RPD322 - Bridging Spiritual Needs and Clinical Practice: Feasibility of the I-SPIRIT Screening Tool in Serious Illness Care

Key Message : The I-SPIRIT tool provides a feasible, acceptable method for integrating spiritual assessment into clinical care. By offering structured, role-specific data on spiritual beliefs, needs and resources, I-SPIRIT enhances interdisciplinary communication, supports goals-of-care discussions, and lays the groundwork for large-scale implementation to improve whole-person, value-aligned care.

Abstract:

Background:
Spiritual needs influence quality of life, coping, and decision-making in serious illness. Despite clinical mandates, spiritual concerns are rarely assessed systematically. The Integrative Spiritual Screening and History Tool (I-SPIRIT) was developed to provide a structured, validated means of identifying patients’ spiritual needs, resources, and beliefs that influence decision-making.

Objectives:
To assess the feasibility, acceptability, and preliminary implementation of I-SPIRIT in a Veterans Health Administration (VA) clinical setting and to explore provider preferences for receiving and using spiritual needs data.

Methods:
Using a mixed-methods design, investigators conducted semi-structured interviews and focus groups with 27 medical providers and 9 chaplains to identify preferred formats and workflows for spiritual data delivery. The tool was piloted in the Durham VA’s Perioperative Optimization of Senior Health (POSH) clinic. Quantitative data were collected from 32 enrolled veterans (mean age 75.6 years). Implementation outcomes were assessed via rapid qualitative analysis and Weiner’s Implementation Scale.

Results:
Providers preferred concise summaries highlighting high spiritual need or low resource scores, visual displays, and referral prompts. Chaplains favored full item-level data. I-SPIRIT integration into POSH workflow was feasible and acceptable, improving interdisciplinary communication and supporting goals-of-care discussions. Mean acceptability, implementability, and feasibility scores were 4.2/5. High spiritual need scores correlated with elevated anxiety and depression.

Conclusions:
I-SPIRIT demonstrated feasibility and acceptability for embedding spiritual screening into VA clinical workflows. Findings inform a future Hybrid Type 1 Effectiveness-Implementation Trial to evaluate its impact on care alignment and quality of life among veterans with serious illness.

References: Steinhauser KE, Jeffreys AS, Perry K, Parker R, Nieuwsma J, Olsen M, Johnson KS, Kirschner M, Majette N, King HA. Validating a Tool to Measure Spiritual Beliefs, Needs and Resources, in Serious Illness: The I-SPIRIT. J Am Geriatr Soc. 2024 Jul;72(7):2148-2156. doi: 10.1111/jgs.18887. Epub 2024 Apr 26.PMID: 38666330