Engaging the African American Church to Improve Communication About Palliative Care and Hospice: Lessons From a Multilevel Approach

Abstract

Background: As the spiritual family for many African Americans, the church presents an opportunity to improve communication about palliative care and hospice (PCH). However, sustainable change in church-based, practices related to PCH requires a compreshensive, multilevel approach. Objectives: Our primary goal was to encourage churches to embrace palliative care and hospice as acceptable alternatives for end-of-life care by creating venues to improve communications about PCH. This paper compares our experience in 5 churches, revealing lessons learned and the challenges of engaging, implementing, and maintaining a multilevel approach in the churches, and our strategies in response to those challenges. Design: Descriptive study Settings/ Subjects: We partnered with 5 African American Churches in the Philadelphia Region. We targeted pastors, other church leaders, and congregants. Methods: We created 1) a leadership-education program, 2) an intensive training program for church-based lay companions (health visitors), and 3) messages and materials to increase knowledge and influence attitudes about PCH. Results: We impacted church structures and policies as shown by: integration of the project activities into existing church structures, new church-based programs dedicated to training lay companions and church leaders, new roles for church members (church liaisons) dedicated to this project, and new materials and messages focusing on PCH for the general congregation. Conclusions: We demonstrated the feasibility of engaging the African American church in a comprehensive, multilevel process designed to improve communication about palliative care and hospice (PCH). Our success demonstrates the potential of the African American church as a community resource for lay education about PCH.

Promoting advance care planning in African American faith communities: literature review and assessment of church-based programs

“…Because faith leaders are familiar with key personnel, procedures, and lay members of the religious organization, they can help the initiative get off the ground and encourage wider member participation and commitment. Partnering with five primarily African American churches in the Philadelphia region, Johnson and colleagues 31 worked with faith communities to develop a leadership education program for pastors, ministry leaders, and other church leaders; establish a training program for lay companions; and distribute education materials about EOL decision-making. Using a church-based health promotion model, Johnson and colleagues found that head pastors were critical for project start-up and implementation, and the most successful lay-companion training program was headed by a pastor who regularly attended leadership education and lay-companion training sessions.…”

LIGHT: A Church-Based Curriculum for Training African American Lay Health Workers to Support Advance Care Planning and End-of-Life Decision-Making

“…14 The African American Church presents a venue to respond to this need. 26 As members of the spiritual family of the persons they visit, African American, church-based LHWs can offer spiritual support while also communicating about the range of issues rel-evant to ACP and end-of-life decision-making. 1,2,26,27 In addition, when LHWs are linked to their church community, the imprimatur of the church creates a receptive environment in which the LHWs can conduct their work.…”

“…African American Church members have expressed interest in education and training about communication with persons with life-limiting illnesses. 26,27 However, no curriculum exists to train African American, churchbased LHWs for the primary role of communicationsfacilitators, serving persons who have reached the stage of a life-limiting illness, and such training presents some unique challenges. First, such an undertaking should be buttressed by church partnerships, in contrast to partnering with church members as individuals.…”

“…This undertaking requires an engagement process that adheres to the principles and processes of partnering with African American Church. 26 Second, the training must be feasible for part-time, LHWs. Third, it must be culturally appropriate and aligned with traditional African American Church norms.…”

“…Third, it must be culturally appropriate and aligned with traditional African American Church norms. 26,28 We undertook the task of creating such a curriculum and in this article we aim to describe (1) the conceptual framework of the curriculum, (2) its development, content, format, and implementation, and (3) the materials and resources required to deliver the training.…”