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RESEARCH ARTICLEOpen AccessThe spiritual distress assessment tool: aninstrument to assess spiritual distress inhospitalised elderly personsStefanie M Monod1*, Etienne Rochat1,2, Christophe J Büla1, Guy Jobin3, Estelle Martin1, Brenda Spencer4AbstractBackground:Although spirituality is usually considered a positive resource for coping with illness, spiritual distressmay have a negative influence on health outcomes. Tools are needed to identify spiritual distress in clinicalpractice and subsequently address identified needs. This study describes the first steps in the development of aclinically acceptable instrument to assess spiritual distress in hospitalized elderly patients.Methods:A three-step process was used to develop the Spiritual Distress Assessment Tool (SDAT): 1)Conceptualisation by a multidisciplinary group of a model (Spiritual Needs Model) to define the differentdimensions characterizing a patient’s spirituality and their corresponding needs; 2) Operationalisation of theSpiritual Needs Model within geriatric hospital care leading to a set of questions (SDAT) investigating needs relatedto each of the defined dimensions; 3) Qualitative assessment of the instrument’s acceptability and face validity inhospital chaplains.Results:Four dimensions of spirituality (Meaning, Transcendence, Values, and Psychosocial Identity) and theircorresponding needs were defined. A formalised assessment procedure to both identify and subsequently scoreunmet spiritual needs and spiritual distress was developed. Face validity and acceptability in clinical practice wereconfirmed by chaplains involved in the focus groups.Conclusions:The SDAT appears to be a clinically acceptable instrument to assess spiritual distress in elderlyhospitalised persons. Studies are ongoing to investigate the psychometric properties of the instrument and toassess its potential to serve as a basis for integrating the spiritual dimension in the patient’s plan of care.BackgroundThe relationship between spirituality and medicine is afield of growing interest [1-3]. In palliative care, thespiritual dimension is considered as an important com-ponent of care along with physical, psychological, andsocial or existential support . Spirituality is also con-sidered an essential component of the multidimensionalapproach used in geriatric care of elderly patients whoface illness, disability, and potentially life-threateningevents .Spirituality has been shown to influence, usually in apositive way, coping with illness, disability, or life-threa-tening events [6-10]. Many studies have documentedsignificant associations between spirituality and bettermental, physical, and functional health, especially incancer, HIV, and hospice patients [11,12]. Some studieshave, however, shown that negative manifestations ofspirituality may be associated with poorer health out-comes. Religious struggle, defined as negative feelingstowards God, feeling punished by God, or believing