Sloan Danetta Hendricks, BrintzenhofeSzoc Karlynn, Kichline Tiffany, Baker Karen, Pinzon Jean-Paul, Tafe Christina, Li Lingsheng, Cheng M Jennifer, Berger Ann
Pain and Palliative Care, National Institutes of Health, Clinical Center, Bethesda, MD.
School of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA.
Patient Relat Outcome Meas. 2017 Feb 16;8:15-21. doi: 10.2147/PROM.S118696. eCollection 2017.
Patients with life-threatening or chronic illness report an experience of increased positive psychological, social, and/or spiritual change during diagnosis and/or treatment of their illness, even in the face of unfavorable prognosis. This transformation begins through the ability to make their life meaningful by forming meaningful connections that emerge through self-introspection and relationships with a divine entity, nature, and other people. The Healing Experience in All Life Stressors (HEALS) assessment provides a way to identify distress-causing changes that may interfere with the development of meaning and psycho-social-spiritual homeostasis.
Preliminary examination of responses to items on the HEALS and examination of the factor structure.
The 48-item HEALS questionnaire was developed using a multistep process: literature review for concept development, item generation from qualitative data, and face and content validity by expert panel. In the current study, HEALS was completed by 100 patients diagnosed with life-limiting disease and seen by the palliative care team at a large research institution in the US. Exploratory factor analysis techniques were used to determine scale structure of the instrument.
Outcome testing of sample adequacy using Kaiser-Meyer-Olkin statistic was 0.75, which exceeds the recommended value of 0.60. The HEALS show very good internal consistency with a Cronbach's of 0.94. Overall results of the exploratory factor analysis established a four-factor questionnaire: 1) religion; 2) spirituality, demonstrated by a) interaction with a religious community and b) belief in higher power; 3) intrapersonal; and 4) interpersonal relationships expressed through psychological changes resulting in enhanced outlook and improvement in relationships with family and friends.
This study involved the initial step to commence the process of scale validation, with promising outcomes identifying subscales as an effective way to assess the construct of healing. These findings support further examination using cognitive appraisal and confirmatory factor analysis.
患有危及生命或慢性疾病的患者报告称，即使面对不利的预后，他们在疾病诊断和/或治疗期间也经历了积极的心理、社会和/或精神变化。这种转变始于通过自我反省以及与神圣实体、自然和他人建立有意义的联系，从而使生活变得有意义。“所有生活压力源中的治愈体验”（HEALS）评估提供了一种方法，以识别可能干扰意义发展和心理-社会-精神平衡的导致痛苦的变化。
对HEALS项目的回答进行初步检查，并检验其因子结构。
48项的HEALS问卷是通过多步骤过程开发的：进行文献综述以形成概念，从定性数据中生成项目，并由专家小组进行表面效度和内容效度评估。在本研究中，100名被诊断患有危及生命疾病的患者完成了HEALS问卷，这些患者在美国一家大型研究机构接受姑息治疗团队的诊治。采用探索性因子分析技术来确定该工具的量表结构。
使用凯泽-迈耶-奥尔金统计量对样本充足性进行的结果检验为0.75，超过了推荐值0.60。HEALS显示出非常好的内部一致性，克朗巴哈系数为0.94。探索性因子分析的总体结果建立了一个四因子问卷：1）宗教；2）灵性，表现为a）与宗教团体的互动和b）对更高力量的信仰；3）个人内部；4）人际关系，通过心理变化表现出来，从而带来更积极的人生观，并改善与家人和朋友的关系。
本研究迈出了量表验证过程的第一步，有希望的结果表明子量表是评估治愈结构的有效方法。这些发现支持使用认知评估和验证性因子分析进行进一步研究。
