Age-stratified validation of the functional assessment of chronic illness therapy-spiritual well-being based on a large cohort of Danish cancer survivors.

OBJECTIVE: Previous research indicates that the FACIT-Sp instrument is susceptible to bias when measuring spiritual well-being in older patients. Our first focus was to evaluate the two-factor vs the three-factor model of the FACIT-Sp and our second focus was to explore how these models behave for different age groups. METHODS: We used a large national cohort of Danish cancer patients (N = 3439) which included a significant number of patients aged at least 70 years (N = 1033). Item-test correlations and factor analyses were conducted on complete cases (N = 2820). Additionally, a reliability analysis was performed using Cronbach's alpha and Guttman's lower-bound estimate. RESULTS: Factor analysis revealed a loading pattern for the oldest age group (70+) showing items on peace and meaning loading into a single factor, as originally proposed in the two-factor model. The loading estimates for the patients younger than 70 matched the three-factor model. Furthermore, item-test correlations changed as age increased. Based on Cronbach's alpha and Guttman's estimate of .83 and .89, respectively, total scores proved reliable. Items 4, 8, and 12 are discussed separately concerning their problematic influence on instrument validity in their current formulation. CONCLUSION: Overall, the three-factor model had a good fit; however, for the eldest patients a two-factor solution proved even better. Interpretation of FACIT-Sp subscale scores of older cancer patients must therefore be done with caution.

Physicians' religious/spiritual characteristics and their behavior regarding religiosity and spirituality in clinical practice: A meta-analysis of individual participant data.

BACKGROUND: Religiosity and/or spirituality (R/S) of physicians have been reported to inform behavior regarding religiosity and spirituality in clinical practice (R/S-B). Our aim was to study this association. METHODS: Building upon a large international data pool of physician values we performed network and systematic literature searches using Google Scholar, Web of Science, Embase, Medline, and PsycInfo. Measures for R/S and R/S-B were selected for comparability with existing research. We performed a two-stage IPDMA using R/S coefficients from sample-wise multiple regression analyses as summary measures. We controlled for age, gender, and medical specialty. An additional sub-analysis compared psychiatrists to non-psychiatrists. RESULTS: We found 11 eligible surveys from 8 countries (n = 3159). We found a positive association between R/S and R/S-B with an overall R/S coefficient of 0.65 (0.48-0.83). All samples revealed a positive association between R/S and R/S-B. Only 2 out of the 11 samples differed from the overall confidence interval. Psychiatrists had a higher degree of R/S-B, but associations with R/S did not differ compared to non-psychiatrists. CONCLUSIONS: We confirmed a significant association between R/S and R/S-B in this study. Despite large cultural differences between samples, coefficients remained almost constant when controlling for confounders, indicating a cultural independent effect of R/S on R/S-B, which to our knowledge has not been documented before.Such interaction can constitute both facilitators and barriers for high quality health care and should be considered in all aspects of patient and relationship-centered medicine.

What is spiritual care? Professional perspectives on the concept of spiritual care identified through group concept mapping.

OBJECTIVES: The overall study aim was to synthesise understandings and experiences regarding the concept of spiritual care (SC). More specifically, to identify, organise and prioritise experiences with the way SC is conceived and practised by professionals in research and the clinic. DESIGN: Group concept mapping (GCM). SETTING: The study was conducted within a university setting in Denmark. PARTICIPANTS: Researchers, students and clinicians working with SC on a daily basis in the clinic and/or through research participated in brainstorming (n=15), sorting (n=15), rating and validation (n=13). RESULTS: Applying GCM, ideas were identified, organised and prioritised online. A total of 192 unique ideas of SC were identified and organised into six clusters. The results were discussed and interpreted at a validation meeting. Based on input from the validation meeting a conceptual model was developed. The model highlights three overall themes: (1) 'SC as an integral but overlooked aspect of healthcare' containing the two clusters SC as a part of healthcare and perceived significance; (2) 'delivering SC' containing the three clusters quality in attitude and action, relationship and help and support, and finally (3) 'the role of spirituality' containing a single cluster. CONCLUSION: Because spirituality is predominantly seen as a fundamental aspect of each individual human being, particularly important during suffering, SC should be an integral aspect of healthcare, although it is challenging to handle. SC involves paying attention to patients' values and beliefs, requires adequate skills and is realised in a relationship between healthcare professional and patient founded on trust and confidence.