Many people use the concepts of religion and spirituality interchangeably, but while they are related, they are not the same. Some people find a spiritual home in religion, either organized (as part of a faith community) or on a very private, personal level as a set of beliefs that may or may not draw from one or more religious traditions. Other people do not consider themselves religious; instead, they may experience a sense of awe and reverence when they experience nature, immerse themselves in solitude, be transported by music or other creative arts, or come face to face with the edges of life as we know it, perhaps by encountering birth or death.

Two broad working definitions can help distinguish religion and spirituality. Religion provides a specific set of beliefs, values, and traditions. Religion also gives specific meaning to events and experiences in life, such as the origins of life or the existence of an afterlife. Religion is also understood as a concept that gives expression to the sense of the extraordinary, describes the concept of transcendence, and provides a language in which to speak of spiritual things.

Spirituality is a broader concept that has to do with the need of all people to find ultimate meaning in life and to confront the mysteries of life and death. A definition of spirituality from an interprofessional consensus conference (Puchalski et al., 2009) is that spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose
and the way they experience their connectedness to the moment as well as self, others, nature, and the significant or sacred.

This for the explanation, meaning, and purpose takes a unique form that is integral to each individual (though not always conscious). It may be expressed in many different ways including religious practices, philosophical commitment or scientific ideal, art, music, literature, a connection to nature, and relationships with family and/or community. The search for meaning and purpose has also been described as a universal characteristic that is part of what makes us human.

Sanders (2002) identified five dimensions of spirituality that lend a greater understanding to the multiple facets of this concept. The first dimension of spirituality is meaning, which can include that which provides significance in one's life, those aspects that offer purpose, and/or the way one makes sense of the world. The second dimension is value, which includes one's beliefs and standards; one's sense of truth; and beauty and worth of thought, object, or behavior. Transcendence is the third common aspect across various definitions of spirituality and it is one's sense of awareness of dimensions beyond one's self. The next dimension is that of connectedness, for example, the feeling of relationship with self, others, God/higher power, and even the environment (or nature). The final dimension is that of always becoming. This involves the sense of continued unfolding of life, which demands reflection and experience. It includes a sense of who one is and how one knows. These five dimensions help to illustrate the broad nature of spirituality, which can include religious expression, relationships, music, art and nature, and/or other belief systems.

Peters (2010) identifies five tasks of religion and spirituality that underscore the importance of spirituality in the well-being of human beings. The tasks include: (a) confronting one's finitude and vulnerability; (b) uncovering meaning, value, and dignity in illness and death; (c) developing meaning, purpose, and connectedness to others; (d) seeking faith, hope, love, and forgiveness in the midst of fear and despair; and (e) engendering serenity and transcendence, which can buffer stress. These tasks also illustrate the importance of the spiritual for health care decision making and ACP. The tasks of confronting one's finitude and vulnerability, as well as seeking hope in the midst of fear and despair, can be catalysts for expressing one's wishes in ACP. Conversely, if one is not able to consider the possibility of dying, it precludes the desire to express one's wishes and plan for EOL.

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