Compassion-Centered Spiritual Health: Fidelity and Patient Outcomes in Hematopoietic Stem Cell Transplantation Restricted; Files Only
Bharadwaj, Advik (Spring 2025)
Abstract
Background: Hematopoietic stem cell transplantation (HSCT) imposes significant physical and psychosocial burdens on patients. While spiritual and compassionate care are valued, evidence-based, structured interventions are needed. Compassion-Centered Spiritual Health (CCSH), a 4-stage chaplain-delivered intervention drawing on Cognitively-Based Compassion Training (CBCT), was developed to address this need. Evaluating the implementation fidelity and preliminary outcomes of such interventions is crucial. This study aimed to assess CCSH fidelity and its relationship with immediate patient outcomes in HSCT recipients.
Methods: Data were analyzed from 22 adult autologous HSCT patients (mean age=60.3; 64% female; 50% Black) who received CCSH as a part of a pilot randomized trial at Emory’s Winship Cancer Institute. Thirty-seven sessions were analyzed (N=35 with fidelity data). Fidelity (adherence, skillfulness) was assessed using a 19-item manual coded by three raters. Patient outcomes included pre-post session Distress Thermometer, post-session Scottish Patient Reported Outcome Measure (PROM), 5-item State-Trait Anxiety Inventory (STAI-T5), and a Likelihood to Return item. Analyses included descriptive statistics, Cronbach’s alpha calculations, Intraclass Correlation Coefficients, and Spearman correlations (fidelity vs. outcomes). Missing data were handled via expectation maximization imputations.
Results: Chaplains delivered CCSH with moderate fidelity (Mean Skillfulness=1.81, Mean Adherence=69.0%). Several fidelity items related to situational responses were frequently rated ‘Not Applicable’. Internal consistency of the core fidelity measure was acceptable-to-adequate (α = .70-.73). However, inter-rater reliability was inconsistent: good-to-moderate between one rater pair (ICC = .69-.83) but poor between another (ICC = .02-.11). Patients reported high perceived benefit (PROM M = 20.17) and likelihood to return (M = 9.46), despite minimal average distress reduction (Distress Thermometer Change M = -0.47). The primary hypothesis was not supported; fidelity scores did not significantly correlate with distress change or PROM scores (p > .05). Exploratory analyses revealed unexpected positive correlations between higher average/Coder 2 fidelity metrics and higher patient anxiety or post-session distress (e.g., Average Skillfulness-STAI: rₛ = .43, p = .021).
Conclusion: CCSH appears feasible and highly valued by HSCT patients, suggesting potential benefits beyond immediate distress reduction. However, this pilot study revealed challenges in reliability measuring CCSH fidelity, particularly inconsistent inter-rater reliability, which limits conclusions about fidelity-outcome relationships. Findings underscore the need for rigorous methodological approaches, such as robust fidelity assessment protocols, in future larger trials evaluating structured spiritual care interventions.
Table of Contents
Introduction 1
The Physical and Psychological Toll of HSCT 1
Palliative and Holistic Care in HSCT 2
Compassion in Healthcare 4
The Behavioral Biology of Compassion 5
Compassion-Centered Spiritual Health 9
Materials and Methods 11
Study Design 11
Participants 11
Intervention 12
Fidelity Assessment 16
Fidelity Coding Procedures 20
Adherence and Skillfulness Calculations 21
Outcome Measures 22
Distress Thermometer 22
Scottish Patient Reported Outcome Measure (PROM) 22
State Anxiety (STAI-T5) 23
Likelihood to Return 23
Data Handling and Sample Sizes 23
Statistical Analyses 24
Results 26
Aim 1: Fidelity of CCSH Delivery 27
Fidelity Score Descriptives 27
Internal Consistency of Fidelity 28
Inter-Rater Reliability 29
Aim 2: Patient Outcomes and Association with Fidelity 30
Reliability of Outcome Measures 30
Immediate Patient Outcomes 31
Association Between Fidelity and Outcomes 32
Discussion 34
Fidelity of CCSH Delivery 35
Patient Outcomes 37
Fidelity and Outcomes 38
Limitations and Future Directions 39
Reference List 40
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File download under embargo until 22 May 2026 | 2025-04-23 09:19:50 -0400 | File download under embargo until 22 May 2026 |
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