Spiritual and Religious Concerns Questionnaire – SRQ

While you are in the hospital, how often do you talk about spiritual and/or religious concerns? (1 = Never, 5 = Average, 9 = Very Often)

Do you consider yourself a person with spiritual and/or religious concerns? (1 = Not religious and/or spiritual at all, 5 = Average, 9 = Very religious and/or spiritual)

Have you had any changes in your concerns relating to spiritual and/or religious matters since your illness began? (1 = Much less interested, 5 = No change, 9 = Much more interested)

Do you believe in God (Supreme Being)? (1 = I don't believe, 5 = I sometimes believe, 9 = I believe firmly)

If you believe in God (Supreme Being), how do you feel toward God (Supreme Being)? (1 = Angry, abandoned, 5 = Indifferent, don't care, 9 = Confident, grateful)

Have your feelings toward God (Supreme Being) changed since your illness began? (1 = I feel negative about God (Supreme Being), 5 = No change, 9 = I feel more positive about God (Supreme Being))

Mark the numeral you feel relates best to your illness. (1 = God (Supreme Being) has nothing to do with my illness, 5 = I don't know if God (Supreme Being) is involved in my illness, 9 = God (Supreme Being) willed my illness)

How often do you pray? (1 = Never, 5 = Sometimes, 9 = Often)

Since you have come to the hospital, do you pray? (1 = Less than before, 5 = Unchanged, 9 = More than before)

If you pray about illness answer the following question: Prayer has helped ... (1 = Not at all, 5 = Some, 9 = Very much)

How often do you participate in organized spiritual and/or religious activities? (1 = Never, 5 = Average, 9 = Very often [at least weekly])

Would you like help with any of your spiritual and/or religious concerns? (Yes / No)