Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Spiritual Welbeing Assessment
Spirituality has been shown to influence, usually in a positive way, coping with illness, disability, or life-threatening events (Kirby SE, 2004).
Spirituality is also considered an essential component of the multidimensional approach used in geriatric care of elderly patients who face illness, disability, and potentially life-threatening events (Monod S, 2009).
In palliative care in particular, the spiritual dimension is considered as an important component of care along with physical, psychological, and social or existential support (Sulmasy DP, 2002).
Religious/Spiritual Struggle Screening Protocol
Brief screening protocol for use in identifying patients who may be experiencing religious/spiritual struggle, as well as patients who would like a visit from a chaplain
3 min. - variable
FICA Spiritual History Tool
Assessment of spirituality and its potential effect on health care
5 min. - variable
Hope Questions for Spritual Assessment
Brief assessment of spirituality
5 min. - variable
Open Invite questions
Encouraging a spiritual dialogue
3 min. - variable
Spiritual Distress Assessment Tool
Assessment of Spiritual Distress
5 min. - variable
FACIT-sp :Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being 12 Item Scale
Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being
FACIT-sp-12 :Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being - 12 Item Scale
FACIT-sp-Ex :Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being - Expanded Subscale
FACIT-sp-NI :Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being - Non-illness version
5-15 min. - variable
Although spirituality is usually considered a positive resource for coping with illness, spiritual distress may have a negative influence on health outcomes.
Spiritual distress, that can be defined as "a state in which the individual is at risk of experiencing a disturbance in his/her system of belief or value that provides strength, hope, and meaning to life" (Carpenito-Moyet, 2004), seems also associated with more severe depression and desire for hastened death in end-of-life patients (Rodin G, 2009).
Spiritual distress might have a potentially harmful effect on patients' prognosis and quality of life (Hills J, 2005).
Whom and When to Assess
Older patients, hospitalized patients, and patients with terminal illness often wish to share their beliefs, to hear those of their physician, and to have their physician pray for or with them.(King DE, 1994) (Mac Lean CD, 2003) ( Ehman JW, 1999).
Physicians may consider conducting a spiritual assessment with patients who fall into these groups, or with other established or new patients.
In addition, physicians may wish to assess patients who face existential crises, such as those in whom a chronic disease has been diagnosed, those with worsening illness, or those with new or persistent mental health disease.
Finally, physicians may consider the casual remarks that patients sometimes make about their faith or spiritual practices as cues inviting discussion. In some cases, a spiritual conversation is most easily introduced when patients bring up concerns and crises without prompting.
Conducting the Spiritual Assessment
Before conducting a spiritual assessment, physicians should consider their personal faith tradition, beliefs and practices, positive and negative experiences, attitudes on faith and healing, and comfort and ability to participate in another's spirituality or share their own.
Some physicians may not consider themselves spiritual, may not wish to discuss spirituality, or may vary in their level of ease or capability in discussing spiritual concerns.
Rather than a coercive responsibility, conducting a spiritual assessment and offering spiritual support are similar to eliciting a social history and empathizing after the delivery of a negative diagnosis. They provide yet another way to understand and support patients in their experience of health and illness.
The Religious/Spiritual Struggle Screening Protocol (RSSSP) is a brief screening protocol for use in identifying patients who may be experiencing religious/spiritual struggle, as well as patients who would like a visit from a chaplain
Several tools exist to help physicians conduct a spiritual history.
The FICA Spiritual History Tool uses an acronym to guide health professionals through a series of questions designed to elicit patient spirituality and its potential effect on health care.
Starting with queries about faith and belief, it proceeds to ask about their importance to the patient, the patient's community of faith, and how the patient wishes the physician to address spirituality in his or her care (The George Washington. Institute for Spirituality and Health, 2011)
The HOPE questions are another tool.
These questions lead the physician from general concepts to specific applications by asking about patients' sources of hope and meaning, whether they belong to an organized religion, their personal spirituality and practices, and what effect their spirituality may have on medical care and end-of-life decisions (Anandarajah, 2001)
A third tool, the Open Invite, is a patient-focused approach to encouraging a spiritual dialogue.
It is structured to allow patients who are spiritual to speak further, and to allow those who are not to easily opt out.
First, it reminds physicians that their role is to open the door to conversation and invite (never require) patients to discuss their needs. Preaching or prescribing spiritual practices generally is beyond the proper bounds of the physician-patient relationship. Second, Open Invite provides a mnemonic for the general types of questions a physician may use.
The Spiritual Distress Assessment Tool (SDAT) is a 5-item instrument developed to assess unmet spiritual needs in hospitalized elderly patients and to determine the presence of spiritual distress.
FACIT-sp was designed to measure important aspects of spirituality, such as a sense of meaning in one's life, harmony, peacefulness, and a sense of strength and comfort from one's beliefs, and is well validated.
Incorporation of Spiritual Needs into Patient Care
After spiritual needs have been identified, the physician may incorporate the results of the assessment into patient care.
The most basic thing a physician can do is to listen compassionately. Regardless of whether patients are devout in their spiritual traditions, their beliefs are important to them. By listening, physicians signal their care for their patients and recognition of this dimension of their lives. Empathetic listening may be all the support a patient requires.
Another way to incorporate the spiritual assessment is to document the patient's spiritual perspective, background, stated impact on medical care, and openness to discussing the topic.
Physicians may find this information helpful when readdressing the subject in the future or during times of crisis when sources of comfort and meaning become crucial.
An additional way to incorporate the assessment is to consider how different traditions and practices may affect standard medical practice.
For instance, patients of the Jehovah's Witness tradition tend to refuse blood transfusion; believers in faith healing may delay traditional medical care in hopes of a miracle; and Muslim and Hindu women tend to decline sensitive (and sometimes general) examinations by male physicians.
Patients with certain beliefs may experience substantial psychological duress if they believe a condition is caused by a lack of belief or transgressions on their part.
Physicians also need to consider how practices may influence acute or chronic health states.
For example, many Muslims fast during Ramadan, which may affect glucose control and other physiologic factors in the ambulatory and inpatient settings.
Persons of some faiths observe strict dietary codes, such as halal and kosher laws, which may require physicians to alter traditional nutrition counseling.
It is important to remember, however, that patients may not adhere to each specific belief or practice of their faith. Physicians should avoid making assumptions when asking patients how their particular practices may affect their medical care.
The spiritual assessment also allows patients to identify spiritual beliefs, practices, and resources that may positively impact their health. Helpful questions include, “Do you have spiritual practices, such as praying, meditating, listening to music, or reading sacred text, that you find helpful or comforting?” and “Are you part of a faith community? If so, does it have resources such as a home visitation program, a food pantry, or health screening?” Physicians can reinforce positive coping behaviors and, with the patient's permission, offer to contact the patient's spiritual community to mobilize community faith resources as appropriate.
Finally, there may be some instances in which physician and patient faith traditions coincide. In these cases, if the patient requests, the physician may consider offering faith-specific support. This may include patient-or physician-led prayer.
Given the variety of spiritual practices followed in multicultural societies, it is best not to assume that a physician's spirituality mirrors that of his or her patients. Prayer should not be a goal of a spiritual assessment, and physicians should not attempt to get patients to agree with them on specific faith issues.
Potential Benefits in the Physician-Patient Relationship
Assessing and integrating patient spirituality into the health care encounter can build trust and rapport, broadening the physician-patient relationship and increasing its effectiveness.
Practical outcomes may include improved adherence to physician-recommended lifestyle changes or compliance with therapeutic recommendations.
Additionally, the assessment may help patients recognize spiritual or emotional challenges that are affecting their physical and mental health. Addressing spiritual issues may let them tap into an effective source of healing or coping.
For physicians, incorporating patient spirituality brings the potential for renewal, resiliency, and growth, even in difficult encounters.
Sometimes physicians have few medical solutions for problems that cause suffering, such as incurable disease, chronic pain, grief, domestic violence, and broken relationships. In these situations, providing comfort to patients can increase professional satisfaction and prevent burnout.(Koenig HG, 2007).
The Spiritual Welbeing Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
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