A qualitative study of Spiritual distress in adults facing elective surgery

Spiritual distress, reflecting difficulty achieving connectedness to self, others, or the sacred, is common in patients facing major health crises. While studied in oncology and palliative care, little is known about spiritual distress in surgical populations. This qualitative study explores how spirituality shapes patients' experiences prior to elective surgery.

We conducted semistructured qualitative interviews with adult patients scheduled for elective procedures requiring overnight admission. Participants were purposively sampled based on scores on the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12 to capture those with high spiritual distress (<36) or spiritual well-being (>46). Interviews explored patient perception of surgery, spiritual and/or religious identity, and the relationship between health and spirituality. Data were analyzed using iterative open and focused coding to identify emergent themes.

Twenty-nine participants (mean age, 53 years; 72% female) undergoing bariatric, orthopedic, hernia, or vascular procedures were interviewed. Twenty-three participants were spiritually distressed, and 6 participants were spiritually well. Three overarching themes emerged: (1) common experience of significant life stressors; (2) surgery begets fear and hope, with spiritually distressed patients expressing anxiety and anticipation of complications, whereas spiritually well patients viewed surgery as restorative; and (3) making sense of the divine, with distressed patients reporting anger or doubt toward a divine power, and well patients expressing trust.

Spirituality meaningfully shapes preoperative experiences, with spiritual distress amplifying vulnerability and spiritual wellness fostering resilience. These findings suggest that routine assessment of spiritual well-being and support are important for enhancing whole-person care and improving patient-centered outcomes in surgical populations.