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,
Significance: 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.