Development, Validity, and Reliability of Three Instruments to Assess Holistic Care from Different Perspectives.

Background: Holistic care emphasizes an integrated approach addressing physical, psychological, social, and spiritual needs, yet validated assessment tools from diverse perspectives remain limited.

Aim: To develop and validate three holistic care assessment tools: the Holistic Care Quality Assessment Scale - Patient (HCQAS-P), Family (HCQAS-F), and the Holistic Care Knowledge Assessment Scale (HCKAS) for professionals.

Methods: A mixed-methods design included qualitative interviews and a cross-sectional survey at two Taiwanese hospitals. Psychometric analyses were conducted on responses from 1,017 participants: 321 patients, 298 family members, and 398 professionals.

Results: Qualitative findings identified five core holistic care themes. A total of 1,017 participants completed the quantitative study, including patients (n = 321), family members (n = 298), and healthcare professionals (n = 398). HCQAS-P and HCQAS-F showed high internal consistency (Cronbach's α > 0.92); HCKAS revealed a four-factor structure (institutional, competence, effectiveness, cost). Holistic care quality positively correlated with shared decision-making (γ = 0.542) and good death perceptions (γ = 0.250), and negatively with demoralization (γ = -0.246) and distress (γ = -0.184). Providers scored lowest in spiritual and social care.

Conclusion: The validated tools offer a comprehensive assessment framework for holistic care. Findings highlight the value of shared decision-making and the need to strengthen training in non-physical care aspects.