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Influence of spirituality and religiousness on outcomes in palliative care patients

Michael J Balboni, PhD, ThM
Tracy A Balboni, MD, MPH
Section Editor
Susan D Block, MD
Deputy Editor
Diane MF Savarese, MD


The experience of serious illness is multifaceted and dynamic, impacting the physical, psychological, social, and spiritual dimensions of the human person. Dame Cecily Saunders, founder of the hospice and palliative care movements, recognized these four distinct yet intertwined domains in defining the concept of "total pain" in the 1960s, a holistic and enduring framework to guide the care of seriously ill persons [1,2].

The relationship between spirituality and health has gained increased attention over the last two decades in the United States and elsewhere. Spirituality (which includes religious and existential aspects of care) is one of eight specific domains of quality within palliative care, endorsed by the National Consensus Project (NCP) for Quality Palliative Care and international palliative care organizations [3,4]. However, spirituality has historically been one of the least studied and addressed domains within the care of the seriously ill [5,6]. A growing body of literature supports the notion that spiritual care is an important patient need in palliative care, that spiritual distress is a significant component of overall distress in palliative care patients, and that patients' spirituality affects healthcare decision making and healthcare outcomes, including coping, quality of life, and pain management.

This topic will review the available evidence linking spirituality and palliative care outcomes. An overview of spirituality in palliative care, which includes how to address spirituality with patients, methods of spiritual assessment, taking of a spiritual history, and approaches to spiritual distress, are addressed elsewhere. (See "Overview of spirituality in palliative care".)    


Spirituality is multidimensional and highly variable in its individual and/or communal experiences and expressions. It is often understood as encompassing the relationship to and experience of transcendence [7] or sense of peace, purpose, and interconnectedness, including beliefs about the meaning of life [8].

Because of the need to standardize a definition for spirituality in palliative care, a group of interdisciplinary experts in palliative and spiritual care produced a consensus definition of spirituality as 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, to self, to others, to nature, and to the significant or sacred [9]. Spirituality may include religion and other worldviews but encompasses far more general ways in which these experiences are expressed, including through the arts, relationships with nature and others, and for some, through the concept of secular humanism, the latter of which emphasizes reason, scientific inquiry, individual freedom and responsibility, human values, compassion, and the needs for tolerance and cooperation [10].

Religion is a structure through which a person or group of persons expresses spirituality within a community. A religious community is one that is organized around common beliefs, attitudes, practices, traditions, and relationships.

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Literature review current through: Nov 2017. | This topic last updated: May 04, 2016.
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