Developing and Validating a Spiritual Assessment Tool for Seriously-ill Veterans

对退伍军人医疗保健的预期影响：精神护理需求的评估是 姑息治疗的目标和任务，退伍军人管理局和联合认证委员会 医疗保健组织。对于那些信教和不信教的人来说，精神信仰和存在主义信仰是 与生活质量的提高、痛苦的减少和对护理的偏好有关。然而，工具 系统地评估需求，将这些需求与干预、治疗联系起来 缺乏建议和成果，以及与其他学科交流需求。 一个经过经验设计和严格评估的精神评估工具将提供 临床医生和管理人员拥有实现这些目标的手段。专门开发的工具 对于患有严重疾病的退伍军人来说，将包括在结束时出现的独特的生存需求 生命即将到来，退伍军人中更常见的情况也是如此，比如精神伤害。正在评估 退伍军人晚期疾病期间的精神需求和资源促进 根据个人价值和偏好进行治疗选择，并加强护理协调，并正在 与退伍军人管理局卓越蓝图的优先事项一致。一种完全被证实的精神 为重病退伍军人提供的评估工具将成为牧师服务的资源， 姑息治疗团队和其他临床医生照顾那些患有严重疾病的人。 背景：限制生命的疾病患者面临着身体、情感和精神上的挑战 痛苦。虽然评估和改善疼痛和症状管理的努力对于 高质量的姑息治疗，临床经验和大量研究都表明 解决精神需求也是减少患者痛苦、提高治疗质量的核心 生活，并为护理决策提供信息。然而，从经验上讲，并不存在黄金标准。 开发并经过严格验证的工具，用于评估退伍军人的精神护理需求，从而 翻译护理人员的首选项。 项目目标：这项研究将开发和验证精神评估工具 为患有严重疾病的患者提供姑息治疗，并制定工具使用指南，包括 将结果传达给团队成员，并告知护理计划。 设计和方法：这是一项混合方法的工具开发和验证研究。 将采用焦点小组的定性方法、深度访谈和认知测试 工具开发。我们将与患者、家属和提供者一起开展焦点小组 (牧师、护士、医生和社会工作者)，以获得关于工具内容和使用的反馈。 牧师的讨论还将集中于工具的格式、可行性和可接受性 牧师们。我们将招募患有晚期癌症等严重疾病的患者， 第三或第四阶段CHF和严重COPD，以及ESRD，失去亲人的退伍军人家属，以及 来自达勒姆退伍军人事务部的医疗保健专业人员和来自国家办公室的牧师也是如此。 随后，我们将开发该工具，并对其一致性、可接受性、 并需要改进。经过改进，传统的心理测试将被用于 如上所述，在大量退伍军人(n=250)中验证该工具，以建立 信度和效度。在验证之后，将使用定性方法来开发 工具使用指南。总体方法是以患者为中心，并包括关键参与 牧师和其他相关利益相关者，包括患有限制生命的疾病的患者、家人 成员、牧师和医疗团队成员输入和首选项。

Anticipated Impact on Veteran's Healthcare: Assessment of spiritual care needs is central to goals and mandates of palliative care, the VA and Joint Commission on Accreditation of Healthcare Organizations. Spiritual and existential beliefs, for those religious and not, are associated with improved quality of life, reduced suffering, and preferences for care. Yet, tools that systematically assess need, link those needs with intervention, treatment recommendations, and outcomes, and communicate needs with other disciplines, are lacking. An empirically designed and rigorously evaluated spiritual assessment tool would provide clinicians and administrators with a means to meet these goals. A tool developed specifically for veterans with serious illness would include the unique existential needs that arise as end of life nears as well as those more common among veterans, such as moral injury. Assessing spiritual needs and resources of veterans during advanced illness facilitates alignment of treatment choices with individual values and preference and enhance care coordination, and is consistent with the priorities of the VA Blueprint for Excellence. A fully validated spiritual assessment tool for seriously ill veterans would be a resource to the chaplaincy service, palliative care teams, and other clinicians caring for those with serious illness. Background: Patients with life-limiting illness confront physical, emotional and spiritual suffering. While efforts to assess and improve pain and symptom management are essential to quality palliative care, both clinical experience and a significant body of research demonstrate that addressing spiritual needs also is central to reducing patient suffering, improving quality of life, and informing care decisions. However, there exists no gold standard, empirically developed and rigorously validated tool to assess veterans spiritual care needs and thus translate preferences for care providers. Project Objectives: This study will develop and validate a spiritual assessment tool for palliative care with serious illness as well as create guidelines for tool use, including communicating results to team members and informing a plan of care. Design and Methods: This is a mixed methods tool development and validation study. Qualitative methods of focus groups, in-depth interviews and cognitive testing will be used for tool development. We will conduct focus groups with patients, families, and providers (chaplains, nurses, physicians and social workers) to gain feedback on tool content and use. Chaplain discussions also will focus on tool format, feasibility and acceptability among chaplains. We will recruit patients with advanced serious illnesses such as stage IV cancer, stage III or IV CHF and severe COPD, and ESRD, bereaved family members of veterans, and healthcare professionals, from the Durham VA and chaplains also from the National Office. Subsequently, we will develop the instrument and cognitively test its consistency, acceptability, and need for refinement. Following refinements, traditional psychometric testing will be used to validate the tool, in a large population of veterans (n=250), as described above, to establish reliability and validity. Following validation, qualitative methods will be used to develop of guidelines for tool use. The overall approach is patient-centered, and includes key involvement of chaplains and other relevant stakeholders including patients with life limiting illness, family members, chaplains, and health care team members input and preferences.