SpiDiScI-PC (Spiritual Distress Scale for Palliative Care in India)

Spiritual Distress in Palliative Care

When patients are suffering from an illness that is life-limiting or causes symptoms that negatively impact their quality of life, they often start asking themselves profound questions that go to the heart of what being human entails. People ask questions such as, “Why is this illness happening to me?” “Will people remember me when I will be gone?” “Has everyone really left me and am I without support?” “Is there a God who will help me?” While it is normal for people to ask themselves such questions in advanced disease, for some people, the inability to find answers to these questions can lead to distress that may prevent them from finding joy and satisfaction in life. Such people suffer from spiritual distress.

Development of SpiDiScI

Culture and local religious beliefs play an important role in people’s spirituality. As a consequence, causes and expressions of spirituality differ across countries and cultures. For that reason, spiritual distress is best assessed by approaches and tools that consider the local cultural and religious context. The Department of Onco-Anaesthesia and Palliative Medicine at IRCH-AIIMS New Delhi together with collaborators from India and abroad has developed a Hindi-language scale that has been specifically designed to assess spiritual distress in palliative care patients in India. Within the context of this scale, palliative care patients are patients who have palliative care needs.

The development process that led to this scale has been described in the article Gielen J, Kashyap K, Singh SP, Bhatnagar S, Chaturvedi SK. Psychometric assessment of SpiDiscI: Spiritual distress scale for palliative care patients in India. Indian J Palliat Care 2022;28:13-20.

Permission to Use SpiDiScI

The original Hindi version of SpiDiScI along with an English translation can be downloaded by clicking here.

SpiDiScI may be used, free of charge, for non-commercial research purposes. SpiDiScI is a research scale and should not be used for clinical assessment of patients. Researchers who wish to used the scale should contact either Joris Gielen (gielenj@duq.edu) or Dr. Santosh K. Chaturvedi (skchatur@gmail.com) to obtain permission to use the scale.

Publications and presentations that describe research in which SpiDiScI has been used, should cite the publication Gielen J, Kashyap K, Singh SP, Bhatnagar S, Chaturvedi SK. Psychometric assessment of SpiDiscI: Spiritual distress scale for palliative care patients in India. Indian J Palliat Care 2022;28:13-20.

How to Use the Scale?

Researchers should start administering SpiDiScI by requesting the research subject to answer in accordance with how he or she felt over the last two weeks. The neutral response is not to be presented as a standard answer category to the patients. It should only be used when patients, for whatever reason, find it impossible to either agree or disagree with a statement. Most often this will be because the item somehow does not apply to them. The scale is not meant to be self-administered. Researchers should read all items one by one, giving the research subject time in between to respond.

The spiritual distress score is calculated by coding the answers as 1 for sahmat (सहमत)/agree and 0 for asahmat (असहमत)/disagree. Neutral responses (निरपेक्ष) are not coded and are not considered while calculating the distress score. There are two ways to calculate the distress score. Both ways will lead to the same score:

  • Calculate the mean score of all answers multiplied by 100, excluding neutral responses
  • Calculate the percentage of positive (1) responses, excluding neutral responses

The outcome will be a score between 0 and 100.

The English-language version of the scale is only provided to give an idea of the content of the scale to people with limited skills in Hindi. Only the Hindi-version of the scale has been validated. The English-language version of the scale has not been validated and should not be used to administer the scale to research subjects. Researchers who wish to use the scale for patient populations whose primary language is not Hindi, should translate the Hindi scale, back-translate the translated scale to Hindi and undertake a psychometric assessment of the translated scale.