Brennan, Mark

Büla, Christophe

Martin, Estelle

Monod, Stéfanie

Rochat, Etienne

Rochat, Stéphane

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Spiritual Assessment in Clinical Setting: The Need for Future ResearchStéfanie Monod, MD1, Mark Brennan, PhD2,3, Etienne Rochat, Theologian1, Estelle Martin, PhD1,Stéphane Rochat, MD MM(ClinEpi)1, and Christophe J. Büla, MD11Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Medical Center, Lausanne, Switzerland; 2AIDS CommunityResearch Initiative of America (ACRIA), ACRIA Center on HIV and Aging, New York, NY, USA; 3New York University College of Nursing,New York, NY, USA.J Gen Intern Med 27(4):402DOI: 10.1007/s11606-011-1974-4© Society of General Internal Medicine 2012D r. Garssen et al. are correct in their assertion that thereis a risk of confounding the constructs of spiritualwell-being and psychological well-being. Such criticismwas previously made for spirituality constructs,1 and couldalso have been mentioned in our paper. However, thepurpose of our review was to systematically identifyinstruments that have been previously used in clinicalresearch to measure spirituality and to classify them incategories that could be easily understandable for research-ers and clinicians interested in choosing an instrument. Ourpurpose was not to critically review the spiritualityconstructs that formed the basis for these instruments, norwas it to endorse one measure over another. Nevertheless,we agree that future work should address this confoundbetween spiritual well-being and mental health outcomes.This should be done not only from a “well-being”perspective but also from a “distress” perspective. Inparticular, distinction between spiritual distress and depres-sion should be further discussed.2We also understand Dr. Garssen et al.’s comments aboutthe number of religious items in these instruments withregard to their suitability for individuals who may bespiritual but not religious in a traditional sense. However,they are not clear as to what this threshold for religiousitems should be. This begs the question of how manyreligious items are too many to use in spiritual assessments.The overlap between spirituality and religion has receivedconsiderable attention in the literature, and there has beenno clear consensus from either a conceptual or measurementperspective as to how to address this issue. In our review,we did exclude instruments that focused exclusively onreligion/religiousness, but decided to include others eventhough they had high proportions of religious items. Asnoted by Pargament,3 for many individuals, spirituality isexpressed in the context of religion. Thus, the inclusionitems referencing religiousness in assessments of spiritualityis certainly warranted for some individuals. For others, whoconsider themselves spiritual but not religious, those sameassessments may not be appropriate. It is up to the clinicianor the researcher to decide which measure would be themost appropriate in any given circumstance.In conclusion, we would like to thank again Dr. Garssenet al. for their emphasis about the need for future research inthe field of spiritual assessment in clinical settings.Corresponding Author: Stéfanie Monod, MD; Service of GeriatricMedicine and Geriatric Rehabilitation, University of LausanneMedical Center, Lausanne, Switzerland (e-mail: Stefanie.monod-zorzi@chuv.ch).REFERENCES1. Moreira-Almeida A, Koenig HG. Retaining the meaning of the wordsreligiousness and spirituality: a commentary on the WHOQOL SRPBgroup’s "a cross-cultural study of spirituality, religion, and personalbeliefs as components of quality of life". Soc Sci Med. 2006;63:843–845.2. Monod SM, Rochat E, Bula CJ, Jobin G, Martin E, Spencer B. TheSpiritual Distress Assessment Tool: An instrument to assess spiritualdistress in hospitalised elderly persons. BMC Geriatr. 2010;10(1):88.3. Pargament, K. I. The psychology of religious coping. 2010;10(1):88.Published online January 19, 2012402

Spiritual Assessment in Clinical Setting: The Need for Future Research

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Spiritual Assessment in Clinical Setting: The Need for Future Research

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