Spiritual and existential issues

Abstract

Background: Spiritual and existential issues become increasingly salient for individuals facing life-threatening illnesses, including those with advanced cardiovascular diseases. Patients with high levels of existential anxiety and low spiritual well-being tend to experience lower quality of life and more depressive symptoms. Thus, identifying patients who are having spiritual and existential issues and utilizing targeted spiritually-informed interventions may improve quality of care and quality of life at the end of life. Method: We review the research examining spiritual and existential issues in patients with advanced cardiovascular disease at the end of life and provide recommendations for spiritual assessments and interventions providers can use with patients at the end of life. Results: In general, observational studies indicate that patients with greater levels of spiritual well-being, religiousness, and meaning or purpose in life experience greater quality of life and fewer depressive symptoms. In contrast, negative aspects of spirituality or religiousness (e.g., existential anxiety) are related to poorer outcomes. Several spiritual assessments for patients at the end of life have been developed and can be used as guidelines for starting conversations with patients. However, few spiritually-integrated interventions have been tested and more research is needed to identify effective spiritual interventions. Conclusions: Spiritual and existential issues are highly prevalent in patients at the end of life. Integrating spiritual care in advanced illness and at end of life can enhance the quality of care and patients’ quality of life.