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2019 HSR&D/QUERI National Conference Abstract

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1110 — Developing a Spiritual Assessment Tool for Seriously-ill Veterans

Lead/Presenter: Karen Steinhauser,  COIN - Durham
All Authors: Steinhauser KE (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham , Duke University), Perry K (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham), Parker R (Durham VAMC Chaplaincy) Niuewsma J (VA Mental Health and Chaplaincy, Duke University) Thulberry, Marion (Durham VAMC Chaplaincy) Fitchett G (Rush University Medical Center) King H (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham; Duke University).

Assessing spiritual care needs is central to goals and mandates of palliative care, VA and Joint Commission on Accreditation of Healthcare Organizations. However, there exists no gold standard, empirically-developed and rigorously validated tool to assess Veterans' spiritual care needs and translate them to care providers. The VSAT parent project develops and validates a veteran-specific spiritual assessment tool for serious illness, and creates guidelines for tool use, including communicating results to team interdisciplinary teams and informing care plans.

Herein, we present results of tool development which included qualitative methods of focus groups, in-depth interviews, and cognitive testing. Participants: Veterans with advanced serious illnesses such as stage IV cancer, stage III or IV CHF and severe COPD, and ESRD, bereaved family members of Veterans, and healthcare professionals (chaplains, nurses, physicians and social workers), from the Durham VAHCS and National Chaplain Center. We used descriptive thematic analyses, with multiple analysts, audit trail, and iterative data collection, coding and analyses, all managed in Atlas.ti.

A total of 83 individuals participated in focus groups and in-depth interviews which were comprised of: 20 veterans, 19 caregivers, 14 chaplains, 10 social workers, 12 nurses and 8 physicians. Over 82 attributes of spiritual experience were identified which fell in five domains: importance of spirituality, impact on decisions, affiliations and practices, impact on healthcare, and beliefs and values. ‘Beliefs and values' tapped veteran-specific issues aspects of: joy, strength, peace, regrets, forgiveness, injury (including moral distress), reconciliation, meaning, and growth. Chaplain discussions also described optimal tool format, feasibility and acceptability. Cognitive testing informed question wording and item reduction. We developed a conceptual framework cross-walking empirically-identified domains, corresponding assessment items, relationship of those items to chaplain assessment frameworks, and relationship to existing palliative care measures. Thus, responses are translatable to both chaplaincy and palliative care teams.

It is possible to create a veteran spiritual assessment that is empirically grounded, designed for quantification, and actionable from interdisciplinary team members.

Assessing spiritual needs and resources of Veterans during advanced illness facilitates alignment of treatment choices with individual values and preference and enhances care coordination.