Many patients in their last year of

Many patients in their last year of life expressed spiritual needs in terms of seeking meaning and purpose in life. The different disease trajectories of lung cancer and heart failure raised contrasting patterns of spiritual needs over time. Carers were also challenged spiritually by suffering and had their own spiritual needs. Patients perceived that professionals sometimes did provide spiritual care, but that they could inadvertently cause spiritual distress by undermining people’s sense of identify and self-worth. We found that patients are generally reticent to raise spiritual issues, but many were able and willing to talk about them when asked open questions or allowed to tell their story by professionals who were able to step beyond rigid professional boundaries. Patients with life-threatening illness, even if still on ‘active treatment’ need help to cope with the prospect of dying, well before the terminal stage.