• Mathieu Bernard, Florian Strasser, Claudia Gamondi, Giliane Braunschweig, Michaela Forster, Karin Kaspers-Elekes, Walther Veri Silvia S Palliative Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland., Gian Domenico Borasio, and SMILE consortium team.
• Palliative and Supportive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. Electronic address: mathieu.bernard@chuv.ch.
• J Pain Symptom Manage. 2017 Oct 1; 54 (4): 514-522.

ContextSpiritual, existential, and psychological issues represent central components of quality of life (QOL) in palliative care. A better understanding of the dynamic nature underlying these components is essential for the development of interventions tailored to the palliative context.ObjectivesThe aims were to explore 1) the relationship between spirituality, meaning in life, wishes for hastened death and psychological distress in palliative patients and 2) the extent to which these nonphysical determinants influence QOL.MethodsA cross-sectional study involving face-to-face interviews with Swiss palliative patients was performed, including the Schedule for Meaning in Life Evaluation (SMILE), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), the Idler Index of Religiosity (IIR), the Hospital Anxiety and Depression Scale (HADS), and the Schedule of Attitudes toward Hastened Death (SAHD). QOL was measured with a single-item visual analogue scale (0-10).ResultsTwo hundred and six patients completed the protocol (51.5% female; mean age = 67.5 years). The results indicated a significant negative relationship between FACIT-Sp/SMILE and HADS total scores (P = 0.000). The best model for QOL explained 32.8% of the variance (P = 0.000) and included the FACIT-Sp, SMILE, and SAHD total scores, the IIR "private religiosity" score, as well as the HADS "depression" score.ConclusionBoth spiritual well-being and meaning in life appear to be potential protective factors against psychological distress at the end of life. Since nonphysical determinants play a major role in shaping QOL at the end of life, there is a need for the development of meaning-oriented and spiritual care interventions tailored to the fragility of palliative patients.Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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