title: Development and Psychometric Assessment of a Spirituality Questionnaire for Indian Palliative Care Patients.
abstract: BACKGROUND
  There are only a few studies on spirituality among palliative care patients in India. This gap in research may be caused by the absence of relevant questionnaires and scales specifically designed for Indian palliative care populations. In this study, we describe the development of such a questionnaire and explain its psychometric characteristics.
  
  
  METHODS
  We designed a questionnaire on the basis of a systematic review of the literature. After a review of the questionnaire by specialists and a subsequent pilot study, the questionnaire was amended. The final questionnaire consisted of a list of 36 spirituality items. It was administered to a sample of 300 cancer patients attending the pain clinic of a tertiary hospital in New Delhi.
  
  
  RESULTS
  A factor analysis led to four factors explaining 54.6% of variance: Shifting moral and religious values (Factor 1), support from religious relationship (Factor 2), existential blame (Factor 3), and spiritual trust (Factor 4). The skewness and kurtosis for Factors 1, 3, and 4 were within a tolerable range for assuming a normal distribution, but Factor 2 was skewed. The alphas showed that the four factors have an acceptable internal consistency. Statistically significant associations were observed for age and Factor 3 (P = 0.004), gender and Factor 4 (P = 0.014), marital status and Factors 3 (P = 0.002) and 4 (P = 0.001), educational level and Factors 3 (P < 0.001) and 4 (P < 0.001), and pain scores and Factors 1 (P < 0.001), 2 (P < 0.001), and 3 (P = 0.001).
  
  
  CONCLUSIONS
  The questionnaire offers promising prospects for the study of spirituality among palliative care patients in India.
authors.affiliation: Unit of Anesthesiology, Pain, and Palliative Care, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sushma
authors.initials: S
authors.lastname: Bhatnagar
authors.affiliation: Institute of Cancer and Genetics, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4YS, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Noble
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.
authors.forename: Santosh K
authors.initials: SK
authors.lastname: Chaturvedi
authors.affiliation: Center for Healthcare Ethics, 301A Fisher Hall, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, USA.
authors.forename: Joris
authors.initials: J
authors.lastname: Gielen
keywords: Factor analysis; India; Palliative care patients; Psychometric assessment; Questionnaire