Spiritual needs in palliative care inpatients: a four-year analysis of clinical data from a tertiary care center

Spiritual needs are a core dimension of palliative care, yet their systematic documentation remains limited. This study explores the spiritual needs expressed by palliative care inpatients and examines how these needs vary in documentation based on gender, below and above the Swiss retirement age, religious affiliation, and specialty documenting them. We conducted a retrospective analysis of 747 electronic health records (EHRs) from the Acute Palliative Care Unit at the University Hospital Zurich (2019–2022). Documentation by psychological and pastoral care services was analyzed using qualitative content analysis along with chi-square test for explorative purposes. Identified needs were categorized according to an adapted four-domain framework (existential, psychological, social/relational, religious). A total of 598 patients were analyzed (median age 68 years (20–97), 52.8% (n = 316) male). We identified 22 distinct spiritual needs. Overall, 61.2% (n = 366) of patients expressed existential needs, 78.9% (n = 472) psychological needs, 66.2% 396) social/relational needs, and 17.4% (n = 104) religious needs. The most common spiritual needs were life reflection (55.5%, n = 332), relationship and family dynamics (43.6%, n = 337), and history of illness (26.8%, n = 160). Women reported significantly more existential fears (p < 0.001), relational themes (p = 0.005), and requests for prayer (p = 0.028). Patients below the retirement age exhibited more needs, including fears (p = 0.019), grief (p = 0.002), and hope (p < 0.001) compared to older patients. Religious affiliation was associated with prayer (p = 0.003) and anointing of the sick (p = 0.036). Psychological services documented spiritual needs in 86.1% of cases (mainly existential and psychological needs), whereas pastoral care (53%) focused on religious themes, including all mentions of sacramental rituals. This is the first Swiss study to classify spiritual needs based on routine clinical documentation. The findings highlight the prevalence and multidimensionality of spiritual concerns, with psychological needs being most frequently documented, and significant differences observed by age, gender, and religious affiliation. Distinct documentation patterns emerged between psychological and pastoral care, underlining the need for structured assessment tools and interprofessional collaboration. Implementing standardized documentation and training could enhance the visibility and continuity of spiritual care and guide future research and clinical practice.