20.3 (7.4) Validated assessment tools for psychological, spiritual, and family issues

Question 1

How does the use of a symptom assessment tool alter the detection of symptoms? What severity are identified symptoms

Answer 1

Comparing patient-reported symptoms following open-ended questioning versus a structured survey among 265 advanced disease patients in the United States, Homsi et al. (2006) reported that the median number of symptoms found using the latter was tenfold higher than those volunteered, with most non-volunteered
symptoms being moderate or severe and distressing

Question 2

Name one tool that can be used to generally assess for palliative needs in a patient with advanced illness that will address the social domain, existential matters and therapeutic relationships

Answer 2

Needs at end of life screening tool - 13 questions that are grouped into four thematic dimensions—corresponding, for mnemonic purposes, to each
letter of NEST (Needs in the social domain, Existential matters, Symptom management needs, and Therapeutic relationship matters)

Question 3

List four features that make a measure reasonable to use

Answer 3

The utility of a measure is determined b:
- its psychometric properties
- how well it relates to its aim.
- has validity (face, content, criterion, and construct)
- reliability (inter-rater, test–retest, and internal consistency)
- appropriateness and acceptability
- responsiveness to change
- interpretable results
- a measure should be easy and relatively quick to administer

Question 4

What are the four domains addressed by the 10 items on the Palliative Care Outcomes Scale?

Answer 4

physical symptoms, emotional, psychological, and spiritual needs and the provision of information and support

Question 5

What is quality improvement? What is the first step in starting quality improvement?

Answer 5

Quality improvement (QI) is a formal, systematic approach to performance analysis that seeks to measure the status quo and identify and implement ways to initiate improvements.

Clinical audit can be the first step in the QI cycle; a method of reviewing existing clinical practice against agreed standards of care to identify areas for improvement

Question 6

List 6 complications of untreated psychological distress in the setting of advanced illness

Answer 6

-undermines medical decision-making and treatment adherence, which can result in disability and high health-care usage
-May augment pain perception
-undermine symptom control
-impair quality of life
-perceived loss of meaning or purpose in life
-decrease in engagement in valued activities
-reduction in pleasure from the social environment
-impede the ability to cope with the emotional stress of preparing for death and separating from loved ones
-worsen distress in family members

Question 7

List two ultrashort screening tests for psychological distress. What is each useful for?

Answer 7

Distress Thermometer - It has high sensitivity and specificity with the Hospital Anxiety and Depression Scale

Patient Health Questionnaire-4 (PHQ-4) - screens for anxiety and depression.

Question 8

List two tools that can be used for screening in for depression in cancer patients

Answer 8

Two widely-used, short screening tools for depression are the HADS (hospital anxiety depression scale) and the CES-D (centre for epidemiological study - depression scale)

Question 9

List three reasons for a lack of measurement tools in the religious/spiritual domain

Answer 9

lack of a generally accepted conceptual definition of spirituality, resulting in confusion

a paucity of tools validated in cross-cultural palliative care populations

dearth, or lack of reporting, of methodologically rigorous supportive validation studies per se, especially for clinical tools

Question 10

List two ultrashort screening tools for spiritual distress

Answer 10

distress thermometer

“are you at peace?”

Question 11

List three tools for taking a spiritual history. Which is the best validated?

Answer 11

1. The HOPE tool (sources of Hope, Organized religion, Personal spirituality, Effects
   on care)
2. SPIRIT tool (Spiritual belief, Personal spirituality, Integration with community, Rituals, Implications for care, Terminal events planning)
3. FICA (Faith, Importance, Community, and
   address in Care) spiritual history tool
   - only such instrument partly supported by a validation study

Question 12

Who should perform comprehensive spiritual assessments using the currently available tools?

Answer 12

a professional chaplain

Question 13

What does the Brief RCOPE measure? What does the FACIT-sp measure?

Answer 13

Brief RCOPE - positive religious coping and negative religious coping

FACIT-Sp focuses on spiritual well-being

Question 14

Name the FOUR levels of spiritual inquiry employed to assess spirituality in the clinical setting

Answer 14

◆ spiritual history taking
◆ spiritual screening
◆ spiritual assessment
◆ spiritual research