title: Development and preliminary testing of the quality of spiritual care scale.
abstract: BACKGROUND
  The provision of spiritual care is considered a key element of hospice and palliative care, but there is a paucity of empirically developed quality-of-care measures in this domain.
  
  
  OBJECTIVE
  To describe the development and reliability and validity of the Quality of Spiritual Care (QSC) scale in family caregivers.
  
  
  METHODS
  We conducted analyses of interviews conducted that included the QSC scale with family members of residents who died in long-term care settings taken after the resident had died. To determine reliability and validity of the QSC scale, we examined internal consistency, concurrent construct validity, and factor analysis with promax rotation.
  
  
  RESULTS
  Of 165 family caregivers of decedents who were asked whether they received spiritual care, 91 (55%) responded yes, and 89 of these (98%) completed at least 80% of the QSC items. Two items (i.e., satisfaction with and value of spiritual care) were perfectly correlated so the latter item was dropped in scale development. Factor analysis identified two factors, personal spiritual enrichment (mean pattern matrix loading = 0.77) and relationship enrichment (mean pattern matrix loading = 0.72). Reliability analysis yielded a Cronbach's alpha of 0.87, and item-total correlations for all items were in excess of 0.55. Preliminary validity of the QSC was supported by significant and expected correlations in both direction and magnitude with items from validated instruments conceptually associated with the quality of spiritual care.
  
  
  CONCLUSIONS
  Preliminary testing of the QSC scale suggests that it is a valid and reliable outcome measure of the quality of spiritual care at the end of life.
authors.affiliation: Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Electronic address: tim_daaleman@med.unc.edu.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Daaleman
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Lauren W
authors.initials: LW
authors.lastname: Cohen
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
mesh_terms: D017028:Caregivers; D005190:Family; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011787:Quality of Health Care; D015203:Reproducibility of Results; D029181:Spirituality; D013727:Terminal Care / Q000379:methods*
keywords: Quality of care; end of life; measurement; spiritual care