With many healthcare systems emphasizing (i) quality and patient outcomes that embrace their experiences, preferences and values and (ii) minimizing health care expenditure, reliable metrics indicating both are critical, with services obligated to demonstrate their value contribution.
Without methodologically rigorous research providing such data, the beneficial impact of services are supported by anecdote rather than empirical evidence, existing practices are followed irrespective of their effect on patient outcomes and constrained budgets, and proven good practice is not transferred.
The role that spiritual and chaplaincy care plays in improving patient outcomes and service costs – especially in end-of-life care – are largely untested. Given many people rely upon religion and spirituality as a coping strategy in such life-threatening situations, often informing their healthcare decisions, it has usually been assumed that chaplains exert a positive contribution; but there is minimal evidence to support that supposition.
Indeed, research in the chaplaincy profession has been one of its developmental weaknesses, often sidelining it from national health care policy debates in countries like the United States of America. As HealthCare Chaplaincy’s (HCC) president and CEO, the Rev. Dr. Walter J. Smith, commented earlier this year in addressing the annual forum of The Network on Ministry in Specialized Settings, held in Virginia, USA:
“Professional health care chaplaincy’s strengths over the past half century have been concentrated in two principal areas, one clinical, the other educational … Turning attention to the first of these strengths—clinical pastoral care—it is fair to say that much of current chaplaincy care practice remains intuitive and insufficiently documented … [M]any chaplains affirm anecdotally that their interventions do seem to help patients to create or modify their own existential and/or theological ‘models’ and to better understand and accept what is happening to them as a result of an illness, disability or aging. But, in general, chaplaincy practice issues are not routinely subjected to the rigors of scientific inquiry because most chaplains have been insufficiently trained or encouraged to research these kinds of questions themselves.”
A recent literature review, funded by the John Templeton Foundation and completed by HCC, echoed this argument, identifying substantial gaps in the understanding of what chaplains do, the knowledge on which their practice is based, and how a chaplain’s clinical judgment is formed and tested.
In their recently published study, funded by the Fannie E. Ripple Foundation, Dr Kevin Flannelly et al. began to answer these questions, finding significantly lower rates of hospital deaths and higher rates of hospice enrolment for patients cared for in hospitals providing chaplaincy services compared to hospitals that did not. While this research did not study causality, it underscores the roles healthcare chaplains function in, especially in helping patients and families move from aggressive to hospice care.
To supplement this research – by developing and testing hypotheses about chaplaincy work in health care and create foundational studies and tools to support future research – with a $3 million grant from the John Templeton Foundation, the HCC recently funded six new important studies:
- Dana Farber Cancer Institute (Boston) for ‘Hospital chaplaincy and medical outcomes at the end of life’
- University of California, San Francisco for ‘Spiritual assessment and intervention model in outpatient palliative care for patients with advanced cancer’
- Children’s Mercy Hospital (Kansas City) for ‘Understanding pediatric chaplaincy in crisis situations’
- Advocate Charitable Foundation & Advocate Health Care (Chicago) for ‘“What do I do” – Developing a taxonomy of chaplaincy activities and interventions for spiritual care in ICU palliative care’
- Emory University (Atlanta) for ‘Impact of hospital-based chaplain support on decision-making during serious illness in a diverse urban palliative care population’
- Duke University Medical Center (Durham, NC) for ‘Caregiver outlook: An evidence-based intervention for the chaplain toolkit’.
The chaplains and medical and behavioral science researchers involved in these studies – which promise to assert the importance of the spiritual domain in healthcare teams seeking to address patients’ holistic needs – with support from a faculty of experts in the field, will also work together under the rubric of the newly formed Chaplaincy Research Collaborative to advance the nascent field of health care chaplaincy research by supporting the skills development of an emerging and sustainable generation of chaplain-researchers.
For further information, please contact: Tony Powell, Deputy Director, Research at HealthCare Chaplaincy, 307 East 60th Street, New York, NY 10022-1505; Tel: 1-212-644-1111 (ext 22); Fax: 1-212 486 1440; Email: TPowell@healthcarechaplaincy.org