Spiritual Complexity in Palliative Home Care in Spain: A Multi-center Prospective Study

This study examined spiritual complexity in end-of-life patients cared for by palliative care teams in Catalonia, Spain, using the HexCom model. Among 1818 patients (55.9% men, average age 75.7), spiritual complexity remained stable (37.5% initially, 35.5% final), while high complexity increased from 8.3 to 11.2%. Intrapersonal complexity was the most common (19.7%), followed by transpersonal (18.4%), and interpersonal (6.8%). Emotional complexity was strongly correlated with spiritual complexity. Key factors included cognitive impairment as a protector and how spiritual complexity sub-areas relate to desires to hasten death, family relationships, and end-of-life circumstances. The findings emphasize integrating spiritual care into routine interdisciplinary care.