Spiritual wellbeing in advanced cancer patients receiving palliative care in a tertiary cancer centre in northern Kerala, India: a qualitative study.

Abstract

Spiritual well-being is an essential component of holistic palliative care. However, patients' lived experiences of spirituality in advanced cancer remain underexplored in low- and middle-income settings. This study aimed to explore spiritual well-being from the perspectives of patients with advanced cancer receiving palliative care in a tertiary cancer centre in Kerala. Qualitative descriptive study using face-to-face, in-depth, semistructured interviews and conventional content analysis conducted between November 2022 and December 2024. Outpatient palliative care services of a tertiary cancer centre in Kerala, India. 20 adults with advanced cancer receiving palliative care were recruited using purposive sampling. Interviews were conducted in Malayalam. Data were audiorecorded, transcribed verbatim, translated into English and analysed using conventional qualitative content analysis as described by Graneheim and Lundman. Data collection continued until saturation was achieved. Trustworthiness was ensured through credibility, dependability, confirmability and authenticity. A total of 127 codes were identified and organised into 18 subthemes and four overarching themes: (1) <i>multidimensional suffering and reflection in advanced cancer</i>, encompassing physical suffering, psycho-existential distress, social concerns, financial burden and moral reflection; (2) <i>healing through social support and relationships</i>, emphasising the supportive roles of family, community and healthcare professionals; (3) <i>coping mechanisms and inner strength</i>, including acceptance, peer inspiration, prior life experiences and adaptive psychological and physical strategies and (4) <i>spiritual beliefs and practices</i>, where faith, prayer, rituals and spiritual questioning contributed to meaning-making and emotional regulation. Spiritual wellbeing in advanced cancer extends beyond religious practices and is shaped by interconnected experiences of illness, relationships, spiritual beliefs and cultural context. Addressing these dimensions through holistic and culturally sensitive palliative care may enhance emotional resilience and overall quality of life.