Development and cultural adaptation of the HOPE spiritual assessment tool to Swedish (HOPE-SE): Expert evaluation in specialized palliative care.

OBJECTIVES

The HOPE spiritual assessment tool (HOPE tool), developed by Anandarajah and Hight, is a clinician-administered tool used to support the identification of patients' existential, spiritual, and religious concerns. In Sweden, a foundational translation exists, but a culturally adapted version suited to a secular and multicultural context is lacking. This study aimed to develop a culturally adapted Swedish version (HOPE-SE) and assess its comprehensibility (face validity) and perceived relevance and coverage (content validity) among specialized palliative care professionals.

METHODS

Building on an earlier Swedish translation of the original 18-item HOPE, we conducted an observational cross-sectional development and expert evaluation study, in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, to simplify wording, improve item focus, streamline flow, and add prompts addressing non-religious existential concerns, resulting in a 16-item draft (HOPE-SE). Expert evaluation was conducted by 18 interdisciplinary experts in specialized palliative care (nurses, n = 6; physicians, n = 9; social workers, n = 3) who provided structured written feedback and participated in cognitive debriefing interviews. The written evaluation was summarized descriptively. The interviews were analyzed using descriptive content analysis of transcripts of the digitally recorded interviews.

RESULTS

Experts generally perceived HOPE-SE as understandable, acceptable, and clinically useful for initiating conversations about existential, spiritual, and religious concerns. Feedback led to minor wording refinements, clarification of potentially sensitive formulations, and the addition of a brief consent-based introduction to support timing and patient autonomy. The final HOPE-SE was approved by all experts and by the original HOPE author.

SIGNIFICANCE OF

RESULTS

HOPE-SE provides the first expert-reviewed Swedish conversation guide addressing existential, spiritual, and religious needs, intended to support spiritual history-taking in a multicultural healthcare context. Patient studies are needed to evaluate content validity and implementation in Swedish settings.