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The Evolution of Spiritual Assessment Tools in Healthcare

  • Symposium: The Religious and Secular in Medicine and Health
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This article explores the history of spiritual assessment tools as a lens through which to consider the place of spirituality and religion in American healthcare. While precise definitions of spiritual assessment have evolved with the concept, the phrase generally refers to the process of evaluating someone’s spiritual needs and resources and addressing those needs in the context of clinical healthcare. We trace the diffusion of spiritual assessment tools from their origins in chaplaincy and pastoral counseling in the 1970s through nursing, medicine and social work in subsequent decades. While engaging with patients around religion and spirituality began as the professional jurisdiction of chaplains, spiritual assessment tools were designed – in part - to enable professionals in other fields to talk with patients about these topics. As such they are both a mechanism of diffusion – a set of questions healthcare professionals who advocate for greater attention to spirituality and religion teach their colleagues to ask – and a symbolic representation of how that diffusion is taking place and where there have been conflicts and bumps along the way.

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  1. See

  2. Individual spiritual assessment tools, as described throughout this chapter, make varying assumptions about what spirituality is and how to approach and measure it though there is much overlap in the dimensions. This approach mirrors broader approaches to spirituality and religion evident in ethnographic research about religion and spirituality in large academic medical centers Cadge, W. (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press. For more on the relationship between spirituality and religion see Bender, C. (2007). “Religion and Spirituality: History, Discourse, Measurement.” SSRC Forum, Bender, C. (2010). The New Metaphysicals: Spirituality and the American Religious Imagination. Chicago, University of Chicago Press.

  3. It is important to note that chaplains are not taught to conduct spiritual assessments in any standard ways in their training.

  4. Our goal is not to evaluate particular assessment tools. For evaluative discussion see the discussion of the six areas along which they should be evaluated in Fitchett, G. (1993). Assessing Spiritual Needs: A Guideline for Caregivers. Minneapolis, Augsburg Publications. The Healthcare Chaplaincy Network, an advocacy organization for chaplains based in New York City, also published the following to help chaplains evaluate such tools:

  5. There are also a number of articles catalogued in PubMed that describe the process of spiritual assessment in the United Kingdom. We do not include those here because of the differing relationship between healthcare organizations and the state and differing requirements about chaplaincy and spiritual care. Also, we rely on whether authors said particular tools were for clinical use in deciding which tools to include in this article.

  6. For one critical discussion see Bishop, J. (2013). “Of Idolatries and Ersatz Liturgies: The False Gods of Spiritual Assessment.” Christian Bioethics 19(3): 332–347.

  7. There are also a number of theologians cited in the early pastoral care literature whose ideas influenced developing ideas of spiritual assessment as described by Fitchett, G. (1993). Assessing Spiritual Needs: A Guideline for Caregivers. Minneapolis, Augsburg Publications.

  8. For more on this history see c. 2 in Cadge (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press.

  9. For further description of this movement see Cadge (2012).

  10. LaRocca-Pitts refers to this as a spiritual history tool, rather than a spiritual assessment tool though argues that because of the follow-up questions, the tool “blurs the conceptual differences between a spiritual history and a spiritual assessment” LaRocca-Pitts, M. (2008). “FACT: Taking a Spiritual History in a Clinical Setting.” Journal of Health Care Chaplaincy 15: 1–12.

  11. For details see Cadge (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press.

  12. Ibid.

  13. Some of the tools designed by and for social workers included spiritual lifemaps, ecomaps, genograms, ecograms and other things not previously a part of spiritual assessment.

  14. An important exception during the 2000s is the Ironson-Woods Spirituality/Religiousness Index that was designed mostly for research to “include items that were both pertinent to traditional religion and relevant for those who described themselves as spiritual only or as both religious and spiritual” Ironson G, Solomon GF, Balbin EG and e. al. (2002). “The Ironson-Woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress and low cortisol in people with HIV/AIDS.” Ann Behav Med 24: 34e48.

  15. See 2001, January 63(1).

  16. These letters were published in volume 64(3).

  17. This response was published in volume 64(3).

  18. Such concerns during the 2000s were further evident amongst nurses in an editorial authored by two British nurse-educators Draper, P. and W. McSherry (2002). “A critical view of spirituality and spiritual assessment.” J Adv Nurs 39(1): 1–2.

  19. These distinctions were first written about in Massey, K., G. Fitchett and P. A. Roberts (2004). Assessment and Diagnosis in Spiritual Care. Spiritual Care in Nursing Practice. K. L. Mauk. Philadelphia, Lippincott, Williams & Wilkins: 209–243

  20. For additional discussion of these issues see Puchalski, C. B, B. Ferrell, R. Virani, S. Otis-Green, P. Baird, J. Bull, H. Chochinov, G. Handzo, H. Nelson-Becker, M. Prince-Paul, K. Pugliese and D. Sulmasy. (2009). Improving the Quality of Spiritual Care as a Dimension of Palliative Care: the Report of the Consensus Conference. Journal of Palliative Medicine. 12(10): 885–904

  21. LaRocca Pitts calls many of what we write about as spiritual assessment tools, spiritual history tools. For more on these jurisdictional disputes see Cadge (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press. VandeCreek, L. (1999). “Professional chaplaincy: an absent profession?” Journal of Pastoral Care 53(4): 417–432.

  22. On spiritual generalists and specialists see Robinson, M. R., M. M. Thiel and E. C. Meyer (2007). “On being a spiritual care generalist.” American Journal of Bioethics 7(7): 24–26. Chaplain Annette Olsen also developed a tool in the late 2000s, BASIC-6 Spiritual Care Screen, designed in her words, “to be tools-for-transition between the initial spiritual care screen (generally done by multidisciplinary caregivers or a rounding chaplain), the chaplain’s spiritual assessment process, and the patient’s discharge, transfer or decendent caregiving” Olsen, A. (2009). “Olsen’s BASIC-6 Spiritual Care Screens.” PlainViews 6(22). This tool helps the chaplain makes sense and be the expert on various other spiritual assessments that have been conducted.

  23. This is one attempt to help educate chaplains about spiritual assessment: Chaplains also see spiritual assessment as just one aspect of their work Cadge (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press.

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Correspondence to Wendy Cadge.

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Cadge, W., Bandini, J. The Evolution of Spiritual Assessment Tools in Healthcare. Soc 52, 430–437 (2015).

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