Perspectives on spirituality at the end of life: a meta-summary.
OBJECTIVE
A meta-summary of the qualitative literature on spiritual perspectives of adults who are at the end of life was undertaken to summarily analyze the research to date and identify areas for future research on the relationship of spirituality with physical, functional, and psychosocial outcomes in the health care setting.


METHODS
Included were all English language reports from 1966 to the present catalogued in PubMed, Medline, PsycInfo, and CINAHL, identifiable as qualitative investigations of the spiritual perspectives of adults at the end of life. The final sample includes 11 articles, collectively representing data from 217 adults.


RESULTS
The preponderance of participants had a diagnosis of cancer; those with HIV/AIDS, cardiovascular disease, and ALS were also represented. Approximately half the studies were conducted in the United States; others were performed in Australia, Finland, Scotland, and Taiwan. Following a process of theme extraction and abstraction, thematic patterns emerged and effect sizes were calculated. A spectrum of spirituality at the end of life encompassing spiritual despair (alienation, loss of self, dissonance), spiritual work (forgiveness, self-exploration, search for balance), and spiritual well-being (connection, self-actualization, consonance) emerged.


CONCLUSIONS
The findings from this meta-summary confirm the fundamental importance of spirituality at the end of life and highlight the shifts in spiritual health that are possible when a terminally ill person is able to do the necessary spiritual work. Existing end-of-life frameworks neglect spiritual work and consequently may be deficient in guiding research. The area of spiritual work is fertile ground for further investigation, especially interventions aimed at improving spiritual health and general quality of life among the dying.
Williams
Anna-Leila
AL
School of Nursing, Yale University, 100 Church Street South, New Haven, CT 06510, USA. anna-leila.williams@yale.edu
D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D002318:Cardiovascular Diseases / Q000523:psychology; D015658:HIV Infections / Q000523:psychology; D006738:Hospices; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology; D011788:Quality of Life; D012068:Religion and Medicine; D012106:Research; D012107:Research Design; D029181:Spirituality; D019452:Terminally Ill / Q000523:psychology*