Biopsychosocial Spiritual Needs of Patients in a Singapore Home Hospice Setting-an Exploratory Qualitative Study.

Abstract

Patients receiving home palliative care face complex biopsychosocial-spiritual (BPSS) needs, yet studies on their experiences are limited. This study sought to investigate the BPSS needs of home palliative care patients from a qualitative perspective. Between October 2023 and December 2024, patients admitted to Assisi HPC service in Singapore were invited to participate in individual semi-structured interviews. Twenty eligible patients who provided written consent were interviewed using the BPSS model. The results were transcribed, anonymized, and analyzed through thematic analysis. Three key themes emerged: (1) total suffering, which captured the interconnected nature of physical, psychological, and spiritual distress; (2) loss of personhood and identity, reflecting the disruptions in self-concept caused by illness; and (3) search for spiritual wellbeing, highlighting coping mechanisms shaped by faith, social connections, or acceptance of life's course. While some participants found meaning, others struggled with despair. Protective factors such as social support, spirituality, and personal coping strategies were crucial in reducing distress and fostering adaptation. These findings emphasize the need for a holistic, patient-centered approach in home palliative care, where BPSS needs are dynamic. Strengthening social networks and integrating spiritual care may help patients transition from futile to meaningful suffering, enhancing dignity at life's end.