ObjectiveGuidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence of the accuracy of measures used to screen adults for spiritual suffering.MethodsA systematic review of the literature. We searched five scientific databases to identify relevant articles. Two independent reviewers screened, extracted data, and assessed study methodological quality.ResultsWe identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the two-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82–87%), and the revised Rush protocol had the highest specificity (81–90%). The methodological quality of all included studies was low.Significance of ResultsWhile most of the identified spiritual screening measures are brief (comprised 1 to 12 items), few had sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.

Background The shared care pathway for ADHD is a program developed in Canada with two main strategies: (a) implement a shared care pathway between general practitioners (GPs) and specialists, and (b) step up or down care so that the patient is treated at the most appropriate level of care, depending on the complexity or outcome of their illness. The current study aims to identify the challenges and facilitators of implementing this program in a Chinese mental health service setting. Methods Two focus groups were conducted using semi-structured interviews with a total of 7 health care providers in Beijing. An adapted grounded theory methodology using open-ended, axial and selective coding was used for data analysis. Results We identified three main levels related to barriers and facilitators: (1) a sociocultural level of patients' and health care providers' perspectives; (2) a structural level related to internal and external organizational environments; (3) and the level of the intervention itself with its characteristics. The project is generally aligned with the mandates and goals of the health system, but two of the main obstacles are the varying qualifications of physicians in hospitals of different levels, implying different needs and flexible and adapted training programs, and the lack of appropriate patient referral systems between the different hospital levels. Conclusion Our study highlights the importance of consultation to obtain a "lay of the land" for deciding on the implementation steps of an a priori well accepted model of care.

Background The ADHD Shared Care Pathways is a program that has been developed in Canada with two main strategies: (a) to implement shared care between general practitioners (GPs) and specialists, and (b) to implement stepped care in which the patient is treated at the most appropriate level of care, depending on complexity or outcome of their illness. The current study aims to identify challenges and facilitators in implementing this program in a Chinese context. Methods Two focus groups were conducted using semi-structured interviews with a total of 7 healthcare providers in Beijing. A grounded theory approach using open, axial and selective coding provided three main themes pertaining to the barriers and facilitators faced at: (1) a Social-level from of the perspectives of patients and healthcare providers; (2) at a structural-level related to both internal and external organizational environments; (3) and at the intervention-level. Results Results reveal multilayered challenges in implementing an ADHD Shared Care Pathways program for children in China. Conclusion Our study highlights the importance of consultation in a new implementation context in order to get a “lay of the land”. By extension, our results demonstrate areas for service development and further research.

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