Current Research In Chaplaincy Care

Transcription

1 Current Research In Chaplaincy Care The Rev. George Handzo, BCC, CSSBB Vice President, Pastoral Care Leadership & Practice Dr. Jackson Kytle, Ph.D. Vice President, Academic Affairs HealthCare Chaplaincy, New York, NY

2 HealthCare Chaplaincy s mission is to advance the profession of pastoral care through visionary leadership and continuing excellence in innovative research, education, and clinical service.

3 Outcomes for our Webinar Review a handful of current studies of interest to chaplains Increase sensitivity to the challenges of doing quality research in our area Improve ability to use research strategically in advocating for chaplaincy 2

4 Question for Consideration What is the recent research on chaplaincy care showing? How does one read this research critically? What does the research suggest about chaplaincy care? 3

5 Coping With Cancer Study Balboni, T. A., et al. (2007). Religiousness and Spiritual Support Among Advanced Cancer Patients and Associations with End-of-Life Treatment Preferences and Quality of Life. Journal of Clinical Oncology, 25(5), Phelps, A. C., et al. (2009). Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients with Advanced Cancer. JAMA, 301(11), Balboni, T. A., et al. (Published ahead of print on December 14, 2009). Provision of Spiritual Care to Patients with Advanced Cancer: Associations With Medical Care and Quality of Life Near Death. Journal of Clinical Oncology. 4

6 Research Methods Multi-institutional, multi-method investigation of advanced cancer patients and their caregivers Sample= 5 centers Sample size= Goal: Establish database for multiple uses to allow for mining in various veins and directions 5

7 Religiousness and Spiritual Support 88% said religion was at least somewhat important 72% said their spiritual needs were minimally or not at all supported by the medical system 47% said their spiritual needs were minimally or not at all supported by a religious community Spiritual support was highly associated with quality of life, QoL (P=.0003) But no specific mention of chaplaincy. 6

8 Religious Coping and Use of Life-Prolonging Care A high level of positive religious coping was correlated with intensive interventions like use of mechanical ventilation Sample data dominated by one center in Dallas Difference in groups statistically significant, but all numbers low Statistical significance vs. clinical significance 7

9 Impact of Spiritual Care on Medical Care and QoL Meeting spiritual needs associated with more hospice care & less aggressive treatment Spiritual support associated with higher QoL scores near death Pastoral visits were associated with higher QoL scores, but not more hospice care or less aggressive treatment Why? What was the pastoral intervention? 8

10 Spiritual Care/Palliative Care and Patient/Family Satisfaction Astrow, A. B., et al. (2007). Is Failure to Meet Spiritual Needs Associated with Cancer Patients Perceptions of Quality of Care and their Satisfaction with Care? Journal of Clinical Oncology, 25(26), Daaleman, T. P., et al. (2008). Spiritual Care at the End of Life in Long Term Care. Medical Care, 46(1), Puchalski, C. M., et al. (2009). Improving the Quality of Spiritual Care as a Dimension of Palliative Care. Journal of Palliative Medicine, 12(10), Morrison, S., et al. (2008). Cost Savings Associated with US Hospital Palliative Care Consultation Programs. Arch Intern Med,168(16),

11 Spiritual Needs/Pat Sat/QoL Sample from one Catholic hospital in NYC Do you feel your spiritual needs are being met? Meeting spiritual needs associated with higher QoL and higher satisfaction with care Sample bias from using one institution? What does this mean? Validity of using simple questions? 10

12 Spiritual Care in Long-Term Care After death interview of family members of decedents in 100 LTC facilities 87% received assistance with spiritual needs Families of those who received spiritual care rated overall care higher Facilitating devotional practice was salient Ministry of staff was more salient than ministry of clergy 11

13 Spiritual Care in Palliative Care Multidisciplinary consensus panel is also a level of evidence Puts other disciplines in position of advocating for chaplaincy Provides theoretical models that can be tested Spiritual care is required Board-certified chaplain is the spiritual care leader on the team Model for other health care teams 12

14 Cost Savings in Palliative Care Example of a study of strategic importance First study that demonstrates that palliative care reduces costs in significant amounts Coupled with consensus panel findings, this study positions chaplains to help reduce medical costs while improving patient/family satisfaction! 13

15 Chaplain Researchers Iler, W. L., Overshain, D., Camac, M. (2001). The Impact of Daily Visits from Chaplains on Patients with Chronic Obstructive Pulmonary Disease (COPD): A Pilot Study. Chaplaincy Today,17(1), Fitchett, G., Risk, J. L. (2009). Screening for Spiritual Struggle. Journal of Pastoral Care and Counseling, 62(1,2), Fitchett, G., et al. (2009). Physicians Experience and Satisfaction with Chaplains: A National Survey. Arch Intern Med, 169(19),

16 Impact of Daily Chaplain Visits Only controlled study of outcomes of chaplain visits Those visited were less anxious, had shorter stays, and were more likely to recommend the hospital Used a population where physical symptoms are related to anxiety Chaplain/investigator was a solo chaplain without any previous research experience 15

17 Screening for Spiritual Struggle Study piloted a screening tool that can isolate patients with spiritual struggle Established baseline for incidence of spiritual struggle--7% Validated a screening tool that reliably identifies patients suffering spiritual struggle Assumes a model of chaplaincy care based on referrals for patients in need 16

18 Physician Experience & Satisfaction With Chaplains Piggy backed on a previous survey Since this use was not anticipated, some questions could not be answered Doctors were much more experienced with, and satisfied with, chaplains than in some previous studies What has changed? Attitude and training of doctors? Integration and training of chaplains? 17

19 The Need for New Theory & Models Flannelly, K. J., Koenig, H. G., Galek, K., & Ellison, C. G. (2007). Beliefs, Mental Health, and Evolutionary Threat Assessment Systems in the Brain. Journal of Nervous and Mental Disease, 195(12),

20 Journals to Watch Journal of Pastoral Care & Counseling Journal of Healthcare Chaplaincy Journal of Pain and Symptom Management Palliative and Supportive Care Journal of Palliative Medicine 19

21 Ten Notes of Caution. When it comes to assessing important effects, empirical evidence is probably better than armchair speculation but hardly foolproof. Oh-so-many threats to validity on a long path to truth claims. Being able to demonstrate empirical outcomes of chaplain interventions is essential to advance the profession s standing. 20

22 Ten Notes of Caution Not simple to measure chaplain interventions and outcomes because of: subtlety of the phenomena, reactivity of most measures of human behavior, shortness of many patient visits, and too few patients receive more than one visit. Chaplaincy research must be advanced by new theory about the most important effects and how they are best measured. 21

23 Ten Notes of Caution Good idea to integrate quantitative and qualitative research on the same question even better to extend the research design to diverse samples and cultures. We need good studies not just of patient outcomes but outcomes for family interventions and staff impact, which might be qualitative studies. Quality of sample drawn for a population and research design are both more important criteria for good research than elegant statistics. 22

24 Ten Notes of Cautions The gold standard for truth claims is a prospective, true experimental design alas, we have few of these in chaplaincy studies. Beware the great challenge of placebo effects based on patient or subject expectations as this variable confounds our best research designs we humans are pattern-seeking, meaning-making creatures. 23

25 Ten Notes of Caution Beware drawing causal inferences from crosssectional data like surveys and most of what we have are survey data! Beware enthusiastic claims for and agin by researchers from both ends of the R/S spectrum, believers to skeptics. This arena is an emotional one for players! 24

26 The Presenters Dr. Kytle, whose Ph.D. is in Social Psychology, has held academic leadership positions at higher educational institutions including Antioch University, Goddard College, Norwich University, and most recently, The New School in New York City. The author of scholarly books and articles on non-traditional education and adult learning, Dr. Kytle is the principal architect of HealthCare Chaplaincy s education and research programs. He is a Commissioner for the Middle States Association. The Rev. George Handzo has been part of HealthCare Chaplaincy for over three decades, first as a chaplain at Memorial Sloan-Kettering Cancer Center and later as a senior member of Chaplaincy s management team. Rev. Handzo heads HealthCare Chaplaincy's entire clinical program and its Consulting Service, which offers a full range of options to help medical institutions across the country build or expand existing multifaith chaplaincy care departments. He is a boardcertified chaplain and a certified six sigma black belt. 25

27 Questions The Rev. George Handzo Dr. Jackson Kytle, Ph.D. 26