VET-Spirit: A Pilot Feasibility and Acceptability Trial to Address Spiritual Needs in Seriously-Ill Veterans

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Background: Seriously-ill veterans rely on spiritual and existential beliefs to cope with their illness, support their quality of life, and make critical healthcare decisions. As a result, VHA (Directive 1111) and other major health care organizations mandate spiritual assessments. With VA funding, our research team developed and validated the first quantifiable spiritual screening tool designed specifically for seriously-ill Veterans, VET-Spirit. The crucial next step is integrating screening and response to spiritual needs into serious illness care. This proposal develops and evaluates the feasibility and acceptability of implementing VET-Spirit, which systematically measures spiritual needs and subsequently equips providers with spiritual needs data into clinical care. VET-Spirit includes a curated summary of VET-Spirit patient response data to providers with communication prompts to aid in discussions of unmet needs. We hypothesize: 80% of veteran enrollees will complete VET-Spirit measure; 75% of providers rate AIM, FIM and IAM items at a mean of four or above on a five-point likert scale indicating agreement with acceptability, feasibility and appropriateness of the implementation strategy. Significance/ Impact: While the VHA mandates spiritual care, VA’s use neither a common: 1) screening tool, or 2) process for integrating identified needs into care. VET-Spirit includes both. Innovation: 1) Ensuring Compliance - No previous intervention has been designed to assess the spiritual needs and resources of seriously-ill veterans, curate that information, and deliver it to the care team. Integrating an actionable spiritual screening tool into the stream of care enhances care coordination and places the VA at the forefront of care of seriously-ill veterans. 2) Spiritual Care Accountability - VET-Spirit creates and evaluates a process for patient-centered care by integrating screening of spiritual beliefs into serious illness decision-making. 3) Whole Patient Care – VET-Spirit serves as a model for integrating patient voices into care. Specific Aims: Aim 1) Identify what and how providers (physicians, palliative care and POSH teams, chaplains) want to receive data on Veterans’ spirital needs. Determine content, format, barriers and facilitators to spiritual needs information delivery and its integration into care. Aim 2) Evaluate the feasibility and acceptability of VET-Spirit among providers of seriously-ill veterans (e.g. stage IV cancer, congestive heart failure, chronic obstructive pulmonary disease). Methodology: Aim 1 - qualitative methods of focus groups and in-depth interviews and directed content analyses of those data will inform: work flow considerations, information delivery location, content, format, conversation prompts, additional facilitators and barriers, and provider self-efficacy. Aim 2 - qualitative and quantitative methods to determine VET-Spirit feasibility and acceptability. Descriptive statistics will be calculated for all quantitative measures as well as trend change scores in outcomes (e.g., provider self-efficacy, knoweldge). Acceptabiltiy and feasiblity measures include: rates of VET-Spirit provider participation, veteran participants accrued, enrolled and retained, number of VET-Spirit completions, number of chaplain referrals and visits, acceptability if implementation measure (AIM), feasibility of implementation measure (FIM) and implementation appropriateness measure (IAM) scores; and provider satisfaction with tool ease, efficiency and self-efficacy in spiritual care communications (assessed qualitatively). Next Steps: Results of this pilot will fill the datagap in spiritual care delivery and inform a large scale Hybrid Type 1 Effectiveness-Implementation Trial of VET-Spirit.