Chaplains Work in Primary Care

Health is holistic, but health services are often not. Primary care is the first point of contact for patients in the UK, and at least two in every three present with complex bio-psycho-socio-economic issues. In Scotland, the Community Chaplaincy Listening (CCL) service was created to see if chaplains could help. CCL involves specially trained chaplains listening to patients referred to them by general practitioners (GP) for spiritual support. Between 2018 and 2019, 143 people used CCL and completed baseline and post-discharge outcome measures. Mean Scottish PROM scores rose from 7.94 (± 3.4) at baseline to 12 (± 3.5) post discharge, a statistically and clinically significant rise of 4.06 (95% CI, 3-5.12), t(50) = 7.7, p < 0.0001, d = 1.08. The improvement was seen whether patients self-described as religious, spiritual, both, or neither. Health-related quality of life outcomes were mixed but patients referred to the service scored some of the lowest baseline EQ-5D-3L scores ever seen in the literature. Together these results suggest that CCL worked in primary care, especially for patients historically considered "difficult to treat." Limitations of the study are considered alongside implications for commissioners and service developers.

Statistical fit is like beauty: A rasch and factor analysis of the Scottish PROM

Chaplains help people face some of the most complex, intractable and traumatic issues in their lives. Spiritual care works. Unfortunately, spiritual needs are rarely met in health and social care because a) spiritual distress is not recognised as such, and b) chaplain interventions are undervalued and misunderstood. The Scottish Patient Reported Outcome Measure (PROM) © was created to help provide evidence for the impact of chaplain interventions. The aim of this study was to establish whether the PROM could also be used to identify patients in need of chaplain interventions. To test this psychometrically, Rasch and Confirmatory Factor Analysis was conducted on an international dataset of post intervention PROMS from UK, Europe and Australia completed between 2018-2020 (n = 1117). The data fit the Rasch model, and the PROM demonstrated uni-dimensionality, construct validity and reliability, meaning PROM scores represent a coherent concept. Higher scores represented lower levels of spiritual distress, and the mean score was 12 out of 20. PROM score of 9 was one standard deviation below the norm, a metric routinely used to identify 'clinically important difference' in psychometric scales. A Scottish PROM^© score of 9 and under could therefore identify people for whom chaplaincy may be beneficial. The clinical implications of this are considerable.