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

背景：身患重病的退伍军人依靠精神和生存信念来应对他们的 疾病，支持他们的生活质量，并做出关键的医疗保健决策。因此，VHA (1111号指令)和其他主要医疗保健组织要求进行精神评估。使用 VA资助，我们的研究团队开发并验证了第一个可量化的精神筛查 专门为重病退伍军人设计的工具，VET-SPIRIT。关键的下一步是整合 对精神需求进行筛查和回应，纳入大病护理。这项建议发展并 对实施职业教育精神的可行性和可接受性进行了评估，系统地 测量精神需求，并随后为提供者提供精神需求数据 临床护理。VET-SPIRE包括对VET-SPIRE患者响应数据的精选摘要 有沟通提示的供应商，帮助讨论未得到满足的需求。我们假设： 80%的资深参与者将完成VET-SPIRIT测量；75%的提供者对AIM、FIM和 在Likert五点量表上，IAM项目的平均分为4分或以上，表明同意 实施战略的可接受性、可行性和适当性。重要性/ 影响：虽然VHA要求进行精神护理，但退伍军人管理局既不使用常见的筛查工具， 或2)将确定的需求整合到护理中的过程。兽医精神包括两者。创新：1) 确保合规-之前没有任何干预措施旨在评估精神上的 重病退伍军人的需求和资源，管理这些信息，并将其提供给护理人员 一队。将可操作的精神筛查工具整合到护理流程中可增强护理 协调，并将退伍军人管理局置于照顾重病退伍军人的最前线。2)精神关怀 责任-兽医精神通过以下方式创建和评估以患者为中心的护理流程 将精神信仰筛查纳入大病决策。3)完整的病人 关怀-兽医-精神是将患者的声音整合到关怀中的典范。具体目标： 目标1)确定提供者的内容和方式(医生、姑息治疗和豪华团队、牧师) 想要收到退伍军人精神需求的数据。确定内容、格式、障碍和 精神需求的促进者提供信息并将其融入关怀。目标2)评估 兽医精神在重病退伍军人提供者中的可行性和可接受性(例如STAGE IV癌症、充血性心力衰竭、慢性阻塞性肺疾病)。方法论：目标 1-焦点小组的定性方法以及深入访谈和定向内容分析 这些数据将告知：工作流程考虑因素、信息交付位置、内容、格式、 对话提示、其他促进者和障碍，以及提供者自我效能。目标2- 用定性和定量的方法确定VET-SPIRE的可行性和可接受性。 将为所有量化指标以及趋势变化计算描述性统计数据 结果得分(例如，提供者自我效能、知识)。可接受性和可行性 衡量标准包括：VET-SPIRE提供者参与率、退伍军人参与率、 注册和保留，完成兽医精神的次数，牧师转介和访问的次数， 实施措施的可接受性(AIM)、实施措施的可行性(FIM)和 实施适当性衡量(IAM)得分；以及提供商对工具易用性的满意度， 精神关怀沟通中的效率和自我效能(定性评估)。下一首 步骤：这项试点的结果将填补精神关怀交付的数据缺口，并大规模通报 混合类型1有效性--VET-SPIRIT的实施试验。

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.