Spirituality in Cancer Care - Screening and Assessment of Spiritual Concerns
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. However, an increasing number of models are becoming available for physician use and training.
Numerous assessment tools are pertinent to performing a religious and spiritual assessment. Table 1 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 Table 1.
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.