This article reports on the processes of staff members in referring patients to a study that explored the experience of palliative patients, family members, and health professionals with the implementation of a family meeting model as an instrument of spiritual care. The reported qualitative study was undertaken in two large metropolitan Australian hospitals. Criteria other than those set by the study protocol were employed by staff members referring patients. These included subjective opinions of who was suitable to refer and perceptions of patients' attitudes to religion or spirituality. Such practices raise ethical issues and may compromise studies that have received ethics approval. Crown Copyright (c) 2010. Published by Elsevier Inc. All rights reserved.