Although not formally assessed information obtained

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rational to define spiritual distress as unmet needs. Although not formally assessed, information obtained from patient contact during the development process indicates the feasibility and acceptability to patients of a systematic and structured bedside assessment of their spirituality. Also, the chaplain s participation in weekly interdisciplinary team meetings to share the results of his assessment has demonstrated the feasibility of integrating spirituality assessment into routine interdisciplinary ger- iatric care. A survey enquiring about interdisciplinary team members appraisal of systematic spirituality assess- ment was conducted and showed that the contribution of the chaplain to improving patient care through weekly team meetings was considered essential [36]. It is, however, acknowledged that the feasibility and acceptability demonstrated is context-specific. Whether similar acceptance will be observed in other settings requires further study. This work was performed in a clini- cal setting already familiar with a comprehensive approach to 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 enrolled in this phase of the development probably facilitated the acceptability of the encounter with the chaplain. Further assessment of acceptability will therefore be needed in lar- ger, more diverse, elderly populations. Besides these acknowledged limitations, the present work also has several strengths. The SDAT was devel- oped according to a rigorous structured process: spiri- tuality in hospitalized older patients was conceptualized through a consensus process, and its dimensions and their corresponding needs were then specified. The model was subsequently implemented within a clinical setting in order to operationalize further the assessment process. 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 development of other spirituality assessment instruments (e.g. The spirituality Index of Well-Being [44,45]) and strengthens the relevance of the instrument. Finally, face validity and acceptability in experienced chaplains were assessed. Though relatively long and complex, this approach had the advantage of ensuring contextual relevance for the instrument since issues regarding implementation could be dealt with progressively and in situ . Although the SDAT was developed specifically in a population of hospitalized elderly patients, chaplains working with different populations saw considerable potential for use in other settings and in other age groups. Our procedure of assessment (a semi-structured interview) enables the patient to speak about spirituality with his or her own words and from very different per- spectives. This should ensure relevancy of the SDAT for every patient, whatever their age or religious or spiritual background. Ultimately, the quality and limitations of

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