The Spiritual Needs Assessment for Patients (SNAP): Development and Validation of a Comprehensive Instrument to Assess Unmet Spiritual Needs

Context. Unmet spiritual needs have been associated with decreased patient ratings of quality of care, satisfaction, and quality of life. There is a need for a well-validated, psychometrically sound instrument to describe and measure spiritual needs. Objectives. To develop a valid and reliable instrument to assess patients' spiritual needs. Methods. Instrument development was based on a literature review, clinical and pastoral evaluation, and cognitive pretesting (n = 15 ambulatory cancer patients). Forty-seven ambulatory cancer patients completed cross-sectional and longitudinal surveys to test instrument validity and reliability. Internal reliability was assessed by Cronbach's alpha, test-retest reliability by Spearman's correlation coefficients, and construct validity by comparing instrument scores to a previously used single-item spiritual needs question. Results. The Spiritual Needs Assessment for Patients (SNAP) comprises a total of 23 items in three domains: psychosocial (n = 5), spiritual (n = 13), and religious (n = 5). Sixty percent of participants were white, 21% black, 13% Hispanic, and 6% Asian or other. Fifty-eight percent were Catholic, 13% Jewish, 11% Protestant, 2% Buddhist, 2% Muslim, and 2% Hindu. Sixty-eight percent described themselves as spiritual but not religious; 15% reported unmet spiritual needs; 19% wanted help meeting their spiritual needs. Cronbach's alpha for the total SNAP was 0.95, and for the subscales was psychosocial = 0.74, spiritual = 0.93, and religious needs = 0.86. Test-retest correlation coefficients were total SNAP = 0.69, psychosocial needs = 0.51, spiritual needs = 0.70, and religious needs = 0.65. Participants reporting unmet spiritual needs had significantly higher mean scores on the total SNAP (66.3 vs. 49.4, P = 0.03) and on the spiritual needs subscale (39.0 vs. 28.3, P = 0.02). Conclusion. The results provide preliminary evidence that the SNAP is a valid and reliable instrument for measuring spiritual needs in a diverse patient population. J Pain Symptom Manage 2012;44:44-51. (C) 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.