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.
","abstract_html":"<p><strong>Purpose:</strong> The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.</p> <p><strong>Background/Rationale:</strong> 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.</p> <p><strong>Methods:</strong> 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.</p> <p><strong>Results:</strong> 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).</p> <p><strong>Implications:</strong> 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.</p>","abstract_has_math":false,"creators":["Robinson, Kathryn Lee"],"institution":null,"degree_name":"PhD Nursing","degree_level":"Dissertation: Open Access","degree_discipline":"Nursing","degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2020,"date_issued":"2020-05-23T07:00:00Z","date_published":"2020-05-23T07:00:00Z","updated_at":"2026-07-24T05:41:42Z","subjects":["pain","spiritual distress","end of life","hospice","Geriatric Nursing","Nursing","Other Nursing","Public Health and Community Nursing"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://digital.sandiego.edu/dissertations/174","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Robinson, Kathryn Lee"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2022-05-06T07:00:00Z"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Nursing"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Dissertation: Open Access"]},{"key":"thesis:degree_name","label":"Degree Name","values":["PhD Nursing"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["pain","spiritual distress","end of life","hospice","Geriatric Nursing","Nursing","Other Nursing","Public Health and Community Nursing"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://digital.sandiego.edu/dissertations/174"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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.
"]},{"key":"dc:title","label":"Title","values":["Pain and Spiritual Distress at End of Life"]}]}],"canonical_facts":{"dc:creator":["Robinson, Kathryn Lee"],"dc:date.available":["2022-05-06T07:00:00Z"],"dc:description.abstract":["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.
"],"dc:identifier":["https://digital.sandiego.edu/dissertations/174"],"dc:subject":["pain","spiritual distress","end of life","hospice","Geriatric Nursing","Nursing","Other Nursing","Public Health and Community Nursing"],"dc:title":["Pain and Spiritual Distress at End of Life"],"thesis:degree_discipline":["Nursing"],"thesis:degree_level":["Dissertation: Open Access"],"thesis:degree_name":["PhD Nursing"]},"updated_at":"2026-07-24T05:41:42Z"}