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Spirituality Concern Toward Patients in Hospice Care during COVID-19 Pandemic in China

Tension, anxiety, or fear spread all over the world during COVID-19 pandemic. How health professionals provide terminally ill patients with humanistic care to deal with fear is worth consideration. A more abundant spirituality concern in the body-mind-spirit care mode on patients in hospice care is appied in our practice.


Spirituality Concern Toward Patients in Hospice Care during COVID-19 Pandemic in China
We read with great interest the article titled "Impact of COVID-19 on Mental Health of Palliative Care Professionals and Services: A Mixed-Methods Survey Study." 1 It is true that tension, anxiety, or fear spread all over the world during COVID-19 pandemic. Many survey studies, including research from China, indicate that fear of death transmits not only among patients but also among health professionals. [2][3][4][5] Sadly, from the current situation, this tension, anxiety, or fear does not cushion with the passage of time.
Looking back to the past 2 years, everything seems like a separated world. During the early months of 2020, China's governments at all levels were forced to grapple with the recent pandemic by the spread of new coronavirus disease and the subsequent sudden increase in death rates, which constituted a huge and unprecedented public health concern and challenge. As the saying goes, a grain of ash of the times, falling on one's head, is a mountain. Here, such a grain of ash is COVID-19 pandemic and such a mountain is death. By December 22, 2021, although about 0.84 billion vaccine doses have been administered, the daily confirmed cases continued to increase. This global threat has led to more than 0.27 billion confirmed cases, including over 5.3 million deaths. 6 To make it worse, the B.1.1.529 (Omicron) variant of SARS-CoV-2 spread from its origin South Africa, and this variant is more contagious than previous variants. 7 Death usually comes unexpectedly. Nobody lives forever. Health professionals in hospice care are already used to working with populations experiencing death, or more precisely, to practice in death environment. However, more challenge is confronted by health professionals during COVID-19 pandemic.
How they provide terminally ill patients with humanistic care to deal with fear is worth consideration.
Before the COVID-19 pandemic, a body-mind-spirit care mode on patients in hospice care is applied in our practice. Briefly, we provide all necessary pain management therapy and basic energy consumption and give a comprehensive psychological care for mind. As for spirit care, frankly speaking, no much work can be done, since many Chinese people are atheists. They have no idea of eternal life, heaven, and paradise. In addition, as China has its own peculiar character in death sense or view of death, death education is offered little even in hospice care ward.
Looking around the world, compared with Western countries, the most stringent epidemic prevention and control measures have been taken so far by China government. Correspondingly, most Chinese people have a high degree of cooperation with the quarantining measures. From the early stage of the pandemic to the current Omicron variant time, they are so orderly and isolated consciously as required in front of the pandemic. Definitely, it produces some question for terminal care patients in hospice care ward. For example, under the no-visiting policy during the pandemic, they are not allowed to be visited by family members as before. They worry about not only being infected by new coronavirus, but worry about a lonely death without presence of family members.
In this case, we encourage them communicate with their family members with video chat as long as possible. We increase the frequency of ward-rounds. More communication and ward-rounds effectively reduce their fear, uneasiness, anxiety, complaint, concern, etc.
The last but most difficult and tricky thing is the care for spirit. We understand that, fortunately or unfortunately, most Chinese people have no religious values of death and life. But they fear death. As many Chinese sayings go, "a man dies the way a lamp goes out," "everything is gone after death." Therefore, dream of "immortality" had never ceased.
It is really a soul project and challenge to teach them, who have no real religious beliefs and do not believe in this life and the after-life, to face death calmly and accept death. Fortunately, in purely non-religious terms, there is still some common sense we may share about how to meet the end of life. Keeping from talking about death will not change the fact that we will eventually grow old and leave. What is the true meaning of life? If we try our best to live every day, to live for ourselves, to live the life we want, to do what we want to do, even if we do not achieve our ultimate life goal, such a life should leave no regrets.
With more abundant spirituality concern in the bodymind-spirit care mode, many patients calm down gradually. They face the passing of life peacefully and reconcile with all readily. "Even though the youth is gone and the time is no longer, we could still have a lot of precious memories to remember. If we spend our life like this, what can be regretted and unwilling?" One of our patients commented that "this was very true, everyone should calmly accept the coming last day of life and say goodbye to the world in love and memory."

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.