Spiritual Assessment in Hospice

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Lisa Jones, MDiv.

The HOPE questions, were developed as a teaching tool to help chaplains begin the process of incorporating a spiritual assessment into the medical interview. These questions have not been validated by research, but the strength of this particular approach is that it allows for an open-ended exploration of an individual’s general spiritual resources and concerns and serves as a natural follow-up to discussion of other support systems. It does not immediately focus on the word “spirituality” or “religion.” This minimizes barriers to discussion based on use of language.

The HOPE questions cover the basic areas of inquiry for chaplains to use in formal spiritual assessments. The first part of the mnemonic, H, pertains to a patient’s basic spiritual resources, such as sources of hope, without immediately focusing on religion or spirituality. This approach allows for meaningful conversation with a variety of patients, including those whose spirituality lies outside the boundaries of traditional religion or those who have been alienated in some way from their religion. It also allows those for whom religion, God or prayer is important to volunteer this information. There are many ways of asking these questions.

The HOPE Questions for a Formal Spiritual Assessment

H: Sources of hope, meaning, comfort, strength, peace, love and connection
O: Organized religion
P: Personal spirituality and practices
E: Effects on medical care and end-of-life issues

Examples of Questions for the HOPE Approach to Spiritual Assessment

H: Sources of hope, meaning, comfort, strength, peace, love and connection
  We have been discussing your support systems. I was wondering, what is there in your life that gives you internal support?
  What are your sources of hope, strength, comfort and peace?
  What do you hold on to during difficult times?
  What sustains you and keeps you going?
  For some people, their religious or spiritual beliefs act as a source of comfort and strength in dealing with life’s ups and downs; is this true for you?
  If the answer is “Yes,” go on to O and P questions.
  If the answer is “No,” consider asking: Was it ever? If the answer is “Yes,” ask: What changed?
O: Organized religion
  Do you consider yourself part of an organized religion?
  How important is this to you?
  What aspects of your religion are helpful and not so helpful to you?
  Are you part of a religious or spiritual community? Does it help you? How?
P: Personal spirituality/ practices
  Do you have personal spiritual beliefs that are independent of organized religion? What are they?
  Do you believe in God? What kind of relationship do you have with God?
  What aspects of your spirituality or spiritual practices do you find most helpful to you personally? (e.g., prayer, meditation, reading scripture, attending religious services, listening to music, hiking, communing with nature)
E: Effects on medical care and end-of-life issues
  Has being sick (or your current situation) affected your ability to do the things that usually help you spiritually? (Or affected your relationship with God?)
  Is there anything that I can do to help you access the resources that usually help you?
  Are you worried about any conflicts between your beliefs and your medical situation/care/decisions?

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