82 Improving spiritual care in hospice – integrating the ‘HOPE’ assessment tool into the medical admission document

Abstract

Background Junior doctors undertake holistic patient assessments on hospice admission. Although physical and psychosocial needs are frequently comprehensively evaluated, medical staff often lack confidence and training in the assessment and management of spiritual issues. This quality improvement project aimed to improve medical staff confidence in the assessment and documentation of patients‘ spiritual needs upon hospice admission. Methods An anonymous survey evaluated hospice medical staff opinion on spiritual care. A chart review examined the spiritual assessments documented at baseline and monthly (February to June 2018). Using the ‘HOPE’ tool, factors assessed were: identification of source of Hope; Organisation/spiritual community; spiritual Practices; desired Effects on healthcare. Interventions included dissemination of a spiritual care journal article, integration of ‘HOPE’, a spiritual assessment tool, into the admission proforma and junior doctor education by the hospice chaplain. Descriptive statistics were generated using Microsoft Excel. Results Eight medical staff (junior doctors and consultants) completed the survey. Spiritual care was identified as important but often forgotten. 63% believed religious leaders should direct spiritual care, but that all staff should have relevant skills. Over 50% lacked confidence in spiritual aspects, particularly regarding religious minorities. Completion of spiritual assessment improved from 83% to 94%. Identification of source of hope increased from 50% to 78%, which was sustained. Identification of a spiritual community improved from 6% to 67%, but this was not maintained. Identification of spiritual practices improved from 28% to 75% and discussing effects on healthcare rose from 17% to 67%. These were sustained. Conclusions Introducing a spiritual assessment tool improves identification of spiritual needs on admission, particularly source of hope and spiritual practices. Ongoing targeted education would ensure continuous improvement. Use of this tool across inpatient and community palliative care settings could improve spiritual care by clinicians.