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J Pain Symptom Manage. 2014 Jun;47(6):1008-1018.e1. doi: 10.1016/j.jpainsymman.2013.06.018. Epub 2013 Oct 5.

Development and validation of a new tool for the assessment and spiritual care of palliative care patients.

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Balearic Strategy of Palliative Care, Palma de Mallorca, Spain.
University of Valencia, Valencia, Spain. Electronic address:
University of Valencia, Valencia, Spain.
Palliative Care Unit, Sant Pau Hospital, Barcelona, Spain.
University Ramon Llull, Barcelona, Spain.
La Paz Hospital, Madrid, Spain.



Spiritual assessment tools and interventions based on holistic approaches are needed to promote healing. Such tools must be adapted to the wide cultural backgrounds of contemporary Western society.


To develop and validate a new brief measure, simultaneously featuring clinical applicability and adequate psychometric properties. The tool uses six initial questions to establish a climate of trust with patients before they complete an eight-item, five-point Likert scale. The questionnaire is based on a model of spirituality generated by the Spanish Society of Palliative Care (SECPAL) Task Force on Spiritual Care (Grupo de Espiritualidad de la SECPAL), which aims to recognize, share, and assess the spiritual resources and needs of palliative care patients.


Multidisciplinary professionals from 15 palliative care teams across Spain interviewed 108 patients using the Grupo de Espiritualidad de la SECPAL questionnaire. Confirmatory factor analysis techniques were used to study the new tool factor structure and reliability. Additionally, concurrent criterion validity coefficients were estimated considering spiritual well-being, anxiety, depression, resilience, and symptoms. Descriptive statistics on questionnaire applicability were reported.


Analyses supported a three-factor structure (intrapersonal, interpersonal, transpersonal) with an underlying second-order factor representing a spirituality construct. Adequate reliability results and evidence for construct validity were obtained.


The new questionnaire, based on empirical research and bedside experience, showed good psychometric properties and clinical applicability.


Palliative care; assessment; questionnaire validation; spiritual care; spirituality; structural equation modeling

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