Spiritual distress in a terminally ill patient with breast cancer

For terminally ill patients, suffering can relate to issues beyond the physical body, such as psychological and spiritual distress. The North American Nursing Diagnosis Association defines spiritual distress as a disruption in the life principle, that, when intact, suffuses a person’s entire self, integrating and transcending biological and psychosocial aspects (Mesnikoff, 2002). Patients in spiritual distress express concern about the meaning of life, death and suffering, and may state that their illness is a punishment. They may be angry, cry, be withdrawn or show apathy. This case study concerns a 45-year-old Malaysian Muslim woman with terminal breast cancer. The woman presented with spiritual distress manifested as anger and deep denial.