| The incidence of cancer in China is increasing year by year.Most of the patients are in the middle and late stages when they are diagnosed with cancer.During the process of diagnosis,treatment and rehabilitation,the patients suffer from various degrees of physical,psychological,social and spiritual distress,which seriously affects the quality of life of them.Influenced by the traditional medical model,spiritual research has not attracted enough attention in China.Studies have shown that Spiritual Distress(SD)is common in cancer patients.Serious spiritual distress will weaken the physical function of patients,increase psychological burden,produce negative emotions such as anxiety and depression,so that hinder the promotion of overall health of patients.With the development of palliative care model in China,the spiritual issues of cancer patients have begun to attract attention.How to screen patients’ spiritual distress,formulate targeted spiritual care model,and promote patients’ spiritual health has become the focus of medicine,nursing,psychology and other fields.At present,there is no screening tool for cancer patients’ spiritual distress in China.Therefore,based on reviewing the literature at home and abroad,this study introduced and revised the simplified spiritual distress scale from Taiwan to investigate the spiritual distress status of cancer patients in three hospitals.The purpose of this study is to provide a scientific and effective assessment tool for evaluating the spiritual distress status of cancer patients in China,and to provide a theoretical basis for exploring effective intervention programs.PART Ⅰ CULTURAL ADAPTATION OF SIMPLIFIED VERSION OF SPIRITUAL DISTRESS SCALEObjective To introduce and revise the Spiritual Distress Scale(SDS),and test its’ reliability and validity strictly,so as to provide a reliable assessment tool for evaluating the spiritual distress of cancer patients effectively.Methods 1.Expert Consultation and Cultural Adjustment: the researcher contacted Professor Ku,the original author of the spiritual distress scale to obtain the original scale and the use authorization.Following the standard procedure of introducing the scale,five related experts were invited to make two rounds of cultural adjustment to form the first draft of spiritual distress scale in simplified form.Forty cancer patients were recruited to conduct preliminary experiments to test the feasibility of the scale and form the Spiritual Distress Scale-Simplified Version(SDS-SV).2.Psychometric testing: The spiritual distress scale was used to investigate 120 hospitalized cancer patients.Content validity index and structure validity were used to evaluate the validity of the scale.Cronbach’s alpha coefficient and test-retest reliability were used to evaluate the reliability of the scale.Results 1.The items and dimensions of the SDS-SV: The Simplified version of SDS includes 28 items and 4 subscales.Each item is scored from 0 to 1.The possible range of scores is 0~28.Higher scores indicate a higher level of spiritual distress.2.The validity and reliability of the SDS-SV(1)Validity:(1)Index of Content validity(CVI)was 0.936,all experts considered the items of the simplified version of SDS were relevant.(2)Construct validity was supported by exploratory factor analysis with varimax and four common factors were relations with self,relations with others,relations with supernatural and attitudes toward death,all of the factor loadings were above 0.3,which is in accordance with the original scale with the total variance explained(51.19%).(3)Criterion-related validity: There was a significant negative correlation between the total score of spiritual distress scale and the score of spiritual well-being scale(r=-0.40,P< 0.01),and a significant positive correlation with anxiety and depression scale(r = 0.60,P< 0.01).(2)Reliability:(1)Internal consistency:The Cronbach’s alpha coefficient of the simplified version of the spiritual distress scale is 0.882,and the Cronbach’s alpha coefficient of each dimension is 0.726~0.896.(2)Test-retest reliability: The total scale and the four dimensions were 0.80,0.67,0.84,0.62 and 0.73 respectively.(3)Internal correlation coefficient: the correlation coefficient between the total scale and four dimensions is 0.446~0.881.Conclusions The simplified version of the Spiritual Distress Scale(SDS-SV)has good reliability and validity.It is in line with the cultural background and medical system of the chinese mainland and can be used to assess the spiritual distress of cancer patients.PART Ⅱ STUDY ON THE LEVEL OF SPIRITUAL DISTRESS IN CANCER PATIENTS AND THE MODEL CONSTRUCTION OF CORRELATED FACTORSObjective The spiritual distress scale of simplified version was used to describe the level of spiritual distress in cancer patients,and structural equation model was applied to explore the interaction between correlated factors about spiritual distress.Methods A cross-sectional survey was conducted among 420 cancer inpatients in three hospitals using the SDS-SV,the Herth Hope Index,the Medical Coping Modes Questionnaire,the Hospital Anxiety and Depression Scale,the Functional Assessment of chronic Illness Therapy Spiritual Well-being.The influencing factors of spiritual distress in cancer patients were explored by single factor analysis of variance,multiple stepwise regression analysis and Pearson correlation analysis preliminarily.Structural equation models of correlated factors of spiritual distress were constructed by AMOS software so that to analyze the path relationship.Results 1.Current status of spiritual distress in cancer patients Among 398 cancer patients in this group,the total score of the spiritual distress was(9.97 ±5.64),81.16% of them had more than moderate spiritual distress.Among the four dimensions,the highest score was in the subscale of attitude toward the supernatural forces,followed by the the attitude toward oneself,death and others.2.The influencing factors of spiritual distress in cancer patients(1)The results of one-way ANOVA analysis: there exists significant difference in the gender,age,family harmony,monthly income level,faith,length of hospital stay and disease metastasis on the score of spiritual distress in cancer patients.That is,female younger patients with worse family harmony,lower monthly income level,without any faith or belief,longer length of hospital stay and accompanied by disease metastasis rated higher scores on spiritual distress scale.(2)The results of multivariate stepwise regression analysis: the main predictors of spiritual distress were anxiety and depression,spiritual well-being,hope level,belief status,length of hospital stay,age and family harmony,which could explain 60.7% of the total variation of spiritual distress.3.The correlated factors of spiritual distress in cancer patients Pearson correlation analysis showed that spiritual distress was negatively correlated with the level of hope and spiritual well-being(r=-0.649,r=-0.679,P<0.01);positively correlated with anxiety and depression(r=0.730,P<0.01),negatively correlated with the confrontation dimension of medical coping mode(r=-0.368,P<0.01);and positively correlated with the acceptance dimension(r= 0.503,P<0.01).4.The path analysis of related factors of spiritual distress in cancer patients The structural equation model constructed in this study has good adaptability,the paths between the four latent variables,hope level,spiritual well-being,anxiety and depression and coping mode were statistically significant(P<0.05).The influence of each variable on spiritual distress is ranked according to the total effect: Hope has a negative impact on spiritual distress through direct and indirect paths,the total effect of this variable in the two models are-0.932 and-0.907,respectively;Anxiety and depression have positive effects on spiritual distress through direct and indirect effects,with a total effect value of 0.701;Coping mode has a positive effect on spiritual distress,with a direct effect value of 0.541;Spiritual well-being has a negative impact on spiritual distress through direct and indirect paths,with a total effect value of-0.425.Conclusions 1.In this study,more than half of the cancer patients’ spiritual distress is above the medium level,mainly reflected in the attitudes toward supernatural forces.2.The influencing factors of spiritual distress of cancer patients include gender,age,family harmony,monthly income level,belief status,hospitalization time,disease metastasis.The main predictive factors include anxiety and depression,spiritual well-being,hope,belief status,hospitalization time,age and family harmony.3.Spiritual distress is negatively correlated with hope,spiritual well-being and the confrontation dimension of coping codes,and positively correlated with anxiety,depression and acceptance dimension of coping codes.Anxiety and depression,spiritual health and hope can predict spiritual distress.4.Hope and spiritual well-being can affect spiritual distress negatively directly or indirectly;anxiety and depression can affect spiritual distress positively directly or indirectly;coping style can positively affect spiritual distress directly. |
