We mapped spiritual distress across different disease trajectories, identifying triggers of spiritual need. We mapped spiritual distress across different disease trajectories, identifying triggers of spiritual need in order to understand better the spiritual issues that patients experienced and the times in patients’ illness journeys when spiritual care could be of most value. These are at diagnosis, at returning home, at disease progression, and in the last days. Many patients identified feelings of emptiness, and loss, a sense of worthlessness and a fear of dying exacerbated by a longing to connect with others including, for many, the sacred. They expressed a desire to be at peace and to make amends and a number looked for religious and social rituals that would help them gain and retain meaning in life, when disease became the predominant concern of the health professionals. For patients spiritual support was often deeply intertwined with empathy and the valuing of the individual. Funder Chief Scientist Office Research Team Liz Grant, Scott Murray, Aziz Sheikh, Marilyn Kendall This article was published on 2024-09-24