Bridging Faith and Care: The Role of Biopsychosociospiritual Competencies in Palliative Care Among Clergy in Nairobi, Kenya

Bridging Faith and Care: The Role of Biopsychosociospiritual Competencies in Palliative Care Among Clergy in Nairobi, Kenya

Moses Muturi Karanja, Rev. Dr. Joyzy Egunjobi, Elijah Macharia Ndung’u

Department of Counselling Psychology, The Catholic University of Eastern Africa

DOI: https://dx.doi.org/10.47772/IJRISS.2025.909000329

Received: 04 September 2025; Accepted: 12 September 2025; Published: 10 October 2025

ABSTRACT

Background: Clergy frequently accompany patients and families in end-of-life care, yet their specific competencies in palliative care contexts remain underexplored in Africa. Understanding these competencies is critical for strengthening holistic, patient-centred care. Aim: To examine the self-reported competencies of Catholic clergy in palliative care across the biological, psychological, social, and spiritual (BPSS) domains and their influence on perceived effectiveness. Methods: A mixed-methods study involving 197 Catholic clergy employed a structured BPSS-based questionnaire and in-depth interviews. Quantitative data were analysed descriptively and with regression modelling, while qualitative responses were thematically analysed. Results: Clergy reported highest competence in the spiritual domain, followed by psychological and social, with biological competencies lowest. Spiritual and psychological competencies emerged as the strongest predictors of perceived effectiveness. Qualitative narratives highlighted clergy’s transformative role in spiritual accompaniment and presence, but also barriers in collaboration with healthcare professionals. Conclusion: Catholic clergy play a vital role in palliative care, particularly in addressing spiritual and emotional distress. Strengthening Clinical Pastoral Education (CPE) and enhancing clergy–healthcare partnerships are recommended to improve holistic end-of-life care.

Keywords: Catholic clergy, palliative care, competencies, BPSS model, Clinical Pastoral Education (CPE), end-of-life care, holistic care, African Cosmologies, Ubuntu, Utu

INTRODUCTION

The experience of serious illness, particularly at the end of life, extends far beyond the physical manifestations of disease. While modern medicine has achieved remarkable success in controlling physiological conditions, shrinking tumours, regulating cardiovascular function, and managing chronic illnesses, patients with terminal or life-limiting conditions often continue to endure suffering that is invisible to diagnostic tools (Steinhauser et al., 2000; Breitbart et al., 2015). In these critical moments, questions shift from “What medication can I take?” to existential concerns, including the search for meaning, dignity, and closure. Such experiences challenge the traditional biomedical model, which predominantly frames disease as a mechanical fault and focuses narrowly on pathophysiology, often overlooking the psychological, social, and spiritual dimensions that shape the lived experience of illness (Engel, 1977; Sturmberg, 2018).

The biomedical approach has been critiqued for its reductionism and siloed structure, which produces fragmented care and, in some cases, poorer outcomes. Studies in the United States have demonstrated that fragmented care increases rehospitalisation risk, in-hospital mortality, and lengths of stay, highlighting the limitations of a system that prioritises organ-specific interventions over whole-person care (Mitchell et al., 2025; Basu et al., 2024). Similarly, the biomedical model inadequately addresses the social determinants of health, which contribute to 30–50% of chronic disease outcomes, including socioeconomic barriers that affect adherence and prognosis (Steinhauser et al., 2017; Hill-Briggs et al., 2021). Patients frequently report feeling dehumanized or unheard within such a framework, contributing to disengagement, reduced treatment adherence, and diminished well-being (Harris Poncin et al., 2019; Haskard-Zolnierek & DiMatteo, 2009).

In response to these limitations, the biopsychosocial (BPS) model, introduced by Engel and Romano (1977), offers a comprehensive framework that integrates biological, psychological, and social dimensions. This model has since evolved into the biopsychosocial–spiritual (BPSS) paradigm, which explicitly incorporates spirituality as a core component of health, recognising its influence on coping, meaning-making, quality of life, and symptom burden (Sulmasy, 2002; Saad et al., 2017; Steinhauser et al., 2017). The BPSS model aligns care with patient-defined goals, addressing multimorbidity, social inequities, and relational contexts that the biomedical model neglects (Barnett et al., 2012; Magnan, 2017; Sturmberg & Martin, 2020). By acknowledging the intertwined nature of mind, body, social environment, and spiritual well-being, the BPSS approach fosters holistic, patient-centred care that improves quality of life and emotional, social, and existential outcomes (Radbruch et al., 2020; Makunda et al., 2024; Puchalski & Ferrell, 2020).

Palliative care (PC) exemplifies the application of the BPSS model, integrating physical, psychological, social, and spiritual support to relieve suffering at every stage of serious illness (WHO, 2020; Temel et al., 2010). Historically rooted in the hospice movement and older healing traditions, contemporary palliative care prioritises dignity, patient autonomy, family involvement, and interdisciplinary teamwork (Clark, 2018; Rosca et al., 2023). Evidence shows that structured palliative interventions reduce symptom burden, improve mood, and enhance survival in some patient populations, highlighting the efficacy of holistic care in both clinical and community contexts (Haun et al., 2017; Kavalieratos et al., 2016). Despite these benefits, access to palliative care remains highly inequitable globally and within low- and middle-income countries (LMICs), including Kenya, where over 850,000 individuals require services annually but fewer than 2% receive them (Ministry of Health, 2021).

In the Kenyan context, Catholic clergy serve as frontline spiritual care providers, yet empirical evidence about their biopsychosociospiritual competencies remains sparse. Studies in other countries highlight significant gaps in clergy training for end-of-life care, with many requesting additional instruction in pastoral and bereavement support (Horey et al., 2015; Hui et al., 2016). Chaplains play a pivotal role as mediators between patients, families, and medical teams, ensuring that spiritual values, beliefs, and existential concerns inform care plans and decision-making (Klitzman et al., 2022; Marin et al., 2015). Their interventions, ranging from empathetic listening, prayer, and rituals to life review and existential counselling, demonstrate measurable benefits for patient satisfaction, spiritual well-being, and perceived emotional support (Steinhauser et al., 2017; Kruizinga et al., 2016; Givler et al., 2023).

Integrating spirituality into clinical care aligns with both international standards and African philosophical perspectives. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandates spiritual assessment in patient care plans, recognising the significance of addressing existential challenges, irrespective of religious affiliation (Joint Commission, 2022). African cosmologies, including Ubuntu and Utu, emphasise relational interdependence and communal responsibility for health, suggesting that holistic interventions should engage not only immediate family but extended networks and spiritual leaders (Ramose, 1999; Mbiti, 1969; Tutu, 1999). Empirical research from Nigeria, Ghana, and South Africa confirms that strong social networks improve adherence to treatment and symptom management in chronic illness, underscoring the relevance of culturally sensitive BPSS approaches in African contexts (Bayuo, 2025; Agyemang-Duah et al., 2019).

Given this backdrop, there is a pressing need to map the BPSS competencies of clergy within the Archdiocese of Nairobi. By examining their self-assessed proficiencies and identifying barriers to effective spiritual care, this study aims to provide data-driven recommendations for integrating clergy into interdisciplinary palliative teams. The overarching goal is to strengthen holistic care delivery, ensuring that patients’ physical, psychological, social, and spiritual needs are met, and that the integrity and dignity of the dying are preserved until life’s end.

METHODOLOGY

Study Design

This study adopted a mixed-methods, cross-sectional design to examine the biopsychosociospiritual (BPSS) competencies of Catholic clergy engaged in palliative care. A structured survey was used to generate quantitative data on self-reported competencies across biological, psychological, social, and spiritual domains, while qualitative insights were obtained through open-ended questions that captured clergy reflections on their pastoral practice. Integrating these two strands provided both breadth and depth: the survey revealed overall patterns and levels of competence, while the qualitative narratives illuminated the lived experiences and contextual meanings behind those patterns. This approach ensured a more comprehensive understanding of clergy capacity for holistic care than could be achieved by either method alone (Creswell & Creswell, 2018).

Participants

The target population consisted of all Catholic clergy actively involved in patient care or hospital chaplaincy within the Archdiocese of Nairobi (N = 275). Inclusion criteria required participants to be engaged in pastoral care to palliative care patients in homes or hospital ministry; clergy without active patient care responsibilities were excluded.

A census approach was employed to reach the entire population, ensuring that the full range of competencies was captured and eliminating sampling bias (Singh & Masuku, 2014). A total of 197 clergy completed the survey, representing a 87.6% response rate, which is adequate for statistical inference. Participants were recruited via official deanery communications, and participation was voluntary. Demographic data (age, years of experience, training in pastoral care, and current role) were collected to describe the sample and control for potential confounders in statistical analyses.

Instruments

Competencies were measured using the BPSS Competence Inventory for Clergy (BPSS-CIC), a 23-item questionnaire assessing biological, psychological, social, and spiritual competencies. The BPSS-CIC was developed by adapting items from established international frameworks and scales (e.g., WHO, 2018; Van Leeuwen & Cusveller, 2004), along with additional validated guidelines to ensure comprehensive coverage of the biopsychosocial–spiritual domains. Items were contextualized for clergy roles and scored on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Domain scores were computed as averages. Pre-testing with 30 clergy confirmed clarity and contextual relevance, and Cronbach’s alpha values ranged from 0.82 to 0.91, indicating high reliability suitable for parametric analysis (Tavakol & Dennick, 2011).

The Chaplaincy Barriers Scale (CBS), consisting of 8 Likert-type items, was included to assess perceived challenges in providing BPSS care, adapted from Jackson-Jordan et al. (2018) and Doobay-Persaud et al. (2022). Pre-testing was conducted with 30 clergy from the Catholic Diocese of Nakuru to ensure clarity, relevance, and appropriateness. Items were refined based on feedback, improving face validity and internal consistency. Cronbach’s alpha coefficients for the four BPSS domains ranged from 0.82 to 0.91, demonstrating high reliability suitable for parametric analysis (Tavakol & Dennick, 2011).

Data Analysis

Quantitative data were analysed using R (version 4.3). The analytical process began with descriptive statistics, including means, standard deviations, frequencies, and percentages, to summarise and characterise clergy competencies across the biological, psychological, social, and spiritual domains. To examine the relationships between individual BPSS competency domains and overall care capacity, Pearson correlation coefficients were computed, providing insight into the strength and direction of bivariate associations.

To determine the predictive influence of each competency on total care capacity, multiple linear regression analyses were conducted, controlling for demographic variables such as age, pastoral experience, and professional training. Prior to running regression models, key assumptions, including normality, linearity, homoscedasticity, and multicollinearity, were assessed to ensure the validity of inferential findings. Responses on Likert scales were treated as near-interval data, and composite scores for each domain were normalised to enable meaningful comparison across competencies. Missing data, which accounted for less than 5% of the dataset, were addressed using listwise deletion to maintain analytical integrity.

Interpretation of the results focused on both statistical significance and practical relevance. Correlation coefficients were considered in terms of magnitude and direction to identify domains most closely associated with overall care capacity, while regression coefficients were interpreted to quantify the expected change in total care capacity for each unit increase in domain-specific competency, adjusting for covariates. This approach provided a rigorous, transparent framework for evaluating how individual BPSS competencies contribute to holistic pastoral care outcomes.

Ethical Considerations

Ethical approval was obtained from the Archbishop of Nairobi and adhered to National Commission for Science, Technology & Innovation (NACOSTI) regulations. Participation was voluntary, with written informed consent obtained from all participants. Confidentiality was ensured through anonymisation, secure digital storage, and password-protected files. The researcher’s dual role as clergy and investigator was explicitly acknowledged, with measures to minimise bias including transparency in reporting, clear boundaries between pastoral and research activities, and systematic documentation of methodological decisions (Francis, 2015). All procedures adhered to respect, beneficence, and justice, and no monetary incentives were offered to preserve participant autonomy. The study also passed plagiarism checks, ensuring academic integrity (APA, 2019).

FINDINGS

Participant Demographics

A total of 197 participants were included in the study. As shown in Table 1, the majority of participants were aged between 45–54 years (41.6%), followed closely by those aged 35–44 years (38.1%). The smallest age groups were 75 years and older (0.5%) and 65–74 years (1.5%).

Table 1. Socio-Demographic Characteristics of Catholic Clergy Participants (N = 197)

Regarding educational attainment, over half of the participants (51.8%) held a baccalaureate degree, 36% had a master’s degree, and 12.2% had completed a doctorate. Most participants were diocesan priests (71.1%), with the remaining 28.9% identifying as missionary or religious priests. The distribution of years in service was fairly balanced, with 36% of participants having served for 11–20 years, 35.5% for 0–10 years, and 25.4% for 21–30 years. Fewer participants reported longer durations of service, with 3.6% serving 31–40 years and 1.5% serving 41–60 years. Overall, the sample was diverse in terms of age, educational level, priestly status, and years of service, providing a comprehensive perspective for examining biopsychosociospiritual competencies in palliative support.

Biological Competencies

In assessing the clergy’s preparedness for palliative care, the biological domain emerges as both a foundation and a limitation. Although priests are not expected to function as clinicians, their ministry inevitably draws them into conversations about symptoms, pain, and treatment access. The data in Table 2 show how clergy rated their competence across six biological items, highlighting areas where pastoral sensitivity overlaps with medical realities. As the findings indicate, clergy feel most confident recognising the broader impact of illness on families and interpreting non-verbal cues of distress, yet they remain least assured when navigating healthcare systems or directly assessing physical conditions. These trends, reinforced by clergy testimonies, underscore the need for targeted training that equips them to accompany patients more effectively at the intersection of faith and physical suffering.

Table 2.Distribution of clergy self-rated biological competencies

The distribution reveals a mixed but generally moderate confidence among clergy in biological competencies. While nearly three-quarters (72.1%) reported being at least competent in recognising the broader impact of illness on family, work and well-being, fewer than half (40.7%) felt similarly confident in directly assessing physical condition. This trend reflects a common reliance on interpretive observation rather than systematic clinical assessment. Competence was stronger in softer aspects of biological care, such as attentiveness to emotional/spiritual distress (59.9% reporting “Competent” or “Very Competent”) and reading non-verbal communication (66%). Collaboration with healthcare professionals also scored relatively high (61.5%), suggesting growing comfort with interdisciplinary engagement. However, the weakest area was “checking access to healthcare services,” where only 49.7% reported competency, pointing to hesitancy in navigating health systems and referral pathways.

Clergy interviews highlighted this blend of confidence and limitation. One chaplain emphasised their reliance on observation rather than clinical assessment: “I can tell when someone is in deep pain, but I don’t have the medical skills to check their condition. I rely on doctors for that.” (Chaplain 004) Others underscored the value of non-verbal communication and collaboration: “Sometimes the silence, the sigh, or the way they hold your hand tells you more than words. That’s where I lean in.” (Chaplain 009) “I have learnt to ask the nurse or doctor directly if I notice something. It makes the patient feel that we are on the same team.” (Chaplain 007) Yet, gaps in navigating structural barriers also emerged: “I struggle when families tell me they can’t afford medicine or tests. I listen and pray, but I feel helpless in solving those system issues.” (Chaplain 002) Together, these findings indicate that clergy situate their biological competencies within relational and observational strengths, while acknowledging limits in medical and systemic navigation.

Psychological Competencies

In exploring the psychological dimension, the findings reveal that clergy approach patient care with deep respect, empathy, and a pastoral commitment to presence. Table 4.3 presents the self-rated competencies, showing that the strongest areas lie in maintaining compassion and professionalism, and in building relationships of trust. These capacities are often cultivated through seminary formation and pastoral experience, giving clergy confidence in offering emotional stability to patients and families. However, other areas, such as providing structured counselling, sustained time with chronically ill patients, and formal assessment of psychological distress, register lower mean ratings, pointing to practical and skill-based gaps that extend beyond pastoral instincts.

Table 3. Psychological Domain Competencies

The verbatim accounts from clergy deepen this picture. Several priests emphasised listening as their primary psychological intervention: “Deep empathic listening that is calm and not rushed, whatever brings joy to the patient, that is where healing begins.” (Chaplain 001) and “Top on my head is listening. Deep empathic listening that is calm and also when one is not rushed.” (Chaplain 003) Others reflected on the challenge of structured counselling and advocacy: “I feel that I still have a lot to learn, especially in counselling and dealing with complex emotional cases.” (Chaplain 001) “There is a need for training in specialised areas like trauma interventions.” (Chaplain 004)

A few also pointed to the time constraints that limit deeper engagement: “Here, I find that priests must wear many hats, and that can be overwhelming.” (Chaplain 008) Taken together, the data and testimonies suggest that while clergy are emotionally attuned and relationally grounded, they would benefit from structured training in counselling techniques, psychological assessment, and strategies for sustained patient engagement.

Social Competencies

Quantitative results indicated that clergy generally demonstrated strong social competencies across multiple areas (Table 4). Respect for diversity in patient care was high, with 81.2% of respondents rating themselves as either competent or very competent. Similarly, 80.7% reported competence in considering the social environment in care. Supporting family caregivers also emerged as a strength, with nearly three-quarters (74.1%) identifying as competent or very competent. However, competence in supporting quality of life and end-of-life decisions was lower, with 29.4% only somewhat competent. Awareness of social and financial circumstances was reported positively by two-thirds of participants, though 25.4% acknowledged only partial competence.

Table 4. Self-Reported Competence in the Social Domain (N = 197)

The qualitative findings provided depth to these statistics. Clergy consistently emphasised the centrality of cultural and social awareness in care. As one chaplain reflected, “I have come to see how important it is to understand grief, fear and cultural beliefs around death” (Chaplain 005). This awareness was considered vital in Nairobi’s cosmopolitan setting, where multiple ethnic and cultural traditions shape patient and family experiences. Financial realities also emerged as a defining social concern. Chaplain 008 explained: “The greatest challenge in terminal illness and palliative care is finances. Families are overstretched emotionally and financially… parents choose who among their children gets treatment.” Though clergy often felt overwhelmed, they sought to respond pastorally through prayer, listening, and connecting families with support services.

Supporting quality of life and end-of-life decisions was more uneven. Clergy with Clinical Pastoral Education (CPE) reported confidence, often collaborating with medical professionals to facilitate family conferences: “Advanced directives are fine to guide but big family fights over critical medical decisions need further consultation” (Chaplain 003). Others admitted hesitancy, recognising dilemmas but lacking tools to intervene effectively. In supporting caregivers, most relied on a ministry of presence. “Top of my list is listening… deep empathetic listening that is calm and also when one is not rushed” (Chaplain 001). Similarly, Chaplain 008 affirmed, “Presence. Listening. Silence. Sacraments. Compassion. These are not buzzwords in care, they are the soul of care.” Those who spent more time with chronically ill patients were most confident in counselling and advocacy.

Finally, awareness of financial hardship was frequently highlighted, rooted in clergy’s formation in social justice and community immersion. As Chaplain 010 stated, “I often call the social worker to fast-track home care.” Yet about a quarter of respondents admitted being only partially equipped, underscoring the need for structured training to strengthen their ability to address these pressing realities.

Spiritual Competencies

Quantitative findings revealed that clergy demonstrated consistently high levels of competence across the spiritual domain (Table 5). Conducting spiritual assessment was a strong area, with 84.7% identifying as competent or very competent. Similarly, 77.7% reported confidence in identifying spiritual distress, while 78% felt competent in providing spiritual care. Responding to spiritual distress scored even higher, with 87.3% reporting competence or high competence. Competence in specific spiritual practices was more mixed, with 71.1% feeling competent, but 23.4% only somewhat competent. The strongest domain overall was deepening personal spirituality, with over 92% rating themselves competent or very competent, highlighting the centrality of personal devotion in sustaining their ministry.

Table 5. Self-Reported Competence in the Spiritual Domain (N = 197)

The qualitative data enriched these findings by showing how clergy translated their competencies into lived ministry. Spiritual assessment was often described as holistic rather than tool-based, aimed at engaging the person as a whole. As one chaplain expressed, “The biopsychosociospiritual competencies are important because they help me to relate to the patient as a whole person and not just to their sickness” (Chaplain 001). Others highlighted discernment of inner struggles such as guilt or fear, while some, like Chaplain 009, underscored the power of sustained presence: “I was there, every day, every morning, every evening.” Clergy were particularly attuned to identifying spiritual distress, with common themes including guilt, abandonment, or fear of God’s judgement. These often surfaced through existential questions: “Why is God doing this to me? Why am I suffering like this?” (Chaplain 007), or deeply personal concerns such as a mother’s anxiety over leaving her children (Chaplain 002).

Providing spiritual care showed greater variability. Some clergy admitted limitations beyond sacramental roles. One acknowledged, “I feel spiritually ready but practically I often find myself lost on how to comfort families after loss beyond prayers” (Chaplain 005). Another stressed the gap in seminary preparation: “Seminary training is not sufficient for what one finds here in the ministry” (Chaplain 007). Yet, others described creative ways of responding, from sacramental absolution, “God is full of mercy” (Chaplain 001), to innovative accompaniment, such as encouraging a grieving mother to write farewell letters (Chaplain 002). Collaboration also emerged as a theme. When faced with requests for euthanasia, Chaplain 003 explained, “I turned to prayer and consultation with the medical team.” Specific spiritual practices, however, were uneven, with some clergy recognising personal limitations or lack of charism for this work.

Finally, deepening personal spirituality was widely described as the cornerstone of effective ministry. Prayer and devotion sustained resilience and pastoral availability. As Chaplain 003 reflected, “Self-awareness, resilience and sound theological grounding are crucial competencies for hospital ministry.” Chaplain 009 echoed this more simply: “I would pray. That is what I always turned to. The rosary never failed me.”

Influence of BPSS Competencies on Clergy Capacity in Palliative Care

The one-way ANOVA showed that clergy age, academic qualification, and years of ministry were not significant predictors of competencies across the BPSS domains. Priestly status influenced only spiritual competence, while biological, psychological, and social domains were unaffected. Clinical Pastoral Education (CPE) consistently predicted higher scores across all BPSS domains. One chaplain explained, “Without CPE, I would not know how to sit with a dying patient and just be present” (Chaplain 002).

Table 6.Interaction Effects of Clinical Pastoral Education (CPE) with Clergy Characteristics Across BPSS Competencies

The two-way ANOVA showed no demographic pairings moderated the CPE effect. CPE produced uniform competency gains across background characteristics. Clergy reported high confidence in the impact of their competencies on palliative-care outcomes, with mean ratings clustering at the upper end of the scale (M ≥ 3.9 on a 0–4 scale). They noted strength in fostering inner peace, reducing anxiety, facilitating meaning-making, and enabling family connection. “They thanked me for listening”, “He died smiling after confession” (Chaplain 004).

The multiple regression model demonstrated strong explanatory power, accounting for about 71% of the variance in clergy-reported palliative care effectiveness (R² = .71, Adjusted R² = .70, F(4,192) = 118.4, p < .001). A more refined model further confirmed this strength, showing an even higher R² of .90 (Adjusted R² = .90, F = 438.5, p < .001) with a small residual error (0.0296). These results indicate that the BPSS competencies collectively provide a robust and statistically significant prediction of clergy effectiveness in palliative care delivery.

Table 7. Multiple Linear Regression: BPSS Competencies as Predictors of Clergy-Perceived Palliative Care Effectiveness

Spiritual competence emerged as the most influential predictor of clergy effectiveness in palliative care. As one chaplain reflected, “He died smiling after confession” (Chaplain 004). Psychological competence also significantly enhanced capacity, illustrated by the emphasis on “presence over answers” (Chaplain 002). Social competence was evident in family mediation and collaboration, with one chaplain noting, “I joined ward rounds” (Chaplain 007), while others acknowledged barriers such as “Doctors see us as secondary” (Chaplain 001). Biological competence contributed more modestly, with clergy recognising their limits: “We’re not therapists” (Chaplain 009).

DISCUSSION

The present study examined the competencies of Catholic clergy in delivering palliative care across the biological, psychological, social, and spiritual (BPSS) domains. Clergy perceived themselves as most competent in the spiritual domain, followed by psychological and social competencies, while biological competencies were weakest. This profile reflects both the distinctive strengths clergy bring to palliative contexts and the structural limitations they face in navigating healthcare systems.

In practice, clergy made their most significant contributions through spiritual accompaniment, meaning-making, and fostering inner peace at the end of life. Rituals such as confession and anointing were described as profoundly transformative for patients and families, while empathic listening and presence provided essential psychological support. These findings highlight the unique role clergy play in alleviating existential and emotional suffering, areas often under-addressed in biomedical care. In contrast, weaker biological competencies suggest a reliance on collaboration with healthcare professionals, pointing to gaps in seminary formation and limited exposure to medical knowledge.

These patterns are consistent with international evidence. Studies in the United States and Europe report that chaplains excel in spiritual care but are less confident in biomedical aspects of palliative practice (Miller et al., 2023). Similar findings have been documented in South Africa, where clergy were recognised for strong pastoral presence but limited medical knowledge (Xing et al., 2018). In Kenya, Poncin et al. (2019) noted that clergy are often first responders for patients in distress but report feeling underprepared for structured counselling and health advocacy. The current study builds on these insights by demonstrating, through regression analysis, that clergy effectiveness in palliative care depends less on demographic characteristics than on the depth of competency development. This underscores the critical role of Clinical Pastoral Education (CPE) in strengthening psychological and spiritual skills, while also bridging gaps in social and biomedical domains.

The findings also reveal a persistent tension between clergy’s pastoral vocation and their integration into institutional healthcare systems. Several participants described being excluded from ward rounds or clinical discussions, reflecting a broader perception of chaplains as peripheral rather than essential care providers. Similar dynamics have been documented internationally, where chaplains often struggle for recognition within interdisciplinary teams (Rhee et al., 2017). In African contexts, South African studies likewise report that clergy are consulted primarily for ritual or prayer rather than as active partners in patient care planning (Masango & Mkhathini 2016; Buffel 2022). However, African spiritual frameworks such as Ubuntu in Southern Africa and Utu in East Africa provide a compelling counter-narrative. Both emphasize interconnectedness, mutual care, and the dignity of each person as part of a wider community. When interpreted through these lenses, clergy roles in palliative care extend beyond individual spiritual support to embody communal healing, reinforcing the idea that “a person is a person through others.” This perspective situates clergy not at the margins but at the heart of care, as they embody and transmit values of solidarity, compassion, and shared humanity in the face of suffering. The present study strengthens this evidence by showing, through regression analysis, that spiritual and psychological competencies account for substantial variance in perceived effectiveness, underscoring the value of clergy as integral members of palliative care teams.

Equally significant is the role of Clinical Pastoral Education (CPE). While demographic factors such as age, years ordained, or priestly status were not predictive, participation in CPE emerged as the strongest determinant of competence. This resonates with international evidence that identifies supervised pastoral training as foundational for professional chaplaincy (Fitchett et al., 2020), and with Ugandan findings that clergy trained in pastoral counselling demonstrate greater confidence in hospital-based care (Tartaglia et al., 2013). Embedding African spiritual worldviews such as Ubuntu and Utu into CPE curricula could further strengthen contextual relevance, ensuring that training resonates with cultural values of relationality and communal flourishing. Embedding CPE within seminary curricula and diocesan structures could therefore address the documented gaps in biomedical and psychosocial competencies, while also fostering collaboration with medical staff. Partnerships between theological institutions and healthcare providers may be essential for scaling such training in Kenya, ensuring that it remains contextually grounded in African cosmologies and responsive to local healthcare realities.

Implications

This study carries important implications for policy and practice. The findings underscore the need to integrate Clinical Pastoral Education (CPE) and biopsychosociospiritual (BPSS) competency training into seminary curricula and diocesan programs in Kenya. This could include dedicated modules on grief counselling, communication in end-of-life care, cultural sensitivity, and collaborative practice with medical teams. Designing joint training programs where clergy and healthcare professionals learn together would foster mutual respect and enhance interdisciplinary practice. Such integration would align with the National Palliative Care Policy (2019–2030) and the African Palliative Care Association (APCA) framework, both of which emphasize interdisciplinary, holistic approaches to care. By formally recognizing clergy as integral contributors within palliative care teams, policymakers and health institutions can strengthen collaboration between spiritual caregivers and medical professionals, particularly in resource-constrained contexts. These insights are also relevant across African Catholic contexts such as Ghana, Uganda, and Tanzania, where the Catholic Church remains a key provider of health and pastoral services. Taken together, these actions would not only enhance the preparedness of Catholic clergy but also create scalable models of holistic palliative care that could be replicated in other African contexts. By embedding clergy training within both ecclesial structures and national health strategies, Kenya has the opportunity to pioneer a culturally grounded, policy-supported model of integrated palliative care.

Limitations

Despite its contributions, the study has several limitations. First, it relied on self-report measures, which may be subject to social desirability bias, with clergy potentially overestimating competencies, particularly in domains less open to external validation. Second, the sample size, though adequate, was limited to Catholic clergy in Nairobi, restricting generalisability to other denominations, dioceses, or rural contexts. Third, qualitative testimonies, while rich, were drawn from a subset of participants and therefore do not capture the full diversity of perspectives. Finally, the cross-sectional design does not allow causal inferences regarding the relationship between CPE training and competency gains.

Future Research

Future research should explore clergy competencies in other African settings to enable cross-country comparisons and strengthen generalisability. Comparative studies across denominations and faith traditions would enrich understanding of how religious formation shapes palliative care competencies. Mixed-methods research incorporating perspectives of patients, families, and medical colleagues would provide a more holistic picture of clergy effectiveness. Longitudinal designs are also needed to assess whether training interventions such as CPE yield sustained improvements in clergy preparedness for palliative contexts. Additionally, studies examining systemic barriers, such as the limited formal recognition of chaplains in Kenyan and wider African health policies, could inform advocacy for more integrated, culturally sensitive models of palliative care.

CONCLUSION

This study revealed that Catholic clergy perceive themselves as most competent in the spiritual domain, moderately competent in psychological and social domains, and least competent in biological competencies. These competency levels directly shaped their capacity to contribute to palliative care. Spiritual and psychological competencies emerged as the strongest predictors of effectiveness, enabling clergy to provide meaning-making, emotional support, and inner peace to patients and families. Social competencies facilitated collaboration and family mediation, while biological competencies played only a modest role.

The findings underscore the need to strengthen clergy training, particularly in psychological counselling and basic medical literacy, while building on their clear strengths in spiritual care. Practical implications include integrating Clinical Pastoral Education (CPE) into clergy formation, fostering closer collaboration between clergy and health professionals, and formally recognising chaplains as essential members of palliative care teams. By developing balanced competencies across the BPSS domains, clergy can more effectively support holistic, patient-centred end-of-life care.

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