Article Text

Download PDFPDF
Patients' spirituality perspectives at the end of life: a qualitative evidence synthesis
  1. Barbara Clyne1,2,
  2. Sinead M O’Neill2,
  3. Daniel Nuzum3,4,
  4. Michelle O'Neill2,
  5. James Larkin1,
  6. Máirín Ryan2 and
  7. Susan M Smith1,2
  1. 1 Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2 Health Research Board – Collaboration in Ireland for Clinical Effectiveness Reviews (HRB-CICER), Health Information and Quality Authority Dublin Regional Office, Dublin, Ireland
  3. 3 Pastoral Care Department, Marymount University Hospital and Hospice, Cork, Ireland
  4. 4 Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
  1. Correspondence to Dr Barbara Clyne, Department of General practice, Royal College of Surgeons in Ireland, Dublin 2, Ireland; barbaraclyne{at}


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 care
  • qualitative evidence synthesis
  • end of life care
  • spirituality

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @barbaraclyne, @danielnuzum

  • Contributors BC, SMO, MO, MR and SMS conceived the study and developed the study protocol. BC conducted the literature search. Screening, data extraction, quality appraisal and GRADE-CERQual was conducted by BC, SMO and JL. BC conducted the thematic analysis, in consultation with MO and DN. BC drafted the manuscript which was read, revised and approved by SMO, MO, DN, JL, MR and SMS. Guarantor: BC.

  • Funding This research was funded by the Health Research Board under grant no. HRB-CICER-2016-1871.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.