COMMENTARY

What Can Chaplains Do in Outpatient Palliative Care?

Betty R. Ferrell, PhD, RN

Disclosures

January 26, 2018

Spirituality in Outpatient Palliative Care

There is strong consensus that spirituality is an important aspect of care for patients and family caregivers facing serious illness or end of life.[1] Yet, even the most supported palliative care programs struggle with how to best provide spiritual care, given the large caseloads, limited staff, and challenges of the patient population's ever-increasing diversity of religious and spiritual needs.[2] These issues have become even more significant as palliative care has shifted to the outpatient setting where there may be even fewer resources.

A recent pilot study[3] conducted among 31 patients with advanced cancer evaluated the feasibility and acceptability of chaplain-delivered spiritual care in an outpatient palliative care setting. The investigators used a well-established intervention known as the Spiritual Assessment and Intervention Model (Spiritual-AIM),[4] which is based on the idea that healing happens in relationships and that all humans have three core spiritual needs:

  • A need for meaning and direction;

  • A need to feel self-worth and belonging to community; and

  • A need to love and be loved, including seeking reconciliation for broken relationships when needed.

During three scheduled encounters, chaplains identified the patients' unmet needs in these three areas and developed plans to meet those needs. In a pre-/post-test design, outcomes were assessed using well-studied tools that measured patient symptoms, spirituality, coping, dignity, depression, and anxiety. From before to after the intervention, increases were seen in several aspects of spiritual well-being, including the subscales for "faith" and "religious coping."

Viewpoint

Spirituality is a key dimension of quality palliative care, yet palliative care programs need models of care to integrate spiritual care into standard practice. As with all domains of palliative care, there is also a need to generate evidence supporting clinical practice. This study makes an important contribution to the fields of palliative care and spiritual care by testing a model of outpatient spiritual care and including important patient-centered outcomes.

In their discussion, the study authors acknowledge that other variables might have influenced their findings and that some of the tools they used might be measuring psychosocial factors rather than strictly religious or spiritual ones. However, these overlapping constructs are related to purpose, meaning, comfort, and peace-all of which are associated with quality of life, regardless of the patient's specific faith or belief system.

Chaplains are the spiritual care specialists within interdisciplinary teams, and their contributions, as well as outcomes of their work, have not been well supported or -studied. The Spiritual-AIM intervention has great potential to guide the training of other chaplains and to help achieve a higher level of care for patients and families.

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