Developing and Validating a Spiritual Assessment Tool for Seriously-ill Veterans

为重病退伍军人开发和验证精神评估工具

基本信息

批准号：
9191630
负责人：
Karen E Steinhauser
金额：
--
依托单位：
DURHAM VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-02-01 至 2021-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9191630
关键词：
Accountability Accreditation Accreditation Address Address Administrator Administrator Affect Affect Assessment tool Assessment tool Attention Attention Belief Belief Caring Caring Charge Charge Chronic Obstructive Airway Disease Chronic Obstructive Airway Disease Clinical Clinical Communication Communication Comprehensive Health Care Comprehensive Health Care Congresses Decision Making Decision Making Diagnostic Neoplasm Staging Discipline Discipline Distress Distress Emotional Emotional End stage renal failure End stage renal failure Ensure Ensure Family Family Family Caregiver Family Caregiver Family member Family member Feedback Feedback Focus Groups Focus Groups Foundations Foundations Frequencies Frequencies Goals Goals Gold Gold Guidelines Guidelines Health Health Health Care Costs Health Care Costs Health Professional Health Professional Healthcare Healthcare Individual Individual Injury Injury Intervention Intervention Interview Interview Joint Commission on Accreditation of Healthcare Organizations Joint Commission on Accreditation of Healthcare Organizations Joints Joints Leadership Leadership Life Life Link Link Malignant Neoplasms Medical Care Team Medical Care Team Methods Methods Mission Mission Morals Morals Nurses Nurses Outcome Outcome Pain management Pain management Palliative Care Palliative Care Patient Recruitments Patients Patients Personal Satisfaction Personal Satisfaction Persons Persons Physicians Physicians Population Population Provider Provider Psychometrics Psychometrics Qualitative Methods Qualitative Methods Quality of life Quality of life Recommendation Recommendation Recruitment Activity Religion and Spirituality Religion and Spirituality Reporting Research Research Research Personnel Research Personnel Resources Resources Services Services Social Workers Social Workers Source Source Staging Standardization Testing Testing Translating Translating Validation Validation Validity and Reliability Validity and Reliability Veterans Veterans advanced disease care coordination care preference care preference care providers cognitive testing cognitive testing coping coping design design end of life end of life evidence base evidence base experience experience follow-up follow-up health care service organization health care service organization health care settings improved improved instrument instrument meetings member member patient oriented patient oriented physical symptom physical symptom practical application practical application preference preference satisfaction satisfaction symptom management symptom management tool tool tool development tool development treatment choice treatment choice validation studies validation studies

项目摘要

Anticipated Impact on Veteran's Healthcare: Assessment of spiritual care needs is central to goals and mandates of palliative care, the VA and Joint Commission on Accreditation of Healthcare Organizations. Spiritual and existential beliefs, for those religious and not, are associated with improved quality of life, reduced suffering, and preferences for care. Yet, tools that systematically assess need, link those needs with intervention, treatment recommendations, and outcomes, and communicate needs with other disciplines, are lacking. An empirically designed and rigorously evaluated spiritual assessment tool would provide clinicians and administrators with a means to meet these goals. A tool developed specifically for veterans with serious illness would include the unique existential needs that arise as end of life nears as well as those more common among veterans, such as moral injury. Assessing spiritual needs and resources of veterans during advanced illness facilitates alignment of treatment choices with individual values and preference and enhance care coordination, and is consistent with the priorities of the VA Blueprint for Excellence. A fully validated spiritual assessment tool for seriously ill veterans would be a resource to the chaplaincy service, palliative care teams, and other clinicians caring for those with serious illness. Background: Patients with life-limiting illness confront physical, emotional and spiritual suffering. While efforts to assess and improve pain and symptom management are essential to quality palliative care, both clinical experience and a significant body of research demonstrate that addressing spiritual needs also is central to reducing patient suffering, improving quality of life, and informing care decisions. However, there exists no gold standard, empirically developed and rigorously validated tool to assess veterans spiritual care needs and thus translate preferences for care providers. Project Objectives: This study will develop and validate a spiritual assessment tool for palliative care with serious illness as well as create guidelines for tool use, including communicating results to team members and informing a plan of care. Design and Methods: This is a mixed methods tool development and validation study. Qualitative methods of focus groups, in-depth interviews and cognitive testing will be used for tool development. We will conduct focus groups with patients, families, and providers (chaplains, nurses, physicians and social workers) to gain feedback on tool content and use. Chaplain discussions also will focus on tool format, feasibility and acceptability among chaplains. We will recruit patients 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, from the Durham VA and chaplains also from the National Office. Subsequently, we will develop the instrument and cognitively test its consistency, acceptability, and need for refinement. Following refinements, traditional psychometric testing will be used to validate the tool, in a large population of veterans (n=250), as described above, to establish reliability and validity. Following validation, qualitative methods will be used to develop of guidelines for tool use. The overall approach is patient-centered, and includes key involvement of chaplains and other relevant stakeholders including patients with life limiting illness, family members, chaplains, and health care team members input and preferences.

对退伍军人医疗保健的预期影响：精神护理需求评估是退伍军人医疗保健的核心姑息治疗的目标和任务，VA 和联合认证委员会医疗保健组织。精神信仰和存在主义信仰，无论是否有宗教信仰，都是与改善生活质量、减少痛苦和对护理的偏好有关。然而，工具系统地评估需求，将这些需求与干预、治疗联系起来缺乏建议、成果以及与其他学科的需求沟通。一个根据经验设计和严格评估的精神评估工具将提供临床医生和管理人员有办法实现这些目标。专门开发的工具对于患有严重疾病的退伍军人来说，将包括随着战争结束而出现的独特的生存需求生活临近，以及退伍军人中更常见的问题，例如精神伤害。评估退伍军人在晚期疾病期间的精神需求和资源有助于协调结合个人价值观和偏好的治疗选择，并加强护理协调，并且与 VA 卓越蓝图的优先事项一致。完全验证的精神重病退伍军人的评估工具将成为牧师服务的资源，姑息治疗团队以及其他照顾重病患者的临床医生。背景：患有生命极限疾病的患者面临着身体、情感和精神上的挑战痛苦。虽然评估和改善疼痛和症状管理的努力对于高质量的姑息治疗，临床经验和大量研究表明解决精神需求对于减少患者痛苦、提高治疗质量也至关重要生活，并为护理决策提供信息。然而，根据经验，不存在黄金标准开发并经过严格验证的工具来评估退伍军人的精神护理需求，从而翻译护理提供者的偏好。项目目标：本研究将开发并验证精神评估工具对严重疾病进行姑息治疗，并制定工具使用指南，包括向团队成员传达结果并告知护理计划。设计和方法：这是一项混合方法工具开发和验证研究。将采用焦点小组、深度访谈和认知测试的定性方法工具开发。我们将与患者、家属和提供者进行焦点小组讨论（牧师、护士、医生和社会工作者）以获得有关工具内容和使用的反馈。牧师讨论还将重点关注工具格式、可行性和可接受性牧师。我们将招募患有晚期严重疾病的患者，例如IV期癌症、 III 期或 IV 期 CHF 和严重 COPD、ESRD、退伍军人家属，以及来自达勒姆退伍军人管理局的医疗保健专业人员和来自国家办公室的牧师。随后，我们将开发该工具并认知测试其一致性、可接受性、并需要细化。经过改进，传统的心理测试将用于如上所述，在大量退伍军人 (n=250) 中验证该工具，以确定可靠性和有效性。验证后，将使用定性方法来开发工具使用指南。总体方法以患者为中心，包括关键参与牧师和其他相关利益相关者，包括患有生命限制性疾病的患者、家人成员、牧师和医疗保健团队成员的意见和偏好。