Validity of the FACIT-Sp to Assess Spiritual Well-Being in Elderly Patients
Author(s)
Stéfanie Monod1*,
Estelle Lécureux1,
Etienne Rochat1,2,
Brenda Spencer3,
Laurence Seematter-Bagnoud1,3,
Anne-Sylvie Martin-Durussel1,2,
Christophe Büla1
Affiliation(s)
1 Service of Geriatric Medicine & Geriatric Rehabilitation, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland. 2 Chaplaincy Service, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland. 3 Institute of Social and Preventive Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland.
1 Service of Geriatric Medicine & Geriatric Rehabilitation, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland. 2 Chaplaincy Service, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland. 3 Institute of Social and Preventive Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland.
ABSTRACT
Among instruments measuring spiritual well-being, the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp-12) is the most widely used instrument in research. It has been validated in patients suffering from cancer or HIV/AIDS, but has rarely been used in elderly patients. The objectives of this study were to determine the psychometric properties and suitability of the FACIT-Spto assess spiritual well-being in hospitalized elderly patients. This cross-sectional study uses a mixed method approach. Subjects were patients (N = 208), aged 65 years and older, consecutively admitted in post-acute rehabilitation. Psychometric properties of the FACIT-Sp were investigated. The internal structure of the FACIT-Sp (factor structure and internal consistency) was assessed. Convergent validity of the FACIT-Sp was assessed using the Spiritual Distress Assessment Tool (SDAT), the question “Are you at peace?” and the Geriatric Depression Scale (GDS). Predictive validity was assessed using length of stay (LOS) and discharge destination. Understanding and interpretation of FACIT-Sp items were consecutively assessed in a sub-sample of 135 patients. Results show that FACIT-Sp scores ranged from 7 to 46 (mean 29.6 ± 7.8); 23.1% of the patients had high spiritual well-being. Cronbach’s α was good (0.85). Item-to-total correlations were all significant (0.34 to 0.73). Principal component analyses performed with 2 or 3 factors were only moderately consistent with previous work. FACIT-Sp correlated with SDAT, “Are you at peace?” and GDS (Rho = -0.45, P < 0.001; 0.51, P < 0.001 and -0.38, P < 0.001). No association was found with LOS or discharge destination. Spontaneous comments about one or more FACIT-Sp items were made by 97/135 (71.9%). Specifically, items that address purpose and meaning in life were frequently found difficult to answer. Analyses suggest that the FACIT-Sp may underestimate spiritual well-being in older patients. In conclusion, despite having acceptable psychometric properties, the FACIT-Sp presents limitations for measurement of spiritual well-being in hospitalized elderly patients.
Among instruments measuring spiritual well-being, the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp-12) is the most widely used instrument in research. It has been validated in patients suffering from cancer or HIV/AIDS, but has rarely been used in elderly patients. The objectives of this study were to determine the psychometric properties and suitability of the FACIT-Spto assess spiritual well-being in hospitalized elderly patients. This cross-sectional study uses a mixed method approach. Subjects were patients (N = 208), aged 65 years and older, consecutively admitted in post-acute rehabilitation. Psychometric properties of the FACIT-Sp were investigated. The internal structure of the FACIT-Sp (factor structure and internal consistency) was assessed. Convergent validity of the FACIT-Sp was assessed using the Spiritual Distress Assessment Tool (SDAT), the question “Are you at peace?” and the Geriatric Depression Scale (GDS). Predictive validity was assessed using length of stay (LOS) and discharge destination. Understanding and interpretation of FACIT-Sp items were consecutively assessed in a sub-sample of 135 patients. Results show that FACIT-Sp scores ranged from 7 to 46 (mean 29.6 ± 7.8); 23.1% of the patients had high spiritual well-being. Cronbach’s α was good (0.85). Item-to-total correlations were all significant (0.34 to 0.73). Principal component analyses performed with 2 or 3 factors were only moderately consistent with previous work. FACIT-Sp correlated with SDAT, “Are you at peace?” and GDS (Rho = -0.45, P < 0.001; 0.51, P < 0.001 and -0.38, P < 0.001). No association was found with LOS or discharge destination. Spontaneous comments about one or more FACIT-Sp items were made by 97/135 (71.9%). Specifically, items that address purpose and meaning in life were frequently found difficult to answer. Analyses suggest that the FACIT-Sp may underestimate spiritual well-being in older patients. In conclusion, despite having acceptable psychometric properties, the FACIT-Sp presents limitations for measurement of spiritual well-being in hospitalized elderly patients.
Cite this paper
Monod, S. , Lécureux, E. , Rochat, E. , Spencer, B. , Seematter-Bagnoud, L. , Martin-Durussel, A. and Büla, C. (2015) Validity of the FACIT-Sp to Assess Spiritual Well-Being in Elderly Patients. Psychology, 6, 1311-1322. doi: 10.4236/psych.2015.610128.
Monod, S. , Lécureux, E. , Rochat, E. , Spencer, B. , Seematter-Bagnoud, L. , Martin-Durussel, A. and Büla, C. (2015) Validity of the FACIT-Sp to Assess Spiritual Well-Being in Elderly Patients. Psychology, 6, 1311-1322. doi: 10.4236/psych.2015.610128.
References
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http://dx.doi.org/10.1016/j.jpainsymman.2009.08.005 [3] Boyle, P. A., Buchman, A. S., & Bennett, D. A. (2010). Purpose in Life Is Associated with a Reduced Risk of Incident Disability among Community-Dwelling Older Persons. American Journal of Geriatric Psychiatry, 18, 1093-1102.
http://dx.doi.org/10.1097/JGP.0b013e3181d6c259 [4] Brady, M. J., Peterman, A. H., Fitchett, G., Mo, M., & Cella, D. (1999). A Case for including Spirituality in Quality of Life Measurement in Oncology. Psycho-Oncology, 8, 417-428.
http://dx.doi.org/10.1002/(SICI)1099-1611(199909/10)8:5<417::AID-PON398>3.0.CO;2-4 [5] Canada, A. L., Murphy, P. E., Fitchett, G., Peterman, A. H., & Schover, L. R. (2008). A 3-Factor Model for the FACIT-Sp. Psychooncology, 17, 908-916.
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http://dx.doi.org/10.1016/S0277-9536(00)00439-1 [11] Davison, S. N., & Janghri, G. S. (2013). The Relationship between Spirituality, Psychosocial Adjustment to Illness, and Health-Related Quality of Life in Patients with Advanced Chronic Kidney Disease. Journal of Pain and Symptom Management, 45, 170-178.
http://dx.doi.org/10.1016/j.jpainsymman.2012.02.019 [12] Delgado, C. (2007). Sense of Coherence, Spirituality, Stress and Quality of Life in Chronic Illness. Journal of Nursing Scholarship, 39, 229-234.
http://dx.doi.org/10.1111/j.1547-5069.2007.00173.x [13] Delgado-Guay, M. O., Hui, D., Parsons, H. A., Govan, K., De la Cruz, M., Thorney, S., & Bruera, E. (2011). Spirituality, Religiosity, and Spiritual Pain in Advanced Cancer Patients. Journal of Pain and Symptom Management, 41, 986-994.
http://dx.doi.org/10.1016/j.jpainsymman.2010.09.017 [14] Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-Mental State”. A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198.
http://dx.doi.org/10.1016/0022-3956(75)90026-6 [15] Fry, P. S. (2000). Religious Involvement, Spirituality and Personal Meaning for Life: Existential Predictors of Psychological Wellbeing in Community-Residing and Institutional Care Elders. Aging & Mental Health, 4, 375-387.
http://dx.doi.org/10.1080/713649965 [16] Grant, E., Murray, S. A., Kendall, M., Boyd, K., Tilley, S., & Ryan, D. (2004). Spiritual Issues and Needs: Perspectives from Patients with Advanced Cancer and Nonmalignant Disease. A Qualitative Study. Palliative & Supportive Care, 2, 371-378.
http://dx.doi.org/10.1017/s1478951504040490 [17] Hill, P. C., & Pargament, K. I. (2003). Advances in the Conceptualization and Measurement of Religion and Spirituality. Implications for Physical and Mental Health Research. American Psychologist, 58, 64-74.
http://dx.doi.org/10.1037/0003-066X.58.1.64 [18] Howden, J. W. (1992). Development and Psychometric Characteristics of the Spirituality Assessment Scale. Unpublished Doctoral Dissertation, Houston, TX: Texas Women’s University. [19] Katz, S. (1983). Assessing Self-Maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living. Journal of the American Geriatrics Society, 31, 721-727.
http://dx.doi.org/10.1111/j.1532-5415.1983.tb03391.x [20] Kirby, S. E., Coleman, P. G., & Daley, D. (2004). Spirituality and Well-Being in Frail and Nonfrail Older Adults. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 59, P123-P129.
http://dx.doi.org/10.1093/geronb/59.3.p123 [21] Koenig, H. G. (2012). Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry, 2012, Article ID: 278730.
http://dx.doi.org/10.5402/2012/278730 [22] Krause, N. (2003). Religious Meaning and Subjective Well-Being in Late Life. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 58, S160-S170.
http://dx.doi.org/10.1093/geronb/58.3.s160 [23] Lawton, M. P., & Brody, E. M. (1969). Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living. The Gerontologist, 9, 179-186.
http://dx.doi.org/10.1093/geront/9.3_Part_1.179 [24] Mak, W. (2011). Self-Reported Goal Pursuit and Purpose in Life among People with Dementia. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 66, 177-184.
http://dx.doi.org/10.1093/geronb/gbq092 [25] Mattingly, C. (1994). The Concept of Therapeutic “Emplotment”. Social Science & Medicine, 38, 811-822.
http://dx.doi.org/10.1016/0277-9536(94)90153-8 [26] McClain, C. S., Rosenfeld, B., & Breitbart, W. (2003). Effect of Spiritual Well-Being on End-of-Life Despair in Terminally-Ill Cancer Patients. The Lancet, 361, 1603-1607.
http://dx.doi.org/10.1016/S0140-6736(03)13310-7 [27] Miller, W. R., & Thoresen, C. E. (2003). Spirituality, Religion, and Health: An Emerging Research Field. American Psychologist, 58, 24-35.
http://dx.doi.org/10.1037/0003-066X.58.1.24 [28] Moberg, D. O. (2005). Research in Spirituality, Religion and Aging. Journal of Gerontological Social Work, 45, 11-40.
http://dx.doi.org/10.1300/J083v45n01_02 [29] Monod, S. M., Martin, E., Spencer, B., Rochat, E., & Bula, C. J. (2012). Validation of the Spiritual Distress Assessment Tool in Older Hospitalized Patients. BMC Geriatrics, 12, 13.
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http://dx.doi.org/10.1007/s11606-011-1769-7 [31] Murphy, P. E., Canada, A. L., Fitchett, G., Stein, K., Portier, K., Crammer, C., & Peterman, A. H. (2010). An Examination of the 3-Factor Model and Structural Invariance across Racial/Ethnic Groups for the FACIT-Sp: A Report from the American Cancer Society’s Study of Cancer Survivors-II (SCS-II). Psycho-Oncology, 19, 264-272.
http://dx.doi.org/10.1002/pon.1559 [32] Pargament, K. I., Koenig, H. G., & Tarakeshwar, N. (2004). Religious Coping Methods as Predictors of Psychological, Physical and spiritual Outcomes among Medically Ill Elderly Patients: A Two-Year Longitudinal Study. Journal of Health Psychology, 9, 713-730.
http://dx.doi.org/10.1177/1359105304045366 [33] Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2001). Religious Struggle as a Predictor of Mortality among Medically Ill Elderly Patients: A 2-Year Longitudinal Study. Archives of Internal Medicine, 161, 1881-1885.
http://dx.doi.org/10.1001/archinte.161.15.1881 [34] Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring Spiritual Well-Being in People with Cancer: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Annals of Behavioral Medicine, 24, 49-58.
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[1] Astrow, A. B., Wexler, A., Texeira, K., He, M. K., & Sulmasy, D. P. (2007). Is Failure to Meet Spiritual Needs Associated with Cancer Patients’ Perceptions of Quality of Care and Their Satisfaction with Care? Journal of Clinical Oncology, 25, 5753-5757.
http://dx.doi.org/10.1200/JCO.2007.12.4362 [2] Bekelman, D. B., Parry, C., Curlin, F. A., Yamashita, T. E., Fairclough, D. L., & Wamboldt, F. S. (2010). A Comparison of Two Spirituality Instruments and Their Relationship with Depression and Quality of Life in Chronic Heart Failure. Journal of Pain and Symptom Management, 39, 515-526.
http://dx.doi.org/10.1016/j.jpainsymman.2009.08.005 [3] Boyle, P. A., Buchman, A. S., & Bennett, D. A. (2010). Purpose in Life Is Associated with a Reduced Risk of Incident Disability among Community-Dwelling Older Persons. American Journal of Geriatric Psychiatry, 18, 1093-1102.
http://dx.doi.org/10.1097/JGP.0b013e3181d6c259 [4] Brady, M. J., Peterman, A. H., Fitchett, G., Mo, M., & Cella, D. (1999). A Case for including Spirituality in Quality of Life Measurement in Oncology. Psycho-Oncology, 8, 417-428.
http://dx.doi.org/10.1002/(SICI)1099-1611(199909/10)8:5<417::AID-PON398>3.0.CO;2-4 [5] Canada, A. L., Murphy, P. E., Fitchett, G., Peterman, A. H., & Schover, L. R. (2008). A 3-Factor Model for the FACIT-Sp. Psychooncology, 17, 908-916.
http://dx.doi.org/10.1002/pon.1307 [6] Carpenito, M. (2004). Nursing Diagnosis: Application to Clinical Practice (10th ed.). Philadelphia: Lippincott Williams & Wilkins. [7] Chandler, C. K., Holden, J. M., & Kolander, C. A. (1992). Counseling for Spiritual Wellness: Theory and Practice. Journal of Counseling & Development, 71, 168-175.
http://dx.doi.org/10.1002/j.1556-6676.1992.tb02193.x [8] Daaleman, T. P., & Frey, B. B. (2004). The Spirituality Index of Well-Being: A New Instrument for Health-Related Quality-of-Life Research. Annals of Family Medicine, 2, 499-503.
http://dx.doi.org/10.1370/afm.89 [9] Daaleman, T. P., Frey, B. B., Wallace, D., & Studenski, S. A. (2002). The Spirituality Index of Well-Being: Development and Testing of a New Measure. Journal of Family Practice, 51. [10] Daaleman, T. P., Kuckelman, C. A., & Frey, B. B. (2001). Spirituality and Well-Being: An Exploratory Study of the Patient Perspective. Social Science & Medicine, 53, 1503-1511.
http://dx.doi.org/10.1016/S0277-9536(00)00439-1 [11] Davison, S. N., & Janghri, G. S. (2013). The Relationship between Spirituality, Psychosocial Adjustment to Illness, and Health-Related Quality of Life in Patients with Advanced Chronic Kidney Disease. Journal of Pain and Symptom Management, 45, 170-178.
http://dx.doi.org/10.1016/j.jpainsymman.2012.02.019 [12] Delgado, C. (2007). Sense of Coherence, Spirituality, Stress and Quality of Life in Chronic Illness. Journal of Nursing Scholarship, 39, 229-234.
http://dx.doi.org/10.1111/j.1547-5069.2007.00173.x [13] Delgado-Guay, M. O., Hui, D., Parsons, H. A., Govan, K., De la Cruz, M., Thorney, S., & Bruera, E. (2011). Spirituality, Religiosity, and Spiritual Pain in Advanced Cancer Patients. Journal of Pain and Symptom Management, 41, 986-994.
http://dx.doi.org/10.1016/j.jpainsymman.2010.09.017 [14] Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-Mental State”. A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198.
http://dx.doi.org/10.1016/0022-3956(75)90026-6 [15] Fry, P. S. (2000). Religious Involvement, Spirituality and Personal Meaning for Life: Existential Predictors of Psychological Wellbeing in Community-Residing and Institutional Care Elders. Aging & Mental Health, 4, 375-387.
http://dx.doi.org/10.1080/713649965 [16] Grant, E., Murray, S. A., Kendall, M., Boyd, K., Tilley, S., & Ryan, D. (2004). Spiritual Issues and Needs: Perspectives from Patients with Advanced Cancer and Nonmalignant Disease. A Qualitative Study. Palliative & Supportive Care, 2, 371-378.
http://dx.doi.org/10.1017/s1478951504040490 [17] Hill, P. C., & Pargament, K. I. (2003). Advances in the Conceptualization and Measurement of Religion and Spirituality. Implications for Physical and Mental Health Research. American Psychologist, 58, 64-74.
http://dx.doi.org/10.1037/0003-066X.58.1.64 [18] Howden, J. W. (1992). Development and Psychometric Characteristics of the Spirituality Assessment Scale. Unpublished Doctoral Dissertation, Houston, TX: Texas Women’s University. [19] Katz, S. (1983). Assessing Self-Maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living. Journal of the American Geriatrics Society, 31, 721-727.
http://dx.doi.org/10.1111/j.1532-5415.1983.tb03391.x [20] Kirby, S. E., Coleman, P. G., & Daley, D. (2004). Spirituality and Well-Being in Frail and Nonfrail Older Adults. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 59, P123-P129.
http://dx.doi.org/10.1093/geronb/59.3.p123 [21] Koenig, H. G. (2012). Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry, 2012, Article ID: 278730.
http://dx.doi.org/10.5402/2012/278730 [22] Krause, N. (2003). Religious Meaning and Subjective Well-Being in Late Life. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 58, S160-S170.
http://dx.doi.org/10.1093/geronb/58.3.s160 [23] Lawton, M. P., & Brody, E. M. (1969). Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living. The Gerontologist, 9, 179-186.
http://dx.doi.org/10.1093/geront/9.3_Part_1.179 [24] Mak, W. (2011). Self-Reported Goal Pursuit and Purpose in Life among People with Dementia. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 66, 177-184.
http://dx.doi.org/10.1093/geronb/gbq092 [25] Mattingly, C. (1994). The Concept of Therapeutic “Emplotment”. Social Science & Medicine, 38, 811-822.
http://dx.doi.org/10.1016/0277-9536(94)90153-8 [26] McClain, C. S., Rosenfeld, B., & Breitbart, W. (2003). Effect of Spiritual Well-Being on End-of-Life Despair in Terminally-Ill Cancer Patients. The Lancet, 361, 1603-1607.
http://dx.doi.org/10.1016/S0140-6736(03)13310-7 [27] Miller, W. R., & Thoresen, C. E. (2003). Spirituality, Religion, and Health: An Emerging Research Field. American Psychologist, 58, 24-35.
http://dx.doi.org/10.1037/0003-066X.58.1.24 [28] Moberg, D. O. (2005). Research in Spirituality, Religion and Aging. Journal of Gerontological Social Work, 45, 11-40.
http://dx.doi.org/10.1300/J083v45n01_02 [29] Monod, S. M., Martin, E., Spencer, B., Rochat, E., & Bula, C. J. (2012). Validation of the Spiritual Distress Assessment Tool in Older Hospitalized Patients. BMC Geriatrics, 12, 13.
http://dx.doi.org/10.1186/1471-2318-12-13 [30] Monod, S., Brennan, M., Rochat, E., Martin, E., Rochat, S., & Bula, C. J. (2011). Instruments Measuring Spirituality in Clinical Research: A Systematic Review. Journal of General Internal Medicine, 26, 1345-1357.
http://dx.doi.org/10.1007/s11606-011-1769-7 [31] Murphy, P. E., Canada, A. L., Fitchett, G., Stein, K., Portier, K., Crammer, C., & Peterman, A. H. (2010). An Examination of the 3-Factor Model and Structural Invariance across Racial/Ethnic Groups for the FACIT-Sp: A Report from the American Cancer Society’s Study of Cancer Survivors-II (SCS-II). Psycho-Oncology, 19, 264-272.
http://dx.doi.org/10.1002/pon.1559 [32] Pargament, K. I., Koenig, H. G., & Tarakeshwar, N. (2004). Religious Coping Methods as Predictors of Psychological, Physical and spiritual Outcomes among Medically Ill Elderly Patients: A Two-Year Longitudinal Study. Journal of Health Psychology, 9, 713-730.
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