Screening and Assessment of Spiritual Concerns
Standardized Assessment Measures
Interviewing Tools
Raising spiritual concerns with patients can be accomplished by the following approaches:[1,2]
- Waiting for the patient to bring up spiritual concerns.
- Requesting that the patient complete a paper-and-pencil assessment.
- Having the physician do a spiritual inquiry or assessment by indicating his or her openness to a discussion.
These approaches have different potential value and limitations. Patients may express reluctance to bring up spiritual issues, noting that they would prefer to wait for the provider to broach the subject. Standardized assessment tools vary, have generally been designed for research purposes, and need to be reviewed and utilized appropriately by the provider. Physicians, unless trained specifically to address such issues, may feel uncomfortable raising spiritual concerns with patients.[3] However, an increasing number of models are becoming available for physician use and training.[4]
Numerous assessment tools are pertinent to performing a religious and spiritual assessment. The Assessment of Religion and Spirituality in Cancer Patients table summarizes a selection of assessment tools. Several factors should be considered before choosing an assessment tool:
- Focus of the evaluation (religious practice or spiritual well-being/distress).
- Purpose of the assessment (e.g., screening for distress vs. evaluation of all patients as part of care).
- Modality of the assessment (interview or questionnaire).
- Feasibility of the assessment (staff and patient burden).
The line between assessment and intervention is blurred, and simply inquiring about an area such as religious or spiritual coping may be experienced by the patient as an opening for further exploration and validation of the importance of this experience. Evidence suggests that such an inquiry will be experienced as intrusive and distressing by only a very small proportion of patients. Key assessment approaches are briefly reviewed below; pertinent characteristics are summarized in the Assessment of Religion and Spirituality in Cancer Patients table.
Standardized Assessment Measures
One of several paper-and-pencil measures can be given to patients to assess religious and spiritual needs. These measures have the advantage of being self-administered; however, they were mostly designed as research tools, and their role for clinical assessment purposes is not as well understood. These measures may be helpful in opening up the area for exploration and for ascertaining basic levels of religious engagement or spiritual well-being (or spiritual distress). Most also assume a belief in God and therefore may seem inappropriate for an atheist or agnostic patient, who may still be spiritually oriented. All of the measures have undergone varying degrees of psychometric development, and most are being used in investigations of the relationship between religion or spirituality, health indices, and adjustment to illness.
Interviewing Tools
The following are semistructured interviewing tools designed to facilitate an exploration, by the physician or other health care provider, of religious beliefs and spiritual experiences or issues. The tools take the spiritual history approach and have the advantage of engaging the patient in dialogue, identifying possible areas of concern, and indicating the need for provision of further resources such as referral to a chaplain or support group. These approaches, however, have not been systematically investigated as empirical measures or indices of religiousness or of spiritual well-being or distress.
-
The SPIRITual History.[16] The SPIRIT is an acronym for the six domains explored by this tool: S, spiritual belief system; P, personal spirituality; I, integration with a spiritual community; R, ritualized practices and restrictions; I, implications for medical care; T, terminal events planning. The 6 domains are covered by 22 items, which may be covered in as little as 10 or 15 minutes or integrated into general interviewing over several appointments. A strength of this tool is the number of questions pertinent to managing serious illness and to gaining an understanding of how patient religious beliefs may bear on patient care decisions.
-
Faith, Importance/Influence, Community, and Address (FICA) Spiritual History.[1] FICA is an acronym for Faith, Importance/Influence, Community, and Address, with a set of questions to explore each area (e.g., What is your faith? How important is it? Are you part of a religious community? How would you like me as your provider to address these issues in your care?). Although developed as a spiritual history tool for use in primary care settings, it would lend itself to any patient population. The relative simplicity of the approach has led to its adoption by many medical schools.
Assessment of Religion and Spirituality in Cancer Patients
Tool
|
Developer
|
Purpose/ Focus/ Subscale (No.)
|
Specific to Cancer Patients?
|
Level of Psychometric Development
|
Length/ Other Characteristics/ Comments
|
Systems of Belief Inventory (SBI-15R) [7] |
Holland et al. |
Two factors: Beliefs/experience (10); religious social support (5) |
Yes |
High |
4 items assume belief in God |
DRI/DUREL [5] |
Sherman et al. |
Religious involvement (5) |
Yes |
Moderate |
|
FACIT-Sp [10,14] |
Brady et al.; Peterman |
Two factors: Meaning & peace (8), faith (4) |
Yes |
High. Limited cross-validation data. |
Part of FACT-G quality-of-life battery [11] |
Brief R-COPE [8] |
Pargament et al. |
Two factors: Positive coping; negative coping/distress |
No |
Very High |
|
Fetzer Multidimensional Scale [17] |
Fetzer |
Multiple subscales |
No |
High. Under development. |
|
FICA: Spiritual history [1] |
Puchalski et al. |
Brief spiritual history |
No |
Low |
MD interview assessment |
SPIRIT [16] |
Maugans |
In-depth interview with guided questions |
No |
Low |
MD interview assessment |
References
-
Puchalski C, Romer AL: Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med 3(1): 129-137, 2000.
-
Kristeller JL, Zumbrun CS, Schilling RF: 'I would if I could': how oncologists and oncology nurses address spiritual distress in cancer patients. Psychooncology 8 (5): 451-8, 1999 Sep-Oct.
[PUBMED Abstract]
-
Sloan RP, Bagiella E, VandeCreek L, et al.: Should physicians prescribe religious activities? N Engl J Med 342 (25): 1913-6, 2000.
[PUBMED Abstract]
-
Puchalski CM, Larson DB: Developing curricula in spirituality and medicine. Acad Med 73 (9): 970-4, 1998.
[PUBMED Abstract]
-
Sherman AC, Plante TG, Simonton S, et al.: A multidimensional measure of religious involvement for cancer patients: the Duke Religious Index. Support Care Cancer 8 (2): 102-9, 2000.
[PUBMED Abstract]
-
Koenig H, Parkerson GR Jr, Meador KG: Religion index for psychiatric research. Am J Psychiatry 154 (6): 885-6, 1997.
[PUBMED Abstract]
-
Holland JC, Kash KM, Passik S, et al.: A brief spiritual beliefs inventory for use in quality of life research in life-threatening illness. Psychooncology 7 (6): 460-9, 1998 Nov-Dec.
[PUBMED Abstract]
-
Pargament KI, Smith BW, Koenig HG, et al.: Patterns of positive and negative religious coping with major life stressors. J Sci Study Relig 37 (4): 710-24, 1998.
-
Hills J, Paice JA, Cameron JR, et al.: Spirituality and distress in palliative care consultation. J Palliat Med 8 (4): 782-8, 2005.
[PUBMED Abstract]
-
Brady MJ, Peterman AH, Fitchett G, et al.: A case for including spirituality in quality of life measurement in oncology. Psychooncology 8 (5): 417-28, 1999 Sep-Oct.
[PUBMED Abstract]
-
Cella DF, Tulsky DS, Gray G, et al.: The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11 (3): 570-9, 1993.
[PUBMED Abstract]
-
O'Mahony S, Goulet J, Kornblith A, et al.: Desire for hastened death, cancer pain and depression: report of a longitudinal observational study. J Pain Symptom Manage 29 (5): 446-57, 2005.
[PUBMED Abstract]
-
Krupski TL, Saigal CS, Hanley J, et al.: Patterns of care for men with prostate cancer after failure of primary treatment. Cancer 107 (2): 258-65, 2006.
[PUBMED Abstract]
-
Peterman AH, Fitchett G, Brady MJ, et al.: Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy--Spiritual Well-being Scale (FACIT-Sp). Ann Behav Med 24 (1): 49-58, 2002 Winter.
[PUBMED Abstract]
-
Johnson ME, Piderman KM, Sloan JA, et al.: Measuring spiritual quality of life in patients with cancer. J Support Oncol 5 (9): 437-42, 2007.
[PUBMED Abstract]
-
Maugans TA: The SPIRITual history. Arch Fam Med 5 (1): 11-6, 1996.
[PUBMED Abstract]
-
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research: A Report of the Fetzer Institute/National Institute on Aging Working Group. Kalamazoo, Mich: Fetzer Institute, 1999.
Back to Top
< Previous Section | Next Section > |