ArticleThe American journal of hospice & palliative care2018
Fear, Pain, Denial, and Spiritual Experiences in Dying Processes.
Article in The American journal of hospice & palliative care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- Pain and Spirituality Outcomes Among Women With Advanced Breast Cancer Participating in a Foot Reflexology Trial.Oncology nursing forum · 2021Trial
- End-of-life dreams and visions in a patient with delirium: A Brazilian case report and narrative review.Palliative & supportive care · 2025Review
- The Relationship Between Spiritual Well-Being and Fear of COVID-19 Among Cancer Patients in Turkey.Journal of religion and health · 2025Article
- Seeking Something Beyond Themselves: A Concept Analysis of Spiritual Awakening Experiences at the End of Life.Nursing reports (Pavia, Italy) · 2025Article
- Exploring the spiritual experiences of older adults with chronic diseases: a qualitative study in a multicultural context.BMC psychology · 2025Article
- Ethical reflection: The palliative care ethos and patients who refuse information.Palliative care and social practice · 2025Article
- The association between death anxiety and nutrition awareness in elderly hospitalized patients: a dual-perspective analysis from person-centered and variable-centered approaches based on future time perspective.Frontiers in nutrition · 2025Article
- Article
- Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives.Journal of palliative care · 2022Article
- Managing terminal restlessness, anxiety, and distress during the dying process with Yintang (EX-HN 3) point acupuncture or acupressure: a case series of 19 palliative care patients from a hospital in Germany.The Pan African medical journal · 2022Article
- The construction of the responsible patient in complex palliative care: interpreting palliative care policies.Palliative care and social practice · 2022Article
- The role of spirituality in symptom experiences among adults with cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022Article
- COVID-19 Pandemic and the Necessity of Spiritual Care.Iranian journal of psychiatry · 2020Article
- Stakeholder Perspectives on the Use of Community Health Workers To Improve Palliative Care Use by African Americans with Cancer.Journal of palliative medicine · 2019Article
- An Observational Study on the Effects of Delayed Initiation of End-of-Life Care in Terminally ill Young Adults in the Intensive Care Unit.Indian journal of palliative careArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeApproaching death seems to be associated with physiological/spiritual changes. Trajectories including the physical-psychological-social-spiritual dimension have indicated a terminal drop. Existential suffering or deathbed visions describe complex phenomena. However, interrelationships between different constituent factors (e.g., fear and pain, spiritual experiences and altered consciousness) are largely unknown. We lack deeper understanding of patients' inner processes to which care should respond. In this study, we hypothesized that fear/pain/denial would happen simultaneously and be associated with a transformation of perception from ego-based (pre-transition) to ego-distant perception/consciousness (post-transition) and that spiritual (transcendental) experiences would primarily occur in periods of calmness and post-transition. Parameters for observing transformation of perception (pre-transition, transition itself, and post-transition) were patients' altered awareness of time/space/body and patients' altered social connectedness.
methodTwo interdisciplinary teams observed 80 dying patients with cancer in palliative units at 2 Swiss cantonal hospitals. We applied participant observation based on semistructured observation protocols, supplemented by the list of analgesic and psychotropic medication. Descriptive statistical analysis and Interpretative Phenomenological Analysis (IPA) were combined. International interdisciplinary experts supported the analysis.
resultsMost patients showed at least fear and pain once. Many seemed to have spiritual experiences and to undergo a transformation of perception only partly depending on medication. Line graphs representatively illustrate associations between fear/pain/denial/spiritual experiences and a transformation of perception. No trajectory displayed uninterrupted distress. Many patients seemed to die in peace. Previous near-death or spiritual/mystical experiences may facilitate the dying process.
conclusionApproaching death seems not only characterized by periods of distress but even more by states beyond fear/pain/denial.
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