Both chronic illness and life threatening diseases confront patients with the question of meaning and purpose in life. In such times of need, several patients rely on external resources of help, i.e. medical doctors, alternative information and help, but also God's help . Studies have shown that spirituality/religiosity can be a source to rely on . An increasing number of published studies have examined the connection between spirituality/religiosity, health and quality of life, and its potential to prevent, heal or cope with disease [3–14]. Most of these studies state that religious involvement is related to better mental and physical health, improved coping with illness, and improved medical outcomes. However, several reviews state methodological problems, and thus firm conclusions can not easily be drawn [7, 12]; more over, a recent systematic review confirmed that spirituality/religiosity was associated with reduced mortality only in healthy population studies, but not in diseased population studies .
Whatever the scientific evidence may prove, one can not ignore that spirituality/religiosity is a relevant resource to cope for many patients [1, 12–17]. Particularly in cancer patients, spirituality/religiosity may be beneficial maintaining self-esteem, providing a sense of meaning and purpose, giving emotional comfort and providing a sense of hope . In a recent study among advanced cancer patients, most (88%) considered religion to be at least somewhat important, and a majority (72%) reported that their spiritual needs were supported minimally or not at all by the medical system . This is of importance, particularly because spiritual support was associated with better quality of life .
However, most studies on patients' spiritual needs refer to the care of patients at the end of life [20, 21, 23–25, 27, 28], and are often qualitative results or surveys, while there is a lack of conceptualisations to measure spiritual, existential and psychosocial need of patients with putatively long courses of chronic illness such as chronic pain conditions, cancer, HIV infection etc.
A qualitative study by Grant et al. found that patients' spiritual needs addressed the loss of roles and self-identity and fear of dying; several patients sought to make sense of life in relation to transcendence . Is was not too surprising that these needs were related to anxiety, sleeplessness, and despair . Murray interviewed terminally-ill patients with inoperable lung cancer and heart failure which expressed needs for love, meaning, purpose and sometimes transcendence . A qualitative study among 13 French patients at the end of life defined the following needs: reinterpretation of life, search for meaning, densification of the connection to the world, to loved ones and to oneself, control, vital energy, ambivalence to the future, confrontation with death, relationship to transcendence . In older Taiwanese patients with terminal cancer two constitutive patterns, "caring for the mortal body" and "transcending the worldly being" emerged from the interviews . Also a meta-summary of the qualitative literature on spiritual perspectives of adults extracted thematic pattern of spirituality at the end of life, which were spiritual despair (alienation, loss of self, dissonance), spiritual work (forgiveness, self-exploration, search for balance), and spiritual well-being (connection, selfactualization, consonance) . Moadel et al. investigated spiritual/existential needs of cancer patients from the USA, and found that patients wanted help with overcoming fears (51%), finding hope (42%), finding meaning in life (40%), finding spiritual resources (39%), or someone to talk to about finding peace of mind (43%), meaning of life (28%), and dying and death (25%) . Hermann measured the spiritual needs of patients near the end of life enrolling hospice patients  and found that several patients reported a higher number of unmet spiritual needs . Enrolling cancer patients in hospice home care, it became evident a that spiritual needs may exhibit a great variability; among these needs, family was the most frequently cited one (80%); attending religious services was the most frequently cited unmet need . In Korean patients with cancer, Yong et al. identified 5 sub-constructs of spiritual needs , i.e., love and connection, hope and peace, meaning and purpose, relationship with God, and acceptance of dying.
Our intention was to develop an instrument addressing the spiritual needs of patients with chronic diseases, and to account for the fact that secularisation and individualisation proceed particularly in Europe. Consequently, the conceptualization of patients' spiritual needs has to involve a much more open concept of spirituality which is valid for more secular countries, too, as described . Because these needs have to be seen in the context of subjective well-being and quality of life, addressing these needs is of outstanding importance for health care and health care research. Therefore, we aimed to validate a newly developed instrument, the Spiritual Needs Questionnaire (SpNQ) to measure spiritual, existential and psychosocial needs, and to analyse the self-ascribed importance of the respective dimensions.