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Unmet spiritual needs in palliative care: psychometrics of a screening checklist
  1. Natasha G Michael1,2,
  2. Irene Bobevski1,3,
  3. Ekavi Georgousopoulou2,
  4. Clare C O'Callaghan1,4,
  5. Josephine M Clayton5,6,
  6. Davinia Seah2,7 and
  7. David Kissane2,7
  1. 1Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, Victoria, Australia
  2. 2University of Notre Dame Australia, School of Medicine, Sydney, NSW, Australia
  3. 3Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
  4. 4Palliative Care Service St Vincent’s Hospital Melbourne, VIC, Australia, St Vincent’s Hospital, Melbourne, VIC, Australia
  5. 5Centre for Learning & Research in Palliative Care, Hammond Care, Greenwich Hospital, Sydney, NSW, Australia
  6. 6The University of Sydney Northern Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
  7. 7Sacred Heart Health Service, St. Vincent’s Hospital Sydney, Sydney, NSW, Australia
  1. Correspondence to Dr Natasha G Michael, Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC 3144, Australia; nmichael{at}


Background While studies in palliative care use measures of spirituality and religious belief, there have been few validation studies of a screening tool that identifies unmet spiritual needs.

Methods A multidisciplinary research team developed and examined the usefulness, reliability and validity of a 17-item Spiritual Concerns Checklist (SCC) as a screening tool for unmet spiritual needs. A cohort of patients recruited from three palliative care services in Sydney and Melbourne, Australia completed anonymous questionnaires. Factor structure and item response theory were used to examine its properties; concurrent validity employed the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale (FACIT-Sp-12).

Results Among 261 patients, while only 15% directly sought spiritual care, nearly 62% identified at least one spiritual concern. Existential needs (fear of the dying process 32%; loss of control 31%), regret (20%), need for forgiveness (17%), guilt (13%), loss of hope (13%) and meaning (15%) were prominent concerns. Eleven concerns were present for more than 10% of the participants and 25% of religiously orientated participants expressed >4 concerns. The 17-item SCC was unidimensional, with satisfactory reliability. Concurrent validity was evident in the reduced sense of meaning and peace on the FACIT-Sp-12.

Conclusion This preliminary Rasch analysis of the newly developed SCC has demonstrated its usefulness, reliability and validity. Our findings encourage refinement and ongoing development of the SCC with further investigation of its psychometric properties in varying populations.

  • spiritual care
  • quality of life
  • psychological care
  • hospice care

Statistics from


  • Contributors CCOC, NGM and DK designed the initial study. NGM, JMC and DS led recruitment across sites. IB conducted the Rasch analyses and EG conducted the statistical analysis. All authors interpreted data. DK, IB, NGM and EG wrote the initial manuscript. All authors approved the final manuscript. NM is responsible for the overall content as guarantor.

  • Funding Financial support was received from the Cabrini Foundation Sambor Family Clinical Research grant and the Palliative Care Research Network (Victoria, Australia) Small Project Grant scheme.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study was granted by the Clinical Research Ethics Committee of Cabrini Health (07-12-09-16) and HammondCare Hospital/St. Vincent’s Hospital (LNR/17/SVH/279).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Deidentified patient data are available from the Supportive, Psychosocial and Palliative Care Research Department at Cabrini Health. The data are available via the corresponding author (orcid ID and reuse is only permitted following further consent from the research team and ethics approval.

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