Skip to main content Accessibility help

Spiritual beliefs, practices, and needs at the end of life: Results from a New Zealand national hospice study

  • Richard Egan (a1), Rod MacLeod (a2), Chrystal Jaye (a3), Rob McGee (a1), Joanne Baxter (a4), Peter Herbison (a1) and Sarah Wood (a1)...



International studies have shown that patients want their spiritual needs attended to at the end of life. The present authors developed a project to investigate people's understanding of spirituality and spiritual care practices in New Zealand (NZ) hospices.


A mixed-methods approach included 52 semistructured interviews and a survey of 642 patients, family members, and staff from 25 (78%) of NZ's hospices. We employed a generic qualitative design and analysis to capture the experiences and understandings of participants' spirituality and spiritual care, while a cross-sectional survey yielded population level information.


Our findings suggest that spirituality is broadly understood and considered important for all three of the populations studied. The patient and family populations had high spiritual needs that included a search for (1) meaning, (2) peace of mind, and (3) a degree of certainty in an uncertain world. The healthcare professionals in the hospices surveyed seldom explicitly met the needs of patients and families. Staff had spiritual needs, but organizational support was sometimes lacking in attending to these needs.

Significance of results:

As a result of our study, which was the first nationwide study in NZ to examine spirituality in hospice care, Hospice New Zealand has developed a spirituality professional development program. Given that spirituality was found to be important to the majority of our participants, it is hoped that the adoption of such an approach will impact on spiritual care for patients and families in NZ hospices.


Corresponding author

Address correspondence and reprint requests to: Richard Egan, Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, P.O. Box 56, Dunedin 9054, New Zealand. E-mail:


Hide All

All authors contributed equally to this work



Hide All
Adams, R.N., Mosher, C.E., Cannady, R.S., et al. (2014). Caregiving experiences predict changes in spiritual well-being among family caregivers of cancer patients. Psycho-Oncology, 23(10), 11781184. Epub ahead of print May 17.
Astrow, A.B., Wexler, A., Texeira, K., et al. (2007). Is failure to meet spiritual needs associated with cancer patients' perceptions of quality of care and their satisfaction with care? Journal of Clinical Oncology, 25(36), 57535757.
Balboni, T.A., Vanderwerker, L.C., Block, S.D., et al. (2007). Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. Journal of Clinical Oncology, 25(5), 555560.
Bregman, L. (2006). Spirituality: A glowing and useful term in search of a meaning. Omega, 53(1–2), 1526. Abstract available from
Breitbart, W. (2002). Spirituality and meaning in supportive care: Spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer, 10(4), 272280. Epub ahead of print Aug 28, 2001.
Cobb, M. (2003). Spiritual care. In Psychological issues in palliative care. Lloyd-Williams, M. (ed.), pp. 135147. New York: Oxford University Press.
Cobb, M., Dowrick, C. & Lloyd-Williams, M. (2012). What can we learn about the spiritual needs of palliative care patients from the research literature? Journal of Pain and Symptom Management, 43(6), 11051119. Epub ahead of print May 9.
Doyle, D. & Woodruff, R. (2004). The IAHPC manual of palliative care, 3rd ed. Chicago: International Association for Hospice & Palliative Care. Available from
Doyle, D., Hanks, G., Cherny, N.I., et al. (eds.) (2004). Oxford textbook of palliative medicine, 3rd ed.. New York: Oxford University Press.
Egan, R., MacLeod, R., Jaye, C., et al. (2011). What is spirituality? Evidence from a New Zealand hospice study. Mortality, 16(4), 307324. Available from
Hanson, L.C., Dobbs, D., Usher, B.M., et al. (2008). Providers and types of spiritual care during serious illness. Journal of Palliative Medicine, 11(6), 907914.
Jim, H., Purnell, J., Richardson, S., et al. (2006). Measuring meaning in life following cancer. Quality of Life Research, 15(8), 13551371. Epub ahead of print Jul 13.
Joint Commission on Accreditation of Healthcare Organizations (2005). The source: Evaluating your spiritual assessment process, Vol. 3, pp. 67. Washington, DC: Joint Commission on Accreditation of Healthcare Organizations.
Kellehear, A. (2000). Spirituality and palliative care: A model of needs. Palliative Medicine, 14(2), 149155.
Kernohan, W.G., Mary, W., Caroline, M., et al. (2007). An evidence base for a palliative care chaplaincy service in Northern Ireland. Palliative Medicine, 21(6), 519525.
Lambie, D., Egan, R., Walker, S., et al. (2015). How spirituality is understood and taught in New Zealand medical schools. Palliative & Supportive Care, 13(1), 5358. Epub ahead of print Oct 29, 2013.
Lin, H.-R. & Bauer-Wu, S.M. (2003). Psycho-spiritual well-being in patients with advanced cancer: An integrative review of the literature. Journal of Advanced Nursing, 44(1), 6980.
MacLeod, R. (2003). Psychosocial care for non-malignant disease. In Psychological issues in palliative care. Lloyd-Williams, M. (ed.), pp. 119135. New York: Oxford University Press.
MacLeod, R.D., Thompson, R., Fisher, J.W., et al. (2012). New Zealanders' knowledge of palliative care and hospice services. The New Zealand Medical Journal, 125(1348), 5160.
Mahoney, M.J. & Graci, G.M. (1999). The meanings and correlates of spirituality: Suggestions from an exploratory survey of experts. Death Studies, 23(6), 521528.
McClain, C.S., Rosenfeld, B. & Breitbart, W. (2003). Effect of spiritual well-being on end-of-life despair in terminally ill cancer patients. Lancet, 361(9369), 16031607.
McCord, G., Gilchrist, V.J., Grossman, S.D., et al. (2004). Discussing spirituality with patients: A rational and ethical approach. Annals of Family Medicine, 2(4), 356361.
McGrath, P. (2003). Spiritual pain: A comparison of findings from survivors and hospice patients. The American Journal of Hospice & Palliative Care, 20(1), 2333.
Milstein, J.M. (2008). Introducing spirituality in medical care: Transition from hopelessness to wholeness. The Journal of the American Medical Association, 299(20), 24402441.
Moadel, A., Morgan, C., Fatone, A., et al. (1999). Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically diverse cancer patient population. Psycho-Oncology, 8(5), 378385.
Morgan, A., MacLeod, R., Schumacher, M., et al. (2015). How do we best meet the spiritual needs of people we care for? European Journal of Palliative Care, 22(3), 130132.
Morgan, D. (2008). Paradigms lost and pragmatism regained: Methodological implications of combing qualitative and quantitative methods. Journal of Mixed Methods Research, 1(1), 4876.
Murata, H. (2003). Spiritual pain and its care in patients with terminal cancer: Construction of a conceptual framework by philosophical approach. Palliative & Supportive Care, 1(01), 1521.
Murray, S. (2010). The quality of death: Ranking end-of-life care across the world. Available from
Murray, S., Kendall, M., Boyd, K., et al. (2004). Exploring the spiritual needs of people dying of lung cancer or heart failure: A prospective qualitative interview study of patients and their carers. Palliative Medicine, 18(1), 3945.
Naylor, W. (2011). National health needs assessment for palliative care. Phase 1 report: Assessment of palliative care need. Wellington: Cancer Control New Zealand. Available from
Nursing Council of New Zealand (2012). New Zealand nursing workforce: A profile of nurse practitioners, registered nurses and enrolled nurses 2011. Wellington: Nursing Council of New Zealand. Available from
Patton, M.Q. (2002). Qualitative research and evaluation methods, 3rd ed. Thousand Oaks, CA: Sage.
Perkins, C. (2015). Promoting spiritual care for older people in New Zealand: The Selwyn Centre for Ageing and Spirituality. Working with Older People, 19(3), 107113. Available from
Phelps, A.C., Lauderdale, K.E., Alcorn, S., et al. (2012). Addressing spirituality within the care of patients at the end of life: Perspectives of patients with advanced cancer, oncologists, and oncology nurses. Journal of Clinical Oncology, 30(20), 25382544. Epub ahead of print May 21.
Puchalski, C.M. (2012). Spirituality in the cancer trajectory. Annals of Oncology, 23(Suppl. 3), 4955. Available from
Puchalski, C.M., Lunsford, B., Harris, M.H., et al. (2006). Interdisciplinary spiritual care for seriously ill and dying patients: A collaborative model. Cancer Journal, 12(5), 398416.
Puchalski, C.M., Vitillo, R., Hull, S.K., et al. (2014). Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine, 17(6), 642656. Epub ahead of print May 19.
Rumbold, B. (2002). From religion to spirituality. In Spirituality and palliative care: Social and pastoral perspectives. Rumbold, B. (ed.), pp. 521. Melbourne: Oxford University Press.
Rumbold, B. (2007). A review of spiritual assessment in health care practice. The Medical Journal of Australia, 186(10 Suppl.), S60S62.
Sinclair, S., Pereira, J. & Raffin, S. (2006). A thematic review of the spirituality literature within palliative care. Journal of Palliative Medicine, 9(2), 464479.
Steinhauser, K., Christakis, N., Clipp, E., et al. (2000). Factors considered important at the end of life by patients, family, physicians, and other care providers. The Journal of the American Medical Association, 284(19), 24762482.
Sulmasy, D. (2002). A biopsychosocial–spiritual model for the care of patients at the end of life. The Gerontologist, 42(3, Spec. Iss.), 2433.
Taylor, E.J. & Brander, P. (2013). Hospice patient and family carer perspectives on nurse spiritual assessment. Journal of Hospice & Palliative Nursing, 15(6), 347354.
Walsh, K., King, M., Jones, L., et al. (2002). Spiritual beliefs may affect outcome of bereavement: Prospective study. British Medical Journal, 324(7353), 1551.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed