King Stephen D W, Fitchett George, Murphy Patricia E, Pargament Kenneth I, Harrison David A, Loggers Elizabeth Trice
Chaplaincy, Child Life, & Clinical Patient Navigators, Seattle Cancer Care Alliance, PO Box 19023, K1-104, Seattle, WA, 98109, USA.
Department of Religion, Health & Human Values, Rush University Medical Center, Chicago, IL, 60612, USA.
Support Care Cancer. 2017 Feb;25(2):471-479. doi: 10.1007/s00520-016-3425-6. Epub 2016 Oct 6.
This study sought to validate for the first time a brief screening measure for religious/spiritual (R/S) distress given the Commission on Cancer's mandated screening for psychosocial distress including spiritual distress.
Data were collected in conjunction with an annual survey of adult hematopoietic cell transplantation (HCT) survivors. Six R/S distress screeners were compared to the Brief RCOPE, Negative Religious Coping subscale as the reference standard. We pre-specified validity as a sensitivity score of at least 85 %. As no individual measure attained this, two post hoc analyses were conducted: analysis of participants within 2 years of transplantation and of a simultaneous pairing of items. Data were analyzed from 1449 respondents whose time since HCT was 6 months to 40 years.
For the various single-item screening protocols, sensitivity ranged from 27 (spiritual/religious concerns) to 60 % (meaning/joy) in the full sample and 25 (spiritual/religious concerns) to 65 % (meaning/joy) in a subsample of those within 2 years of HCT. The paired items of low meaning/joy and self-described R/S struggle attained a net sensitivity of 82 % in the full sample and of 87 % in those within 2 years of HCT but with low net specificities.
While no single-item screener was acceptable using our pre-specified sensitivity value of 85 %, the simultaneous use of meaning/joy and self-described struggle items among cancer survivors is currently the best choice to briefly screen for R/S distress. Future research should validate this and other approaches in active treatment cancer patients and survivors and determine the best times to screen.
鉴于癌症委员会要求对包括精神痛苦在内的心理社会痛苦进行筛查，本研究首次试图验证一种针对宗教/精神（R/S）痛苦的简短筛查方法。
数据收集与成人造血细胞移植（HCT）幸存者的年度调查同时进行。将六个R/S痛苦筛查工具与作为参考标准的《简易宗教应对量表》的消极宗教应对分量表进行比较。我们预先设定有效性为灵敏度得分至少85%。由于没有单个工具达到这一标准，因此进行了两项事后分析：对移植后2年内的参与者进行分析以及对项目的同时配对进行分析。对1449名自HCT后6个月至40年的受访者的数据进行了分析。
对于各种单项筛查方案，在整个样本中，灵敏度范围为27%（精神/宗教问题）至60%（意义/喜悦），在HCT后2年内的子样本中为25%（精神/宗教问题）至65%（意义/喜悦）。低意义/喜悦和自我描述的R/S挣扎这两个配对项目在整个样本中的净灵敏度为82%，在HCT后2年内的受访者中为87%，但净特异性较低。
虽然使用我们预先设定的85%的灵敏度值时，没有单个筛查工具是可接受的，但目前在癌症幸存者中同时使用意义/喜悦和自我描述的挣扎项目是简短筛查R/S痛苦的最佳选择。未来的研究应在积极治疗的癌症患者和幸存者中验证这种方法及其他方法，并确定最佳筛查时间。
