Spirituality at the End of Life: Conceptualization of Measurable Aspects-a Systematic Review.

Abstract: Although spiritual caregiving is a key domain
of palliative care, it lacks a clear definition, which impedes both caregiving
and research in this domain. The aim of this study was to conceptualize
spirituality by identifying dimensions, based on instruments measuring
spirituality in end-of-life populations. A systematic literature review was
conducted. Literature published between 1980 and 2009, focussing on instruments
measuring spirituality at the end of life was collected from the PubMed,
Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO
databases. Inclusion criteria were: (1) the studies provide empirical data
collected with an instrument measuring spirituality or aspects of spirituality
at the end of life; (2) the data report on a (subgroup) of an end-of-life
population, and (3) the instrument is available in the public domain. Content
validity was assessed according to a consensus-based method. From the items of
the instruments, three investigators independently derived dimensions of
spirituality at the end of life. In 36 articles that met the inclusion criteria
we identified 24 instruments. Nine instruments with adequate content validity
were used to identify dimensions of spirituality. To adequately represent the
items of the instruments and to describe the relationships between the
dimensions, a model defining spirituality was constructed. The model
distinguishes the dimensions of Spiritual Well-being (e.g., peace), Spiritual
Cognitive Behavioral Context (Spiritual Beliefs, Spiritual Activities, and
Spiritual Relationships) , and Spiritual Coping, and also indicates
relationships between the dimensions. This model may help researchers to plan
studies and to choose appropriate outcomes, and assist caregivers in planning
spiritual care.