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RESEARCH ARTICLE Open Access The spiritual distress assessment tool: an instrument to assess spiritual distress in hospitalised elderly persons Stefanie M Monod 1* , Etienne Rochat 1,2 , Christophe J Büla 1 , Guy Jobin 3 , Estelle Martin 1 , Brenda Spencer 4 Abstract Background: Although spirituality is usually considered a positive resource for coping with illness, spiritual distress may have a negative influence on health outcomes. Tools are needed to identify spiritual distress in clinical practice and subsequently address identified needs. This study describes the first steps in the development of a clinically 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 different dimensions characterizing a patient s spirituality and their corresponding needs; 2) Operationalisation of the Spiritual Needs Model within geriatric hospital care leading to a set of questions (SDAT) investigating needs related to each of the defined dimensions; 3) Qualitative assessment of the instrument s acceptability and face validity in hospital chaplains. Results: Four dimensions of spirituality (Meaning, Transcendence, Values, and Psychosocial Identity) and their corresponding needs were defined. A formalised assessment procedure to both identify and subsequently score unmet spiritual needs and spiritual distress was developed. Face validity and acceptability in clinical practice were confirmed by chaplains involved in the focus groups. Conclusions: The SDAT appears to be a clinically acceptable instrument to assess spiritual distress in elderly hospitalised persons. Studies are ongoing to investigate the psychometric properties of the instrument and to assess its potential to serve as a basis for integrating the spiritual dimension in the patient s plan of care. Background The relationship between spirituality and medicine is a field of growing interest [1-3]. In palliative care, the spiritual dimension is considered as an important com- ponent of care along with physical, psychological, and social or existential support [4]. Spirituality is also con- sidered an essential component of the multidimensional approach used in geriatric care of elderly patients who face illness, disability, and potentially life-threatening events [5]. Spirituality has been shown to influence, usually in a positive way, coping with illness, disability, or life-threa- tening events [6-10]. Many studies have documented significant associations between spirituality and better mental, physical, and functional health, especially in cancer, HIV, and hospice patients [11,12]. Some studies have, however, shown that negative manifestations of spirituality may be associated with poorer health out- comes. Religious struggle, defined as negative feelings towards God, feeling punished by God, or believing

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