Prevalence and Nature of Spiritual Distress Among Palliative Care Patients in India

Spiritual Distress, Hopelessness, and Depression in Palliative Care: Simultaneous Concept Analysis

Spiritual distress, hopelessness, and depression are concepts that are often used in palliative care. A simultaneous concept analysis (SCA) of these concepts is needed to clarify the terminology used in palliative care. Therefore, the aim of this study is to conduct a SCA of spiritual distress, hopelessness, and depression in palliative care. A SCA was performed using the methodology of Haase's model. A literature search was conducted in March 2020 and updated in April 2022 and April 2024. The search was performed on the following online databases: CINAHL with Full-Text, MEDLINE with Full-Text, MedicLatina, LILACS, SciELO, and PubMed. The search was achieved without restrictions on the date of publication. A total of 84 articles were included in this study. The results highlight that the three concepts are different but also share some overlapping points. Spiritual distress is embedded in the rupture of their spiritual/religious belief systems, a lack of meaning in life, and existential issues. Hopelessness is a sense of giving up and an inability to control and fix the patient's situation. Finally, depression is a state of sadness with a multi-impaired situation. In conclusion, refining the three concepts in palliative care is essential since it promotes clarification and enhances knowledge development towards intervention.

Finding the Hidden Professional Culture of Mental Health Nursing-Spiritual Care for Individuals with a Co-morbid Life-Limiting Illness

People with severe mental illness are dying up to thirty years earlier than the general population. The limited literature on their experience of dying indicates that they often suffer from inequities in their access to healthcare services, and further, what care they do receive is frequently poor. Living with both a mental illness and facing death can engender spiritual concerns and dying at a younger age is a risk factor for spiritual despair. Hence, addressing spiritual concerns can be an important dimension of mental health nursing care. The aim of this ethnographic study of 11 senior and experienced mental health nurses was to determine if the culture of the mental health service impacted their spiritual care for those patients who were facing death. The data highlighted that the nurses felt comfortable in providing spiritual care when the person was suffering from psychosis. Yet, the results also revealed that nurses felt disempowered by the dominance of the biomedical culture, in which they felt unable to articulate their care. However, it was identified that their spiritual care was inherent within the professional values, knowledge, and skills of mental health nursing and framed through their therapeutic relationships. Therefore, strategies need to be used by the organization to assist nurses to reclaim their power and assist the mental health service to further develop and engage in spiritual care practices.

Issues Related to Children-Faced by Armed Forces Families When Caring for Patients in Palliative Care - A Qualitative Study

Objectives

Access to palliative care is limited, especially in rural India. Children needing care by palliative teams may themselves be patients, or siblings and children of patients. Armed forces families face characteristic lifestyle challenges - frequent transfers, living in difficult and remote areas, serving personnel staying apart from families for long periods - very different from issues faced by civilians. Military service increases the risk of psychosocial burden for serving personnel as well as families. Most depend on private and state medical services for palliative care so it is important for the palliative community to understand their issues. This study aimed to explore the issues related to children - faced by armed forces families when caring for patients in palliative care.

Material and Methods

Qualitative study based on thematic analysis of semi-structured interviews with caregivers - either serving personnel or their dependents, in three centres.

Results

Analysis of the 15 interviews showed that armed forces families face complex challenges related to children when caring for the palliative patient due to frequent movement, lack of paediatric palliative services in far-flung areas, disruption of the continuity of care, social isolation, language, and cultural barriers when living in non-native areas, inability to build and access family and community support and financial burden due to restrictive reimbursement policies.

Conclusion

Although medical and administrative support within the organisation provides a cushion, wives have to manage alone in the father's prolonged absence, and safety is a concern for children when living outside the campuses and serving personnel report guilt, anger, and helplessness at not being present when needed. Awareness of these issues can enable palliative workers to provide more meaningful support tailored to the needs of service families.

Volunteers' spiritual care competence and its relationship with attitudes toward palliative care: A cross-sectional study

OBJECTIVES

Given the rising burden of palliative care and the limited human resources for its facilitation in China, volunteers are becoming increasingly indispensable. In particular, there is a high demand for volunteers who can serve as spiritual caregivers. However, a volunteer's ability to provide good spiritual care in a palliative setting may be influenced by their attitude toward palliative care. To uncover the current state of spiritual caregiving in palliative settings in China and insights into best practices for its improvement, this study measured spiritual care competence and identified its influencing factors and explored its relationship with attitudes toward palliative care among volunteers. Notably, this study is the first to consider spiritual care competence alongside attitudes toward palliative care.

METHODS

A descriptive cross-sectional study using online survey methods was conducted with 385 volunteers in Shanghai, China. Data were collected using a structured questionnaire.

RESULTS

Volunteers demonstrated relatively low levels of spiritual care competence (58.50 ± 10.92). Statistically significant correlations were found between spiritual care competence and the following variables: age, educational background, marital status, religious beliefs, occupational status, and relevant training and practical experience. Attitude toward palliative care significantly correlated with spiritual care competence (r = 0.49, p < 0.001).

SIGNIFICANCE OF RESULTS

To continually improve volunteers' spiritual care competence, diversified education and training programs about spiritual care should be designed for different kinds of volunteers; moreover, because attitude toward palliative care significantly impacted spiritual care competence, such programs should encourage positive attitudes toward palliative care.

What Aspects of Religion and Spirituality Affect the Physical Health of Cancer Patients? A Systematic Review

In recent years, the literature on the relationship between religion and spirituality (R/S) and the health of cancer patients has been flourishing. Although most studies focus on mental health, many study the physical health of these individuals. In order to summarize the findings of these studies, we reviewed the most recent research on this subject using the PubMed and PsycInfo databases. The objective of this systematic review was to recognize the primary R/S variables studied in research on physical health in cancer contexts. We found that spiritual well-being was the most-researched variable in studies of these characteristics, followed by R/S struggles and other variables such as religious coping; religious commitment or practice; or self-rated R/S. In general, R/S seems to have a positive association with the physical health of cancer patients, although the results are quite heterogeneous, and occasionally there are no relationships or the association is negative. Our results may assist in improving interventions that include spirituality in clinical settings as well as the development of holistic approaches, which may have a positive impact on the quality of life and well-being of cancer patients.

Pain and Spiritual Distress at End of Life: A Correlational Study

Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ² (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ² (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ² (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ² (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.

Spiritual Distress and Spiritual Needs of Chronically Ill Patients in Poland: A Cross-Sectional Study

Introduction: Spiritual care is needed in a clinical setting to improve the patients’ quality of life. Deep connection with another person and delight with the beauty of nature or art and (in some cases) with God are all transcendental experiences. They may enable patients to ascribe meaning to their life with a chronic illness, find hope and well-being despite burdening symptoms. The opposite situation: lack of inner peace, inability to accept what is happening, feeling disconnected from others is called spiritual distress. Objectives: The aim of this research is to assess spiritual distress and spiritual needs of a group of Polish chronically ill patients and find associations with independent variables in order to provide data for recommendations on spiritual care in Poland. Patients and methods: 204 patients treated at the University Hospital and the Cystic Fibrosis Clinic in Poznan were surveyed in 2017 and 2018 with an original questionnaire. Results: Over half of the patients felt that their illness was life-threatening. A little more than half reported that faith was a resource to cope with suffering. Almost all patients showed signs of spiritual distress, and more than half expressed spiritual needs. The intensity of distress correlated only with the severity of the disease. The most important predictor of having spiritual needs was recognizing faith as a resource. Conclusions: Spiritual needs are associated with personal beliefs; however, spirituality spans beyond the religious context since spiritual distress is unrelated to the level of religious devotion. Therefore, any patient with a severe chronic disease needs basic spiritual care, which includes being treated with compassion.

Psychometric Assessment of SpiDiscI: Spiritual Distress Scale for Palliative Care Patients in India

Objectives:

Spirituality has an impact on the quality of life of palliative care patients and it influences the way in which they experience their disease. Spiritual distress is a common issue among palliative care patients in India that is best assessed through a tool specifically designed for them. This study presents the findings of a psychometric assessment of SpiDiscI: a 16-item spiritual distress scale for Hindi speaking palliative care patients in India.

Materials and Methods:

This study used a non-experimental cross-sectional sample survey design. 400 cancer patients undergoing pain treatment at the pain and palliative care unit of a tertiary cancer hospital in New Delhi enrolled in the study and completed the study’s questionnaire. The questionnaire contained a section on demographic information, a numerical rating scale (NRS) for pain, SpiDiscI, FACIT-Sp-12, and WHOQOL-BREF. A subset of 50 patients with stable pain completed SpiDiscI a 2^nd time 2 weeks after the first administration of the scale to assess test-retest reliability.

Results:

The scale’s internal consistency is very good (Cronbach’s Alpha 0.85). Spiritual distress scores ranged from 0 to 93.8 (mean 37.1, SD 23.6). Significant negative correlations between SpiDiScI and both FACIT-Sp-12 (R = –0.16, P = 0.001) and WHOQOL-BREF (R = –0.27, P < 0.001) confirmed convergent validity. There was no significant association with NRS pain scores (R = 0.06, P = 0.224). The highly significant association (R = 0.75, P < 0.001) of the scores on assessments 2 weeks apart confirmed test-retest reliability.

Conclusion:

SpiDiScI is a reliable and valid measure to assess spiritual distress in research among Hindi speaking palliative care patients in India.

Patients' Awareness of Advanced Disease Status, Psychological Distress and Quality of Life Among Patients With Advanced Cancer: Results From the APPROACH Study, India

BACKGROUND

Prognostic disclosure to patients with advanced cancer facilitates treatment decisions and goals of care discussions. However, the perspectives of patients, families and physicians differ in this regard across different cultures. Non-disclosure of cancer diagnosis or prognosis is commonly observed in family-centric cultures such as India.

AIM

To assess the prevalence of and factors associated with cancer patients' awareness of advanced disease status; and its with quality of life and psychological distress.

METHODS

Patients for this cross-sectional questionnaire-based survey were recruited from oncology and palliative medicine clinics at a tertiary cancer hospital in India from January 2017 to June 2018. Patients aged ≥ 21 years, aware of cancer diagnosis and receiving oncology treatment for Stage IV solid cancer were included in the study after obtaining written informed consent.

RESULTS

Two hundred patients were enrolled, of which 146 (73%) were not aware of the stage of their malignancy and 9 (4.5%) believed that their disease was at stage I, II or III. Those who were aware of their advanced cancer stage had more years of education (9.9 years vs 8.1 years, p = .05) and had poorer spiritual wellbeing in the faith domain (adjusted difference -1.6, 95% confidence interval -3.1 to -0.1, p = .03) compared to those who were unaware.

CONCLUSION

It is recommended that future studies may explore prognostic understanding in Indian patients according to their socio-cultural, spiritual and educational background.

The Universality of Palliative Care Philosophy

The modern hospice movement, which is the origin of what is now known as palliative care, derived strong inspiration from Christianity. Given this original Christian inspiration, the global spread of palliative care even to countries where Christianity is only a minority religion may look surprising. In line with the theory of the “secularization of hospice,” it could be argued that palliative care has spread globally because its underlying philosophy has become secular, allowing it to become universal. However, given the continuing importance of religion in many areas of palliative care, we could wonder how secular contemporary palliative care really is. This article argues that the universality of palliative care philosophy resides in its susceptibility to contextualization. Palliative care has become a global success story because people all over the world committed to palliative care’s principles and ideas have contextualized these and developed models of palliative care delivery and even philosophy that are adapted to the local socio-economic and cultural-religious contexts. This article analyzes palliative care in India to illustrate this point, describing contextualized models of palliative care delivery and showing that palliative care physicians and nurses in India draw inspiration from their local context and religiosity.

Associated factors of distress in patients with advanced cancer: A retrospective study

OBJECTIVE

The objective of this study was to assess the psychosocial distress and associated factors in advanced cancer patients consulting at the outpatient Palliative Care Unit at the National Cancer Institute in Mexico City.

DESIGN

A retrospective study was conducted using electronic records (June 2015 to December 2016).

SAMPLE

A total of 646 patients with advanced cancer during their first visit to the outpatient palliative care unit at the National Cancer Institute in Mexico were evaluated using the Distress Thermometer (DT) and ECOG performance status scores.

FINDINGS

Overall, 62% were women, with a median age of 57 years, and married (54.8%). The most frequent diagnosis was gastrointestinal cancer (28.6%), and 38.9% had a functional performance status of ECOG 2. The median DT score was 4.0 (IQR = 2-6), with 56% reporting DT scores ≥4. The three most frequent problems ≥4 were sadness (82.6%), feeling weak (81.2%), worry (79.6%), and <4 were feeling weak (57.7%), fatigue (55.6%), and financial security (52.1%). The variables associated with distress according to the multiple logistic regression analysis were problems with housing (OR = 2.661, 95% CI = 1.538-4.602), sadness (OR = 2.533, 95% CI = 1.615-3.973), transportation (OR = 1.732, 95% CI = 1.157-2.591), eating (OR = 1.626, 95% CI = 1.093-2.417), nervousness (OR = 1.547, 95% CI = 1.014-2.360), and sleep (OR = 1.469, 95% CI = 1.980-2.203).

CONCLUSION

The principal factors were related to distress levels, housing problems, transportation issues, and emotional problems such as sadness, nervousness, lower functionality, and younger age. Therefore, psychosocial support is of considerable relevance in palliative care. These findings will help clinicians understand the distress of patients with advanced cancer in palliative care in Latin American countries.

Quality of life of cancer patients at palliative care units in developing countries: systematic review of the published literature

Purpose

This systematic review aims to summarize factors that influence the quality of life (QOL) of advanced cancer patients in palliative care (PC) in developing countries. Understanding this context in developing countries milieu is necessary; however, this outcome is rarely reported.

Methods

Following the PRISMA guidelines, the electronic databases MEDLINE, Embase, CINAHL, and Web of Science were systematically searched using the search terms: QOL, cancer, PC, and names of all developing countries. Studies with less than ten subjects, qualitative or pilot studies, reviews, conference abstracts, and that reported validation of QOL questionnaires were excluded.

Results

Fifty-five studies from 15 developing countries in the African (n = 5), Latin America and the Caribbean (n = 10), and Asian (n = 40) region were included in the narrative synthesis. 65.4% were cross-sectional, 27.3% were cohort studies, 7.3% were RCTs or quasi-experimental studies. Around 30 QOL factors were studied with 20 different types of QOL instruments. Advanced cancer patients who were older, married/ever married, participated in additional care within PC, used complementary and alternative medicine (CAM), and practiced spirituality/religiosity showed higher QOL score. Low educational level and high depression were associated with a lower QOL.

Conclusion

Various factors affect QOL among cancer patients in PC. Patients valued the use of CAMs; however, the quality and safety aspects should be properly addressed. Important factors that influenced the QOL score were social and spiritual support. While there is a general need to develop PC strategies further, recognizing patients’ needs should be prioritized in national cancer programs.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02633-z) contains supplementary material, which is available to authorized users.

The influence of spirituality on decision-making in palliative care outpatients: a cross-sectional study

BACKGROUND

Decision-making in palliative care can be complex due to the uncertain prognosis and general fear surrounding decisions. Decision-making in palliative care may be influenced by spiritual and cultural beliefs or values. Determinants of the decision-making process are not completely understood, and spirituality is essential for coping with illness. Thus, this study aims to explore the influence of spirituality on the perception of healthcare decision-making in palliative care outpatients.

METHODS

A cross-sectional study was developed. A battery of tests was administered to 95 palliative outpatients, namely: sociodemographic questionnaire (SQ), Decisional Conflict Scale (DCS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp), and a semi-structured interview (SSI) to study one's perception of spirituality and autonomy in decision-making. Statistical analyses involved descriptive statistics for SQ and SSI. The Mann-Whitney test was used to compare scale scores between groups and correlations were used for all scales and subscales. The analysis of patients' definitions of spirituality was based on the interpretative phenomenological process.

RESULTS

Spiritual wellbeing significantly correlated with greater levels of physical, emotional and functional wellbeing and a better quality of life. Greater spiritual wellbeing was associated with less decisional conflict, decreased uncertainty, a feeling of being more informed and supported and greater satisfaction with one's decision. Most patients successfully implemented their decision and identified themselves as capable of early decision-making. Patients who were able to implement their decision presented lower decisional conflict and higher levels of spiritual wellbeing and quality of life. Within the 16 themes identified, spirituality was mostly described through family. Patients who had received spiritual care displayed better scores of spiritual wellbeing, quality of life and exhibited less decisional conflict. Patients considered spirituality during illness important and believed that the need to receive spiritual support and specialised care could enable decision-making when taking into consideration ones' values and beliefs.

CONCLUSION

The impact of spiritual wellbeing on decision-making is evident. Spirituality is a key component of overall wellbeing and it assumes multidimensional and unique functions. Individualised care that promotes engagement in decision-making and considers patients' spiritual needs is essential for promoting patient empowerment, autonomy and dignity.

Patient Spirituality as a Component of Supportive Care: Assessment and Intervention

OPINION STATEMENT

National supportive care guidelines for patients with cancer include recognition of patients' spirituality and spiritual needs. Experts differ on how best to address this dimension to our patients' lives. Some suggest that patients' medical team should take on spiritual care, and others suggest referral to chaplains or collaboration with outside clergy. In our view, the patient's medical team ought to best acknowledge patient spirituality when so desired by the patient, but intervention in the case of serious spiritual crisis ought to be the responsibility of those with specific training in this realm. For some patients, "concordance" between the specific spiritual tradition of the patient and chaplain is necessary where for others, non-denominational, secular, or inter-faith chaplaincy services are welcome. The central role for physicians and nurses in this area, is listening, awareness, respect, and where necessary, referral.

Patients' spirituality perspectives at the end of life: a qualitative evidence synthesis

BACKGROUND

Understanding patient perceptions of their spiritual needs when approaching the end of life is essential to support the delivery of patient-centred care.

AIM

To conduct a qualitative evidence synthesis on spirituality and spiritual care needs at the end of life in all healthcare settings from the patients' perspective.

DESIGN

Studies were included where they were primary qualitative studies exploring spirituality in patients with a life expectancy of 12 months or less in any setting. Two reviewers independently screened titles, extracted data and conducted methodological quality appraisal. A thematic synthesis was conducted. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) - Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to summarise the certainty of the evidence.

DATA SOURCES

Six databases (Medline, Embase, Cochrane, CINAHL, PsycINFO, Applied Social Science Index and Abstracts) were searched from inception up to January 2019.

RESULTS

Fifty papers (42 unique datasets), incorporating data from 710 patients were included. Studies recruited from a mix of inpatient, outpatient, hospice and community settings across 12 different countries. Three overarching themes were generated: the concept of spirituality, spiritual needs and distress, and spiritual care resources. Relationships were an intrinsic component of spirituality.

CONCLUSION

Meeting patients' spiritual needs is an integral part of end-of-life care. This work emphasises that supporting relationships should be a central focus of spiritual care for patients at the end of life.

PROSPERO REGISTRATION NUMBER

CRD42019122062.

Spiritual Distress in Cancer Patients: A Synthesis of Qualitative Studies

Cancer affects individuals in all human dimensions. Cancer patients are more susceptible to spiritual distress. Several studies have addressed spiritual distress using quantitative designs; however, a qualitative approach to the experience of spiritual distress could provide a deeper understanding of the phenomenon. This study aims to synthesis the experience of spiritual distress as lived by cancer patients in qualitative primary studies. This is a literature review based on electronic databases search. A total of 4075 citations was identified and 23 studies were included. The most frequent qualitative research method was phenomenology (n = 15), and interviews were the main data collection method (n = 20). Two major themes have been identified related to the experience of spiritual distress: suffering and coping. Spiritual distress is an intimate, deep and suffering experience in life, which requires coping strategies and involves spiritual values and beliefs. Healthcare providers should be aware of this experience and recognize spiritual distress in cancer patients, as it is critical in providing holistic nursing care.

The cultural expression of spiritual distress in Israel

BACKGROUND

Although spiritual distress is present across cultures, the ways in which patients experience it vary between cultures. Our goal was to examine the cultural expression and key indicators of spiritual distress in Israel.

METHODS

We conducted a structured interview of 202 oncology outpatients in a cross-sectional study. Self-diagnosis of spiritual distress, which is a demonstrated gold standard for identifying its presence, was compared with the Facit-Sp-12 and a number of other items (from the Spiritual Injury Scale and newly developed Israeli items) hypothesized as Israeli cultural expressions of spiritual distress, demographic and medical data, and patient desire to receive spiritual care.

RESULTS

Significant variation was found between Israeli cultural expression of spiritual distress and that found in studies from other countries. Key expressions of spiritual distress in this study included lack of inner peace, grief, and an inability to accept what is happening. Items related to faith were not significant, and loss of meaning showed mixed results. Patients requesting spiritual care were more likely to be in spiritual distress. No demographic or medical data correlated with spiritual distress.

CONCLUSIONS

Specially designed interventions to reduce spiritual distress should address the expressions of the distress specific to that culture. Studies of the efficacy of spiritual care can examine the extent of spiritual distress in general or of its specific cultural expressions.

Signs of Spiritual Distress and its Implications for Practice in Indian Palliative Care

Introduction:

Given the particularity of spirituality in the Indian context, models and tools for spiritual care that have been developed in Western countries may not be applicable to Indian palliative care patients. Therefore, we intended to describe the most common signs of spiritual distress in Indian palliative care patients, assess differences between male and female participants, and formulate contextually appropriate recommendations for spiritual care based on this data.

Methods:

Data from 300 adult cancer patients who had completed a questionnaire with 36 spirituality items were analyzed. We calculated frequencies and percentages, and we compared responses of male and female participants using Chi-squared tests.

Results:

Most participants believed in God or a higher power who somehow supports them. Signs of potential spiritual distress were evident in the participants’ strong agreement with existential explanations of suffering that directly or indirectly put the blame for the illness on the patient, the persistence of the “Why me?” question, and feelings of unfairness and anger. Women were more likely to consider illness their fate, be worried about the future of their children or spouse and be angry about what was happening to them. They were less likely than men to blame themselves for their illness. The observations on spirituality enabled us to formulate recommendations for spiritual history taking in Indian palliative care.

Conclusion:

Our recommendations may help clinicians to provide appropriate spiritual care based on the latest evidence on spirituality in Indian palliative care. Unfortunately, this evidence is limited and more research is required.

Indian philosophical foundations of spirituality at the end of life

Growing understanding of spirituality at the end of life demands more theoretical research on the subject. Empirical studies have highlighted the need for exploring philosophical and cultural concepts to facilitate a fuller understanding of spirituality at the end of life. This paper explores Indian philosophy to inform the conceptualisation of spirituality at the end of life in the Indian context. Three key themes from discourses on spirituality at the end of life have been analysed: the concept of the human person, the purpose of life and the meaning of death. The human person is from and of the Divine, eternal and is capable of cognition and experience. The purpose of human life is to unite with the ultimate Reality, the Divine, by living life righteously according to prescribed ways and by achieving detachment from the illusion of the world. Death is part of life and not that which ends it. The moment of death is an opportunity for the ultimate transformation, Moksha. Analysing these philosophical foundations can provide the contextual frame for understanding the spiritual needs of palliative care patients and their families and the possibility of developing culturally relevant approaches to providing spiritual care at the end of life.

Spiritual Pain. Annäherung an einen Schlüsselbegriff interprofessioneller Spiritual Care

Der Beitrag untersucht das Konzept des ‚spirituellen Schmerzes‘ an einem Beispiel aus dem Bereich der Pädiatrie und im Hinblick auf die interprofessionellen Aufgaben von Spiritual Care. In einem ersten Schritt wird die mehrschichtige Genese des Konzepts bei Cicely Saunders nachgezeichnet, um es anschließend in Abgrenzung gegenüber verwandten Begriffen wie seelischem Schmerz (psychic pain), religiöser Anfechtung (religious struggle) oder spiritueller Bedrängnis (spiritual distress) weiter zu schärfen und theologisch zu vertiefen. Die Überlegungen münden in der These, dass ‚spiritueller Schmerz‘ als Sinnschmerz zu verstehen ist, der sich in körperlichem Schmerz manifestiert und diesen verstärkt.