. Author manuscript; available in PMC: 2021 Jun 1.

Published in final edited form as: Am J Hosp Palliat Care. 2021 Jan 19;38(6):618–625. doi: 10.1177/1049909120988280

Table 3.

Themes, Concepts, Subthemes, and Text Exemplars

Themes	Concept	Subthemes/Text Exemplar
Spiritual Orienting System (SOS)	Values, beliefs, meanings, and practices of ultimate importance that help people make decisions and create a coherent understanding of the world and their experiences. ²⁵	Values: “So I try to thank [God] for waking me up every day and allowing me to do, or try to do, the right things each day, and it’s paramount. It’s just something that I was brought up and raised.” Beliefs: “I was certain the Lord was taking care of me.” Meanings: “I have a strong, strong belief that [God’s] keeping me here for a purpose.” “A lot of our stuff that we go through is genetics. We inherit a lot of things that we go through as far as health wise.” Practices: “If you do not pray, do not study your word, 9 times out of 10 you're not going to be successful with a healing process.” Shared SOS with Healthcare Providers: “I asked my doctors: ‘Do you believe in God? Are you spiritual?’ That’s the first thing I ask because I want to know the one who's administering to me, are we on the same page.”
Psycho-Spiritual Struggles	Emotional and spiritual distress that threatens a person’s spiritual orienting system and/or their sense of well-being.¹⁶	“You know, this [health condition] is a heavy burden, and I don’t know if I can deal with this.” “The last time that I had to go to the hospital, I couldn’t walk, and I’d pray each day. And when I woke up that morning I prayed to God. Like I was saying, ‘Am I going to walk? Am I going to walk?’”
Social Struggles	Experiences of racial inequality, mistrust toward healthcare professionals, and challenges accessing adequate resources.	“I think we need to start using these resources because you know they're there and somebody is using them, I'm sure. But if we don’t know, we can’t use what we don’t know.” “There's a double standard in our society today. People of color are not exposed to resources like other cultures”
Social Support and Resources	The perception and actuality that one is cared for, can rely on other people, and is part of a supportive social network.³⁸	“I love my church…when you have a group that is praying for you and praying with you, that helps. It helps me as a caregiver and I'm hoping it kind of helps my husband as well. You know, he doesn’t go to church, but still it helps me.” “We [the church] provide them with resources because there are some community services that if they don’t have to go more than a 10 mile radius, we will pick them up and take them.” “What we’ve come to understand and do as a family, is when one of us is in the hospital, we have patient advocates within the family who are there.”
Spiritual Coping	Relying on spiritual values, beliefs, meanings, and practices to cope with stress, heal, and restore well-being.^16,24	Deferring Style (rely on God/the sacred): “Okay, God, I'm trusting in you. I give my life to you and that I'm just gonna have to trust. In order to get through this, I'm going to have to just put my full trust in you and be okay with whatever the situation is.” Self-directing Style (rely on self): “You know, I didn’t use my spirituality to make a decision after I had all the surgery and stuff like that. I just went on my own and started doing some, some research.” Collaborative Style (partner with God): “I consider the Lord a member of my health team.” Surrender Style (do what you can and surrender to God’s will): “I don’t worry about it anymore or concern myself with it and all my prayers for the most part always end with ‘your will be done.”