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

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

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.

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.

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.

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.