An assessment of meaning in life-threatening illness: development of the Healing Experience in All Life Stressors (HEALS)

Abstract

ContextPatients with life-threatening or chronic illness report an experience of increased positive psychological, social, and/or spiritual change during diagnosis and/or treatment of their illness, even in the face of unfavorable prognosis. This transformation begins through the ability to make their life meaningful by forming meaningful connections that emerge through self-introspection and relationships with a divine entity, nature, and other people. The Healing Experience in All Life Stressors (HEALS) assessment provides a way to identify distress-causing changes that may interfere with the development of meaning and psycho–social–spiritual homeostasis.ObjectivePreliminary examination of responses to items on the HEALS and examination of the factor structure.MethodThe 48-item HEALS questionnaire was developed using a multistep process: literature review for concept development, item generation from qualitative data, and face and content validity by expert panel. In the current study, HEALS was completed by 100 patients diagnosed with life-limiting disease and seen by the palliative care team at a large research institution in the US. Exploratory factor analysis techniques were used to determine scale structure of the instrument.ResultsOutcome testing of sample adequacy using Kaiser–Meyer–Olkin statistic was 0.75, which exceeds the recommended value of 0.60. The HEALS show very good internal consistency with a Cronbach’s a of 0.94. Overall results of the exploratory factor analysis established a four-factor questionnaire: 1) religion; 2) spirituality, demonstrated by a) interaction with a religious community and b) belief in higher power; 3) intrapersonal; and 4) interpersonal relationships expressed through psychological changes resulting in enhanced outlook and improvement in relationships with family and friends.ConclusionThis study involved the initial step to commence the process of scale validation, with promising outcomes identifying subscales as an effective way to assess the construct of healing. These findings support further examination using cognitive appraisal and confirmatory factor analysis.

The National Institutes of Health measure of Healing Experience of All Life Stressors (NIH-HEALS): Factor analysis and validation

“…HEALS is a 42-item self-report questionnaire developed by the NIH Clinical Center PPCS as a comprehensive measure of psychological, social, religious and spiritual healing experience that assesses an individual’s psycho-social-spiritual mechanisms for coping during life’s difficult situations and/or life-threatening–challenges (S4 File) [18]. It is scored on a five-point Likert scale from Strongly Disagree (1) to Strongly Agree (5).…”

“…Benor emphasizes the holistic nature of healing experience as involving body, emotions, mind, relationships, and spirit [15]. Recent studies [16–18] have illustrated potential mechanisms of psychosocial spiritual healing. Reduction of suffering [12], restoring well-being [19–21], and achieving personal growth above and beyond the pre-disease state are considered to be important angles when considering the concept of healing.…”

“…In particular, assessment of healing in palliative medicine, which is concerned with the relief of physical, psychological, social, and spiritual pain and suffering, is of paramount importance. The literature is clear about the importance of meaning as a central component to healing [20, 25–28], however, it does not provide a set of factors that contribute to healing and the healing experience with specificity [18].…”

“…We have previously reported three studies [18, 29, 30] that were conducted at the National Institutes of Health (NIH), Clinical Center (CC), Pain and Palliative Care Service (PPCS) that elucidate the process of developing the HEALS, the predecessor to the NIH-HEALS, (see reference #18 for detailed description of the multi-step process and the pilot study) as a measure of the construct of healing. In the pilot study, factor analysis was conducted with the HEALS 48-item version.…”

Using cognitive interviews to improve a Psychological-Social-Spiritual Healing instrument: Voices of aging African Americans with serious illness

“…The results of initial scale validation through exploratory factor analysis techniques for the instruments development are reported elsewhere. (Sloan et al, 2017).…”