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Spiritual Care in Serious Illness: A Narrative Review of Low- and Middle-Income Country Evidence Cover

Spiritual Care in Serious Illness: A Narrative Review of Low- and Middle-Income Country Evidence

Open Access
|Sep 2026

References

  1. Balboni TA, VanderWeele TJ, Doan‑Soares SD, et al. Spirituality in serious illness and health. JAMA. 2022;328(2):184–189. doi:10.1001/jama.2022.11086.
  2. Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: The report of the Consensus Conference. J Palliat Med. 2009;12(10):885–904. doi:10.1089/jpm.2009.0142.
  3. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: Reaching national and international consensus. J Palliat Med. 2014;17(6):642–656. doi:10.1089/jpm.2014.9427.
  4. Ferngren GB. Medicine and Religion: A Historical Introduction. Johns Hopkins University Press; 2014. doi:10.56021/9781421412153.
  5. Levin J. Conflict and cooperation. In: Levin J, Post SG. eds. Religion and Medicine: A History of the Encounter Between Humanity’s Two Greatest Institutions. Oxford University Press; 2020:1‑17 doi:10.1093/oso/9780190867355.003.0001.
  6. Oman D. Why Religion and Spirituality Matter for Public Health: Evidence, Implications, and Resources. Springer; 2018. doi:10.1007/978-3-319-73966-3.
  7. World Health Organization. World Health Organization strategy for engaging religious leaders, faith‑based organizations and faith communities in health emergencies. Published November 3, 2021. https://www.who.int/publications/i/item/9789240037205.
  8. Peng‑Keller S, Winiger F, Rauch R. The Spirit of Global Health: The World Health Organization and the ‘Spiritual Dimension’ of Health, 1946–2021. Oxford University Press; 2022. doi:10.1093/oso/9780192865502.001.0001.
  9. Pew Research Center. A changing world: Global views on diversity, gender equality, family life and the importance of religion. Published April 22, 2019. https://www.pewresearch.org/global/2019/04/22/a-changing-world-global-views-on-diversity-gender-equality-family-life-and-the-importance-of-religion/.
  10. World Bank. World Bank country and lending groups. Accessed August 25, 2026. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.
  11. Afrooz R, Rahmani A, Zamanzadeh V, et al. The nature of hope among Iranian cancer patients. Asian Pac J Cancer Prev. 2014;15(21):9307–9312. doi:10.7314/apjcp.2014.15.21.9307.
  12. Akuoko CP, Chambers S, Yates P. Supportive care needs of women with advanced breast cancer in Ghana. Eur J Oncol Nurs. 2022;58:102142. doi:10.1016/j.ejon.2022.102142.
  13. Bar‑Sela G, Schultz MJ, Elshamy K, et al. Human Development Index and its association with staff spiritual care provision: A Middle Eastern oncology study. Support Care Cancer. 2019;27(9):3601–3610. doi:10.1007/s00520-019-04733-0.
  14. Bar‑Sela G, Schultz MJ, Elshamy K, et al. Training for awareness of one’s own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses. Palliat Support Care. 2019;17(3):345–352. doi:10.1017/S147895151800055X.
  15. Camargos MGD, Paiva CE, Barroso EM, Carneseca EC, Paiva BSR. Understanding the differences between oncology patients and oncology health professionals concerning spirituality/religiosity: A cross‑sectional study. Medicine. 2015;94(47):e2145. doi:10.1097/MD.0000000000002145.
  16. Chacko R, Anand JR, Rajan A, John S, Jeyaseelan V. End‑of‑life care perspectives of patients and health professionals in an Indian health‑care setting. Int J Palliat Nurs. 2014;20(11):557–564. doi:10.12968/ijpn.2014.20.11.557.
  17. Chaiviboontham S. Factors predicting the effectiveness of palliative care in patients with advanced cancer. Palliat Support Care. 2015;13(4):997–1003. doi:10.1017/S1478951514000856.
  18. Chen J, You H, Liu Y, Kong Q, Lei A, Guo X. Association between spiritual well‑being, quality of life, anxiety and depression in patients with gynaecological cancer in China. Medicine. 2021;100(1):e24264. doi:10.1097/MD.0000000000024264.
  19. Effendy C, Vissers K, Tejawinata S, Vernooij‑Dassen M, Engels Y. Dealing with symptoms and issues of hospitalized patients with cancer in Indonesia: The role of families, nurses, and physicians. Pain Pract. 2015;15(5):441–446. doi:10.1111/papr.12203.
  20. Farahani AS, Rassouli M, Salmani N, et al. Evaluation of health‑care providers’ perception of spiritual care and the obstacles to its implementation. Asia Pac J Oncol Nurs. 2019;6(2):122–129. doi:10.4103/apjon.apjon_69_18.
  21. Fawares F, Ibdah R, Ammar K, et al. Spiritual beliefs of Jordanian adult patients receiving palliative care. J Relig Health. 2021;60(4):2849–2861. doi:10.1007/s10943-020-01054-z.
  22. Gravier AL, Shamieh O, Paiva CE, et al. Meaning in life in patients with advanced cancer: A multinational study. Support Care Cancer. 2020;28(8):3927–3934. doi:10.1007/s00520-019-05239-5.
  23. Haokip HR, Chauhan H, Rawat I, et al. Relationship between spirituality and depression among patients with malignant cancer at a selected tertiary care institute ‑ A study from North India. J Psychosoc Oncol. 2022;40(3):331–346. doi:10.1080/07347332.2021.1990184.
  24. Malhotra C, Krishnan A, Yong JR, et al. Socio‑economic inequalities in suffering at the end of life among advanced cancer patients: Results from the APPROACH study in five Asian countries. Int J Equity Health. 2020;19(1):158. doi:10.1186/s12939-020-01274-5.
  25. Myint AT, Tiraphat S, Jayasvasti I, Hong SA, Kasemsup V. Factors influencing the willingness of palliative care utilization among the older population with active cancers: A case study in Mandalay, Myanmar. Int J Environ Res Public Health. 2021;18(15):7887. doi:10.3390/ijerph18157887.
  26. Ratshikana‑Moloko M, Ayeni O, Tsitsi JM, et al. Spiritual care, pain reduction, and preferred place of death among advanced cancer patients in Soweto, South Africa. J Pain Symptom Manage. 2020;60(1):37–47. doi:10.1016/j.jpainsymman.2020.01.019.
  27. Rohani C, Abedi HA, Omranipour R, Langius‑Eklöf A. Health‑related quality of life and the predictive role of sense of coherence, spirituality and religious coping in a sample of Iranian women with breast cancer: A prospective study with comparative design. Health Qual Life Outcomes. 2015;13(1):40. doi:10.1186/s12955-015-0229-1.
  28. Valentino TCDO, De Oliveira MA, Paiva CE, Paiva BSR. Where do Brazilian cancer patients prefer to die? Agreement between patients and caregivers. J Pain Symptom Manage. 2022;64(2):186–204. doi:10.1016/j.jpainsymman.2022.03.015.
  29. Wisesrith W, Sukcharoen P, Sripinkaew K. Spiritual care needs of terminal ill cancer patients. Asian Pac J Cancer Prev. 2021;22(12):3773–3779. doi:10.31557/APJCP.2021.22.12.3773.
  30. Yang Y, Zhao X, Cui M, Wang S, Wang Y. Longitudinal changes in spiritual well‑being and associations with emotional distress, pain, and optimism–pessimism: A prospective observational study of terminal cancer patients admitted to a palliative care unit. Support Care Cancer. 2021;29(12):7703–7714. doi:10.1007/s00520-021-06320-8.
  31. Zafar W, Hafeez H, Jamshed A, Shah MA, Quader A, Yusuf MA. Preferences regarding disclosure of prognosis and end‑of‑life care: A survey of cancer patients with advanced disease in a lower‑middle‑income country. Palliat Med. 2016;30(7):661–673. doi:10.1177/0269216315625810.
  32. Bashar FR, Vahedian‑Azimi A, Salesi M, et al. Spiritual health and outcomes in Muslim ICU patients: A nationwide cross‑sectional study. J Relig Health. 2018;57(6):2241–2257. doi:10.1007/s10943-017-0543-5.
  33. Martinez BB, Custodio RP. Relationship between mental health and spiritual wellbeing among hemodialysis patients: A correlation study. Sao Paulo Med J. 2014;132(1):23–27. doi:10.1590/1516-3180.2014.1321606.
  34. Ramirez SP, Macêdo DS, Sales PMG, et al The relationship between religious coping, psychological distress and quality of life in hemodialysis patients. J Psychosom Res. 2012;72(2):129–135. doi:10.1016/j.jpsychores.2011.11.012.
  35. Yaghoobzadeh A, Soleimani MA, Allen KA, Chan YH, Herth KA. Relationship between spiritual well‑being and hope in patients with cardiovascular disease. J Relig Health. 2018;57(3):938–950. doi:10.1007/s10943-017-0467-0.
  36. Liu Y, Xue H, Yan L, Xia Y, Wang Y. The assessment of spirituality between cancer and chronic inpatients: A cross‑sectional study. Support Care Cancer. 2022;30(5):4157–4167. doi:10.1007/s00520-022-06847-4.
  37. Kwok JYY, Huang TW, Tretriluxana J, et al. Symptom burden and unmet support needs of patients with Parkinson’s disease: A cross‑sectional study in Asia‑Pacific regions. J Am Med Dir Assoc. 2021;22(6):1255–1264. doi:10.1016/j.jamda.2020.09.012.
  38. Dadsetan F, Shahrbabaki PM, Mirzai M, Nouhi E. Palliative care needs of patients with multiple sclerosis in southeast Iran. BMC Palliat Care. 2021;20(1):169. doi:10.1186/s12904-021-00867-3.
  39. Lowther K, Harding R, Simms V, et al. Active ingredients of a person‑centered intervention for people on HIV treatment: Analysis of mixed methods trial data. BMC Infect Dis. 2018;18(1):27. doi:10.1186/s12879-017-2900-0.
  40. Nkhoma K, Ahmed A, Ali Z, Gikaara N, Sherr L, Harding R. Does being on TB treatment predict a higher burden of problems and concerns among HIV outpatients in Kenya? A cross‑sectional self‑report study. AIDS Care. 2018;30(suppl 2):28–32. doi:10.1080/09540121.2018.1469726.
  41. Şahan S, Yıldız A. Determining the spiritual care requirements and death anxiety levels of patients diagnosed with COVID‑19 in Turkey. J Relig Health. 2022;61(1):786–797. doi:10.1007/s10943-021-01454-9.
  42. Chui PL, Abdullah KL, Wong LP, Taib NA. Prayer‑for‑health and complementary alternative medicine use among Malaysian breast cancer patients during chemotherapy. BMC Complement Altern Med. 2014;14(1):425. doi:10.1186/1472-6882-14-425.
  43. Mah K, Powell RA, Malfitano C, et al. Evaluation of the Quality of Dying and Death Questionnaire in Kenya. J Glob Oncol. 2019;5:1–16. doi:10.1200/JGO.18.00257.
  44. Mishra S, Gupta R, Bhatnagar S, et al. The COVID‑19 pandemic: A new epoch and fresh challenges for cancer patients and caregivers—A descriptive cross‑sectional study. Support Care Cancer. 2022;30(2):1547–1555. doi:10.1007/s00520-021-06564-4.
  45. Ndiok A, Ncama B. Assessment of palliative care needs of patients/families living with cancer in a developing country. Scand J Caring Sci. 2018;32(3):1215–1226. doi:10.1111/scs.12568.
  46. Satija A, Bhatnagar S, Ozdemir S, et al. Patients’ awareness of advanced disease status, psychological distress and quality of life among patients with advanced cancer: Results from the APPROACH study, India. Am J Hosp Palliat Care. 2022;39(7):772–778. doi:10.1177/10499091211042837.
  47. Selman LE, Higginson IJ, Agupio G, et al. Quality of life among patients receiving palliative care in South Africa and Uganda: A multi‑centered study. Health Qual Life Outcomes. 2011;9(1):21. doi:10.1186/1477-7525-9-21.
  48. Demirbag B, Ozkan C. Interventions by hospital nurses for the spiritual needs of patients in the Eastern Black Sea Region of Turkey. Niger J Clin Pract. 2018;21(5):624–631. doi:10.4103/njcp.njcp_62_17.
  49. Amini K, Tahrekhani M, Abbas‑Alamdari Z, Faghihzadeh S. The effect of spiritual care on anxiety about death in patients with gastrointestinal cancer undergoing chemotherapy: A randomized controlled trial. Eur J Integr Med. 2020;36:101117. doi:10.1016/j.eujim.2020.101117.
  50. Kang KA, Han SJ, Lim YS, Kim SJ. Meaning‑centered interventions for patients with advanced or terminal cancer: A meta‑analysis. Cancer Nurs. 2019;42(4):332–340. doi:10.1097/NCC.0000000000000628.
  51. Weru J, Gatehi M, Musibi A. Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life. BMC Palliat Care. 2020;19(1):114. doi:10.1186/s12904-020-00614-0.
  52. Xiao J, Chow KM, Choi KC, et al. Effects of family‑oriented dignity therapy on dignity, depression and spiritual well‑being of patients with lung cancer undergoing chemotherapy: A randomised controlled trial. Int J Nurs Stud. 2022;129:104217. doi:10.1016/j.ijnurstu.2022.104217.
  53. Mahdavi B, Fallahi‑Khoshknab M, Mohammadi F, Hosseini MA, Haghi M. Effects of spiritual group therapy on caregiver strain in home caregivers of the elderly with Alzheimer’s disease. Arch Psychiatr Nurs. 2017;31(3):269–273. doi:10.1016/j.apnu.2016.12.003.
  54. Wang C, Chen J, Wang Y, et al. Effects of family participatory dignity therapy on the psychological well‑being and family function of patients with haematologic malignancies and their family caregivers: A randomised controlled trial. Int J Nurs Stud. 2021;118:103922. doi:10.1016/j.ijnurstu.2021.103922.
  55. Sankhe A, Dalal K, Agarwal V, Sarve P. Spiritual care therapy on quality of life in cancer patients and their caregivers: A prospective non‑randomized single‑cohort study. J Relig Health. 2017;56(2):725–731. doi:10.1007/s10943-016-0324-6.
  56. Han XB, Fang YQ, Liu SX, et al. Efficacy of combined Naikan and Morita therapies on psychological distress and posttraumatic growth in Chinese patients with advanced cancer: A randomized controlled trial. Medicine. 2021;100(30):e26701. doi:10.1097/MD.0000000000026701.
  57. Ferngren GB, Lomperis EN. Essential Readings in Medicine and Religion. Johns Hopkins University Press; 2017. doi:10.1353/book.72137.
  58. Farmer P. Rethinking medical ethics: A view from below. Dev World Bioeth. 2004;4(1):17–41. doi:10.1111/j.1471-8731.2004.00065.x.
  59. Sherman AC, Merluzzi TV, Pustejovsky JE, et al. A meta‑analytic review of religious or spiritual involvement and social health among cancer patients. Cancer. 2015;121(21):3779–3788. doi:10.1002/cncr.29352.
  60. Park CL. Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychol Bull. 2010;136(2):257–301. doi:10.1037/a0018301.
  61. Ano GG, Vasconcelles EB. Religious coping and psychological adjustment to stress: A meta‑analysis. J Clin Psychol. 2005;61(4):461–480. doi:10.1002/jclp.20049.
  62. Pargament KI, Koenig HG, Perez LM. The many methods of religious coping: Development and initial validation of the RCOPE. J Clin Psychol. 2000;56(4):519–543. doi:10.1002/(SICI)1097-4679(200004)56:4<;519::AID-JCLP6>3.0.CO;2-1.
  63. Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of positive and negative religious coping with major life stressors. J Sci Study Relig. 1998;37(4):710–724. doi:10.2307/1388152.
  64. Vos J, Vitali D. The effects of psychological meaning‑centered therapies on quality of life and psychological stress: A meta‑analysis. Palliat Support Care. 2018;16(5):608–632. doi:10.1017/S1478951517000931.
  65. Edwards ME, Booker JA, Cook K, Miao M, Gan Y, King LA. Hope as a meaningful emotion: Hope, positive affect, and meaning in life. Emotion. 2025;25(6):1365–1380. doi:10.1037/emo0001513.
  66. Long KNG, Kim ES, Chen Y, Wilson MF, Worthington EL Jr, VanderWeele TJ. The role of hope in subsequent health and well‑being for older adults: An outcome‑wide longitudinal approach. Glob Epidemiol. 2020;2:100018. doi:10.1016/j.gloepi.2020.100018.
  67. Ando M, Kawamura R, Morita T, et al. Value of religious care for relief of psycho‑existential suffering in Japanese terminally ill cancer patients: The perspective of bereaved family members. Psychooncology. 2010;19(7):750–755. doi:10.1002/pon.1625.
  68. Breitbart W, Rosenfeld B, Pessin H, Applebaum A, Kulikowski J, Lichtenthal WG. Meaning‑centered group psychotherapy: An effective intervention for improving psychological well‑being in patients with advanced cancer. J Clin Oncol. 2015;33(7):749–754. doi:10.1200/JCO.2014.57.2198.
  69. Chochinov HM, Kristjanson LJ, Breitbart W, et al. Effect of dignity therapy on distress and end‑of‑life experience in terminally ill patients: A randomised controlled trial. Lancet Oncol. 2011;12(8):753–762. doi:10.1016/S1470-2045(11)70153-X.
DOI: https://doi.org/10.5334/aogh.5384 | Journal eISSN: 2214-9996
Language: English
Page range: 98 - 98
Submitted on: Jun 9, 2026
Accepted on: Aug 22, 2026
Published on: Sep 18, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services

© 2026 Ryan Meachen, Junita Henry, Sabbi Lall, Tracy A. Balboni, Constantine S. Psimopoulos, Tyler J. VanderWeele, Katelyn Long, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.