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

为重病退伍军人开发和验证精神评估工具

• 批准号: 9191630
• 负责人: Karen E Steinhauser
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9191630
• 关键词: Accountability; Accreditation; Accreditation; Address; Address; Administrator; Administrator; Affect; Affect; Assessment tool; Assessment tool; Attention; Attention; Belief; Belief; Caring; Caring; Charge; Charge; Chronic Obstructive Airway Disease; Chronic Obstructive Airway Disease; Clinical; Clinical; Communication; Communication; Comprehensive Health Care; Comprehensive Health Care; Congresses; Decision Making; Decision Making; Diagnostic Neoplasm Staging; Discipline; Discipline; Distress; Distress; Emotional; Emotional; End stage renal failure; End stage renal failure; Ensure; Ensure; Family; Family; Family Caregiver; Family Caregiver; Family member; Family member; Feedback; Feedback; Focus Groups; Focus Groups; Foundations; Foundations; Frequencies; Frequencies; Goals; Goals; Gold; Gold; Guidelines; Guidelines; Health; Health; Health Care Costs; Health Care Costs; Health Professional; Health Professional; Healthcare; Healthcare; Individual; Individual; Injury; Injury; Intervention; Intervention; Interview; Interview; Joint Commission on Accreditation of Healthcare Organizations; Joint Commission on Accreditation of Healthcare Organizations; Joints; Joints; Leadership; Leadership; Life; Life; Link; Link; Malignant Neoplasms; Medical Care Team; Medical Care Team; Methods; Methods; Mission; Mission; Morals; Morals; Nurses; Nurses; Outcome; Outcome; Pain management; Pain management; Palliative Care; Palliative Care; Patient Recruitments; Patients; Patients; Personal Satisfaction; Personal Satisfaction; Persons; Persons; Physicians; Physicians; Population; Population; Provider; Provider; Psychometrics; Psychometrics; Qualitative Methods; Qualitative Methods; Quality of life; Quality of life; Recommendation; Recommendation; Recruitment Activity; Religion and Spirituality; Religion and Spirituality; Reporting; Research; Research; Research Personnel; Research Personnel; Resources; Resources; Services; Services; Social Workers; Social Workers; Source; Source; Staging; Standardization; Testing; Testing; Translating; Translating; Validation; Validation; Validity and Reliability; Validity and Reliability; Veterans; Veterans; advanced disease; care coordination; care preference; care preference; care providers; cognitive testing; cognitive testing; coping; coping; design; design; end of life; end of life; evidence base; evidence base; experience; experience; follow-up; follow-up; health care service organization; health care service organization; health care settings; improved; improved; instrument; instrument; meetings; member; member; patient oriented; patient oriented; physical symptom; physical symptom; practical application; practical application; preference; preference; satisfaction; satisfaction; symptom management; symptom management; tool; tool; tool development; tool development; treatment choice; treatment choice; validation studies; validation studies

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.

对退伍军人医疗保健的预期影响：精神护理需求的评估是核心