A pilot study screening for spiritual distress in patients at Hospice Africa Uganda

Abstract

Background: Hospice Africa Uganda (HAU) is a nongovernmental organization that has been a pioneer in African palliative care since 1993. As standard of care at HAU, a patient’s spiritual well-being is assessed thoroughly upon admission, but not screened routinely at subsequent visits due to heavy clinical volume and no standardized instrument for spiritual distress. The “Spirit 8” is an eight-question, multiple-choice survey developed by Selman et al. that has shown preliminary utility assessing patients in hospice care in Africa. This study proposed that it would be feasible to use the Spirit 8 as a regular, quantitative screen for spiritual distress in patients cared for by HAU. Structure/Method/Design: Between June 20 and October 21, 2013, the Spirit 8 survey was administered verbally to consenting patients upon admission to HAU. Potential scores range from 8 to 40 with the highest representing the best state of spiritual well-being. Available in English or Luganda, the assessment was repeated at up to four subsequent visits. Based on the interaction, study staff scored patient understanding of the survey on a 5-point scale with 5 representing excellent understanding. Demographic data was collected for each patient. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): At the time of data analysis, 81 patients were enrolled on study and completed the assessment at visit 1. Additionally, 44 completed the assessment at visit 2 and 20 at visit 3. At visit 1, the mean Spirit 8 score was 27.20 ( 6.11) out of 40. Paired t tests were used to compare patient scores over time and within certain demographics. No significant difference was found when comparing scores at visit 1 to scores at the second and third visits. Patients who reported having dependents scored 3.2 points higher on average than patients with no dependents (P 1⁄4 0.024). No statistical difference was noted when comparing patients across different demographics (age, gender, HIV status, ECOG score, pain score). Assessment by the study staff of patients understanding of the survey yielded an average score of 4 ( 0.9) out of 5. Of all the assessments given, 98.1% had all eight questions answered. Summary/Conclusion: The Spirit 8 is a feasible screening tool in clinical practice at HAU. In the 4 months from study initiation to data analysis, more than half of the enrolled patients had completed assessments at multiple visits. The high rate of assessment completion (98.1%) and the study staff’s assessment of patient understanding averaging 4 out of 5, both further suggest that the Spirit 8 is an appropriate screening tool for use at HAU. Patient enrollment to n 1⁄4 100 is ongoing with expected study completion by February 2014.