Distinguishing Between Spiritual Distress, General Distress, Spiritual Well Being, and Spiritual Pain Among Cancer Patients During Oncology Treatment.
CONTEXT Spiritual distress is present in approximately 25% of oncology patients. OBJECTIVES We examined the extent to which this measure is identical to a variety of other measures, such as spiritual well being, spiritual injury, spiritual pain, and general distress. METHODS Structured interview of oncology outpatients over 12 months, approached nonselectively. The presence or absence of spiritual distress was compared against spiritual pain and two spiritual well being tools: Functional Assessment of Chronic Illness Therapy Spiritual Well Being 12 Item Scale (FACIT Sp 12) and the Spiritual Injury Scale (SIS) We also examined whether a general distress visual analogue scale sufficed to identify spiritual distress. Other questions concerned demographic and clinical data. RESULTS Of 416 patients approached, 202 completed the interview, of whom 23% reported spiritual distress. All measures showed significant correlation (receiver operating characteristic, area under the curve: SIS 0.79; distress thermometer [DT] 0.68; FACIT Sp 12 0.67) yet none were identical with spiritual distress (sensitivity/specificity: SIS 64%/79% spiritual pain 72%/76% DT 41%/76% FACIT Sp 12 57%/72% Of the FACIT Sp 12 subscales, only peace correlated with spiritual distress. A significant predictor of spiritual distress was patients' self evaluation of grave clinical condition (odds ratio 3.3; 95% CI 1.1 9.5) Multivariable analysis of individual measure items suggests an alternative three parameter model for spiritual distress: not feeling peaceful, feeling unable to accept that this is happening, and perceived severity of one's illness. CONCLUSION The DT is not sufficient to identify spiritual distress. The peace subscale of FACIT Sp 12 is a better match than the measure as a whole. The SIS is the best match for spiritual distress, although an imperfect one.
Journal of pain and symptom management