Although music therapists are often called upon to address spiritual needs and issues of clients in end-of-life care, most have limited education and/or training in this and few resources exist to help guide them in this area of clinical practice. Furthermore, it is important for music therapists to understand the pertinent ethical and professional boundaries. The purpose of this integrative literature review was to synthesize information contained in the music therapy literature in order to describe how music therapists are addressing spiritual issues in end-of-life care. This in turn helped to identify positive aspects of the work, problems that need to be addressed, and possible gaps in services. Twenty-four sources that met the criteria for inclusion were reviewed. Results revealed that music therapists are addressing a range of spiritual needs/issues with their clients in end-of-life care and are using multiple types of interventions to do so. However, the literature also revealed that music therapists experience a number of complex challenges in this work. Although there are some specific and general suggestions on how these challenges may be addressed, the extent to which music therapists are following through on these suggestions is unknown. Reflections upon the results and limitations of the research as well as potential implications for practice, research, and training/education are presented.