The review, led by Alan Roger Santos-Silva of the Piracicaba Dental School at the University of Campinas in Brazil, together with colleagues from the University of Toronto, the Federal University of Juiz de Fora, City of Hope Comprehensive Cancer Center, and Cedars-Sinai, synthesizes evidence on structured spiritual history-taking and its relevance to oral oncology. The authors ground their argument in a definition that the World Health Organization has formally endorsed: spirituality is a dimension of health. In clinical terms, researchers describe it as the way individuals seek and express meaning and purpose, and the way they experience connectedness to the moment, to themselves, to others, to nature, and to the significant or sacred. Crucially, this framing does not require any religious belief. A patient who finds meaning in family, in art, or in nature has a spiritual life that can shape how they endure treatment.

Why does this matter so much in oral cancer specifically? The review catalogs the cascade of complications that follow diagnosis and therapy. Tumor biology, surgical resections, radiation-induced toxicities, and the side effects of chemotherapy, targeted therapy, and immunotherapy can produce facial disfigurement, speech impairment, dysphagia, chronic pain, taste loss, and salivary dysfunction. These physical outcomes ripple directly into body image, autonomy, and quality of life. Patients frequently respond with emotional distress, social withdrawal, fear of recurrence, financial strain, and existential uncertainty, which clinicians may observe as tears, silence, expressions of hopelessness, or outright resistance to treatment. Prior studies cited in the review have documented demoralization, loneliness, and even suicidal ideation among oral cancer inpatients, with spiritual needs emerging as a significant correlate of these outcomes.

The core practical proposal of the review is the spiritual history: a structured conversation designed to identify a patient’s beliefs, values, and coping resources. Several validated frameworks exist, including FICA, HOPE, SPIRIT, FAITH, a tool endorsed by the Royal College of Psychiatrists, and the Patient-Centered Clinical Method. Among these, FICA and HOPE stand out as the most widely used, validated, and adaptable across healthcare environments. FICA, which prompts clinicians to explore Faith or belief, the Importance of that belief, the individual’s spiritual Community, and how they wish those beliefs Addressed in care, takes only about two minutes to administer. HOPE, developed by Anandarajah and Hight, similarly guides clinicians through questions about sources of hope, organized religion, personal spirituality and practices, and how these should be integrated into medical decision-making. The tools provide structured pathways for clinicians to explore spirituality respectfully and efficiently within professional boundaries.

The evidence that such conversations actually help is more robust than many clinicians might assume. In a systematic review cited by the authors, the majority of patient samples considered it appropriate for healthcare professionals to ask about spiritual needs in at least some circumstances, and a cross-sectional study found approval rates for specific spiritual history questions ranging from 94.0 percent to 99.8 percent. Integration of spiritual inquiry into clinical encounters has been associated with improved provider-patient relationships, increased trust, and greater satisfaction with care. In an intervention study, patients who received a spiritual intervention over three weeks showed a significantly greater reduction in depressive symptoms and greater improvement in quality of life compared with controls, and also reported a more positive perception of the interpersonal care provided by their physician.

Randomized trial data add further weight. In a cluster-randomized trial, patients who reported that spirituality played an important role in their lives showed a 6.2-point difference in mental well-being on the SF-12 mental health subscale compared with the control group, a moderate effect size, although the primary outcome of health-related self-efficacy showed no significant benefit. In another randomized controlled trial, patients who underwent spiritual assessment attended significantly more clinical appointments during a three-month follow-up period: only 8 percent of patients in the intervention group missed appointments, compared with 26 percent in the control group. For oncology teams, where missed radiation fractions and skipped follow-up visits can directly compromise survival, a two-minute conversation that triples attendance is a striking result. The review also notes that brief conversations acknowledging spiritual concerns can foster emotional support and signal clinician openness without causing distress or discomfort, addressing a common fear that raising the topic might upset patients.

So why is spiritual assessment still so rare in oral oncology? The review identifies a familiar cluster of barriers: insufficient time, lack of knowledge and training, discomfort discussing spiritual topics, and uncertainty about professional boundaries. These obstacles may appear early in the care pathway, because some professionals, particularly dentists, often lack specific training in psychosocial care, a gap the authors suggest may extend to other members of the healthcare team as well. The problem is compounded by the fact that dentists and oral medicine specialists are frequently the first clinicians to encounter oral cancer patients and continue caring for them throughout and after treatment, positioning them ideally to notice spiritual distress but rarely equipped to respond to it.

The good news, according to the review, is that these skills are teachable. Educational interventions including role-play exercises, standardized patient interactions, and curriculum modules have increased healthcare providers’ confidence, communication skills, and the feasibility of spiritual assessment. Spiritual care competencies can be embedded in undergraduate and postgraduate programs as well as continuing education, with demonstrated improvements in knowledge retention and behavioral application. A systematic review of teaching spirituality to medical students and a scoping review of educational strategies in nursing and healthcare both support the conclusion that targeted training produces measurable gains. Expanding such initiatives into health training curricula, the authors argue, would equip clinicians to address spiritual concerns confidently and ethically within their scope of care.

The multiprofessional dimension is central to the authors’ vision. Dentists and oral medicine specialists collaborate with physicians, nurses, nutritionists, and psycho-oncology teams, any of whom may encounter spiritual concerns and emotional distress during patient care. A documented spiritual history can facilitate appropriate referrals to chaplaincy or mental health services, support shared decision-making, and align treatment plans with patient values. As supportive cancer care evolves toward multidisciplinary, patient-centered models, the review contends that all team members should be prepared to identify and respectfully address spiritual needs that may affect adherence, coping, and quality of life. In this model, the spiritual history functions less as a standalone intervention and more as a connective tissue that links the dental chair to the wider supportive care network.

The review’s conclusions are measured but actionable. There is evidence supporting structured frameworks for obtaining a spiritual history in clinical practice; these strategies are well accepted by patients, improve communication and satisfaction, and enhance clinician preparedness to deliver holistic care. Incorporating spiritual assessment into multiprofessional practice, beginning with oral medicine and continuing throughout the care pathway, may strengthen supportive oncology care, promote cultural sensitivity, and address a frequently unmet dimension of patient well-being. The recommended actions are concrete: adopt spiritual history-taking tools such as FICA and HOPE in routine oral oncology practice, and expand targeted education to build clinician skills and confidence. For a disease that attacks identity as much as tissue, the review suggests that healing may sometimes begin with a question that takes two minutes to ask.

Subject of Research: Spiritual history-taking in supportive care for oral cancer patients

Article Title: Taking a spiritual history in the oral oncology setting

Article References: Santos-Silva, A. R., Magalhaes, M., Calderipe, C. B., Lopes, M. A., Ávila-Pires, E. V., & Epstein, J. B. (2026). Taking a spiritual history in the oral oncology setting. Supportive Care in Cancer, 34(10), Article 989. https://doi.org/10.1007/s00520-026-11215-7

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11215-7

Keywords: oral cancer, spirituality, spiritual history, FICA tool, HOPE questions, supportive care, palliative care, dentistry, holistic care, patient-centered care, multiprofessional teams, health professional education