Spiritual needs among hospitalized patients at a public hospital in Brazil: a cross-sectional study

ABSTRACT BACKGROUND: The relationship between spirituality and health has been the object of growing discussion. There is a lack of data on spiritual needs assessments in Brazil. OBJECTIVE: This study aimed to assess the spiritual needs of patients admitted to a public tertiary hospital and perform a comparative analysis between patients with and without indications for palliative care. DESIGN AND SETTING: A cross-sectional observational study included patients hospitalized between August and December 2020 in Hospital do Servidor Publico Municipal, Sao Paulo, Brazil. METHODS: The included patients answered a questionnaire consisting of sociodemographic data, the Duke religiosity scale, and the Spiritual Needs Assessment for Patients (SNAP) tool for a spiritual needs assessment. The World Health Organization Palliative Needs tool (NECPAL) was used to evaluate the indications for palliative care. The level of significance adopted was 5%. RESULTS: A total of 66 patients were included in this study. Most participants (97%) declared themselves as belonging to a religion. The group without indication for palliative care by the NECPAL showed greater spiritual (P = 0.043) and psychosocial needs (P = 0.004). No statistically significant difference was observed in the religious needs domain (P = 0.176). There were no statistically significant differences in the Duke scale scores between the two groups. CONCLUSION: Spiritual, psychosocial, and religious needs are prevalent among hospitalized patients, and multidisciplinary teams must consider these needs in their management approach. In addition, this study suggests that psychosocial and spiritual needs can be even higher in patients who do not receive palliative care.

may influence the results obtained from different populations. Therefore, the Spiritual Needs Assessment for Patients (SNAP) scale, culturally adjusted and translated into Portuguese, is the primary tool validated for assessing spiritual needs in Brazil. 14,15 Interest in spiritual care is growing worldwide, including in Brazil. However, there is a lack of data on spiritual needs in hospitalized patients. 16 In this context, this study proposes identifying spiritual needs in different domains using the adapted SNAP scale.

OBJECTIVE
This study aimed to assess the spiritual needs of patients admitted to a public tertiary hospital and to conduct a comparative analysis between patients with and without indications for palliative care.

Study design
This observational cross-sectional study aimed to assess the spiritual needs of hospitalized patients at the Hospital do Servidor Publico Municipal (HSPM) in Sao Paulo, Brazil.
The patients hospitalized between August and December 2020 were included. The inclusion criteria consisted of patients who were at least 18 years old, voluntarily provided written informed consent, and were capable of understanding, interpreting, and answering the questionnaires. Patients who could not complete the questionnaires or had impaired consciousness were excluded.

Data collection
The data were obtained through questionnaires administered during face-to-face interviews conducted by the author, coauthors, and the research volunteers. Patients were randomly selected through a draw, and questionnaires were administered from August to December 2020. The questionnaire consisted of three main parts. The first part included clinical and sociodemographic data evaluating variables such as age, sex, marital status, and aspects of the patient's primary diagnosis. Next, patients were assessed for religiosity using a version of the Duke religiosity scale (DUREL) validated in Brazil, consisting of organizational, non-organizational, and intrinsic religiosity domains. 17 The third part was the assessment of spiritual needs using the SNAP scale, using a version adapted for a Brazilian population. 15 This questionnaire evaluates the patient through three subscales: psychosocial (5 items), spiritual (13 items), and religious (5 items), with objective questions to quantify the patient's needs in each respective domain. Patients were divided into two groups according to whether palliative care was indicated by the World Health Organization Palliative Needs tools (NECPAL) in its adapted form for Brazilian culture. 18,19 The palliative performance score (PPS) was evaluated for every patient in this study.

Statistical analysis
For sample size calculation, an effect size of 0.66 was considered.
In addition, the probabilities of type I and type II errors were set to 0.05 and 0.20, respectively. Thus, a sample of 31 cases per group was calculated, with a total of 62 cases. The Wilcoxon-Mann-Whitney test was used to compare means.
Descriptive analyses of the data were carried out using tables Council. The study details were adequately explained, and informed consent was obtained from each participant.

RESULTS
A total of 66 patients were included in the study, with a mean  Table 2).

DISCUSSION
This study used the SNAP tool to assess spiritual needs in a sample of hospitalized patients in the public health system in Brazil.
The results showed a greater need for psychosocial and spiritual domains in patients who did not meet the NECPAL criteria for palliative care follow-up.
To fulfill the spiritual needs using a medical approach, it is necessary to recognize the importance of this topic. People expe-     In this context, palliative care professionals should be able to approach the spiritual suffering of hospitalized patients. A model of spiritual care by trained professionals that seeks to obtain a focused spiritual history and screen for possible unmet demands, involving cultural limits and individual values of family members and patients is suggested. 23 Training healthcare professionals in spiritual care is a promising strategy for a holistic approach, as suggested by a Brazilian study. 24 The inclusion of spiritual care in the continuing education of these professionals can benefit a greater number of patients who do not have access to specialized palliative care staff to meet their spiritual needs.