This secondary analysis compared two groups of home hospice patients (expressed spirituality, N = 44, and nonexpressed spirituality, N = 53) on psychological well-being and adaptation, social support, physical function, pain, and demographic variables. Independent-samples t tests found no significant differences at p < .05 for age, psychological well-being and adaptation, social support, and physical function. Three components of the McGill-Melzack Pain Questionnaire were significantly higher for the nonexpressed spirituality group: Affective Dimension, Pain Rating Index, and Number of Words Chosen. A comparative analysis of two groups of home hospice patients supported higher pain reports as significant indicators of non-expressed spirituality in a home hospice population.
Keywords: spirituality; hospice and palliative care; pain; psychological adaptation; death and dying; Roy adaptation model
Due to the personal meaning that each person ascribes to spirituality, research on this complex phenomenon can be problematic, particularly, in life-threatening illness (Holland et al., 1999). With recognition that spirituality is a personal experience, two groups of home hospice patients-those with expressed and nonexpressed spirituality-were compared in this study, the purpose of which was to explore group differences in psychological well-being and adaptation, social support, physical function, and pain.
Spirituality integrates notions of existential reality, connectedness, transcendence, and power/force/energy (Chiu, Emblen, Van Hofwegen, Sawatzky, & Meyerhoff, 2004), and so, it is multifaceted in its meaning. Coyle's (2002) notion of spirituality also includes meaning and purpose, and faith and hope, as well as transcendence and connectedness. Coyle, Chiu, and associates' views of spirituality as transcendent and value driven provide a wide lens through which to view spirituality as "any firmly held value that gives life meaning and purpose" (Coyle, p. 592). If one adheres to this viewpoint, spirituality can be expressed in relationship with others, a Higher Being, nature, and also with self (Chiu et al., 2004), making it difficult to quantify. In contrast, belief systems that pertain to religion or religiosity are enacted through rituals and traditions (Coyle, 2002; Daaleman & VandeCreek, 2000) and, thus, may be easier to determine. Even though spiritual values may be held closely, when individuals face life-threatening illness, expressions of spirituality assume even greater meaning (Kaasa & Loge, 2003; McMillian & Weitzner, 2000; Murray, Kendall, Boyd, Worth, & Benton, 2004; Reed, 1987). Hence, research is needed that unravels the complexities of this personal but fundamental end-of-life experience.
While dying persons may not express religious beliefs, they still convey their need for love, meaning, and purpose (Murray et al., 2004). These human attributes cut across all religious and nonreligious boundaries, and so, a broadened notion of spirituality must include these values (Wright, 2001). Since love, meaning in life, forgiveness, and transcendence are all intrinsic human values (Tanyi, 2002), one can safely say that "all people are spiritual beings" (Wright, 2002, p. 127). When persons with life-threatening illness are unable to express their spiritual self or when they are unable to find meaning in life, they are prone to spiritual pain (McGrath, 2002). Hence, professionals' capacity to ascertain a dying person's spiritual values is a critical component of end-of-life care (Daaleman & VandeCreek, 2000).
Although spirituality is such a central part of hospice and palliative care, research on this important phenomenon is sparse (Wright, 2001), and only a few studies examine the central concepts of this multidimensional construct or attempt to clarify personal meanings of spirituality. Meraviglia (2004) studied meaning in life, which was defined by Chiu and associates (2004) as an existential part of spirituality. …