OBJECTIVE: Health care professionals and policy makers acknowledge that spiritual needs are important for many patients with life-limiting illnesses. We asked such patients to describe their spiritual needs and how these needs may impinge on their physical, psychological, and social well-being. Patients were also encouraged to explain in what ways their spiritual needs, if they had any, could be addressed. METHODS: We conducted two qualitative interviews, 3 months apart, with 20 patients in their last year of life: 13 patients with advancedcancer and 7 with advanced nonmalignant illness. We also interviewed each patient’s general practitioner. Sixty-six interviews were tape-recorded, transcribed, and analyzed. RESULTS: Patients’ spiritual needs centered around their loss of roles and self-identity and their fear of dying. Many sought to make sense of life in relation to a nonvisible or sacred world. They associated anxiety, sleeplessness, and despair with such issues, which at times resulted in them seeking support from health professionals. Patients were best able to engage their personal resources to meet these needs when affirmed and valued by health professionals. SIGNIFICANCE OF RESULTS: Enabling patients to deal with their spiritual needs through affirmative relationships with health professionals may improve quality of life and reduce use of health resources. Further research to explore the relationship between spiritual distress and health service utilization is indicated.