Spiritual care department leaders' response to racial reckoning in 2020 and 2021.

Ascension, one of the largest Roman Catholic healthcare systems, and Transforming Chaplaincy (TC) collaborated on a research project "Managing Spiritual Care (SC) Departments During the COVID-19 Pandemic: A Qualitative Study." Research participants included 22 leaders from Ascension and TC contacts. Four rounds of individual interviews were conducted from April, 2020 to February, 2021. After issues of race and racial reckoning following George Floyd's murder were brought up spontaneously in interviews, questions on how leaders responded to racial reckoning were added to the subsequent interviews. A secondary analysis examined responses from participants on racial reckoning from interviews 2-4. The objective of this study was to better understand how SC leaders understand their role in issues concerning justice, equity, and inclusion. This study utilized hermeneutic phenomenology methodology. Four phenomenological patterns emerged including: World of Racial Reckoning, Lack of Safety, Creating Safety, and Movement Toward Justice.

American health care chaplains' narrative experiences serving during the COVID-19 pandemic: a phenomenological hermeneutical study.

The COVID-19 pandemic significantly impacted North American health care chaplains' modes of work and emotions. To capture the experiences of health care chaplains across the United States, 30 Board Certified (or eligible) chaplains were asked to keep a weekly narrative journal of their experiences and emotions during the pandemic from April of 2020 through June of 2020. Twenty-one chaplains submitted their journals for qualitative analysis, amounting to over 90,000 words of chaplain reflection containing rich, descriptive, and often personal stories of health care chaplains. Journals were analyzed using hermeneutic phenomenological methodology. The overarching patterns identified included: The World of Chaplaincy, Policies/Procedures/Visitation, Staff Care, Rituals, Chaplain Emotional Responses, Coping, and Racism. A significant finding was the resiliency and creativity of chaplains despite the rapid changes, uncertainty, and fear brought on by the pandemic. The results further suggest that journaling is a feasible and acceptable method in chaplaincy research.

Assessing the impact of religious resources and struggle on well-being: a report from the American Cancer Society's Study of Cancer Survivors-I.

PURPOSE: The current study examined the relationships between religious resources (i.e., certainty of belief in God and attendance at religious services), religious struggle (e.g., belief that cancer is evidence of God's punishment or abandonment), and physical and mental health-related quality of life (HRQoL), including fear of cancer recurrence (FCR), in a large, geographically and clinically diverse sample of long-term survivors of cancer. METHODS: Participants were 2021 9-year survivors of cancer from the American Cancer Society's Study of Cancer Survivors - I. Religious resources included belief in God and attendance at religious services. Items from the Brief RCOPE and the PROMIS Psychosocial Impact of Illness were combined to assess religious struggle. Survivors also completed the Fear of Cancer Recurrence Inventory, SF-12, and Meaning and Peace subscales of the FACIT-Sp. Regression models were used to predict HRQoL and FCR from religious resources and struggle. RESULTS: In multivariable models, certain belief in God predicted greater mental HRQoL (B = 1.99, p < .01), and attendance at religious services was associated with greater FCR (B = .80, p < .05) as well as better mental (B = .34, p < .01) and physical (B = .29, p < .05) HRQoL. In addition, religious struggle predicted greater FCR (B = 1.32, p < .001) and poorer mental (B = - .59, p < .001) and physical (B = - .29, p < .001) HRQoL. Many of these relationships were mediated through Meaning. CONCLUSIONS: With the exception of FCR, religious resources predicted better HRQoL outcomes in these long-term survivors of cancer. Conversely, religious struggle consistently predicted poorer HRQoL, including greater FCR. IMPLICATIONS FOR CANCER SURVIVORS: Given the documented importance of its role in coping with the cancer experience, religion/spirituality should be a consideration in every survivorship care plan. Multidisciplinary assessment and support of religious resources and identification of and referral for religious struggle are needed to ensure the well-being of most long-term survivors of cancer.

Managing Spiritual Care Departments During the COVID-19 Pandemic: A Qualitative Study.

This qualitative study reports how 20 spiritual care leaders provided leadership in the early months of the COVID-19 pandemic. The patterns and themes that emerged centered around the changing world of chaplaincy, the administrative role of the leader, and the personal story of the leader. Spiritual care leaders demonstrated creativity with the potential to shape chaplaincy in positive ways, expanding the reach of spiritual care.

Spirituality in Serious Illness and Health.

Importance: Despite growing evidence, the role of spirituality in serious illness and health has not been systematically assessed. Objective: To review evidence concerning spirituality in serious illness and health and to identify implications for patient care and health outcomes. Evidence Review: Searches of PubMed, PsycINFO, and Web of Science identified articles with evidence addressing spirituality in serious illness or health, published January 2000 to April 2022. Independent reviewers screened, summarized, and graded articles that met eligibility criteria. Eligible serious illness studies included 100 or more participants; were prospective cohort studies, cross-sectional descriptive studies, meta-analyses, or randomized clinical trials; and included validated spirituality measures. Eligible health outcome studies prospectively examined associations with spirituality as cohort studies, case-control studies, or meta-analyses with samples of at least 1000 or were randomized trials with samples of at least 100 and used validated spirituality measures. Applying Cochrane criteria, studies were graded as having low, moderate, serious, or critical risk of bias, and studies with serious and critical risk of bias were excluded. Multidisciplinary Delphi panels consisting of clinicians, public health personnel, researchers, health systems leaders, and medical ethicists qualitatively synthesized and assessed the evidence and offered implications for health care. Evidence-synthesis statements and implications were derived from panelists' qualitative input; panelists rated the former on a 9-point scale (from "inconclusive" to "strongest evidence") and ranked the latter by order of priority. Findings: Of 8946 articles identified, 371 articles met inclusion criteria for serious illness; of these, 76.9% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for serious illness: (1) incorporate spiritual care into care for patients with serious illness; (2) incorporate spiritual care education into training of interdisciplinary teams caring for persons with serious illness; and (3) include specialty practitioners of spiritual care in care of patients with serious illness. Of 6485 health outcomes articles, 215 met inclusion criteria; of these, 66.0% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for health outcomes: (1) incorporate patient-centered and evidence-based approaches regarding associations of spiritual community with improved patient and population health outcomes; (2) increase awareness among health professionals of evidence for protective health associations of spiritual community; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation. Conclusions and Relevance: This systematic review, analysis, and process, based on highest-quality evidence available and expert consensus, provided suggested implications for addressing spirituality in serious illness and health outcomes as part of person-centered, value-sensitive care.

Spiritual Well-Being and Associated Factors in Dutch Patients With Advanced Cancer.

CONTEXT: Palliative care aims to support patients' spiritual needs with the intention of promoting their spiritual well-being (SWB), an important dimension of quality of life. SWB is one of the less-studied dimensions of QoL, particularly in a secular country such as the Netherlands. OBJECTIVES: In this study we aimed to get a better understanding of SWB in Dutch patients with advanced cancer. We therefore examined its prominence and associated factors. METHODS: We used the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), which included 1,103 patients with advanced cancer. In addition to sociodemographic and religious/spiritual characteristics, study measures comprised the SWB subscales Meaning, Peace, and Faith of the revised FACIT-Sp-12, spiritual problems and needs (PNPCsv), quality of life (EORTC-QLQ-C30) and satisfaction with healthcare professionals' interpersonal skills (INPATSAT-32). RESULTS: On average, patients experienced quite a bit of Meaning (8.9, SD 2.3), a little bit to somewhat Peace (6.8, SD 2.7), and very low levels of Faith (2.9, SD 3.7). Two-thirds (71%) of patients reported one or more spiritual problems, for which the majority (54%) wanted to receive attention. In the final multivariable models, only a few factors were associated with SWB, such as greater spiritual needs with lower levels of Meaning and Peace. CONCLUSION: Dutch patients with advanced cancer experience medium to low levels of Meaning, Peace, and Faith. More attention for their SWB is warranted.

Top Ten Tips Palliative Care Clinicians Should Know About Spirituality in Serious Illness.

Assessment of spiritual suffering and provision of spiritual care are a central component of palliative care (PC). Unfortunately, many PC clinicians, like most medical providers, have received limited or superficial training in spirituality and spiritual distress. This article, written by a group of spiritual care providers, and other PC and hospice clinicians, offers a more in-depth look at religion and spirituality to help to enhance readers' current skills while offering a practical roadmap for screening for spiritual distress and an overview of partnering with colleagues to ensure patients receive values-aligned spiritual care provision.

Examining Factors Associated with Utilization of Chaplains in the Acute Care Setting.

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.

What organizational and business models underlie the provision of spiritual care in healthcare organizations? An initial description and analysis.

Two-thirds of American hospitals have chaplains. This article explores the organizational and business models that underlie how chaplains are integrated into hospitals. Based on interviews with 14 chaplain managers and the 11 healthcare executives to whom they report at 18 hospitals in 9 systems, we identify three central findings. First, there is significant variation in how spiritual care programs are staffed and integrated into their hospitals. Second, executives and chaplain managers see the value of chaplains in terms of their quality of care, reliability and responsivity to emergent patient and staff needs, and clinical training and experience working within a complex environment. Third, few departments rely on empirical data when making decisions about staffing, tending instead to default to the budgetary status quo. These findings provide the basis for a larger more systematic study.

Management and leadership competencies among spiritual care managers.

Both the healthcare and religious landscapes in the United States are rapidly changing. Despite the dynamic environment that spiritual care managers face, many do not receive management training prior to assuming their roles and many receive little or no training once they are in their roles. This study used mixed methods to examine the applicability of the National Center for Healthcare Leadership (NCHL) competency model to spiritual care manager roles. Interviews were conducted with 10 spiritual care managers across the country, using a Behavioral Event Interviewing (BEI) methodology. Interviews were quantitatively analyzed by using Natural Language Processing and qualitatively analyzed by thematic approach using NVIVO. The results found the EXECUTION domain to be the most discussed theme, followed by RELATIONS, TRANSFORMATION, and BOUNDARY SPANNING. Collectively these analyses suggest the NCHL Leadership Competency Model can provide a useful framework for understanding the roles and development needs of spiritual care managers.

Validation of the FACIT-Sp-12 in a Dutch cohort of patients with advanced cancer.

OBJECTIVE: Although the Dutch Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12 Item Scale (FACIT-Sp-12) has been used in several Dutch studies, no study has assessed the measurement properties of the translation. The aim of this study was to perform an item-reduction analysis, confirmatory factor analysis (CFA), test of reliability, and test of convergent validity. METHODS: From the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), 400 advanced cancer patients without missing values on any of the variables were selected. In addition to demographic and religious/spiritual characteristics, study measures included the FACIT-Sp-12 and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC-QLQ-C30). RESULTS: Item reduction analysis showed that Items 4 and 8 had low correlations to the total scale (<0.30). Items 6 and 7, and Items 9, 10, and 11 were highly correlated (>0.75). CFA indicated a good fit for a three-factor structure with Meaning, Peace and Faith, and good Cronbach's α coefficients for the total as well as the subscales (0.71-0.86). The removal of Items 4, 8, and 12 further improved the goodness of fit and Cronbach's α coefficients. Convergent validity was adequate with the EORTC-QLQ-C30. CONCLUSION: Our analysis of the FACIT-Sp-12 revealed serious questions about three items and concerns about the Faith subscale. These problematic items deserve further attention so should be interpreted with care when using this scale. A future study could look into the items and test possible replacements.

Prevalence, Predictors and Correlates of Religious and Spiritual Struggles in Palliative Cancer Patients.

CONTEXT: Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. This concise measure allows for the assessment of multiple types of r/s struggles for people from different religious backgrounds or none. OBJECTIVES: The aim of the present study was to examine the prevalence, predictors and correlates of r/s struggles as measured by the RSS-14 and its subdomains in a cancer population receiving palliative care. METHODS: Data were collected from six outpatient palliative care services across the US. Inclusion criteria for patients were age 55 or older with a cancer diagnosis. In addition to demographic and r/s characteristics, study measures included the Edmonton Symptom Assessment Scale (ESAS), the Patient Dignity Inventory (PDI) and the Quality of Life at the End of Life (QUAL-E). RESULTS: The study included 331 participants. Some r/s struggle was reported by 66%, moderate to high struggle for at least one item was reported by 20% of the patients. In bivariate analyses, r/s struggle was associated with greater symptom burden, greater dignity-related problems and poorer quality of life; in multivariable analyses, dignity-related problems remained a predictor of total r/s struggle. CONCLUSION: R/S struggles may compromise well-being for cancer patients receiving palliative care. Clinicians should consider periodic screening for r/s struggles and referrals for spiritual care if indicated.

Improving End of Life Cancer Outcomes Through Development and Implementation of a Spiritual Care Advocate Program.

BACKGROUND: Explored whether increased support for spiritual concerns between the healthcare team and patients through the provision of a Spiritual Care Advocate (SCA) would improve end of life outcomes in a metastatic cancer population. DESIGN: Newly diagnosed metastatic cancer patients were recruited at the University of Chicago Medical Center and received spiritual support from a Spiritual Care Advocate during chemotherapy treatments. The final sample consisted of 42 patients (58% of those approached) who completed the baseline survey and had known survival status. MEASUREMENT: Patients completed pre/post surveys measuring spiritual support and palliative quality of life. Baseline measurements of religious practice and externalizing religious health beliefs were also obtained. Receipt of aggressive EOL care was derived from the electronic medical record. RESULT: Median age was 61 years, with 48% Black, and predominantly male (62%). Of the 42 patients, 30 (70%) had died by the time of this analysis. Perceived spiritual support from the medical team increased in 47% of those who received non-aggressive EOL care and by 40% in those who received aggressive EOL care (p=0.012). Patient perceptions of spiritual support from the medical community increased from 27% at baseline to 63% (p=0.005) after the SCA intervention. Only 20% of recipients received aggressive treatments at end of life. CONCLUSION: The SCA model improved the perceived spiritual support between the healthcare team and patients. Although limited by a small sample size, the model was also associated with an improvement in EOL patients' quality of life, spiritual wellbeing, and decreased aggressive EOL care.

How Do Healthcare Executives Understand and Make Decisions about Spiritual Care Provision?

OBJECTIVES: This pilot study explores how healthcare leaders understand spiritual care and how that understanding informs staffing and resource decisions. METHODS: This study is based on interviews with 11 healthcare leaders, representing 18 hospitals in 9 systems, conducted between August 2019 and February 2020. RESULTS: Leaders see the value of chaplains in terms of their work supporting staff in tragic situations and during organizational change. They aim to continue to maintain chaplaincy efforts in the midst of challenging economic realities. CONCLUSIONS: Chaplains' interactions with staff alongside patient outcomes are a contributing factor in how resources decisions are made about spiritual care.

Chaplaincy Care in the MICU: Examining the Association Between Spiritual Care and End-of-Life Outcomes.

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.

Religious/spiritual concerns of patients with brain cancer and their caregivers.

Research conducted over the last 20 years supports that many patients with cancer engage religion and spirituality (R/S) when coping with their illness. Research on patients with brain cancer is more minimal but mirrors the same findings. This article provides a brief overview of the research about R/S and coping among cancer patients, then summarizes the research about R/S among patients with brain cancer and their caregivers. The following topics are discussed: (I) the importance of R/S to patients with brain cancer and their caregivers, (II) specific R/S needs experienced by patients with brain cancer and their caregivers over the cancer continuum, (III) R/S coping mechanisms engaged by brain cancer patients and their caregivers, and (IV) the healthcare systems' engagement of R/S needs within the healthcare setting. This is followed by professional chaplains' descriptions of their own experience with R/S concerns of patients with brain cancer and their caregivers, and the spiritual care they have offered them. Hear My Voice, a new spiritual life review intervention, is described. Research to deepen understanding of the R/S concerns of patients with brain cancer and their loved ones, and spiritual care interventions offered to them is recommended.

Age-stratified validation of the functional assessment of chronic illness therapy-spiritual well-being based on a large cohort of Danish cancer survivors.

OBJECTIVE: Previous research indicates that the FACIT-Sp instrument is susceptible to bias when measuring spiritual well-being in older patients. Our first focus was to evaluate the two-factor vs the three-factor model of the FACIT-Sp and our second focus was to explore how these models behave for different age groups. METHODS: We used a large national cohort of Danish cancer patients (N = 3439) which included a significant number of patients aged at least 70 years (N = 1033). Item-test correlations and factor analyses were conducted on complete cases (N = 2820). Additionally, a reliability analysis was performed using Cronbach's alpha and Guttman's lower-bound estimate. RESULTS: Factor analysis revealed a loading pattern for the oldest age group (70+) showing items on peace and meaning loading into a single factor, as originally proposed in the two-factor model. The loading estimates for the patients younger than 70 matched the three-factor model. Furthermore, item-test correlations changed as age increased. Based on Cronbach's alpha and Guttman's estimate of .83 and .89, respectively, total scores proved reliable. Items 4, 8, and 12 are discussed separately concerning their problematic influence on instrument validity in their current formulation. CONCLUSION: Overall, the three-factor model had a good fit; however, for the eldest patients a two-factor solution proved even better. Interpretation of FACIT-Sp subscale scores of older cancer patients must therefore be done with caution.

Examining the impact of cancer on survivors' religious faith: A report from the American Cancer Society study of cancer survivors-I.

OBJECTIVES: The impact of religion/spirituality (R/S) on cancer outcomes, including health-related quality of life (HRQoL), has been the topic of much investigation. Reports of the opposite, that is, the impact of cancer on R/S and associations with HRQoL, are few. The current study sought to explore the positive and negative impacts of cancer on the religious faith of survivors as well as the associations of such impacts with HRQoL. METHODS: Participants included 2309 9-year survivors of cancer from the American Cancer Society's Studies of Cancer Survivors-I. The impact of cancer on R/S was measured using items from the Patient-Reported Outcomes Measurement Information System (PROMIS) psychosocial impact of illness-faith, and HRQoL was measured with the 12-item short form (SF-12). Hierarchical regressions were used to examine the impact of cancer on R/S controlling for medical and demographic covariates. RESULTS: Consistent with hypotheses, the majority of survivors (70%) reported that cancer had a positive impact on religious faith, while the negative impact of cancer on religious faith was relatively rare (17%). In multivariable models, the negative impact of cancer on faith was associated with poorer HRQoL, both mental and physical, while the positive impact of cancer on faith was associated with greater mental well-being. CONCLUSIONS: Cancer has a negative impact on religious faith for a minority of survivors. However, when it is reported, such negative impact is indicative of poorer mental and physical well-being. As such, it is important to identify those survivors at risk early in survivorship and provide support and intervention as needed.

Chaplaincy Care in the MICU: Describing the Spiritual Care Provided to MICU Patients and Families at the End of Life.

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.