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Varner-Perez SE, Hoffman SM, Coleman-Phox K, Bhamidipalli S, Monahan PO, Kuppermann M, Tucker Edmonds B. Feasibility and acceptability of chaplain decision coaching on Periviable resuscitation decision quality: A pilot study. PEC INNOVATION 2024; 4:100266. [PMID: 38440389 PMCID: PMC10909622 DOI: 10.1016/j.pecinn.2024.100266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
Objective To pilot test and assess the feasibility and acceptability of chaplain-led decision coaching alongside the GOALS (Getting Optimal Alignment around Life Support) decision support tool to enhance decision-making in threatened periviable delivery. Methods Pregnant people admitted for threatened periviable delivery and their 'important other' (IO) were enrolled. Decisional conflict, acceptability, and knowledge were measured before and after the intervention. Chaplains journaled their impressions of training and coaching encounters. Descriptive analysis and conventional content analysis were completed. Results Eight pregnant people and two IOs participated. Decisional conflict decreased by a mean of 6.7 (SD = 9.4) and knowledge increased by a mean of 1.4 (SD = 1.8). All rated their experience as "good" or "excellent," and the amount of information was "just right." Participants found it "helpful to have someone to talk to" and noted chaplains helped them reach a decision. Chaplains found the intervention a valuable use of their time and skillset. Conclusion This is the first small-scale pilot study to utilize chaplains as decision coaches. Our results suggest that chaplain coaching with a decision support tool is feasible and well-accepted by parents and chaplains. Innovations Our findings recognize chaplains as an underutilized, yet practical resource in value-laden clinical decision-making.
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Affiliation(s)
- Shelley E. Varner-Perez
- Department of Spiritual Care and Chaplaincy, Indiana University Health, Indianapolis, Indiana, USA
| | - Shelley M. Hoffman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sruthi Bhamidipalli
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patrick O. Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Brownsyne Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Leavitt-Alcántara S, Meeks AR, Miller LJ, Giambra BK. Pediatric chaplains iterative process to address religious & spiritual struggle: a qualitative study. J Health Care Chaplain 2024:1-16. [PMID: 38828791 DOI: 10.1080/08854726.2024.2354004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
The growing body of literature on religious and spiritual (R/S) struggles consistently highlights its association with various health outcomes in Pediatrics. Chaplains or spiritual care providers, as members of interdisciplinary teams, frequently offer spiritual care to patients and families grappling with R/S struggles. However, there is a paucity of literature demonstrating how chaplains address R/S struggle in their practice. This study aimed to construct a theory describing the process by which pediatric chaplains conceptualize and address it. Employing a constructivist Grounded Theory study design, we sought to comprehend the approaches pediatric chaplains utilize in addressing R/S struggles. Following a semi-structured interview guide, we interviewed twelve Board Certified or Board Certification-eligible chaplains. Findings reveal that chaplains use an iterative three-phase process to address R/S struggles. Thirteen categories emerged, which were further organized into four major themes: Assessing, Processing, Intervening, and Navigating Limitations. A model depicting this iterative process was constructed.
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Affiliation(s)
| | - Angela R Meeks
- Center for Spiritual and Grief Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Logan J Miller
- Center for Spiritual and Grief Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Barbara K Giambra
- Division of Research in Patient Services, Nursing, Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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3
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Klitzman R, Di Sapia Natarelli G, Garbuzova E, Sinnappan S, Al-Hashimi J. When and why patients and families reject chaplains: challenges, strategies and solutions. J Health Care Chaplain 2024; 30:46-59. [PMID: 36433796 DOI: 10.1080/08854726.2022.2150026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hospital chaplains perform important activities, but critical questions arise about the challenges they may face in working with patients, and how these professionals respond. Thirty-three telephone interviews of approximately 1 hour and were conducted with 21 board-certified chaplains. When asked about their biggest challenges and most rewarding interactions, several chaplains described rejections by patients or families. Patients and families at times rejected chaplains, and did so for six broad types of reasons - not wanting to discuss the disease due to conflicted feelings, including anger or frustration at the patient, the cosmos or God; or wanting to minimize it; wanting a chaplain of their own faith; or of a particular gender or other characteristic; being atheist or wary of religion; or misunderstanding what chaplains do. Patients at times also disagreed with family members about whether to reject a chaplain. Chaplains responded variously: feeling transitory hurt (which generally decreases with experience); respecting patients' autonomy and leaving; exploring reasons for rejection; and revisiting later and often then making helpful connections. These data have important implications for future practice, education and research regarding chaplains and other providers - suggesting, for example, how patients' families and the public might benefit from increased understanding about the field.
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Affiliation(s)
- Robert Klitzman
- Masters of Bioethics Program, Columbia University, New York, NY, USA
| | | | | | | | - Jay Al-Hashimi
- Masters of Bioethics Program, Columbia University, New York, NY, USA
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4
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Głusiec W, Suchodolska M. Chaplains as mediators in conflicts concerning method of patients' medical care-study of the situation in Poland. J Health Care Chaplain 2023; 29:412-423. [PMID: 35904441 DOI: 10.1080/08854726.2022.2104566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND AND AIMS Health Care Chaplains, whose primary role is to provide spiritual care to patients, their families, and medical staff, are sometimes asked for help in making difficult decisions and resolving conflicts. Their help is justified especially when religious beliefs and values constitute the root of the problem. The study aims to analyze the phenomenon of asking hospital and hospice chaplains in Poland to take on the role of mediators in conflicts concerning methods of patients' medical care. METHODS A survey was conducted among 108 Catholic chaplains, i.e. at least 10% of all chaplains currently working in Polish hospitals and hospices. The survey was conducted using the electronic questionnaire through an intermediary with no follow-up and so self-selecting. The findings obtained were subjected to statistical analysis. RESULTS Of all the respondents, 31% admitted having received requests to mediate in a conflict over patient care. Such requests were not conditional upon the type of medical facility, its location, or the chaplain's years of experience. 30% of chaplains receive requests to mediate between patients and doctors. Solving disputes between family members and members of the medical teams are less frequent (25 and 19%, respectively). The majority of the respondents (73%) accept the role of the mediator, although 46% reserve the right to refuse in certain situations. CONCLUSIONS Asking health care chaplains to become mediators in conflicts over patients' medical care confirms the need to include mediation skills in the course of their education and gaining professional experience.
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Affiliation(s)
- Waldemar Głusiec
- Department of Humanities and Social Medicine, Medical University of Lublin, Lublin, Poland
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5
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Klitzman R, Di Sapia Natarelli G, Sinnappan S, Garbuzova E, Al-Hashimi J. The Effects of Contextual Factors on Hospital Chaplains: A Qualitative Study. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2023; 77:137-147. [PMID: 38061335 DOI: 10.1177/15423050231214459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Critical questions arise about how contextual factors affect hospital chaplains. We interviewed 23 chaplains in-depth. Hospitals' religious or other institutional affiliation, geography, and leadership can influence chaplains both explicitly/directly and implicitly/indirectly-for example, in types/amounts of support chaplains receive, scope of chaplains' roles/activities, amounts/types of chaplains' interactions, chaplains' views of their roles and freedom to innovate, and patients', families' and other providers' perceptions/expectations regarding spiritual care. These data have critical implications for research, practice, and education.
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Affiliation(s)
| | | | | | | | - Jay Al-Hashimi
- Bioethics Program, Columbia University, New York, NY, USA
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6
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Wirpsa MJ, Galchutt P, Price CS, Schaefer B, Szilagyi C, Palmer PK. Mandatory COVID-19 vaccination for healthcare workers: The experience of chaplains evaluating religious accommodation requests from coworkers. Soc Sci Med 2023; 332:116103. [PMID: 37506485 DOI: 10.1016/j.socscimed.2023.116103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Mandatory COVID-19 vaccination requirements for healthcare workers in the United States, instituted at the height of the pandemic to protect vulnerable patients and preserve the infrastructure of healthcare, nonetheless met with resistance by some members of the work force. As unprecedented numbers of employees sought religious accommodations, chaplain leaders were recruited by institutional leadership to adjudicate these requests, either alone or as part of a committee. This study reports results of a survey conducted from 6/1/2022 to 7/15/2022 with U.S. healthcare chaplains (n = 76) who were involved in the evaluation of coworker requests for religious exemption to the COVID-19 vaccine anytime during the pandemic until they accessed the survey. Chaplains were recruited online through national chaplaincy and ethics organizations. A mixed methods design facilitates integration of statistically significant associations with chaplains' in-depth reflections on their experience. Surveying the religious experts on the review committee affords a rare look into how the tension between the free exercise of religion in the workplace and the obligation to protect the public played out during the pandemic. The study further addresses a gap in research literature on the experience of chaplains during the pandemic and identifies unique features of moral injury experienced by a subset of healthcare providers. Chaplains largely perceived their involvement as promoting an ethical, informed process of review. Although all chaplains found this role stressful, high levels of meaning were protective against distress. Sources of distress identified included: ethical concern that granting exemptions would lead to the spread of the virus; inconsistencies in the review process; and, repeated exposure to coworkers' misunderstanding and political use of religious teachings. Featuring prominently in comments from chaplains was the difficulty navigating requests in the context of anti-science, anti-vaccine, and politically charged public discourse.
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Affiliation(s)
| | - P Galchutt
- M Health Fairview, University of Minnesota Medical Center, USA
| | - C S Price
- University of Texas Medical Branch, USA
| | | | | | - P K Palmer
- Woodruff Health Sciences Center, Emory University, USA
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7
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Farr S, Roser T, Coors M. Ethical Conflicts in Healthcare Chaplaincy: Results of an Exploratory Survey Among Protestant Chaplains in Switzerland, Germany, and Austria. JOURNAL OF RELIGION AND HEALTH 2023; 62:130-146. [PMID: 36418754 PMCID: PMC9685038 DOI: 10.1007/s10943-022-01681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The paper reports the results of an exploratory online survey among German, Austrian, and Swiss hospital chaplains (n = 158, response rate 17%) to identify the ethical conflicts they encounter in their work. Respondents indicated that questions surrounding end-of-life care are predominant among the conflicts faced. Chaplains get involved with these conflicts most often through the patients themselves or through nursing staff. Most encounters occur during pastoral care visits rather than in structured forms of ethics consultation such as clinical ethics committees. The results add to the ongoing discussion of chaplains as agents in ethics consultation within healthcare systems as well as their specific role and contribution.
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Affiliation(s)
- Sebastian Farr
- Institute of Social Ethics, Center for Ethics, University of Zurich, Zürich, Switzerland.
| | - Traugott Roser
- Seminar für Praktische Theologie und Religionspädagogik, University of Münster, Münster, Germany
| | - Michael Coors
- Institute of Social Ethics, Center for Ethics, University of Zurich, Zürich, Switzerland
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8
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Ehman JW, Edgar JR. Spirituality and Chaplaincy Supporting ICU Survivorship: A Practical Overview and Strategy for Clinicians. JOURNAL OF RELIGION AND HEALTH 2023; 62:65-82. [PMID: 36583768 DOI: 10.1007/s10943-022-01730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
This overview of the current literature of spirituality and health and the role of professional chaplains specifically considers intensive care unit survivorship, instead of the more common focus on end-of-life circumstances or family support on an ICU. The purpose is to enhance clinicians' understanding and use of spiritual resources for patient care and outcomes. It is a product of comprehensive daily monitoring of the Medline database from 2002 to 2022 for all publications indexed by the terms "spiritual," "religion," and "chaplain." A case will be used throughout, to illustrate spirituality dynamics. Also, a practical strategy, developed by the authors from clinical experience, will be outlined for clinicians' spiritual support of patients, requiring little time or specialized knowledge and avoiding the blurring of professional roles and boundaries, while potentially yielding clinical benefits suggested in the medical literature.
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Affiliation(s)
- John W Ehman
- Department of Pastoral Care, Penn Presbyterian Medical Center, Chaplain's Office (CU1 206), 51 N. 39 St., Philadelphia, PA, 19104, USA.
| | - Joshua R Edgar
- Department of Pastoral Care, Penn Presbyterian Medical Center, Chaplain's Office (CU1 206), 51 N. 39 St., Philadelphia, PA, 19104, USA
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Klitzman R, Al-Hashimi J, Di Sapia Natarelli G, Garbuzova E, Sinnappan S. How hospital chaplains develop and use rituals to address medical staff distress. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100087. [PMID: 35966632 PMCID: PMC9357992 DOI: 10.1016/j.ssmqr.2022.100087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 01/12/2023]
Abstract
Physicians and nurses face high levels of moral distress and burnout, exacerbated by the COVID-19, yet are often busy, without time for extended interventions. Hospital chaplains have recently been asked to assist staff, but many questions arise concerning whether they do so, and if so, how and when, and whether they may vary in doing so. Thirty-one telephone interviews of ∼1 h each were conducted with 21 board-certified chaplains to examine these and related issues. Respondents reported how they help staff, often creating, on their own, innovative kinds of practices that appear to take the form of rituals. These rituals vary in audience (physicians, nurses and/or other staff, with or without patients or families), form (from open-ended to structured), formality (from formal to informal), timing (at hospital discharge, time of death or after death), duration (from a few minutes to longer), frequency (from once to several times or ongoing), content (expressing and/or reframing feelings and experiences), and activities (e.g., talking, eating and/or making commemorative objects). Such rituals can help staff cope with death, grief, and other stresses. Challenges arise, including hospital leaders' wariness, resistance or lack of support, and staff time constraints, making briefer sessions more practical. These data highlight how chaplains can assist staff through use of rituals, and learn from innovations/initiatives devised by colleagues elsewhere. Chaplains can thus enhance what they do as individuals and as a profession. These data have critical implications for future research, education and practice for physicians, nurses, hospital administrators, chaplains and others.
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Affiliation(s)
- Robert Klitzman
- Columbia University, 1051 Riverside Drive, Mail Unit #15, New York, NY, 10032, USA
| | - Jay Al-Hashimi
- Columbia University, 203 Lewisohn Hall, 2970 Broadway, MC 4119, New York, NY, 10027, USA
| | | | - Elizaveta Garbuzova
- Columbia University, 203 Lewisohn Hall, 2970 Broadway, MC 4119, New York, NY, 10027, USA
| | - Stephanie Sinnappan
- Columbia University, 203 Lewisohn Hall, 2970 Broadway, MC 4119, New York, NY, 10027, USA
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10
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Klitzman R, Garbuzova E, Di Sapia Natarelli G, Sinnappan S, Al-Hashimi J. Hospital chaplains' communication with patients: Characteristics, functions and potential benefits. PATIENT EDUCATION AND COUNSELING 2022; 105:2905-2912. [PMID: 35577635 DOI: 10.1016/j.pec.2022.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Hospital chaplains communicate with patients concerning spirituality/religion, but many aspects of their interactions have received little attention. METHODS Telephone qualitative interviews of ~1 h each were conducted with chaplains and analyzed, drawing on grounded theory. RESULTS We interviewed 21 U.S. chaplains. Chaplains have relatively unique characteristics, having relatively more time to spend with patients, and less rigid and less medicalized agendas, while gaining respect/trust as religious figures. Chaplains can thus provide several critical beneficial functions - e.g., obtaining key information from patients/families that can help with decision-making and with diagnosis and treatment, and conveying medical providers' points of view to patients/families. Consequently, chaplains can serve as mediators between patients/families and providers; and also overcome staff biases and "labelling" of patients, and pursue or encourage psychological interventions, in part because psychotherapists are often unavailable. CONCLUSION While past research suggested certain ways how chaplains might benefit hospitals, these professionals can aid these institutions and improve patient care in additional vital, tangible ways. PRACTICAL IMPLICATIONS Hospital administrators, chaplaincy departments, doctors, nurses and others should more fully recognize, encourage and facilitate these functions. Targeted improvements in practice and education can help achieve these goals. The findings suggest, too, several specific questions for further investigation.
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11
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Russell J, Quaack KR, Nunez J. Chaplain reported plans for end-of-life care conversations: Role clarity for the spiritual care specialists. J Health Care Chaplain 2022; 29:337-352. [PMID: 35757912 DOI: 10.1080/08854726.2022.2087965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The present study examined chaplain reported plans for patient conversations regarding end-of-life (EOL) care through the lens of multiple goals. Chaplains (n = 69) were asked to curate a plan for engaging with a patient about EOL treatment options, including how they would engage in the conversation and what they would plan to discuss. Findings indicated that plans primarily consisted of relational and identity goals, with a majority navigating multiple goal orientations. Content overwhelmingly involved developing rapport with patients, eliciting patient preferences for care, and serving as a patient liaison. The current study addresses the paucity of research around the role a chaplain plays on the interdisciplinary team and their respective approach to EOL conversations. Examination of curated plans affords insight to what content is prioritized and which conversational goals are present. Integration of multiple goals offers preliminary evidence for conversational quality. Awareness of goal approach and content prioritized affords clarity on how chaplains can be called upon to support members of the interdisciplinary care team.
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Affiliation(s)
- Jessica Russell
- Department of Communication Studies, California State University, Long Beach, CA, USA
| | - Karly R Quaack
- Department of Communication, University of Texas, Austin, TX, USA
| | - Jade Nunez
- Department of Communication Studies, California State University, Long Beach, CA, USA
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12
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Głusiec W. Hospital chaplains as ethical consultants in making difficult medical decisions. JOURNAL OF MEDICAL ETHICS 2022; 48:256-260. [PMID: 33722982 PMCID: PMC8961752 DOI: 10.1136/medethics-2020-107096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND AIMS Few Polish hospitals have Hospital Ethics Committee (HECs) and the services are not always adequate. In this situation, the role of HECs, in providing, among others, ethical advice on the discontinuation of persistent therapies, may be taken over by other entities. The aim of our research was to investigate, how often and on what issues hospital chaplains are asked for ethical advice in reaching difficult medical decisions. METHODS A survey of 100 Roman Catholic chaplains was conducted, that is, at least 10% of all chaplains currently working in Polish hospitals. RESULTS Of the participants, 29% confirmed receiving requests for advice in making a morally difficult medical decision. Receiving this type of request was not conditional on the place of their service, duration of their pastoral mission or HEC membership. The largest group of chaplains (21%) encounter questions concerning the ethical dilemmas associated with discontinuing persistent therapy. Patients and their families most often raise issues related to the methods of birth control, and the medical staff raise the issue of termination of pregnancy-as reported by 9% and 15% of chaplains, respectively. Most of the chaplains asked for help (79%) experience a deficit of specialist knowledge in the area of medicine or ethics. CONCLUSIONS In order to improve the quality of ethical consultations in Polish hospitals, in addition to further development of HECs, it is postulated to develop a system for bioethical education of chaplains.
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Affiliation(s)
- Waldemar Głusiec
- Chair and Department of Humanities and Social Medicine, Medical University of Lublin, Lublin, Poland
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13
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White K, Jennings J'AC, Karimi S, Johnson CE, Fitchett G. Examining Factors Associated with Utilization of Chaplains in the Acute Care Setting. JOURNAL OF RELIGION AND HEALTH 2022; 61:1095-1119. [PMID: 34797457 DOI: 10.1007/s10943-021-01460-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
Hospitalized persons want their spiritual needs addressed and discussed by the healthcare team, but medical providers and nurses lack the necessary training. Patients want chaplaincy care, but very few receive it, and little is known about utilization factors. To identify the population characteristics associated with the utilization of chaplaincy services, hospitalization data from March 2012 to July 2017 were analyzed (N = 15,242 patients). Religiously affiliated individuals and those with the most acute health needs were more likely to receive chaplaincy care and received more total care. Patient-centered healthcare models may need to evaluate strategic integration of spiritual care beyond reactive spiritual care provision.
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Affiliation(s)
- Kelsey White
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY, 40202, USA.
| | - J 'Aime C Jennings
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY, 40202, USA
| | - Seyed Karimi
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY, 40202, USA
| | - Christopher E Johnson
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY, 40202, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL, 60612, USA
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Galchutt P, Labuschagne D, Usset T. Patient-Family Experience at the Onset of COVID-19: Interviews with Ten Palliative Chaplains. J Palliat Med 2022; 25:1222-1227. [PMID: 35143347 DOI: 10.1089/jpm.2021.0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: As thousands of patients, often with complex care needs, were hospitalized due to the coronavirus disease 2019 (COVID-19) pandemic, demand for palliative care was magnified. Part of hospitals' palliative care teams, palliative chaplains delivered emotional support while specializing in the religious, spiritual, and the existential aspects of care. With COVID-19 containment measures increasing isolation and disrupting supportive family connections, the emotional and spiritual well-being of the patients and families were unclear. Objectives: Through the unique perspectives and insights of inpatient palliative care chaplains, we sought to qualitatively capture their perceptions and the patient-family experience as the pandemic emerged. Setting/Subjects: This investigation was based in the United States. Design: Individual semistructured telephone interviews (n = 10) were conducted between April 22 and May 6, 2020. Through thematic analysis, analyses progressed through initial coding sessions, refining a codebook, identifying representative quotes, and recognizing themes. Results: Five themes were identified and described through the coding process and recognizing representative quotes: (1) visitor restrictions-patients, (2) visitor restrictions-families, (3) religious struggle, (4) spiritual distress, and (5) decision making. Conclusions: Inpatient palliative care chaplains were active interprofessional partners caring for patients and families as the uncertainty of the pandemic unfolded. The crises of this pandemic magnified chaplain specialization as they attended to emotional, spiritual, and religious suffering and as well as complex decision making with patients and their family members.
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Affiliation(s)
- Paul Galchutt
- Spiritual Health Services, M Health Fairview, Minneapolis, Minnesota, USA
| | - Dirk Labuschagne
- Supportive Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy Usset
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
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15
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Nageswaran S, Banks Q, Golden SL, Gower WA, King NM. The role of religion and spirituality in caregiver decision-making about tracheostomy for children with medical complexity. J Health Care Chaplain 2022; 28:95-107. [PMID: 32319863 PMCID: PMC7577925 DOI: 10.1080/08854726.2020.1755812] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Children with medical complexity (CMC) receive life-sustaining treatments such as tracheostomy. The objective of this paper is to explore the roles of religion and spirituality (R&S) of caregivers of children with medical complexity (CMC) in their decision to pursue tracheostomy for their children. We conducted 41 in-depth interviews of caregivers of CMC who had received tracheostomies in the prior 5 years. Four themes emerged: (1) Caregivers believed R&S to be powerful for their children's healing, and helped them cope with their children's illnesses; (2) Spirituality was an important factor for caregivers in the decision to pursue tracheostomy for their children; (3) Many caregivers did not discuss their spirituality with clinicians for a variety of reasons; (4) Clergy and hospital chaplains played a major supportive role overall; however, they did not play a significant role in the decision-making process. Our study shows the importance of R&S, and the roles of clergy and chaplains in pediatric tracheostomy decision-making.
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Affiliation(s)
| | - Quincy Banks
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Shannon L. Golden
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - W. Adam Gower
- Department of Pediatrics, University of North Carolina at Chapel Hill, NC
| | - Nancy M.P. King
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
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16
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Tan H, Holmes C. Professional development for spiritual care practitioners: a program review. J Health Care Chaplain 2021; 28:467-481. [PMID: 34092202 DOI: 10.1080/08854726.2021.1916337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Professional development is a crucial aspect for further successful progression of an individual's skills and effective function in their role. It is also a compulsory part of registration for most professionals in the health care sector. This article reports on the evaluation of a monthly professional development program, specifically for spiritual care practitioners, offered over the period 2017-2019 by Spiritual Health Association (Victoria, Australia) and its partners. Many common themes such as motivation, culture, purpose and areas for improvement have been identified and are further examined. Recommendations such as greater emphasis on the professionalism in the sector, broader inclusions of sessions across culture and ethnicity and the development of cross disciplinary communication skills are made for the future of this program.
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Affiliation(s)
- Heather Tan
- Research and Policy, Spiritual Health Association Australia, Melbourne, Australia
| | - Cheryl Holmes
- Management, Spiritual Health Association Australia, Melbourne, Australia
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17
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Nuzum D, Fitzgerald B, Evans MJ, O'Donoghue K. Maternity Healthcare Chaplains and Perinatal Post-Mortem Support and Understanding in the United Kingdom and Ireland: An Exploratory Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:1924-1936. [PMID: 33415602 DOI: 10.1007/s10943-020-01176-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
Perinatal autopsy rates have declined significantly in recent decades. There is a lack of consensus concerning the potential religious influences for bereaved parents in their decision making process for post-mortem. This online study of British and Irish maternity healthcare chaplains explored their understanding of general and local perinatal post-mortem procedures and their experiences in the support of parents. Participants included Christian, Muslim and non-faith chaplains. No chaplain identified any religious prohibition to perinatal post-mortem. A majority of chaplains reported that they had been asked about post-mortem by parents; only a minority felt adequately prepared. A key recommendation is that following appropriate training chaplains may be well placed to support colleagues and parents during the decision making process.
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Affiliation(s)
- D Nuzum
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - B Fitzgerald
- Department of Histopathology, Cork University Hospital, Wilton, Cork, Ireland
| | - M J Evans
- Department of Pathology, Edinburgh Royal Infirmary, Edinburgh, Scotland
- Honorary Professor, Department of Molecular, Genetic and Population Health Studies, University of Edinburgh, Edinburgh, Scotland
| | - K O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
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18
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Muehlhausen BL, Foster T, Smith AH, Fitchett G. Patients' and Loved Ones' Expectations of Chaplain Services. J Health Care Chaplain 2021; 28:350-364. [PMID: 33882787 DOI: 10.1080/08854726.2021.1903734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A study assessing the expectations patients and loved ones have of hospital chaplains was conducted at Ascension St. Vincent Indiana hospitals. In-person interviews were conducted with 452 patients and loved ones during an inpatient stay. The survey instrument was a modified version of a survey developed by Dr. Katherine Piderman of the Mayo Clinic. Participants answered questions regarding demographics, awareness of availability, expectations of visits, reasons for wanting to see a chaplain and gave feedback regarding visits if they had seen a chaplain. Results showed that patients and loved ones value chaplains with 93% saying they wanted a chaplain visit. This study was unique in seeking feedback from loved ones as well as patients. It may be equally important to reach out to loved ones during times of crisis when patients themselves are in surgery or sedated and loved ones are experiencing heightened anxiety.
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Affiliation(s)
| | - Todd Foster
- Graduate Medical Education, Indianapolis, IN, USA
| | - Aaron H Smith
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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19
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Hamill Howard E, Schwartz R, Feldstein B, Grudzen M, Klein L, Piderman KM, Wang D. Harnessing the Chaplain's Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department. J Palliat Care 2021; 37:480-485. [PMID: 33818162 DOI: 10.1177/08258597211003359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To explore chaplains' ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. METHODS A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. RESULTS Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. CONCLUSION Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.
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Affiliation(s)
| | - Rachel Schwartz
- WellMD Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Bruce Feldstein
- Spiritual Care Service, Stanford Health Care, Stanford, CA, USA.,Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.,Jewish Chaplaincy Services serving Stanford Medicine, a program of Jewish Family & Children's Services of San Francisco, the Peninsula, Marin and Sonoma Counties, CA, USA
| | - Marita Grudzen
- Stanford Geriatric Education Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lori Klein
- Spiritual Care Service, Stanford Health Care, Stanford, CA, USA
| | - Katherine M Piderman
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.,Transforming Chaplaincy, Chicago, IL, USA
| | - David Wang
- Palliative Medicine, Scripps Health, San Diego, CA, USA
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20
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Kirchoff RW, Tata B, McHugh J, Kingsley T, Burton MC, Manning D, Lapid M, Chaudhary R. Spiritual Care of Inpatients Focusing on Outcomes and the Role of Chaplaincy Services: A Systematic Review. JOURNAL OF RELIGION AND HEALTH 2021; 60:1406-1422. [PMID: 33575891 DOI: 10.1007/s10943-021-01191-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To identify demographic trends associated with patient utilization and healthcare provider request for spiritual care services and to describe the impact of spiritual care on the quality of life (QoL), spiritual well-being (SWB) and level of satisfaction (SAT) of hospitalized patients. PATIENTS AND METHODS A systematic search of Ovid MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, was combined with review of relevant bibliographies. A total of 464 titles and abstracts were reviewed. Data were independently extracted by reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data on the effects of spiritual interventions on QoL, SWB and SAT were extracted, along with demographic data reflecting chaplain services. The results of the studies are presented narratively and in a qualitative manner. RESULTS Observational or experimental studies investigating chaplain utilization demographics (n = 12), patient satisfaction (n = 9) and QoL/SWB (n = 3) were included. Perceived severity of illness, average length of stay and older age were consistently found to be predictors of higher need for spiritual care. Receipt of spiritual care was correlated with increased patient and family satisfaction, independent of clinical outcome. Chaplain interventions were associated with improvement in perceived QoL and SWB. In spite of this, healthcare workers rarely attempt to explore the patient's or family's need for spiritual care, with the majority of chaplaincy consults occurring in the final day of the patient's life, potentially leading to a failure to meet the spiritual needs of non-terminal patients who have spiritual trauma related to their resolving illnesses. CONCLUSION Attention to the spiritual needs of hospitalized patients is an essential yet often overlooked aspect of patient care. Chaplains serve as spiritual care specialists whose services can enhance the hospital experience, improve patient satisfaction and help to bridge potential gaps between the patient and medical providers.
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Affiliation(s)
| | - Beba Tata
- Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA
| | - Jack McHugh
- Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA
| | | | | | | | - Maria Lapid
- Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA
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21
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Lasair S. HAVE-H: Five Attitudes for a Narratively Grounded and Embodied Spirituality. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2021; 75:13-22. [PMID: 33843311 DOI: 10.1177/1542305020965546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Western cultures are becoming increasingly cognitive. While this trend has produced many advances in science and related fields, it has also resulted in the neglect of human emotions and bodies in many domains. This article argues that spiritual care practitioners can counterbalance this trend through the embodiment of five specific attitudes summarized by the acronym HAVE-H ((a) honoring the origins of perception; (b) acknowledging the inevitability of projection; (c) validating experiential neutrality; (d) embodying a commitment to truth; and (e) holding space for metaphysics/transcendence/time).
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22
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Kwak J, Cho S, Handzo G, Hughes BP, Hasan SS, Luu A. The Role and Activities of Board-Certified Chaplains in Advance Care Planning. Am J Hosp Palliat Care 2021; 38:1495-1502. [PMID: 33504174 DOI: 10.1177/1049909121989996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. OBJECTIVES To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. METHODS A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains' organizations in the U.S. The survey data included chaplains' demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. RESULTS More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. CONCLUSION Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.
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Affiliation(s)
- Jung Kwak
- School of Nursing, 12330The University of Texas at Austin, TX, USA
| | - Soyeon Cho
- Human Services Department, The City University of New York, City Tech, Brooklyn, New York, NY, USA
| | - George Handzo
- 101595HealthCare Chaplaincy Network, New York, NY, USA
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23
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Labuschagne D, Torke A, Grossoehme D, Rimer K, Rucker M, Schenk K, Slaven JE, Fitchett G. Chaplaincy Care in the MICU: Examining the Association Between Spiritual Care and End-of-Life Outcomes. Am J Hosp Palliat Care 2021; 38:1409-1416. [PMID: 33464118 DOI: 10.1177/1049909120987218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Seriously ill patients admitted to the Intensive Care Unit (ICU) experience severe spiritual and existential distress. Patients' surrogate decision makers face the burden of making complex decisions about their loved ones' care. Experienced chaplains may play a role in assisting with decision-making, possibly by aligning patients' values and wishes with treatment plans and avoiding non-beneficial aggressive measures. OBJECTIVES To identify associations between chaplaincy care and length of stay (LOS) in the medical ICU (MICU). METHODS This was a retrospective observational study of usual spiritual care in the adult MICUs of 4 medical centers in the United States over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information. Through bivariate and multivariable analyses associations between spiritual care and LOS were examined. RESULTS In multivariable analysis of the 254 patients, receiving spiritual care was associated with an increased likelihood of being in a higher LOS tertile (adjusted odds ratio = 2.94, p < .001). In post hoc bivariate analysis, cases receiving spiritual care within the first 48 hours of MICU admission revealed a trend toward lower LOS (p = .181). CONCLUSION Spiritual care in the MICU was associated with longer LOS. Early intervention by chaplains who are well-integrated in the ICU may assist patients and their loved ones in coming to terms with grave illness and making difficult treatment decisions. Further well-designed studies of spiritual care interventions that may affect outcomes are needed.
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Affiliation(s)
| | - Alexia Torke
- Indiana University School of Medicine, Daniel F Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, IN, USA
| | - Daniel Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, OH, USA
| | - Katie Rimer
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Kristen Schenk
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
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24
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Ragsdale JR, Desjardins CM. Proposing religiously informed, relationally skillful chaplaincy theory. J Health Care Chaplain 2020; 28:239-254. [PMID: 33369533 DOI: 10.1080/08854726.2020.1861533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Research on the multiple uses of religion/spirituality (R/S) in healthcare and on the practices of healthcare chaplaincy support creation of a middle-range, prescriptive theory for chaplaincy for patients who use R/S in their healthcare experiences. Religiously Informed, Relationally Skillful Chaplaincy Theory (RIRSCT) seeks to integrate research into practice in order to improve spiritual care and allow for testing RIRSCT. The components of RIRSCT are: patients whose religion is a significant part of their worldview often use R/S in healthcare to make meaning, to cope, and to make medical decisions; chaplains should be the members of the healthcare team to assess and address R/S; healthcare teams could provide more personalized treatment by integrating patients' R/S into the treatment plan, which could improve patient experience. This article describes the components of RIRSCT and provides examples of chaplaincy guided by RIRSCT. Selected research articles supporting theory components are reviewed.
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Affiliation(s)
- Judith R Ragsdale
- Department of Pastoral Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cate Michelle Desjardins
- Department of Pastoral Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Religion, Health & Human Values, Transforming Chaplaincy, Rush University Medical Center, Chicago, IL, USA
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25
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Labuschagne D, Torke A, Grossoehme D, Rimer K, Rucker M, Schenk K, Slaven J, Fitchett G. Chaplaincy Care in the MICU: Describing the Spiritual Care Provided to MICU Patients and Families at the End of Life. Am J Hosp Palliat Care 2020; 37:1037-1044. [PMID: 32193950 DOI: 10.1177/1049909120912933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gravely ill patients admitted to the intensive care unit (ICU), and their families experience acute spiritual and existential needs and often require complex decisions about their care. Little is known about what constitutes chaplaincy care for patients or families in ICUs. Chaplains report that participation in medical decision-making is part of their role. OBJECTIVE To describe the spiritual care provided to patients and their families in the ICU. METHODS This was a retrospective observational study of spiritual care for patients and families in the medical ICUs (MICUs) at 4 medical centers over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information (number of visits, length of visit, chaplain categories, and type of spiritual care provided). RESULTS Of the 254 patients, 197 (78%) received a total of 485 spiritual care visits. Seventy-seven percent of visits included provision of emotional/spiritual support; only 15% included decision-making support such as family meetings or goals-of-care conversations. The proportion receiving spiritual care increased as patients neared death or discharge. Staff chaplains were involved in goals-of-care conversations to a greater extent than student or part-time chaplains (P < .05). CONCLUSION Spiritual care was provided to most patients and/or families at the end of life. Low chaplain involvement in decision-making in the MICU suggests opportunities to improve chaplains' contributions to ICU care.
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Affiliation(s)
- Dirk Labuschagne
- Department of Religion, Health and Human Values, 2468Rush University Medical Center, Chicago, IL, USA
| | - Alexia Torke
- Department of Medicine, 12250 Indiana University School of Medicine, Indianapolis, IN, USA.,Daniel F Evans Center for Spiritual and Religious Values in Healthcare, 12250IU Health, Indianapolis, IN, USA
| | - Daniel Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
| | - Katie Rimer
- Department of Spiritual Care and Education, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Martha Rucker
- Department of Spiritual Care, Ascension St. Thomas, Nashville, TN, USA
| | - Kristen Schenk
- Department of Religion, Health and Human Values, 2468Rush University Medical Center, Chicago, IL, USA
| | - James Slaven
- Department of Biostatistics, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, 2468Rush University Medical Center, Chicago, IL, USA
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26
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Torke AM, Fitchett G, Maiko S, Burke ES, Slaven JE, Watson BN, Ivy S, Monahan PO. The Association of Surrogate Decision Makers' Religious and Spiritual Beliefs With End-of-Life Decisions. J Pain Symptom Manage 2020; 59:261-269. [PMID: 31539603 PMCID: PMC6989362 DOI: 10.1016/j.jpainsymman.2019.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/20/2022]
Abstract
CONTEXT Although religion and spirituality are important to surrogate decision makers, little is known about the role of religion in decision making regarding life-sustaining treatments. OBJECTIVES To determine the relationships between dimensions of religion and spirituality and medical treatment decisions made by surrogates. METHODS This prospective observational study enrolled patient/surrogate dyads from three hospitals in one metropolitan area. Eligible patients were 65 years or older and admitted to the medicine or medical intensive care services. Baseline surveys between hospital days 2 and 10 assessed seven dimensions of religion and spirituality. Chart reviews of the electronic medical record and regional health information exchange six months after enrollment identified the use of life-sustaining treatments and hospice for patients who died. RESULTS There were 291 patient/surrogate dyads. When adjusting for other religious dimensions, demographic, and illness factors, only surrogates' belief in miracles was significantly associated with a lower surrogate preference for do-not-resuscitate status (adjusted odds ratio [aOR] 0.39; 95% CI 0.19, 0.78). Among patients who died, higher surrogate intrinsic religiosity was associated with lower patient receipt of life-sustaining treatments within the last 30 days (aOR 0.66; 95% CI 0.45, 0.97). Belief in miracles (aOR 0.30; 95% CI 0.10, 0.96) and higher intrinsic religiosity (aOR 0.70; 95% CI 0.53, 0.93) were associated with lower hospice utilization. CONCLUSION Few religious variables are associated with end-of-life preferences or treatment. Belief in miracles and intrinsic religiosity may affect treatment and should be identified and explored with surrogates by trained chaplains or other clinicians with appropriate training.
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Affiliation(s)
- Alexia M Torke
- Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA; IU Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA; Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA.
| | - George Fitchett
- Department of Religion, Health and Human Values, College of Health Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Saneta Maiko
- Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA; Indiana Conference, United Methodist Church, Greenwood, Indiana, USA
| | - Emily S Burke
- Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - James E Slaven
- IU Department of Biostatistics, IU School of Medicine, Indianapolis, Indiana, USA
| | | | - Steven Ivy
- Association for Clinical Pastoral Education, Decatur, Georgia, USA
| | - Patrick O Monahan
- IU Department of Biostatistics, IU School of Medicine, Indianapolis, Indiana, USA
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27
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Malcolm HV, Desjardins CM, Ferrara B, Kitamura EA, Mueller M, Betz J, Ragsdale JR, Grossoehme DH. Parental Use of Religion and Spirituality in Medical Decision-Making. J Health Care Chaplain 2019; 27:146-158. [DOI: 10.1080/08854726.2019.1670566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Hailey V. Malcolm
- Department of Pastoral Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Cate M. Desjardins
- Department of Pastoral Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Brycen Ferrara
- Department of Pastoral Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth A. Kitamura
- Department of Pastoral Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Mark Mueller
- Cancer and Blood Disease Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - John Betz
- Department of Pastoral Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Judith R. Ragsdale
- Department of Pastoral Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel H. Grossoehme
- Department of Pastoral Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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28
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Damen A, Labuschagne D, Fosler L, O'Mahony S, Levine S, Fitchett G. What Do Chaplains Do: The Views of Palliative Care Physicians, Nurses, and Social Workers. Am J Hosp Palliat Care 2018; 36:396-401. [PMID: 30336692 DOI: 10.1177/1049909118807123] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
It is well accepted that attention to spiritual concerns is a core dimension of palliative care. It is similarly well accepted that chaplains are the spiritual care specialists who should address such concerns. However, what chaplains do when they provide care for patients and families is often poorly understood by their palliative care colleagues. Having a clear understanding of what chaplains do is important because it contributes to improved utilization of the spiritual care and other resources of the palliative care team and thereby to better care for patients and families. The aim of this study was to describe what palliative care physicians, nurses, and social workers understand about what chaplains do. Brief surveys were distributed to participants at 2 workshops for palliative care professionals in 2016. The survey was completed by 110 participants. The majority reported that they understood what chaplains do moderately well or very well. Thirty-three percent of the written comments about what chaplains do were very general; 25% were more specific. Only a small proportion of the participants were aware that chaplains provide care for the team, are involved in facilitating treatment decision-making, perform spiritual assessments, and bridge communication between the patient/family/team/community. Based on our survey, palliative care colleagues appear to have a broad understanding of what chaplains do but many may be unfamiliar with important contributions of chaplains to care for patients, families, and teams. These findings point to the need for ongoing education of palliative teams about what chaplains do in palliative care.
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Affiliation(s)
- Annelieke Damen
- 1 Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Dirk Labuschagne
- 2 School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Laura Fosler
- 3 College of Nursing, Section of Palliative Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- 4 Palliative Care, Rush University Medical Center, Chicago, IL, USA
| | | | - George Fitchett
- 6 Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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