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：精神护理需求评估是退伍军人医疗保健的核心 姑息治疗的目标和任务，VA 和联合认证委员会 医疗保健组织。对于那些有宗教信仰的人和非宗教信仰的人来说，精神和存在主义信仰是 与改善生活质量、减少痛苦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、成果以及与其他学科的需求沟通。 一个根据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有办法实现这些目标。专门开发的工具 对于患有严重疾病的退伍军人来说，将包括随着战争结束而出现的独特的生存需求 生活临近，以及退伍军人中更常见的问题，例如精神伤害。评估 退伍军人在晚期疾病期间的精神需求和资源有助于协调 结合个人价值观和偏好的治疗选择，并加强护理协调，并且 与 VA 卓越蓝图的优先事项一致。完全验证的精神 重病退伍军人的评估工具将成为牧师服务的资源， 姑息治疗团队以及其他照顾重病患者的临床医生。 背景：患有生命极限疾病的患者面临着身体、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表明 解决精神需求对于减少患者痛苦、提高治疗质量也至关重要 生活，并为护理决策提供信息。然而，根据经验，不存在黄金标准 开发并经过严格验证的工具来评估退伍军人的精神护理需求，从而 翻译护理提供者的偏好。 项目目标：本研究将开发并验证精神评估工具 对严重疾病进行姑息治疗，并制定工具使用指南，包括 向团队成员传达结果并告知护理计划。 设计和方法：这是一项混合方法工具开发和验证研究。 将采用焦点小组、深度访谈和认知测试的定性方法 工具开发。我们将与患者、家属和提供者进行焦点小组讨论 （牧师、护士、医生和社会工作者）以获得有关工具内容和使用的反馈。 牧师讨论还将集中于工具格式、可行性和可接受性 牧师。我们将招募患有晚期严重疾病的患者，例如IV期癌症、 III 期或 IV 期 CHF 和严重 COPD、ESRD、退伍军人家属，以及 来自达勒姆退伍军人管理局的医疗保健专业人员和来自国家办公室的牧师。 随后，我们将开发该工具并认知测试其一致性、可接受性、 并需要细化。经过改进，传统的心理测试将用于 如上所述，在大量退伍军人 (n=250) 中验证该工具，以确定 可靠性和有效性。验证后，将使用定性方法来开发 工具使用指南。总体方法以患者为中心，包括关键参与 牧师和其他相关利益相关者，包括患有生命限制性疾病的患者、家人 成员、牧师和医疗保健团队成员的意见和偏好。

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.