditional, religious or idiosyncratic, that are used by people witnessing or experiencing the dying process, as well as the specific elements and impacts of such activities.

This review used methodology proposed by Whittemore and Knafl⁹ and searched the following databases: Web of Science, Medline, PubMed, CINAHL and EMBASE. Articles were limited to qualitative and quantitative studies in English with keywords in the title or abstract and no limits on year of publication. Of the 482 studies identified, 34 were included and categorised as rituals conducted for patients, staff or patients and staff together. Data analysis involved deductive content analysis and a narrative approach to summarise the synthesised results.

Two distinct ritual patterns that differed in purpose and impacts were identified: rituals within coherent religious or cultural frameworks and personally-derived idiosyncratic rituals. Traditional religious and cultural rituals supported passage from life to death and affirmed identity and belonging, while idiosyncratic rituals affirmed individuality and provided psychosocial and physiological support.

Rituals continue to be defined ambiguously and evolve organically to signify the significance of death. Rituals support a 'good death' as unification with a divine force or through honouring values of individualism, humanism and existentialism. The level of impact of rituals depends on conscious use of collectively understood symbolism for context and participants.