**6. Conclusions**

In this study, we explored rituals and ritualized care practices in a hospice in the Netherlands. The exploration of these practices led to two types of categorization: the first one is more or less practical, referring to the moments of the day and the character of the acts; the second one is linked to the health condition of the patient and the impending death.

We have brought the exploration of rituals and ritualizing within the broader framework of the spiritual dimension of palliative care, using a general and broad definition of spirituality referring to notions of meaning, purpose and transcendence, and the way people connect to the moment, to self, to others, to nature and to the significant and/or the sacred. In ritualized care practices, meaning and purpose are linked to the concept of the good death. Hospice staff recognize the major life transition their patients and families are going through when they enter the hospice. Although the care professionals do not mention the concept of the good death, the analysis from a ritual and cultural perspective has shown that this value guides the everyday care practices and the professionals' approach of the patients.

**Author Contributions:** Conceptualization, K.v.d.W. and M.H.; Methodology, K.v.d.W. and M.H.; Participant Observation and Interviews: K.v.d.W.; Formal Analysis, K.v.d.W., M.H., M.T., and A.v.d.H.; Writing-Original Draft Preparation, K.v.d.W. and M.H.; Writing-Review & Editing, M.H.; Supervision, A.v.d.H. and M.T.; Funding Acquisition, M.T., A.v.d.H., and M.H. All authors have read and agreed to the published version of the manuscript.

**Funding:** The authors obtained a grant from the Netherlands Organisation for Health Research and Development (ZonMw) to conduct the research project titled 'Spiritual care and rituals in primary care'. The project is registered under the Dutch title 'Spirituele zorg en rituelen in de eerste lijn', with the corresponding Project Number: 80-84400-98-335.

**Acknowledgments:** We thank the two anonymous reviewers for their valuable suggestions to improve the first draft of this article.

**Conflicts of Interest:** The authors declare no conflict of interest.

**Ethics Statement:** Approval for this study was granted by the medical ethics committee of the Erasmus Medical Centre (Rotterdam, the Netherlands) on August 18th 2017.
