As founder and chief executive of the Alzheimer's Foundation of America, I saw firsthand the important role that spirituality played in the lives of patients and their caregivers. Maybe you have, too. There's a paradigm shift in healthcare today toward a holistic approach to caring for people who are ill. Good patient outcomes require more than tending to physical needs. We need to care for patients' spiritual needs, too.
The growing attention to spirituality as an aspect of healthcare is based in emerging research demonstrating that spirituality helps people cope with illness, suffering and death, and influences end-of-life decisions.1
Where's the Evidence?
The demonstrated need for spiritual care in healthcare means that we need more research to understand how best to integrate it into daily practice. But how can we understand and measure processes of the human spirit? How can we describe spirituality to generate hypotheses for clinically meaningful research? What is spirituality, anyway?
That's one question I can answer. The healthcare community crafted a definition of spirituality at a 2009 National Consensus Conference sponsored by the Archstone Foundation. The conference brought together more than 50 physicians, nurses, professional chaplains, social workers, professors, and university level researchers to address the need to improve spiritual care in palliative care. The definition reads: "Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred."2
The next step, then, is to create an evidence base demonstrating the efficacy of spiritual interventions in healthcare outcomes. Inspiration comes from visionaries such as the late Sir John Templeton, who sought to acquire "new spiritual information" through rigorous scientific research and related scholarship. His aim, and ours, is to raise the visibility and value of research about spiritual care in healthcare among the scientific, provider and consumer communities.
Driving the Research Agenda
In April 2014, HealthCare Chaplaincy Network (which I now direct) sponsored the first annual conference for nurses, physicians, social workers, chaplains and other professionals interested in understanding or participating in research about spiritual care in healthcare. We see it as a launch pad for a rigorous new field of long overdue research.
The inaugural conference, titled "Caring for the Human Spirit: Driving the Research Agenda for Spiritual Care in Healthcare," was held at the New York Academy of Medicine in New York City. Three hundred-twenty-five healthcare providers from around the world attended in person or via webcast.3
The conference was designed to help healthcare professionals understand, use in their practice, and build the evidence base for spiritual care. Six studies released at the conference opened a new field of research about spiritual care in healthcare. The research revealed important advances in understanding the role of spiritual care in treating people facing serious illness, including cancer and amyotrophic lateral sclerosis. Specifically, the studies provide the first empirical data on the role and effectiveness of chaplaincy care interventions in patient outcomes. (The conference and the research were funded by a grant from The John Templeton Foundation.)
The Role of Chaplains
The six studies presented at the conference examined the role of board-certified chaplains as members of multidisciplinary healthcare teams. Like all medical professionals, NPs and PAs are spiritual care generalists. We all have our individual connections to the sacred and transcendent. Chaplains are spiritual care specialists, trained to help patients and caregivers connect with their spiritual resources, to offer comfort and support, and to help them make meaning.
As all members of the professional healthcare team become more attuned to the importance of spiritual care, professional chaplains are recognizing that because they are part of the multidisciplinary team, their expertise must become as evidence-based as nursing and medicine.
One study, conducted at the University of California, San Francisco, was titled "Spiritual Assessment and Intervention Model (AIM) in Outpatient Palliative Care for Patients with Advanced Cancer." This in-depth picture of spiritual care work with patients examined a spiritual assessment tool called AIM, which posits that people have core spiritual needs in the domains of meaning and direction; self-worth and belonging; and reconciliation - that is, to love and to be loved. The study found that just three sessions with a professional chaplain had important, positive effects for patients.
At Emory University in Atlanta, chaplains provided data on nearly 500 hours of visits with more than 700 patients across 1,100 visits. The results, analyzed and presented as "Impact of Hospital-Based Chaplain Support on Decision-Making During Serious Illness in a Diverse Urban Palliative Care Population," looked at the impact of hospital chaplains on end-of -life (EOL) decision-making in a diverse urban population. Findings showed that chaplains were able to relieve spiritual distress, ease guilt and provide comfort for a population whose key barriers to EOL planning are low health literacy and misperceptions about palliative care and hospice care.
A Spiritual Care Taxonomy
A third study, titled "What Do I Do? Developing a Taxonomy of Chaplaincy Activities and Interventions for Spiritual Care in ICU Palliative Care Patients," was undertaken by Advocate Health Care in Chicago. The research identified an inventory of chaplain activities by conducting a mixed-method exploration of chaplain thought and language. The results were organized into a taxonomy of chaplaincy interventions, methods and intended effects. You can use this taxonomy in your own practice to better organize patient-centered, outcome -based spiritual care, and to work more effectively with the chaplains in your healthcare setting.
The taxonomy captures "Intended Effects," "Methods" and "Interventions." For example, if the intent is to "de-escalate emotionally charged situations," the method is to collaborate with a care team member. Suggested interventions are asking guided questions and facilitating communication between the patient and family members. If the intended effect is "meaning-making," the method is to encourage storytelling. Suggested interventions include assisting with advanced directives, and incorporating cultural and religious needs in the place of care.
The Advocate team has generously made the taxonomy available at http://www.advocateheawlth.com/body.cfm?id=9&eformind=120. They are providing this link to let users test, discuss and give feedback to the team. You will be asked to share your email address so that the Advocate team can alert you to any updates related to the taxonomy. Email email@example.com for permission and information.
Research into the role of spiritual care in healthcare finally is starting to catch up with practice. In 2009, the Consensus Conference recommended that all patients undergo spiritual screenings as part of their medical history. Some electronic medical records already incorporate spiritual assessment tools. Patients identified as experiencing difficulties should be referred to a board-certified chaplain for a full spiritual assessment.
Eric J. Hall is the president and CEO of HealthCare Chaplaincy Network. Learn more at www.healthcarechaplaincy.org
1. Koenig HG. Religion, spirituality and medicine. Research findings and implications for clinical practice. South Med J. 2004;97(12):1194-1200.
2. Puchalski C, Ferrell B. Making Healthcare Whole. Integrating Spirituality Into Patient Care. West Conshohocken, PA: Templeton Press; 2010.
3. Studies presented at the conference: Caring for the Human Spirit: Driving the Research Agenda for Spiritual Care in Healthcare, New York City, March 31-April 3. http://bit.ly/1iGKWD1