Spiritual and Existential Issues in the Care of the Dying

Spirituality is important in the lives of patients with serious illnesses. Terminally patients may experience a number of spiritual issues, including lack of meaning, guilt, shame, hopelessness, loss of dignity, loneliness, anger toward God, abandonment by God, feeling out of control, grief, and spiritual suffering. Assessment of a patient’s spiritual beliefs, assessing the importance of spirituality in his or her life, exploring whether he or she belongs to a spiritual community, and offering chaplaincy referral or connection with the patient’s religious or spiritual leaders comprise essential components of a spiritual assessment. Psycho-oncologists should seek both specialized training, as well as referrals to appropriate sources, in order to help patients deal more effectively with the often complicated and painful spiritual issues that arise as a consequence of serious illness. Existential concerns are intrinsic to the human experience of facing mortality in palliative care settings. Patients diagnosed with terminal cancer often confront universal existential issues such as death anxiety, isolation, and meaninglessness. Psycho-oncologists must therefore be familiar with these existential concerns, their manifestations, and approaches to deal with existential issues. Psycho-oncologists have the unique ability to use a variety of psychotherapeutic interventions to alleviate existential distress in palliative care settings including cognitive therapies to help patients and families modify their appraisal of their lives with terminal illness, known as cognitive restructuring, life review techniques to facilitate a constructive reappraisal of life events, dignity-conserving therapies, and meaning-centered therapies have been shown to effectively reduce existential distress in this patient population.