Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Jane M. Georges, PhD, RN, Chairperson; Cynthia D. Connelly, PhD, RN, FAAN, Committee Member; Bethany Turner, MA, MC, EdD, Committee Member


pain, spiritual distress, end of life, hospice


Purpose: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.

Background/Rationale: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Research is needed to examine the relationships between physical pain, spiritual distress, and other relevant variables specific to EOL patients receiving home hospice care.

Methods: Retrospective correlational design. Pre-existing data were extracted from a hospice agency’s electronic health record to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, levels of pain, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N=3484). Descriptive, bivariate, and multivariate analyses were conducted.

Results: Participants ranged in age from 25 to 107 years, M = 82 + 12.08, one third were married or had a designated life partner, 16% reported moderate to severe pain; 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, p < .001, Cramer’s V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, p < .001, Cramer’s V = .08), pain severity (χ2 (1, N = 3464) = 19.75, p < .001, Cramer’s V = .08), and age t (393.17) = 2.84, p = .005, d = .17 were significantly related to spiritual distress. The logistic model was statistically significant, χ2 (11) = 45.25, p < .001. Cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, p = .02), were single (OR = 1.6, p = .02), and had moderate to severe pain (OR = 1.4, p = .04).

Implications: Moderate to severe pain, marital status, and diagnosis should be considered in a refined spiritual distress screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.

Document Type

Dissertation: Open Access