Spiritual Care in Serious Illness: A Narrative Review of Low- and Middle-Income Country Evidence

Background: Spiritual care (SC) is a component of person-centered care in serious illness, yet most evidence derives from high-income countries (HICs). Most patients with serious illness live in low- and middle-income countries (LMICs), where religion and spirituality often play distinctive social, cultural, and clinical roles. Methods: We synthesized 46 LMIC studies drawn from the Balboni et al. [1] systematic review of 371 empirical studies on spirituality in serious illness. Eligible studies were conducted in at least one LMIC, used valid spirituality measures, included ≥100 adult participants, and were rated as low or moderate risk of bias using adapted Cochrane criteria. We examined the role of spirituality in coping and outcomes, as well as the approaches used to assess and deliver SC across Asia, the Middle East and North Africa, sub-Saharan Africa, and Latin America. Results: Across the 46 studies, higher spiritual well-being and positive religious coping were consistently associated with better quality of life, lower psychological distress, and stronger family outcomes. Religious or spiritual struggle was associated with poorer mental health. SC was most often delivered by family members and faith communities rather than clinicians. Of the 46 studies, 38 (83%) used HIC-developed measurement instruments. Locally developed instruments from Thailand, Iran, and Nigeria revealed culturally distinctive pathways to spiritual well-being. Conclusion: Across diverse LMIC settings, SC emerges as a generalizable yet locally inflected component of person-centered serious-illness care. We propose a both/and measurement framework retaining validated global tools while integrating locally developed instruments. Health systems in LMICs should integrate SC competencies into clinical curricula while preserving partnerships with family and faith networks.