What Impact Do Chaplains Have? A Pilot Study of Spiritual AIM for Advanced Cancer Patients in Outpatient Palliative Care

Abstract

Context Spiritual care is integral to quality palliative care. Although chaplains are uniquely trained to provide spiritual care, studies evaluating chaplains’ work in palliative care are scarce. Objectives The goals of this pre-post study, conducted among patients with advanced cancer receiving outpatient palliative care, were to evaluate the feasibility and acceptability of chaplain-delivered spiritual care, utilizing the Spiritual Assessment and Intervention Model (“Spiritual AIM”); and to gather pilot data on Spiritual AIM’s effects on spiritual well-being, religious and cancer-specific coping, and physical and psychological symptoms. Methods Patients with advanced cancer (n=31) who were receiving outpatient palliative care were assigned based on chaplains’ and patients’ outpatient schedules, to one of three professional chaplains for three individual Spiritual AIM sessions, conducted over the course of approximately six to eight weeks. Patients completed the following measures at baseline and post-intervention: Edmonton Symptom Assessment Scale (ESAS), Steinhauser spirituality, Brief Religious Coping (Brief RCOPE), Functional Assessment of Chronic Illness Therapy—Spiritual (FACIT-Sp-12), Mini-Mental Adjustment to Cancer (Mini-MAC), Patient Dignity Inventory, Center for Epidemiological Studies – Depression (CES-D, 10-item), and Spielberger State Anxiety Inventory (STAI-S). Results From baseline to post-Spiritual AIM, significant increases were found on the FACIT-Sp-12 Faith subscale, the Mini-MAC Fighting Spirit subscale, and Mini-MAC Adaptive Coping factor. Two trends were observed, i.e., an increase in Positive religious coping and an increase in Fatalism (a subscale of the Mini-MAC). Conclusion Spiritual AIM, a brief chaplain-led intervention, holds potential to address spiritual needs, as well as religious and general coping in patients with serious illnesses.

Does heart failure-specific health status identify patients with bothersome symptoms, depression, anxiety, and/or poorer spiritual well-being?

“…Interventions fostering meaning and direction may be adapted for this purpose from the cancer literature. 44 Future research should also focus on the effect of treatments for QoL domain deficits on downstream hospitalization or mortality outcomes. Finally, future research should also focus on improving processes of care for patients with poor health status and QoL domain deficits.…”

Can Outcome Research Respect the Integrity of Chaplaincy? A Review of Outcome Studies

“…Several studies examined a predefined structured intervention, in which it was clear what the chaplain was going to do, despite strong resistance within the field to standardizing interventions. Interestingly, however, the studied interventions;Spiritual AIM (Kestenbaum et al, 2017), Hear My Voice (Piderman et al, 2017) and the Caregiver Outlook (Steinhauser et al, 2016)-offered a framework or semistructured protocol while also keeping the content of conversation highly individualized, since the interventions are intended to enable clients to relate personal stories. We argued that respecting the integrity of chaplaincy requires explicating how the standardized intervention is related to chaplaincy practice more generally.…”

“…Three studies find a high satisfaction with chaplain care (Purvis, Crowe, Wright, & Teague, 2018;Vandecreek, 2004;Wall et al, 2007). Four studies find a positive relationship between chaplaincy care and better patient quality of life (Balboni et al, 2007(Balboni et al, , 2010Piderman et al, 2017;Rummans et al, 2006) and four studies show an increase in spiritual well-being (Kestenbaum et al, 2017;Piderman et al, 2017;Rabow et al, 2004;Sun et al, 2016). Three studies document a decrease in anxiety by patients visited by a chaplain (Berning et al, 2016;Iler et al, 2001;Rabow et al, 2004).…”

Cuidado espiritual

“…La expresión de la espiritualidad a través de prácticas o experiencias espirituales se ha asociado con menores niveles de depresión, por lo cual se recomienda, desde el enfoque de los cuidados paliativos, diseñar e implementar una evaluación espiritual completa por parte de un capellán o un asesor espiritual dentro de un modelo de atención interdisciplinario (44)(45)(46)(47). Sin duda, la religión hace parte del abordaje espiritual dado que la oración, la religión y el impacto de los capellanes tienen un gran potencial en el cuidado espiritual (48). Sin embargo, no hay suficiente preparación del grupo de religiosos ni de los profesionales de la salud en el campo del cuidado paliativo (46)(47)(48)(49)(50).…”

“…Sin duda, la religión hace parte del abordaje espiritual dado que la oración, la religión y el impacto de los capellanes tienen un gran potencial en el cuidado espiritual (48). Sin embargo, no hay suficiente preparación del grupo de religiosos ni de los profesionales de la salud en el campo del cuidado paliativo (46)(47)(48)(49)(50).…”