-.46***.69*** Hopelessness Depression Religious Belief.17** ***p<.001, **p<.01. N = 271 CURRENT RESEARCH AND TRENDS IN SPIRITUAL CARE George Fitchett, DMin, PhD, BCC Department of Religion, Health and Human Values Rush University Medical Center, Chicago, IL and Katherine M. Piderman, PhD, BCC Department of Chaplain Services Mayo Clinic, Rochester, MN

Why Care About Research Three Approaches to Research Structure Chaplain-Patient Ratios Process Productivity Screening for Spiritual Distress Outcomes Quality of Life Recovery Satisfaction Treatment Preferences & Cost Implications, Applications, Next Steps Discussion Outline Mowat, 2008

Why Should Chaplains Care about Research? Chaplains bring a unique perspective that can inform research design, application, interpretation, and application. Research is an opportunity to build relationships with others on the health care team. Presentations and publications based on research can be “prophetic” in bringing spiritual and religious issues forward.

4 Flannelly et al., 2004 Measures of Structure: Chaplain-Patient Ratios

Pastoral Intervention Pre-Op (n=324) Treatment (n=598) Emotional enabling91.5%56.9% Bible reading or prayer82.0%32.6% Religious ritual or blessing4.0%21.5% Faith affirmation7.6%16.8% Bringing a religious item1.6%13.0% Life review4.4%11.2% Other spiritual support1.9%5.2% Counseling0.6%4.0% Confession/amends0.6%2.7% Crisis intervention0.9%1.8% Chaplains interventions during initial visits (MSKCC). From Flannelly et al, 2003 Measures of Process: What Chaplains Do

Measures of Process: Screening for Religious Struggle A woman in her fifties with advanced cancer told a chaplain, “Why? Why me? I just can’t figure it out. And I get so depressed that I just want to give up on life altogether, you know? And I’m so very angry at God. So angry. I refuse to speak to Him. You know what I mean?” From: Fitchett and Roberts, In the Garden with Andrea, 2004

7 Sample (study) Religious/spiritual struggle associated with 94 stem cell transplant pts, 3 mo f/u (Sherman et al., 2009) Greater anxiety Greater depression Worse emotional WB 300 breast cancer pts (stage I/II, IV), 12 mo f/u (Herbert et al., 2009) Worse mental health (MCS) More depressive sx (CESD) Lower life satisfaction (SWLS) 202 CHF pts, 6 mo f/u (Park et al., 2008) Poorer adherence to instructions re smoking and alcohol 101 end stage CHF pts, 3 mo f/u (Park et al., 2011) More hospital days Poorer physical functioning Harmful Effects Associated with Religious Struggle

23% with distress in 3+ Prevalence of Spiritual Distress in Palliative Care Patients Chaplain ratings of spiritual distress for 113 palliative care in-patients at MD Anderson. Hui et al., 2011

3 Actions: 1.Refer for spiritual assessment re: possible RS struggle. 2.Spiritual care requested, make referral. 3.No action: no indication of RS struggle, no interest in spiritual care. Fitchett & Risk, 2009

StudyMako et al, 2005 Delgado Guay et al., 2011 CenterCalvary Hospice, NYCMD Anderson Patients Inpatients w advanced cancer Palliative care outpt clinic Sample size5791 Yes %61%44% Median (IQR)3 (1, 6) Mean4.7 Are you experiencing spiritual pain right now? Spiritual pain is a pain deep in your soul (being) that is not physical How would you rate your overall spiritual pain 0 (none) – 10 (worst)? Are you experiencing spiritual pain right now?

Rummans et al 2006

Patient’s Ratings of Reasons for Wanting to See a Chaplain (n=1,591)

14 Sample (study)Findings 397 oncology clinic patients, NYC (Astrow et al, 2007) Having unmet spiritual needs was associated with lower ratings of quality of and satisfaction with care 356 family members of patients who died in ICU, Seattle (Wall et al, 2007) Rating spiritual care as excellent was associated with higher ratings of satisfaction with ICU care overall 3,000 general medicine inpatients, Chicago (Willams et al., 2011) Discussion of R/S concerns was associated with being extremely satisfied with MD care and rating overall care as excellent Measures of Outcomes: Satisfaction, Other Studies

Avg QoL= 19, SD=7.9 N=299 patients; Balboni et al, 2010 Measures of Outcome: QoL (& treatment preferences & cost of care)

Health Care Chaplaincy Improving our Care and Making our Case Through Research -.46***.69*** Hopelessness Depression Religious Belief.17** ***p<.001, **p<.01. N = 271 Implications, Applications, Next Steps

QUESTION IMPLICATION FOR SPIRITUAL CARE How did you decide which patients to see this week? Good stewards of scarce resources How did staff you work with determine who to refer and who not to refer? Protocol for screening and referral What evidence did you generate this week that your spiritual care made a difference in measurable patient outcomes? Accountability and documentation How many chaplains does your institution/service need? Can estimate level of spiritual acuity and staffing needs Implications of Screening for Spiritual Pain

Cancer Program Standards 2012: Ensuring Patient-Centered Care Pirl W et al., Available at

FINDING QUESTIONS TO CONSIDER The Spiritual QOL of patients with advanced cancer receiving radiation therapy can be maintained. How do I engage in spiritual conversation with patients receiving radiation therapy? More? Differently? Study? An increase in private spiritual practices during treatment for alcohol dependence is associated with abstinence. How do I encourage patients with alcohol dependence to engage in spiritual practices? More? Differently? Study? Patients who want to be visited are likely to look to chaplains to be a sign of God’s care and presence. How am I a sign of God’s care and presence? More? Differently? Study? Implications for Clinical Practice

Next Steps in Chaplaincy Research: Begin with Case Studies

Need to teach research literacy skills in CPE residency programs Create research journal clubs in chaplaincy departments Demonstrate research literacy for chaplaincy certification Next Steps: Research Literacy, Chaplain Education and Certification Fitchett et al, 2012 Any Research Education YesSomeNoTotal CPE Centers 3 (14%)5 (24%)13 (62%)21 CPE Systems 0 (0%)2 (40%)3 (60%)5 All Programs 3 (12%)7 (27%)16 (62%)26 Margin of Error 12%17%19%

George Fitchett, DMin, PhD, BCC Our research website: click on Research in Religion, Health & Human Values Kate Piderman, PhD, BCC Time for Discussion