From Despair to Peace: Spiritual Experience of Chinese Palliative Care Patients At the End of Life

Background and Purpose: Spirituality has been increasingly recognized as a central component of holistic well-being at the end of life. Yet, most studies on spirituality in palliative care have focused on the experience of people from a Judeo-Christian tradition; there is very little information on the perspective of patients from other backgrounds. Given that spirituality encompasses both the religious and non-religious meaning and values of an individual, understanding how people in different cultures find peace and make sense of life and death becomes of paramount importance for culturally respectful practice. The purpose of this study is to understand the spiritual experience of Chinese patients at the end of life. Corresponding themes across the spectrum of spiritual despair to well-being and how patients achieve spiritual well-being are reported.

Method: Adopting a constructivist grounded theory approach, purposive sampling was used to recruit twenty cancer patients from the palliative care unit of a hospital in Hong Kong. Participants include both males and females with diverse cancer diagnoses. Their ages ranged from 22 to over 80. A semi-structured interview integrating the life review technique was used in data collection, which provided in-depth and contextual understanding of the experience related to the spirituality of the patients. Line-by-line coding was conducted with the transcripts of these interviews, using the qualitative analysis software ATLAS.ti. By constant comparison analysis, conceptual categories were constructed and patterns identified from the codes.

Results: Findings reveal that spirituality at the end of life encompasses a spectrum from spiritual despair (loss of self, dissonance, and hopelessness) to spiritual peace (self-integrity, interpersonal harmony, equanimity). The patients' process from despair to peace includes (1) creating meaning, which involves actualization of a moral self (being a good person and living out one's virtues), fulfillment of familial responsibilities and appreciating strengths in self; (2) making connection, which includes reconciliation with self and others, giving and receiving love, and passing on one's life values to one's children; and (3) transcending death, which is achieved through accepting the Mandate of Heaven and living in the moment.

Conclusions and Implications: This study expands our understanding of the range of spiritual experiences of patients at the end of life. It highlights the possibility of shifts from spiritual distress to well-being when an individual is able to go through the necessary spiritual process. In particular, this study sheds light on how Chinese patients use culturally specific ways to enhance their spiritual well-being. Relational orientation, familial obligations and harmony with life's process remain core components of Chinese culture. The findings of this study illuminate how these values interact with the experience of dying, and they inform palliative social work at the end of life. The area of patients' spiritual process in coping with end-of-life issues in diverse cultures is fertile ground for further investigation, as it has important implications for improving interventions for holistic and culturally respectful end-of-life care.

Acknowledgement: The work described in this presentation was supported by the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. HKU 747019H)