Background: When patients are facing the ends of their lives, spiritual concerns often become more important.It is argued that effective, integrated palliative care should include addressing patients' spiritual wellbeing.In 2002 the EORTC Quality of Life Group began an international study to develop an spiritual wellbeing measure for palliative patients (SWB).Spiritual wellbeing is a complex construct, which comprises multiple contributory components.While conducting the EORTC SWB validation study with Dutch palliative cancer patients we also conducted an exploratory side study to examine the relationship between their spiritual wellbeing, images of God, and attitudes towards death.Methods: Patients with incurable cancer who were able to understand Dutch and were well enough to participate, completed the provisional SWB measure and two scales assessing "Images of God" and "attitudes towards death and afterlife".Linear stepwise regression analysis was conducted to assess the relation between SWB and other factors.Results: Fifty two Dutch patients, 28 females and 24 males, participated.The whole SWB measure validation identified four scoring scales: Existential (EX), Relationship with Self (RS), Relationships with Others (RO), Relationship with Something Greater (RSG) and Relationship with God (RG, for believers only).Adherence to an image of an Unknowable God and a worse WHO performance status were negatively associated with the EX scale.The image of an Unknowable God was also found to be negatively associated with the RS scale.Higher education correlated positively with the RO scale.Adherence to a Personal or Non-Personal Image of God was not found to be positively influencing any of the domains of SWB.Conclusions: For our participants, an Unknowable Image of God had a negative relationship with their SWB.Furthermore, specific images of God (Personal or Non Personal) are not associated with domains of SWB.Together, these findings suggest that spiritual wellbeing surpasses traditional religious views.The development of a new language which more naturally expresses different images of a higher being amongst patients in western late-modern societies may further aid our understanding and subsequently lead to an improvement in patients' spiritual wellbeing.
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