PURPOSE Despite considerable interest in examining spirituality in health-related quality-of-life studies, there is a paucity of instruments that measure this construct. The objective of this study was to test a valid and reliable measure of spirituality that would be useful in patient populations. METHODSWe conducted a multisite, cross-sectional survey using systematic sampling of adult outpatients at primary care clinic sites in the Kansas City metropolitan area (N = 523). We determined the instrument reliability (Cronbach's α, test-retest) and validity (confi rmatory factor analysis, convergent and discriminant validation) of the Spirituality Index of Well-Being (SIWB). RESULTSThe SIWB contains 12 items: 6 from a self-effi cacy domain and 6 from a life scheme domain. Confi rmatory factor analysis found the following fi t indices: χ 2 (54, n = 508) = 508.35, P <.001; Comparative Fit Index = .98; TuckerLewis Index = .97; root mean square error of approximation = .13. The index had the following reliability results: for the self-effi cacy subscale, α = .86 and test-retest r = 0.77; for the life scheme subscale, α = .89 and test-retest r = 0.86; and for the total scale α = .91 and test-retest r = 0.79, showing very good reliability. The SIWB had signifi cant and expected correlations with other quality-of-life instruments that measure well-being or spirituality: Zung Depression Scale (r = 0 -.42, P <.001), General Well-Being Scale (r = 0.64, P <.001), and Spiritual Well-Being Scale (SWB) (r = 0.62, P <.001). There was a modest correlation between the religious well-being subscale of the SWB and the SIWB (r = 0.35, P <.001). CONCLUSIONSThe Spirituality Index of Well-Being is a valid and reliable instrument that can be used in health-related quality-of-life studies. INTRODUCTIONT here is continued interest in examining the association of religion and spirituality with health-related outcomes.1 Despite this interest, the use of small, nongeneralizable samples, confounding, and the lack of valid and reliable instruments that measure spirituality or religiosity compromise most studies in this fi eld.2 Although there is no shortage of instruments from the disciplines of sociology, psychology, and pastoral theology and chaplaincy, 3 these measures frequently are not applicable or useful in studies of individual or population health.The current study describes the development and evaluation of the Spirituality Index of Well-Being (SIWB), which was designed to measure the effect of spirituality on subjective well-being. Two assumptions guided our study design and analysis. First, we recognized that no global, yet parsimonious, instrument captures the complexity and depth of spirituality in any context, health care or otherwise. Next, based on our qualitative From a cultural and social perspective, spirituality and religion are especially salient in the lives of the elderly minority populations, 5,6 particularly within the settings of serious illness and end-of-life care.7 From a population health perspective, inc...

PURPOSE Although spiritual care is a core element of palliative care, it remains unclear how this care is perceived and delivered at the end of life. We explored how clinicians and other health care workers understand and view spiritual care provided to dying patients and their family members. METHODSOur study was based on qualitative research using key informant interviews and editing analysis with 12 clinicians and other health care workers nominated as spiritual caregivers by dying patients and their family members.RESULTS Being present was a predominant theme, marked by physical proximity and intentionality, or the deliberate ideation and purposeful action of providing care that went beyond medical treatment. Opening eyes was the process by which caregivers became aware of their patient's life course and the individualized experience of their patient's current illness. Participants also described another course of action, which we termed cocreating, that was a mutual and fl uid activity between patients, family members, and caregivers. Cocreating began with an affi rmation of the patient's life experience and led to the generation of a wholistic care plan that focused on maintaining the patient's humanity and dignity. Time was both a facilitator and inhibitor of effective spiritual care.CONCLUSIONS Clinicians and other health care workers consider spiritual care at the end of life as a series of highly fl uid interpersonal processes in the context of mutually recognized human values and experiences, rather than a set of prescribed and proscribed roles.

Efforts to improve physician communication with families of LTC residents may be promoted using face-to-face meetings between the physician and family caregivers, explanation of the patient's prognosis, and timely conveyance of information about health status changes, especially when a patient is actively dying.

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