Testing items to screen for religious or spiritual distress in adult outpatient cancer care.

purposeThe experience of cancer diagnosis and treatment is associated with significant stress. While religion and spirituality (R/S) can provide crucial support, many patients also experience R/S distress. Screening for distress has gained recognition, with tools evolving to address spiritual needs; however, existing screening measures have limitations. This study aims to validate screening items for R/S distress among cancer patients undergoing treatment, using a standardized chaplain assessment as a reference standard.

methodsThe study involved adult cancer patients undergoing outpatient treatment at Rush Cancer Center. Procedures included researcher-administered screening questions and the ONC-5 spiritual assessment interview with a board-certified chaplain. Data included demographics, illness variables, and R/S measures. Eight single-item and two multi-item screening measures were evaluated against the ONC-5. Analysis entailed descriptive statistics and sensitivity/specificity determination.

resultsStudy participants (N = 71) were predominantly female (53.5%) with common cancers (breast, colon/rectum, and lung). R/S distress was evident in 19.7%. Single-item screeners exhibited sensitivities from 14 to 71% and specificities from 72 to 98%. The King 2-question combination showed 71% sensitivity and 63% specificity. The Rush protocol demonstrated 36% sensitivity and 88% specificity. Post hoc analyses of two-item combinations did not enhance sensitivity.

conclusionThis study evaluated R/S distress screening items among outpatient cancer patients. The single-item screener asking whether participants' R/S provided all the strength and comfort needed now performed best with a sensitivity and specificity of 71% and 83%, respectively. Despite limitations, our findings underscore the importance of refining R/S distress screening tools in oncology care.