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rational to define spiritual distress as unmet needs.Although not formally assessed, information obtainedfrom patient contact during the development processindicates the feasibility and acceptability to patients of asystematic and structured bedside assessment of theirspirituality. Also, the chaplain’s participation in weeklyinterdisciplinary team meetings to share the results of hisassessment has demonstrated the feasibility of integratingspirituality assessment into routine interdisciplinary ger-iatric care. A survey enquiring about interdisciplinaryteam members’appraisal of systematic spirituality assess-ment was conducted and showed that the contribution ofthe chaplain to improving patient care through weeklyteam meetings was considered essential .It is, however, acknowledged that the feasibility andacceptability demonstrated is context-specific. Whethersimilar acceptance will be observed in other settingsrequires further study. This work was performed in a clini-cal setting already familiar with a comprehensive approachto patients’needs; these conditions may prove to be a pre-requisite for successful integration of spirituality assess-ment and for the participation of chaplains in routine care.The Christian origin and advanced age of patients enrolledin this phase of the development probably facilitated theacceptability of the encounter with the chaplain. Furtherassessment of acceptability will therefore be needed in lar-ger, more diverse, elderly populations.Besides these acknowledged limitations, the presentwork also has several strengths. The SDAT was devel-oped according to a rigorous structured process: spiri-tuality in hospitalized older patients was conceptualizedthrough a consensus process, and its dimensions andtheir corresponding needs were then specified. Themodel was subsequently implemented within a clinicalsetting in order to operationalize further the assessmentprocess. This process, going from the definition of spiri-tuality to the definition of an instrument to assess spiri-tuality, has previously been adopted in the developmentof other spirituality assessment instruments (e.g. Thespirituality Index of Well-Being [44,45]) and strengthensthe relevance of the instrument. Finally, face validity andacceptability in experienced chaplains were assessed.Though relatively long and complex, this approach hadthe advantage of ensuring contextual relevance for theinstrument since issues regarding implementation couldbe dealt with progressively andin situ.Although the SDAT was developed specifically in apopulation of hospitalized elderly patients, chaplainsworking with different populations saw considerablepotential for use in other settings and in other agegroups. Our procedure of assessment (a semi-structuredinterview) enables the patient to speak about spiritualitywith his or her own words and from very different per-spectives. This should ensure relevancy of the SDAT forevery patient, whatever their age or religious or spiritualbackground. Ultimately, the quality and limitations of