Evaluation of the HOPE spiritual assessment model: a scoping review of international interest, applications and studies over 20+ years.

Background: Evidence supports classifying spiritual health as a determinant of health and including spiritual care in comprehensive patient-centered care. Despite delineation of primary versus specialty palliative skills, including spiritual care, and availability of spiritual history/assessment communication tools designed for non-specialist (SH/SAs), medical teams continue to neglect patients' spiritual needs. A possible contributor is that consolidated evidence regarding uses and/or effectiveness of these SH/SA tools is lacking.

Aim: To explore interest, applications and evaluations of one of the well-known SH/SA tools - the HOPE spiritual assessment.

Methods: We conducted a scoping review following Arksey and O'Malley's protocol and PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched PubMed, Web-of-Science, Google Scholar, PsycInfo, Academic Search Premier, CINAHL, Atla Religion Database, with AtlaSerials and SocIndex, for all sources citing the original 2001 HOPE article (to July 2023); no restrictions on article type, location, language. We used tiered inclusion/exclusion criteria, corresponding to our specific research questions regarding interest, applications and evaluations of HOPE.

Results: Of 1,047 unique sources, 909 underwent full-text review. 571 explicitly mentioned/cited HOPE, representing 51 countries, 21 languages, and multiple disciplines including: 55% medicine, 15% nursing, 7.5% psychology, 6% chaplaincy, 5% social work. 266 sources offered expert opinions about HOPE. 63 described specific experience using and/or evaluating HOPE; 17 from non-English speaking countries. 59 demonstrated acceptability, 34 feasibility, 30 content validity. Of the 31 formal studies/evaluations, 17 intervention studies of HOPE demonstrated validity as a clinical, educational, or qualitative research tool, and 14 studies analyzed the HOPE model itself, with 10 comparing SH/SA tools. In these comparisons, HOPE rated highly, as did some others. HOPE's comparative strengths include: acceptability for diverse (secular/religious/multicultural) populations; adaptability across clinical settings; flexibility for use by novice and expert clinicians.

Conclusion: This first systematically constructed review of any of the well-known SH/SA tools revealed broad, international interest in HOPE and evidence for its acceptability, feasibility, and validity in diverse settings. Next steps for improving patient-centered spiritual care include: disseminating evidence; clarifying spiritual care competencies/boundaries for different disciplines/settings; increasing required primary spiritual care training; increasing availability of spiritual care specialists; and improving clinical systems to support whole-person care.