Nilmanat and Street (2007) found acknowledgment of spiritual, religious, and cultural values to be central to palliative care nursing practice in Thailand. A study that surveyed 538 Thai nurses found spiritual care to be their greatest concern. These nurses, who were providing end-of-life care at six general hospitals, perceived the three most important problems in end-of-life care to be (a) inability to meet patients’ spiritual needs, (b) patients’ loneliness, and (c) control of pain (Manosilapakorn, 2003).