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Labuschagne D, Fleisher J, Woo K, Fitchett G. Feasibility and Acceptability of Dignity Therapy for People with Advanced Neurodegenerative Disease. J Pain Symptom Manage 2024; 67:e499-e502. [PMID: 38307374 DOI: 10.1016/j.jpainsymman.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Affiliation(s)
| | - Jori Fleisher
- Rush University Medical Center, Chicago, Illinois, USA
| | - Katheryn Woo
- Rush University Medical Center, Chicago, Illinois, USA
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Fitchett G, Yao Y, Emanuel LL, Guay MOD, Handzo G, Hauser J, Kittelson S, O'Mahony S, Quest T, Rabow M, Schoppee TM, Solomon S, Wilkie DJ, Chochinov HM. Examining Moderation of Dignity Therapy Effects by Symptom Burden or Religious/Spiritual Struggles. J Pain Symptom Manage 2024; 67:e333-e340. [PMID: 38215893 PMCID: PMC10939845 DOI: 10.1016/j.jpainsymman.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
CONTEXT Dignity therapy (DT) is a well-researched psychotherapeutic intervention but it remains unclear whether symptom burden or religious/spiritual (R/S) struggles moderate DT outcomes. OBJECTIVE To explore the effects of symptom burden and R/S struggles on DT outcomes. METHODS This analysis was the secondary aim of a randomized controlled trial that employed a stepped-wedge design and included 579 participants with cancer, recruited from six sites across the United States. Participants were ages 55 years and older, 59% female, 22% race other than White, and receiving outpatient specialty palliative care. Outcome measures included the seven-item dignity impact scale (DIS), and QUAL-E subscales (preparation for death; life completion); distress measures were the Edmonton Symptom Assessment Scale (ESAS-r) (symptom burden), and the Religious Spiritual Struggle Scale (RSS-14; R/S). RESULTS DT effects on DIS were significant for patients with both low (P = 0.03) and moderate/high symptom burden (P = 0.001). They were significant for patients with low (P = 0.004) but not high R/S struggle (P = 0.10). Moderation effects of symptom burden (P = 0.054) and R/S struggle (P = 0.52) on DIS were not significant. DT effects on preparation and completion were not significant, neither were the moderation effects of the two distress measures. CONCLUSION Neither baseline symptom burden nor R/S struggle significantly moderated the effect of DT on DIS in this sample. Further study is warranted including exploration of other moderation models and development of measures sensitive to effects of DT and other end-of-life psychotherapeutic interventions.
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Affiliation(s)
- George Fitchett
- Department of Religion, Health and Human Values (G.F.), Rush University Medical Center, Chicago, Illinois, USA.
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing (Y.Y., T.M.S., D.J.W.), University of Florida, Gainesville, Florida, USA
| | - Linda L Emanuel
- Department of Medicine (L.L.E., J.H.), Northwestern University, Chicago, Illinois, USA; Mongan Institute (L.L.E.), Harvard University, Boston, Massachusetts, USA
| | - Marvin O Delgado Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine (M.O.D.G.), MD Anderson Cancer Institute, Houston, Texas, USA
| | - George Handzo
- HealthCare Chaplaincy Network (G.H.), New York, New York, USA
| | - Joshua Hauser
- Department of Medicine (L.L.E., J.H.), Northwestern University, Chicago, Illinois, USA; Jesse Brown VA Medical Center (J.H.), Chicago, Illinois, USA
| | - Sheri Kittelson
- Department of Medicine (S.K.), University of Florida; Gainesville, Florida, USA
| | - Sean O'Mahony
- Department of Medicine (S.M.), Rush University Medical Center, Chicago, Illinois, USA
| | - Tammie Quest
- Department of Family and Preventive Medicine (T.Q.), Emory University, Atlanta, Georgia, USA
| | - Michael Rabow
- Department of Medicine (M.R.), University of California San Francisco, San Francisco, California, USA
| | - Tasha M Schoppee
- Department of Biobehavioral Nursing Science, College of Nursing (Y.Y., T.M.S., D.J.W.), University of Florida, Gainesville, Florida, USA; Community Hospice and Palliative Care (T.M.S.), Jacksonville, Florida, USA
| | - Sheldon Solomon
- Department of Psychology (S.S.), Skidmore College, Saratoga Springs, New York, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing (Y.Y., T.M.S., D.J.W.), University of Florida, Gainesville, Florida, USA
| | - Harvey Max Chochinov
- Department of Psychiatry and Cancer Care Manitoba Research Institute (H.M.C.), University of Manitoba, Winnipeg, Manitoba, Canada
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Wilkie DJ, Fitchett G, Yao Y, Schoppee T, Delgado Guay MO, Hauser J, Kittelson S, O'Mahony S, Rabow M, Quest T, Solomon S, Handzo G, Chochinov HM, Emanuel LL. Engaging Mortality: Effective Implementation of Dignity Therapy. J Palliat Med 2024; 27:176-184. [PMID: 37676977 PMCID: PMC10825264 DOI: 10.1089/jpm.2023.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 09/09/2023] Open
Abstract
Background: Patients consider the life review intervention, Dignity Therapy (DT), beneficial to themselves and their families. However, DT has inconsistent effects on symptoms and lacks evidence of effects on spiritual/existential outcomes. Objective: To compare usual outpatient palliative care and chaplain-led or nurse-led DT for effects on a quality-of-life outcome, dignity impact. Design/Setting/Subjects: In a stepped-wedge trial, six sites in the United States transitioned from usual care to either chaplain-led or nurse-led DT in a random order. Of 638 eligible cancer patients (age ≥55 years), 579 (59% female, mean age 66.4 ± 7.4 years, 78% White, 61% stage 4 cancer) provided data for analysis. Methods: Over six weeks, patients completed pretest/posttest measures, including the Dignity Impact Scale (DIS, ranges 7-35, low-high impact) and engaged in DT+usual care or usual care. They completed procedures in person (steps 1-3) or via Zoom (step 4 during pandemic). We used multiple imputation and regression analysis adjusting for pretest DIS, study site, and step. Results: At pretest, mean DIS scores were 24.3 ± 4.3 and 25.9 ± 4.3 for the DT (n = 317) and usual care (n = 262) groups, respectively. Adjusting for pretest DIS scores, site, and step, the chaplain-led (β = 1.7, p = 0.02) and nurse-led (β = 2.1, p = 0.005) groups reported significantly higher posttest DIS scores than usual care. Adjusting for age, sex, race, education, and income, the effect on DIS scores remained significant for both DT groups. Conclusion: Whether led by chaplains or nurses, DT improved dignity for outpatient palliative care patients with cancer. This rigorous trial of DT is a milestone in palliative care and spiritual health services research. clinicaltrials.gov: NCT03209440.
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Affiliation(s)
- Diana J. Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Tasha Schoppee
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
- Community Hospice & Palliative Care, Jacksonville, Florida, USA
| | - Marvin O. Delgado Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Institute, Houston, Texas, USA
| | - Joshua Hauser
- Department of Medicine, Northwestern University and Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Sheri Kittelson
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Sean O'Mahony
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Michael Rabow
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tammie Quest
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Sheldon Solomon
- Department of Psychology, Skidmore College, Saratoga Springs, New York, USA
| | - George Handzo
- HealthCare Chaplaincy Network, New York, New York, USA
| | - Harvey Max Chochinov
- Department of Psychiatry and Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Canada
| | - Linda L. Emanuel
- Mongan Institute, Harvard University, Boston, Massachusetts, USA; Supportive Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern Medical Group, Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA
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Stacey MJ, Brett S, Fitchett G, Hill NE, Woods D. What do environment-related illnesses tell us about the character of military medicine and future clinical requirements? BMJ Mil Health 2024; 170:43-46. [PMID: 34686561 DOI: 10.1136/bmjmilitary-2021-001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/11/2021] [Indexed: 11/03/2022]
Abstract
Extreme environments present medical and occupational challenges that extend beyond generic resuscitation, to formulating bespoke diagnoses and prognoses and embarking on management pathways rarely encountered in civilian practice. Pathophysiological complexity and clinical uncertainty call for military physicians of all kinds to balance intuition with pragmatism, adapting according to the predominant patterns of care required. In an era of smaller operational footprints and less concentrated clinical experience, proposals aimed at improving the systematic care of Service Personnel incapacitated at environmental extremes must not be lost to corporate memory. These general issues are explored in the particular context of thermal stress and metabolic disruption. Specific focus is given to the accounts of military physicians who served on large-scale deployments into the heat of Iraq and Kuwait (Operation TELIC) and Oman (Exercise SAIF SAREEA). Generalisable insights into the enduring character of military medicine and future clinical requirements result.
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Affiliation(s)
- Michael John Stacey
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - S Brett
- Faculty of Medicine, Imperial College London, London, UK
| | - G Fitchett
- Blood Far Forward, British Army HQ, Andover, UK
| | - N E Hill
- Faculty of Medicine, Imperial College London, London, UK
| | - D Woods
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
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Tartaglia A, Corson T, White KB, Charlescraft A, Jackson-Jordan E, Johnson T, Fitchett G. Chaplain staffing and scope of service: benchmarking spiritual care departments. J Health Care Chaplain 2024; 30:1-18. [PMID: 36102782 DOI: 10.1080/08854726.2022.2121579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The functions of hospital chaplains and the corresponding staffing of spiritual care departments remain persistent and parallel questions within the profession. No consensus exists on services provided by spiritual care departments nor the staffing patterns to meet those expectations. This study describes the key activities and staffing at the 20 U.S. News and World Report Best Hospitals 2020-2021 as well as the connections between services, staffing, and select hospital characteristics such as average daily census. Information about each hospital's chaplaincy department was gathered via a Zoom/telephone assisted survey with its spiritual care manager. Findings reveal that while spiritual care departments are structurally integrated into their organizations and chaplains respond consistently to requests for care, involvement in established organizational protocols varies. Study findings support the notion that staffing levels are a function of chaplain integration into an organization and the activities organizations expect chaplains to fulfill.
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Affiliation(s)
- Alexander Tartaglia
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Tyler Corson
- College of Health Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Kelsey B White
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Ann Charlescraft
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Tricia Johnson
- College of Health Sciences, Rush University Medical Center, Chicago, IL, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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Tartaglia A, White KB, Corson T, Charlescraft A, Johnson T, Jackson-Jordan E, Fitchett G. Supporting staff: The role of health care chaplains. J Health Care Chaplain 2024; 30:60-73. [PMID: 36520544 DOI: 10.1080/08854726.2022.2154107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of this study was to describe the range of spiritual care activities in support of clinical colleagues at a subset of U.S. hospitals. A descriptive cross-sectional design using a 76-item Zoom/telephone guided survey containing a subset of staff care questions was employed. Data were provided by directors/managers responsible for spiritual care services at the 2020-2021 U.S. News & World Report top hospitals. Results identified staff support as an important chaplaincy function at both organizational and spiritual care department levels. Staff chaplains at over half of the hospitals spend an estimated 10-30% of their time on staff care, with chaplains in five hospitals spending greater than 30%. The most frequently reported activities were religiously associated, such as blessings and rituals for hospital events. Additionally, chaplains actively support staff during critical events such as patient deaths and through organizational protocols such as code lavender and critical incident debriefings. Chaplain support for staff most commonly grew out of personal relationships or referrals from clinical managers. Future research opportunities in this area include systematic data collection for chaplains' specific staff support activities as well as efforts to investigate the impact of those activities on patient experience.
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Affiliation(s)
- Alexander Tartaglia
- Patient Counseling, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Kelsey B White
- Patient Counseling, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Tyler Corson
- Adjunct Faculty, College of Health Sciences, Rush University, Chicago, IL, USA
| | - Ann Charlescraft
- Retired Faculty, Patient Counseling, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Tricia Johnson
- Professor, Health Systems Management, College of Health Sciences, Rush University Chicago, IL, USA
| | | | - George Fitchett
- Professor, Religion, Health and Human Values, College of Health Sciences, Rush University, Chicago, IL, USA
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Usset TJ, Stratton RG, Knapp S, Schwartzman G, Yadav SK, Schaefer BJ, Harris JI, Fitchett G. Factors Associated With Healthcare Clinician Stress and Resilience: A Scoping Review. J Healthc Manag 2024; 69:12-28. [PMID: 38175533 DOI: 10.1097/jhm-d-23-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
GOAL Clinician stress and resilience have been the subjects of significant research and interest in the past several decades. We aimed to understand the factors that contribute to clinician stress and resilience in order to appropriately guide potential interventions. METHODS We conducted a scoping review (n = 42) of published reviews of research on clinician distress and resilience using the methodology of Peters and colleagues (2020). Our team examined these reviews using the National Academy of Medicine's framework for clinician well-being and resilience. PRINCIPAL FINDINGS We found that organizational factors, learning/practice environment, and healthcare responsibilities were three of the top four factors identified in the reviews as contributing to clinician distress. Learning/practice environment and organizational factors were two of the top four factors identified in the reviews as contributing to their resilience. PRACTICAL APPLICATIONS Clinicians continue to face numerous external challenges that complicate their work. Further research, practice, and policy changes are indicated to improve practice environments for healthcare clinicians. Healthcare leaders need to promote resources for organizational and system-level changes to improve clinician well-being.
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Affiliation(s)
- Timothy J Usset
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, and VA Maine Health Care System, Augusta, Maine
| | | | - Sarah Knapp
- Ascension St. Vincent Hospital, Indianapolis, Indiana
| | - Gabrielle Schwartzman
- The School of Medicine and Health Sciences, George Washington University, Washington, DC
| | | | | | - J Irene Harris
- VA Maine Health Care System, Augusta, Maine, and Department of Psychology, University of Maine, Orono, Maine
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois
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Muehlhausen BL, Chappelle C, DeLaney A, Peacock D, Stratton RG, Fitchett G. Providing spiritual care to cancer patients in the outpatient context: a pilot study. J Health Care Chaplain 2023:1-14. [PMID: 37811644 DOI: 10.1080/08854726.2023.2266303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
The aim of this pilot study was to test an effort to provide spiritual care (SC) to oncology outpatients in the Ascension healthcare system. Medical providers referred patients who would benefit from spiritual and emotional support. Twenty-seven cancer outpatients from 5 states were enrolled in the project. Based on the chaplain assessment, 45% of the patients had moderate or severe spiritual concerns. On average patients had 4 sessions with a chaplain (range 2-9). Of the 136 chaplain sessions, 56% were in-person in the clinic and 35% were by phone. The most common chaplain activities were active listening (87% of the sessions) and demonstrate caring and concern (55%). For the 20 patients who provided follow-up data, there were decreases in all measures of religious/spiritual distress, though statistically insignificant, and a marginally significant increase (p < .054) in well-being. The study adds to the emerging literature that describes the importance of SC in the outpatient context.
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Affiliation(s)
| | | | | | | | | | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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White KB, Lee SYD, Jennings JC, Karimi S, Johnson CE, Fitchett G. Provision of chaplaincy services in U.S. hospitals: A strategic conformity perspective. Health Care Manage Rev 2023; 48:342-351. [PMID: 37615944 DOI: 10.1097/hmr.0000000000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
BACKGROUND Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available. PURPOSE The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services. METHODOLOGY Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level. RESULTS Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services. CONCLUSION The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services. PRACTICE IMPLICATIONS Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.
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Al Yacoub R, Rangel AP, Shum-Jimenez A, Greenlee A, Yao Y, Schoppee TM, Fitchett G, Handzo G, Chochinov HM, Emanuel LL, Kittelson S, Wilkie DJ. Cost considerations for implementing dignity therapy in palliative care: Insights and implications. Palliat Support Care 2023:1-5. [PMID: 37565429 PMCID: PMC10858976 DOI: 10.1017/s1478951523001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Despite the clinical use of dignity therapy (DT) to enhance end-of-life experiences and promote an increased sense of meaning and purpose, little is known about the cost in practice settings. The aim is to examine the costs of implementing DT, including transcriptions, editing of legacy document, and dignity-therapists' time for interviews/patient's validation. METHODS Analysis of a prior six-site, randomized controlled trial with a stepped-wedge design and chaplains or nurses delivering the DT. RESULTS The mean cost per transcript was $84.30 (SD = 24.0), and the mean time required for transcription was 52.3 minutes (SD = 14.7). Chaplain interviews were more expensive and longer than nurse interviews. The mean cost and time required for transcription varied across the study sites. The typical total cost for each DT protocol was $331-$356. SIGNIFICANCE OF RESULTS DT implementation costs varied by provider type and study site. The study's findings will be useful for translating DT in clinical practice and future research.
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Affiliation(s)
- Raed Al Yacoub
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FLUSA
| | - Andrea P Rangel
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FLUSA
| | - Adriana Shum-Jimenez
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FLUSA
| | - Amelia Greenlee
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FLUSA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FLUSA
| | - Tasha M Schoppee
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FLUSA
- Community Hospice & Palliative Care, Jacksonville, FLUSA
| | - George Fitchett
- Department of Religion, Health and Human Values, College of Health Sciences, Rush University Medical Center, Chicago, ILUSA
| | | | - Harvey Max Chochinov
- Department of Psychiatry and Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, MB, Canada
| | | | - Sheri Kittelson
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FLUSA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FLUSA
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Canada AL, Murphy PE, Stein K, Alcaraz KI, Leach CR, Fitchett G. Assessing the impact of religious resources and struggle on well-being: a report from the American Cancer Society's Study of Cancer Survivors-I. J Cancer Surviv 2023; 17:360-369. [PMID: 35726114 PMCID: PMC10084782 DOI: 10.1007/s11764-022-01226-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/14/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The current study examined the relationships between religious resources (i.e., certainty of belief in God and attendance at religious services), religious struggle (e.g., belief that cancer is evidence of God's punishment or abandonment), and physical and mental health-related quality of life (HRQoL), including fear of cancer recurrence (FCR), in a large, geographically and clinically diverse sample of long-term survivors of cancer. METHODS Participants were 2021 9-year survivors of cancer from the American Cancer Society's Study of Cancer Survivors - I. Religious resources included belief in God and attendance at religious services. Items from the Brief RCOPE and the PROMIS Psychosocial Impact of Illness were combined to assess religious struggle. Survivors also completed the Fear of Cancer Recurrence Inventory, SF-12, and Meaning and Peace subscales of the FACIT-Sp. Regression models were used to predict HRQoL and FCR from religious resources and struggle. RESULTS In multivariable models, certain belief in God predicted greater mental HRQoL (B = 1.99, p < .01), and attendance at religious services was associated with greater FCR (B = .80, p < .05) as well as better mental (B = .34, p < .01) and physical (B = .29, p < .05) HRQoL. In addition, religious struggle predicted greater FCR (B = 1.32, p < .001) and poorer mental (B = - .59, p < .001) and physical (B = - .29, p < .001) HRQoL. Many of these relationships were mediated through Meaning. CONCLUSIONS With the exception of FCR, religious resources predicted better HRQoL outcomes in these long-term survivors of cancer. Conversely, religious struggle consistently predicted poorer HRQoL, including greater FCR. IMPLICATIONS FOR CANCER SURVIVORS Given the documented importance of its role in coping with the cancer experience, religion/spirituality should be a consideration in every survivorship care plan. Multidisciplinary assessment and support of religious resources and identification of and referral for religious struggle are needed to ensure the well-being of most long-term survivors of cancer.
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Affiliation(s)
- Andrea L Canada
- Rosemead School of Psychology, Biola University, 13800 Biola Ave, La Mirada, CA, 90639, USA.
| | - Patricia E Murphy
- Religion, Health, and Human Values, Rush University Medical Center, Chicago, USA
| | - Kevin Stein
- Rollins School of Public Health, Emory University, Atlanta, USA
| | | | | | - George Fitchett
- Religion, Health, and Human Values, Rush University Medical Center, Chicago, USA
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Muehlhausen BL, Desjardins CM, Tata-Mbeng BS, Chappelle C, DeLaney A, Olszewski A, Szilagyi C, Fitchett G. Spiritual care department leaders' response to racial reckoning in 2020 and 2021. J Health Care Chaplain 2023:1-15. [PMID: 36749157 DOI: 10.1080/08854726.2023.2167416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Ascension, one of the largest Roman Catholic healthcare systems, and Transforming Chaplaincy (TC) collaborated on a research project "Managing Spiritual Care (SC) Departments During the COVID-19 Pandemic: A Qualitative Study." Research participants included 22 leaders from Ascension and TC contacts. Four rounds of individual interviews were conducted from April, 2020 to February, 2021. After issues of race and racial reckoning following George Floyd's murder were brought up spontaneously in interviews, questions on how leaders responded to racial reckoning were added to the subsequent interviews. A secondary analysis examined responses from participants on racial reckoning from interviews 2-4. The objective of this study was to better understand how SC leaders understand their role in issues concerning justice, equity, and inclusion. This study utilized hermeneutic phenomenology methodology. Four phenomenological patterns emerged including: World of Racial Reckoning, Lack of Safety, Creating Safety, and Movement Toward Justice.
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Affiliation(s)
| | - Cate Michelle Desjardins
- Transforming Chaplaincy, Chicago, IL, USA.,Mennonite Healthcare Fellowship, Philadelphia, PA, USA
| | | | | | | | | | | | - George Fitchett
- Transforming Chaplaincy, Chicago, IL, USA.,Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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Emanuel LL, Solomon S, Chochinov HM, Delgado Guay MO, Handzo G, Hauser J, Kittelson S, O'Mahony S, Quest TE, Rabow MW, Schoppee TM, Wilkie DJ, Yao Y, Fitchett G. Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care. J Palliat Med 2023; 26:235-243. [PMID: 36067074 PMCID: PMC9894592 DOI: 10.1089/jpm.2022.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Death anxiety is powerful, potentially contributes to suffering, and yet has to date not been extensively studied in the context of palliative care. Availability of a validated Death Anxiety and Distress Scale (DADDS) opens the opportunity to better assess and redress death anxiety in serious illness. Objective: We explored death anxiety/distress for associations with physical and psychosocial factors. Design: Ancillary to a randomized clinical trial (RCT) of Dignity Therapy (DT), we enrolled a convenience sample of 167 older adults in the United States with cancer and receiving outpatient palliative care (mean age 65.9 [7.3] years, 62% female, 84% White, 62% stage 4 cancer). They completed the DADDS and several measures for the stepped-wedged RCT, including demographic factors, religious struggle, dignity-related distress, existential quality of life (QoL), and terminal illness awareness (TIA). Results: DADDS scores were generally unrelated to demographic factors (including religious affiliation, intrinsic religiousness, and frequency of prayer). DADDS scores were positively correlated with religious struggle (p < 0.001) and dignity-related distress (p < 0.001) and negatively correlated with existential QoL (p < 0.001). TIA was significantly nonlinearly associated with both the total DADDS (p = 0.007) and its Finitude subscale (p ≤ 0.001) scores. There was a statistically significant decrease in Finitude subscale scores for a subset of participants who completed a post-DT DADDS (p = 0.04). Conclusions: Findings, if replicable, suggest that further research on death anxiety and prognostic awareness in the context of palliative medicine is in order. Findings also raise questions about the optimal nature and timing of spiritual and psychosocial interventions, something that might entail evaluation or screening for death anxiety and prognostic awareness for maximizing the effectiveness of care.
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Affiliation(s)
- Linda L. Emanuel
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Sheldon Solomon
- Department of Psychology, Skidmore College, Saratoga Springs, New York, USA
| | - Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Marvin Omar Delgado Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George Handzo
- Health Services Research and Quality, HealthCare Chaplaincy Network, New York, New York, USA
| | - Joshua Hauser
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Sheri Kittelson
- Division of Palliative Care, Department of Medicine and University of Florida, Gainesville, Florida, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Internal Medicine and Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA
| | - Tammie E. Quest
- Department of Family and Preventive Medicine and Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael W. Rabow
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Tasha M. Schoppee
- Community Hospice and Palliative Care, Jacksonville, Florida, USA
- Center for Palliative Care Research and Education, University of Florida, Gainesville, Florida, USA
| | - Diana J. Wilkie
- Center for Palliative Care Research and Education, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Center for Palliative Care Research and Education, University of Florida, Gainesville, Florida, USA
| | - George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA
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14
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Handzo GF, Chochinov HM, Emanuel L, Fitchett G, Hauser J, Kittelson S, Schoppee TM, Yao Y, Solomon S, Wilkie DJ. Letter to the Editor: Feasibility of Dignity Therapy to Reduce Death Anxiety. J Palliat Med 2022; 25:1458-1459. [DOI: 10.1089/jpm.2022.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Harvey Max Chochinov
- CancerCare Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Emanuel
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - George Fitchett
- Department of Religion, Health, and Human Values, College of Health Sciences, Rush University, Chicago, Illinois, USA
| | - Joshua Hauser
- Jesse Brown (Chicago) VA Medical Center, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sherri Kittelson
- Division of Palliative Care, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Tasha M. Schoppee
- Center for Palliative Care Research & Education, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Sheldon Solomon
- Department of Psychology, Skidmore College, Saratoga Springs, New York, USA
| | - Diana J. Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
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15
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Desjardins CM, Muehlhausen BL, Galchutt P, Tata-Mbeng BS, Fitchett G. American health care chaplains' narrative experiences serving during the COVID-19 pandemic: a phenomenological hermeneutical study. J Health Care Chaplain 2022; 29:229-244. [PMID: 35820036 DOI: 10.1080/08854726.2022.2087964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The COVID-19 pandemic significantly impacted North American health care chaplains' modes of work and emotions. To capture the experiences of health care chaplains across the United States, 30 Board Certified (or eligible) chaplains were asked to keep a weekly narrative journal of their experiences and emotions during the pandemic from April of 2020 through June of 2020. Twenty-one chaplains submitted their journals for qualitative analysis, amounting to over 90,000 words of chaplain reflection containing rich, descriptive, and often personal stories of health care chaplains. Journals were analyzed using hermeneutic phenomenological methodology. The overarching patterns identified included: The World of Chaplaincy, Policies/Procedures/Visitation, Staff Care, Rituals, Chaplain Emotional Responses, Coping, and Racism. A significant finding was the resiliency and creativity of chaplains despite the rapid changes, uncertainty, and fear brought on by the pandemic. The results further suggest that journaling is a feasible and acceptable method in chaplaincy research.
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Affiliation(s)
- Cate Michelle Desjardins
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA.,Mennonite Healthcare Fellowship, Philadelphia, PA, USA
| | | | - Paul Galchutt
- Spiritual Health Services, University of Minnesota Medical Center, Minneapolis, MN, USA
| | | | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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16
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Balboni TA, VanderWeele TJ, Doan-Soares SD, Long KNG, Ferrell BR, Fitchett G, Koenig HG, Bain PA, Puchalski C, Steinhauser KE, Sulmasy DP, Koh HK. Spirituality in Serious Illness and Health. JAMA 2022; 328:184-197. [PMID: 35819420 DOI: 10.1001/jama.2022.11086] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Despite growing evidence, the role of spirituality in serious illness and health has not been systematically assessed. OBJECTIVE To review evidence concerning spirituality in serious illness and health and to identify implications for patient care and health outcomes. EVIDENCE REVIEW Searches of PubMed, PsycINFO, and Web of Science identified articles with evidence addressing spirituality in serious illness or health, published January 2000 to April 2022. Independent reviewers screened, summarized, and graded articles that met eligibility criteria. Eligible serious illness studies included 100 or more participants; were prospective cohort studies, cross-sectional descriptive studies, meta-analyses, or randomized clinical trials; and included validated spirituality measures. Eligible health outcome studies prospectively examined associations with spirituality as cohort studies, case-control studies, or meta-analyses with samples of at least 1000 or were randomized trials with samples of at least 100 and used validated spirituality measures. Applying Cochrane criteria, studies were graded as having low, moderate, serious, or critical risk of bias, and studies with serious and critical risk of bias were excluded. Multidisciplinary Delphi panels consisting of clinicians, public health personnel, researchers, health systems leaders, and medical ethicists qualitatively synthesized and assessed the evidence and offered implications for health care. Evidence-synthesis statements and implications were derived from panelists' qualitative input; panelists rated the former on a 9-point scale (from "inconclusive" to "strongest evidence") and ranked the latter by order of priority. FINDINGS Of 8946 articles identified, 371 articles met inclusion criteria for serious illness; of these, 76.9% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for serious illness: (1) incorporate spiritual care into care for patients with serious illness; (2) incorporate spiritual care education into training of interdisciplinary teams caring for persons with serious illness; and (3) include specialty practitioners of spiritual care in care of patients with serious illness. Of 6485 health outcomes articles, 215 met inclusion criteria; of these, 66.0% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for health outcomes: (1) incorporate patient-centered and evidence-based approaches regarding associations of spiritual community with improved patient and population health outcomes; (2) increase awareness among health professionals of evidence for protective health associations of spiritual community; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation. CONCLUSIONS AND RELEVANCE This systematic review, analysis, and process, based on highest-quality evidence available and expert consensus, provided suggested implications for addressing spirituality in serious illness and health outcomes as part of person-centered, value-sensitive care.
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Affiliation(s)
- Tracy A Balboni
- Departments of Radiation Oncology and Psychosocial Oncology and Palliative Care, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Tyler J VanderWeele
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Stephanie D Doan-Soares
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katelyn N G Long
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Betty R Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, California
| | - George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois
| | - Harold G Koenig
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Paul A Bain
- Harvard Medical School, Boston, Massachusetts
| | - Christina Puchalski
- The George Washington Institute for Spirituality and Health, Departments of Medicine and Health Care Sciences, George Washington University, Washington, DC
| | - Karen E Steinhauser
- Division of Palliative Medicine, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Daniel P Sulmasy
- Kennedy Institute of Ethics, Departments of Medicine and Philosophy and the Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- John F. Kennedy School of Government, Harvard University, Boston, Massachusetts
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17
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White K, Jennings J'AC, Karimi S, Johnson CE, Fitchett G. Examining Factors Associated with Utilization of Chaplains in the Acute Care Setting. J Relig Health 2022; 61:1095-1119. [PMID: 34797457 DOI: 10.1007/s10943-021-01460-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
Hospitalized persons want their spiritual needs addressed and discussed by the healthcare team, but medical providers and nurses lack the necessary training. Patients want chaplaincy care, but very few receive it, and little is known about utilization factors. To identify the population characteristics associated with the utilization of chaplaincy services, hospitalization data from March 2012 to July 2017 were analyzed (N = 15,242 patients). Religiously affiliated individuals and those with the most acute health needs were more likely to receive chaplaincy care and received more total care. Patient-centered healthcare models may need to evaluate strategic integration of spiritual care beyond reactive spiritual care provision.
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Affiliation(s)
- Kelsey White
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY, 40202, USA.
| | - J 'Aime C Jennings
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY, 40202, USA
| | - Seyed Karimi
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY, 40202, USA
| | - Christopher E Johnson
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY, 40202, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL, 60612, USA
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18
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Gelfand SL, Fitchett G, Moss AH. Recognizing the Potential Importance of Religion and Spirituality in the Care of Black Americans with Kidney Failure. J Am Soc Nephrol 2022; 33:1255-1257. [PMID: 35304429 PMCID: PMC9257821 DOI: 10.1681/asn.2021101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Samantha L Gelfand
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts .,Harvard Medical School, Boston, Massachusetts.,Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois
| | - Alvin H Moss
- Section of Nephrology, West Virginia University School of Medicine, Morgantown, West Virginia.,Section of Geriatrics and Palliative Medicine, West Virginia University School of Medicine, Morgantown, West Virginia.,Center for Health Ethics and Law, West Virginia University Health Sciences Center, Morgantown, West Virginia
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19
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Szilagyi C, Vandenhoeck A, Best MC, Desjardins CM, Drummond DA, Fitchett G, Harrison S, Haythorn T, Holmes C, Muthert H, Nuzum D, Verhoef JHA, Willander E. Chaplain Leadership During COVID-19: An International Expert Panel. J Pastoral Care Counsel 2022; 76:56-65. [PMID: 34931932 PMCID: PMC8926913 DOI: 10.1177/15423050211067724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Chaplain leadership may have played a pivotal role in shaping chaplains' roles in health care amidst the COVID-19 pandemic. We convened an international expert panel to identify expert perception on key chaplain leadership factors. Six leadership themes of professional confidence, engaging and trust-building with executives, decision-making, innovation and creativity, building integrative and trusting connections with colleagues, and promoting cultural competencies emerged as central to determining chaplains' integration, perceived value, and contributions during the pandemic.
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Affiliation(s)
- Csaba Szilagyi
- Csaba Szilagyi, Johns Hopkins Medicine, 5755 Cedar Lane, Columbia, MD 21044, USA.
| | - Anne Vandenhoeck
- Faculty of Theological and Religious Studies, KU Leuven, Leuven, Belgium; European Research Institute for Chaplains in Healthcare, Leuven, Belgium
| | - Megan C. Best
- Institute for Ethics and Society, University of Notre Dame Australia, Sydney, Australia
| | | | | | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA; Transforming Chaplaincy, Chicago, IL, USA
| | | | - Trace Haythorn
- ACPE: The Standard for Spiritual Care and Education, Atlanta, GA, USA
| | - Cheryl Holmes
- Spiritual Health Association, Melbourne, Australia; School of Public Health and Psychology, La Trobe University, Melbourne, Australia
| | - Hanneke Muthert
- Faculty of Theology and Religious Studies, University of Groningen, Groningen, the Netherlands
| | - Daniel Nuzum
- University College Cork, Cork University Hospital, Cork, Ireland; Association of Clinical Pastoral Education (Ireland) Ltd
| | - Joost H. A. Verhoef
- OLVG, Amsterdam, the Netherlands; European Research Institute for Chaplains in Healthcare, Leuven, Belgium
| | - Erika Willander
- Department of Sociology, Uppsala University, Uppsala, Sweden
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20
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Damen A, Raijmakers NJH, van Roij J, Visser A, Beuken-Everdingen MVD, Kuip E, van Laarhoven HWM, van Leeuwen-Snoeks L, van der Padt-Pruijsten A, Smilde TJ, Leget C, Fitchett G. Spiritual Well-Being and Associated Factors in Dutch Patients With Advanced Cancer. J Pain Symptom Manage 2022; 63:404-414. [PMID: 34656652 DOI: 10.1016/j.jpainsymman.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT Palliative care aims to support patients' spiritual needs with the intention of promoting their spiritual well-being (SWB), an important dimension of quality of life. SWB is one of the less-studied dimensions of QoL, particularly in a secular country such as the Netherlands. OBJECTIVES In this study we aimed to get a better understanding of SWB in Dutch patients with advanced cancer. We therefore examined its prominence and associated factors. METHODS We used the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), which included 1,103 patients with advanced cancer. In addition to sociodemographic and religious/spiritual characteristics, study measures comprised the SWB subscales Meaning, Peace, and Faith of the revised FACIT-Sp-12, spiritual problems and needs (PNPCsv), quality of life (EORTC-QLQ-C30) and satisfaction with healthcare professionals' interpersonal skills (INPATSAT-32). RESULTS On average, patients experienced quite a bit of Meaning (8.9, SD 2.3), a little bit to somewhat Peace (6.8, SD 2.7), and very low levels of Faith (2.9, SD 3.7). Two-thirds (71%) of patients reported one or more spiritual problems, for which the majority (54%) wanted to receive attention. In the final multivariable models, only a few factors were associated with SWB, such as greater spiritual needs with lower levels of Meaning and Peace. CONCLUSION Dutch patients with advanced cancer experience medium to low levels of Meaning, Peace, and Faith. More attention for their SWB is warranted.
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Affiliation(s)
- Annelieke Damen
- Netherlands Comprehensive Cancer Organisation (A.D., N.J.H.R.), Utrecht, The Netherlands.
| | - Natasja J H Raijmakers
- Netherlands Comprehensive Cancer Organisation (A.D., N.J.H.R.), Utrecht, The Netherlands; Netherlands Association for Palliative Care (N.J.H.R.), Utrecht, The Netherlands
| | - Janneke van Roij
- Netherlands Comprehensive Cancer Organization (IKNL) (J.V.R.), Department of Research & Development, Utrecht, The Netherlands; CoRPS - Center of Research on Psychology in Somatic Diseases (J.V.R.), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Netherlands Association for Palliative Care (PZNL) (J.V.R.), Utrecht, The Netherlands; Libra Rehabilitation and Audiology (J.V.R.), Tilburg, The Netherlands
| | - Anja Visser
- Faculty of Theology and Religious Studies (A.V.), University of Groningen, Groningen, The Netherlands
| | | | - Eveline Kuip
- Department of Medical Oncology and Anesthesiology (E.K.), Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology (H.W.M.L.), Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Tineke J Smilde
- Department of Oncology (T.J.S.), Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Carlo Leget
- Department of Care Ethics (C.L.), University of Humanistic Studies, Utrecht, The Netherlands
| | - George Fitchett
- Department of Religion (G.F.), Health and Human Values, Rush University Medical Center, Chicago, IL
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21
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Schoppee TM, Scarton L, Bluck S, Yao Y, Keenan G, Samuels V, Fitchett G, Handzo G, Chochinov HM, Emanuel LL, Wilkie DJ. Dignity therapy intervention fidelity: a cross-sectional descriptive study with older adult outpatients with cancer. BMC Palliat Care 2022; 21:8. [PMID: 35016670 PMCID: PMC8751346 DOI: 10.1186/s12904-021-00888-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives Intervention fidelity is imperative to ensure confidence in study results and intervention replication in research and clinical settings. Like many brief protocol psychotherapies, Dignity Therapy lacks sufficient evidence of intervention fidelity. To overcome this gap, our study purpose was to examine intervention fidelity among therapists trained with a systematized training protocol. Methods For preliminary fidelity evaluation in a large multi-site stepped wedge randomized controlled trial, we analyzed 46 early transcripts of interviews from 10 therapists (7 female; 7 White, 3 Black). Each transcript was evaluated with the Revised Dignity Therapy Adherence Checklist for consistency with the Dignity Therapy protocol in terms of its Process (15 dichotomous items) and Core Principles (6 Likert-type items). A second rater independently coded 26% of the transcripts to assess interrater reliability. Results Each therapist conducted 2 to 10 interviews. For the 46 scored transcripts, the mean Process score was 12.4/15 (SD = 1.2), and the mean Core Principles score was 9.9/12 (SD = 1.8) with 70% of the transcripts at or above the 80% fidelity criterion. Interrater reliability (Cohen’s kappa and weighted kappa) for all Adherence Checklist items ranged between .75 and 1.0. For the Core Principles items, Cronbach’s alpha was .92. Conclusions Preliminary findings indicate that fidelity to Dignity Therapy delivery was acceptable for most transcripts and provide insights for improving consistency of intervention delivery. The systematized training protocol and ongoing monitoring with the fidelity audit tool will facilitate consistent intervention delivery and add to the literature about fidelity monitoring for brief protocol psychotherapeutic interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00888-y.
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22
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Rantanen P, Chochinov HM, Emanuel LL, Handzo G, Wilkie DJ, Yao Y, Fitchett G. Existential Quality of Life and Associated Factors in Cancer Patients Receiving Palliative Care. J Pain Symptom Manage 2022; 63:61-70. [PMID: 34332045 PMCID: PMC8766863 DOI: 10.1016/j.jpainsymman.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Enhancing quality of life (QoL) is a goal of palliative care. Existential QoL is an important aspect of this. OBJECTIVES This study sought to advance our understanding of existential QoL at the end of life through examining levels of Preparation and Completion, subscales of the QUAL-E, and their associated factors. METHODS We used data from a multi-site study of 331 older cancer patients receiving palliative care. We examined levels of Preparation and Completion and their association with demographic, religious, and medical factors, and with the Patient Dignity Inventory. RESULTS Preparation and Completion scores were moderately high. In adjusted models, being 10 years older was associated with an increase of 0.77 in Preparation (P = 0.002). Non-white patients had higher Preparation (1.03, P = 0.01) and Completion (1.56, P = 0.02). Single patients reported Completion score 1.75 point lower than those married (P = 0.01). One-point increase in intrinsic religiousness was associated with a 0.86-point increase in Completion (P = 0.03). One-point increase in terminal illness awareness was associated with 0.75-point decrease in Preparation (P = 0.001). A 10-point increase in symptom burden was associated with a decrease of 0.55 in Preparation (P < 0.001) and a decrease of 1.0 in Completion (P < 0.001). The total Patient Dignity Inventory score and all of its subscales were negatively correlated with Preparation (r from -.26 to -.52, all P < 0.001) and Completion (r from -.18 to -.31, all P < 0.001). CONCLUSION While most patients reported moderate to high levels of existential QoL, a subgroup reported low existential QoL. Terminal illness awareness and symptom burden may be associated with lower existential QoL.
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Affiliation(s)
- Petra Rantanen
- University of Rochester School of Medicine and Dentistry (P.R.) Rochester, New York, USA
| | - Harvey Max Chochinov
- Research Institute of Oncology and Hematology (H.M.C.), Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada, USA
| | - Linda L Emanuel
- Buehler Center on Aging (L.L.E.), Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - George Handzo
- Health Services Research & Quality (G.H.), HealthCare Chaplaincy Network, Caring for the Human Spirit TM, New York, New York, USA
| | - Diana J Wilkie
- Center for Palliative Care Research and Education (D.J.W., Y.Y.), College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Center for Palliative Care Research and Education (D.J.W., Y.Y.), College of Nursing, University of Florida, Gainesville, Florida, USA
| | - George Fitchett
- Department of Religion (G.F.), Health and Human Values, Rush University Medical Center, Chicago, Illinois, USA.
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23
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Kestenbaum A, Fitchett G, Galchutt P, Labuschagne D, Varner-Perez SE, Torke AM, Kamal AH. Top Ten Tips Palliative Care Clinicians Should Know About Spirituality in Serious Illness. J Palliat Med 2021; 25:312-318. [PMID: 34871044 DOI: 10.1089/jpm.2021.0522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Assessment of spiritual suffering and provision of spiritual care are a central component of palliative care (PC). Unfortunately, many PC clinicians, like most medical providers, have received limited or superficial training in spirituality and spiritual distress. This article, written by a group of spiritual care providers, and other PC and hospice clinicians, offers a more in-depth look at religion and spirituality to help to enhance readers' current skills while offering a practical roadmap for screening for spiritual distress and an overview of partnering with colleagues to ensure patients receive values-aligned spiritual care provision.
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Affiliation(s)
- Allison Kestenbaum
- Spiritual Care Services, UC San Diego Health, San Diego, California, USA
| | - George Fitchett
- Department of Religion, Health & Human Values, Rush University Medical Center, Chicago, Illinois, USA
| | - Paul Galchutt
- Spiritual Health Services, M Health Fairview, Minneapolis, Minnesota, USA
| | - Dirk Labuschagne
- Supportive Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Shelley E Varner-Perez
- Indiana University (IU) Health, Indianapolis, Indiana, USA.,IU Center for Aging Research, Regenstrief Institute, Inc., Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA
| | - Alexia M Torke
- Indiana University School of Medicine, Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA
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Ansari A, Baron A, Nelson-Becker H, Deamant C, Fitchett G, Fister E, O'Mahony S, Levine S. Practice Improvement Projects in an Interdisciplinary Palliative Care Training Program. Am J Hosp Palliat Care 2021; 39:831-837. [PMID: 34490785 DOI: 10.1177/10499091211044689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Demand for palliative care (PC) continues to increase with an insufficient number of specialists to meet the need. This requires implementation of training curricula to expand the workforce of interdisciplinary clinicians who care for persons with serious illness. OBJECTIVES To evaluate the impact of utilizing individual practice improvement projects (PIP) as part of a longitudinal PC curriculum, the Coleman Palliative Medicine Training Program (CPMTP-2). METHODS Participants developed their PIPs based on their institutional needs and through a mentor, and participated in monthly meetings and bi-annual conferences, thereby allowing for continued process improvement and feedback. RESULTS Thirty-seven interdisciplinary participants implemented 30 PIPs encompassing 7 themes: (1) staff education; (2) care quality and processes; (3) access to care; (4) documentation of care delivered; (5) new program development; (6) assessing gaps in care/patient needs; and (7) patient/family education. The majority of projects did achieve completion, with 16 of 30 projects reportedly being sustained several months after conclusion of the required training period. Qualitative feedback regarding mentors' expertise and availability was uniformly positive. CONCLUSION The CPMTP-2 demonstrates the positive impact of PIPs in the development of skills for interdisciplinary learners as part of a longitudinal training program in primary PC. Participation in a PIP with administrative support may lead to operational improvement within PC teams.
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Affiliation(s)
- Aziz Ansari
- Division of Hospital Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Aliza Baron
- University of Chicago Medicine, Chicago, IL, USA
| | | | - Catherine Deamant
- Rosalind Franklin University of Medicine and Sciences, North Chicago, IL, USA
| | | | - Erik Fister
- Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Stacie Levine
- Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, Chicago, IL, USA
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25
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Damen A, Exline J, Pargament K, Yao Y, Chochinov H, Emanuel L, Handzo G, Wilkie DJ, Fitchett G. Prevalence, Predictors and Correlates of Religious and Spiritual Struggles in Palliative Cancer Patients. J Pain Symptom Manage 2021; 62:e139-e147. [PMID: 33984462 PMCID: PMC8419029 DOI: 10.1016/j.jpainsymman.2021.04.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
CONTEXT Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. This concise measure allows for the assessment of multiple types of r/s struggles for people from different religious backgrounds or none. OBJECTIVES The aim of the present study was to examine the prevalence, predictors and correlates of r/s struggles as measured by the RSS-14 and its subdomains in a cancer population receiving palliative care. METHODS Data were collected from six outpatient palliative care services across the US. Inclusion criteria for patients were age 55 or older with a cancer diagnosis. In addition to demographic and r/s characteristics, study measures included the Edmonton Symptom Assessment Scale (ESAS), the Patient Dignity Inventory (PDI) and the Quality of Life at the End of Life (QUAL-E). RESULTS The study included 331 participants. Some r/s struggle was reported by 66%, moderate to high struggle for at least one item was reported by 20% of the patients. In bivariate analyses, r/s struggle was associated with greater symptom burden, greater dignity-related problems and poorer quality of life; in multivariable analyses, dignity-related problems remained a predictor of total r/s struggle. CONCLUSION R/S struggles may compromise well-being for cancer patients receiving palliative care. Clinicians should consider periodic screening for r/s struggles and referrals for spiritual care if indicated.
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Affiliation(s)
- Annelieke Damen
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands.
| | - Julie Exline
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Kenneth Pargament
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio
| | - Yingwei Yao
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, Florida
| | - Harvey Chochinov
- Research Institute of Oncology and Hematology, Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Emanuel
- Buehler Center on Aging, Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - George Handzo
- Health Services Research & Quality, HealthCare Chaplaincy Network, Caring for the Human Spirit TM, New York, New York
| | - Diana J Wilkie
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, Florida
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois
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26
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Damen A, Visser A, van HWM, Leget C, Raijmakers N, van J, Fitchett G. Validation of the FACIT-Sp-12 in a Dutch cohort of patients with advanced cancer. Psychooncology 2021; 30:1930-1938. [PMID: 34258819 DOI: 10.1002/pon.5765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 07/05/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although the Dutch Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12 Item Scale (FACIT-Sp-12) has been used in several Dutch studies, no study has assessed the measurement properties of the translation. The aim of this study was to perform an item-reduction analysis, confirmatory factor analysis (CFA), test of reliability, and test of convergent validity. METHODS From the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), 400 advanced cancer patients without missing values on any of the variables were selected. In addition to demographic and religious/spiritual characteristics, study measures included the FACIT-Sp-12 and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC-QLQ-C30). RESULTS Item reduction analysis showed that Items 4 and 8 had low correlations to the total scale (<0.30). Items 6 and 7, and Items 9, 10, and 11 were highly correlated (>0.75). CFA indicated a good fit for a three-factor structure with Meaning, Peace and Faith, and good Cronbach's α coefficients for the total as well as the subscales (0.71-0.86). The removal of Items 4, 8, and 12 further improved the goodness of fit and Cronbach's α coefficients. Convergent validity was adequate with the EORTC-QLQ-C30. CONCLUSION Our analysis of the FACIT-Sp-12 revealed serious questions about three items and concerns about the Faith subscale. These problematic items deserve further attention so should be interpreted with care when using this scale. A future study could look into the items and test possible replacements.
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Affiliation(s)
- Annelieke Damen
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Anja Visser
- Faculty of Theology and Religious Studies, University of Groningen, Groningen, The Netherlands
| | - Hanneke W M van
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Carlo Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Natasja Raijmakers
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Janneke van
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois, USA
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27
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Bluck S, Mroz EL, Wilkie DJ, Emanuel L, Handzo G, Fitchett G, Chochinov HM, Bylund CL. Quality of Life for Older Cancer Patients: Relation of Psychospiritual Distress to Meaning-Making During Dignity Therapy. Am J Hosp Palliat Care 2021; 39:54-61. [PMID: 33926243 DOI: 10.1177/10499091211011712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nearly 500,000 older Americans die a cancer-related death annually. Best practices for seriously ill patients include palliative care that aids in promoting personal dignity. Dignity Therapy is an internationally recognized therapeutic intervention designed to enhance dignity for the seriously ill. Theoretically, Dignity Therapy provides opportunity for patients to make meaning by contextualizing their illness within their larger life story. The extent to which Dignity Therapy actually elicits meaning-making from patients, however, has not been tested. AIM The current study examines (i) extent of patient meaning-making during Dignity Therapy, and (ii) whether baseline psychospiritual distress relates to subsequent meaning-making during Dignity Therapy. DESIGN Participants completed baseline self-report measures of psychospiritual distress (i.e., dignity-related distress, spiritual distress, quality of life), before participating in Dignity Therapy. Narrative analysis identified the extent of meaning-making during Dignity Therapy sessions. PARTICIPANTS Twenty-five outpatients (M age = 63, SD = 5.72) with late-stage cancer and moderate cancer-related symptoms were recruited. RESULTS Narrative analysis revealed all patients made meaning during Dignity Therapy but there was wide variation (i.e., 1-12 occurrences). Patients who made greater meaning were those who, at baseline, reported significantly higher psychospiritual distress, including greater dignity-related distress (r = .46), greater spiritual distress (r = .44), and lower quality of life (r = -.56). CONCLUSION Meaning-making was found to be a central component of Dignity Therapy. Particularly, patients experiencing greater distress in facing their illness use the Dignity Therapy session to express how they have made meaning in their lives.
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Affiliation(s)
- Susan Bluck
- Department of Psychology, 3463University of Florida, Gainesville, FL, USA
| | - Emily L Mroz
- Department of Psychology, 3463University of Florida, Gainesville, FL, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, 3463University of Florida, Gainesville, FL, USA
| | - Linda Emanuel
- Division of General Internal Medicine, 3270Northwestern University, Chicago, IL, USA
| | | | - George Fitchett
- Department of Religion, Health and Human Values, 2468Rush University Medical Center, Chicago, IL, USA
| | - Harvey Max Chochinov
- Research Institute of Oncology and Hematology CancerCare Manitoba, , Winnipeg, Manitoba, Canada.,Department of Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA.,College of Medicine, 3463University of Florida, Gainesville, FL, USA
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Antoine A, Fitchett G, Sharma V, Marin DB, Garman AN, Haythorn T, White K, Cadge W. How Do Healthcare Executives Understand and Make Decisions about Spiritual Care Provision? South Med J 2021; 114:207-212. [PMID: 33787932 DOI: 10.14423/smj.0000000000001230] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This pilot study explores how healthcare leaders understand spiritual care and how that understanding informs staffing and resource decisions. METHODS This study is based on interviews with 11 healthcare leaders, representing 18 hospitals in 9 systems, conducted between August 2019 and February 2020. RESULTS Leaders see the value of chaplains in terms of their work supporting staff in tragic situations and during organizational change. They aim to continue to maintain chaplaincy efforts in the midst of challenging economic realities. CONCLUSIONS Chaplains' interactions with staff alongside patient outcomes are a contributing factor in how resources decisions are made about spiritual care.
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Affiliation(s)
- Aja Antoine
- From the Department of Sociology, Brandeis University, Boston, Massachusetts, Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, Department of Psychiatry, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, Department of Health Systems Management, Rush University, Chicago, Illinois, Association for Clinical Pastoral Education, Atlanta, Georgia, School of Public Health & Information Sciences, University of Louisville, Louisville, Kentucky
| | - George Fitchett
- From the Department of Sociology, Brandeis University, Boston, Massachusetts, Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, Department of Psychiatry, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, Department of Health Systems Management, Rush University, Chicago, Illinois, Association for Clinical Pastoral Education, Atlanta, Georgia, School of Public Health & Information Sciences, University of Louisville, Louisville, Kentucky
| | - Vanshdeep Sharma
- From the Department of Sociology, Brandeis University, Boston, Massachusetts, Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, Department of Psychiatry, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, Department of Health Systems Management, Rush University, Chicago, Illinois, Association for Clinical Pastoral Education, Atlanta, Georgia, School of Public Health & Information Sciences, University of Louisville, Louisville, Kentucky
| | - Deborah B Marin
- From the Department of Sociology, Brandeis University, Boston, Massachusetts, Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, Department of Psychiatry, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, Department of Health Systems Management, Rush University, Chicago, Illinois, Association for Clinical Pastoral Education, Atlanta, Georgia, School of Public Health & Information Sciences, University of Louisville, Louisville, Kentucky
| | - Andrew N Garman
- From the Department of Sociology, Brandeis University, Boston, Massachusetts, Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, Department of Psychiatry, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, Department of Health Systems Management, Rush University, Chicago, Illinois, Association for Clinical Pastoral Education, Atlanta, Georgia, School of Public Health & Information Sciences, University of Louisville, Louisville, Kentucky
| | - Trace Haythorn
- From the Department of Sociology, Brandeis University, Boston, Massachusetts, Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, Department of Psychiatry, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, Department of Health Systems Management, Rush University, Chicago, Illinois, Association for Clinical Pastoral Education, Atlanta, Georgia, School of Public Health & Information Sciences, University of Louisville, Louisville, Kentucky
| | - Kelsey White
- From the Department of Sociology, Brandeis University, Boston, Massachusetts, Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, Department of Psychiatry, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, Department of Health Systems Management, Rush University, Chicago, Illinois, Association for Clinical Pastoral Education, Atlanta, Georgia, School of Public Health & Information Sciences, University of Louisville, Louisville, Kentucky
| | - Wendy Cadge
- From the Department of Sociology, Brandeis University, Boston, Massachusetts, Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, Department of Psychiatry, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, Department of Health Systems Management, Rush University, Chicago, Illinois, Association for Clinical Pastoral Education, Atlanta, Georgia, School of Public Health & Information Sciences, University of Louisville, Louisville, Kentucky
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Abstract
A study assessing the expectations patients and loved ones have of hospital chaplains was conducted at Ascension St. Vincent Indiana hospitals. In-person interviews were conducted with 452 patients and loved ones during an inpatient stay. The survey instrument was a modified version of a survey developed by Dr. Katherine Piderman of the Mayo Clinic. Participants answered questions regarding demographics, awareness of availability, expectations of visits, reasons for wanting to see a chaplain and gave feedback regarding visits if they had seen a chaplain. Results showed that patients and loved ones value chaplains with 93% saying they wanted a chaplain visit. This study was unique in seeking feedback from loved ones as well as patients. It may be equally important to reach out to loved ones during times of crisis when patients themselves are in surgery or sedated and loved ones are experiencing heightened anxiety.
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Affiliation(s)
| | - Todd Foster
- Graduate Medical Education, Indianapolis, IN, USA
| | - Aaron H Smith
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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30
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O'Mahony S, Kittelson S, Barker PC, Delgado Guay MO, Yao Y, Handzo GF, Chochinov HM, Fitchett G, Emanuel LL, Wilkie DJ. Association of Race with End-of-Life Treatment Preferences in Older Adults with Cancer Receiving Outpatient Palliative Care. J Palliat Med 2021; 24:1174-1182. [PMID: 33760658 DOI: 10.1089/jpm.2020.0542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: End-of-life discussions and documentation of preferences are especially important for older cancer patients who are at high risk of morbidity and mortality. Objective: To evaluate influence of demographic factors such as religiosity, education, income, race, and ethnicity on treatment preferences for end-of-life care. Methods: A retrospective observational study was performed on baseline data from a multisite randomized clinical trial of Dignity Therapy in 308 older cancer patients who were receiving outpatient palliative care (PC). Interviews addressed end-of-life treatment preferences, religion, religiosity and spirituality, and awareness of prognosis. End-of-life treatment preferences for care were examined, including preferences for general treatment, cardiopulmonary resuscitation (CPR), and mechanical ventilation (MV). Bivariate associations and multiple logistic regression analysis of treatment preferences with demographic and other baseline variables were conducted. Results: Our regression models demonstrated that race was a significant predictor for CPR preference and preferences for MV, although not for general treatment goals. Minority patients were more likely to want CPR and MV than whites. Men were more likely to opt for MV, although not for CPR or overall aggressive treatment, than women. Higher level of education was a significant predictor for preferences for less aggressive care at the end-of-life but not for CPR or MV. Higher level of terminal illness awareness was also a significant predictor for preferences for CPR, but not MV or aggressive care at the end-of-life. Discussion: Race was significantly associated with all three markers for aggressive care in bivariate analysis and with two out of three markers in multiple regression analysis, with minorities preferring aggressive care and whites preferring less aggressive care. Contrary to our hypothesis, income was not significantly associated with treatment preferences, whereas religion was significantly associated with all markers for aggressive care in bivariate models, but not in multiple regression models. Clinical Trial Registration Number NCT03209440.
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Affiliation(s)
- Sean O'Mahony
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Sheri Kittelson
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Paige C Barker
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marvin O Delgado Guay
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingwei Yao
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - George F Handzo
- CSSBB Health Care Chaplaincy Network, New York, New York, USA
| | - Harvey M Chochinov
- Department of Psychiatry, FRSC University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Fitchett
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Linda L Emanuel
- Department of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Diana J Wilkie
- Department of Medicine, University of Florida, Gainesville, Florida, USA
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Cipriano-Steffens T, Cursio JF, Hlubocky F, Sumner M, Garnigan-Peters D, Powell J, Arndt N, Phillips L, Lassiter RH, Gilliam M, Petty LE, Pastor RSO, Malec M, Fitchett G, Polite B. Improving End of Life Cancer Outcomes Through Development and Implementation of a Spiritual Care Advocate Program. Am J Hosp Palliat Care 2021; 38:1441-1450. [PMID: 33663241 DOI: 10.1177/1049909121995413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Explored whether increased support for spiritual concerns between the healthcare team and patients through the provision of a Spiritual Care Advocate (SCA) would improve end of life outcomes in a metastatic cancer population. DESIGN Newly diagnosed metastatic cancer patients were recruited at the University of Chicago Medical Center and received spiritual support from a Spiritual Care Advocate during chemotherapy treatments. The final sample consisted of 42 patients (58% of those approached) who completed the baseline survey and had known survival status. MEASUREMENT Patients completed pre/post surveys measuring spiritual support and palliative quality of life. Baseline measurements of religious practice and externalizing religious health beliefs were also obtained. Receipt of aggressive EOL care was derived from the electronic medical record. RESULT Median age was 61 years, with 48% Black, and predominantly male (62%). Of the 42 patients, 30 (70%) had died by the time of this analysis. Perceived spiritual support from the medical team increased in 47% of those who received non-aggressive EOL care and by 40% in those who received aggressive EOL care (p=0.012). Patient perceptions of spiritual support from the medical community increased from 27% at baseline to 63% (p=0.005) after the SCA intervention. Only 20% of recipients received aggressive treatments at end of life. CONCLUSION The SCA model improved the perceived spiritual support between the healthcare team and patients. Although limited by a small sample size, the model was also associated with an improvement in EOL patients' quality of life, spiritual wellbeing, and decreased aggressive EOL care.
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Affiliation(s)
| | - John F Cursio
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Fay Hlubocky
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Marsha Sumner
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Judy Powell
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nicole Arndt
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lee Phillips
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | | | | | - Monica Malec
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - George Fitchett
- Department of Religion, Rush University Medical Center, Chicago, IL, USA
| | - Blase Polite
- Department of Medicine, University of Chicago, Chicago, IL, USA
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32
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Samuels V, Schoppee TM, Greenlee A, Gordon D, Jean S, Smith V, Reed T, Kittelson S, Quest T, O'Mahony S, Hauser J, Guay MOD, Rabow MW, Emanuel L, Fitchett G, Handzo G, Chochinov HM, Yao Y, Wilkie DJ. Interim Analysis of Attrition Rates in Palliative Care Study on Dignity Therapy. Am J Hosp Palliat Care 2021; 38:1503-1508. [PMID: 33557587 DOI: 10.1177/1049909121994309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A routine threat to palliative care research is participants not completing studies. The purpose of this analysis was to quantify attrition rates mid-way through a palliative care study on Dignity Therapy and describe the reasons cited for attrition. Enrolled in the study were a total of 365 outpatients with cancer who were receiving outpatient specialty palliative care (mean age 66.7 ± 7.3 years, 56% female, 72% White, 22% Black, 6% other race/ethnicity). These participants completed an initial screening for cognitive status, performance status, physical distress, and spiritual distress. There were 76 eligible participants who did not complete the study (58% female, mean age 67.9 ± 7.3 years, 76% White, 17% Black, and 7% other race). Of those not completing the study, the average scores were 74.5 ± 11.7 on the Palliative Performance Scale and 28.3 ± 1.5 on the Mini-Mental Status Examination, whereas 22% had high spiritual distress scores and 45% had high physical distress scores. The most common reason for attrition was death/decline of health (47%), followed by patient withdrawal from the study (21%), and patient lost to follow-up (21%). The overall attrition rate was 24% and within the a priori projected attrition rate of 20%-30%. Considering the current historical context, this interim analysis is important because it will serve as baseline data on attrition prior to the outbreak of the COVID-19 pandemic. Future research will compare these results with attrition throughout the rest of the study, allowing analysis of the effect of the COVID-19 pandemic on the study attrition.
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Affiliation(s)
| | - Tasha M Schoppee
- University of Florida, Gainesville, FL, USA.,Community Hospice & Palliative Care, Jacksonville, FL, USA
| | | | | | | | | | - Tyra Reed
- University of Florida, Gainesville, FL, USA
| | | | - Tammie Quest
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Michael W Rabow
- University of California San Francisco, San Francisco, CA, USA
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33
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Emanuel L, Solomon S, Fitchett G, Chochinov H, Handzo G, Schoppee T, Wilkie D. Fostering Existential Maturity to Manage Terror in a Pandemic. J Palliat Med 2021; 24:211-217. [PMID: 32552500 PMCID: PMC7840299 DOI: 10.1089/jpm.2020.0263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 02/03/2023] Open
Abstract
Background: The COVID-19 pandemic has created an environment in which existence is more fragile and existential fears or terror rises in people. Objective: Managing existential terror calls for being mature about mortality, something with which palliative care providers are familiar and in need of greater understanding. Methods: Using a case to illustrate, we describe existential terror, terror management, and existential maturity and go on to outline how existential maturity is important for not only the dying and the grieving but for also those facing risk of acquiring COVID-19. Results: Next, we describe how essential components in attaining existential maturity come together. (1) Because people experience absent attachment to important people as very similar to dying, attending to those experiences of relationship is essential. (2) That entails an internal working through of important relationships, knowing their incompleteness, until able to "hold them inside," and invest in these and other connections. (3) And what allows that is making a meaningful connection with someone around the experience of absence or death. (4) We also describe the crucial nature of a holding environment in which all of these can wobble into place. Discussion: Finally, we consider how fostering existential maturity would help populations face up to the diverse challenges that the pandemic brings up for people everywhere.
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Affiliation(s)
| | | | | | - Harvey Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - George Handzo
- Health Services Research and Quality at HealthCare Chaplaincy Network, New York, New York, USA
| | - Tasha Schoppee
- Center for Palliative Care Research and Education at University of Florida, Gainesville, Florida, USA
| | - Diana Wilkie
- Center for Palliative Care Research and Education at University of Florida, Gainesville, Florida, USA
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Labuschagne D, Torke A, Grossoehme D, Rimer K, Rucker M, Schenk K, Slaven JE, Fitchett G. Chaplaincy Care in the MICU: Examining the Association Between Spiritual Care and End-of-Life Outcomes. Am J Hosp Palliat Care 2021; 38:1409-1416. [PMID: 33464118 DOI: 10.1177/1049909120987218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Seriously ill patients admitted to the Intensive Care Unit (ICU) experience severe spiritual and existential distress. Patients' surrogate decision makers face the burden of making complex decisions about their loved ones' care. Experienced chaplains may play a role in assisting with decision-making, possibly by aligning patients' values and wishes with treatment plans and avoiding non-beneficial aggressive measures. OBJECTIVES To identify associations between chaplaincy care and length of stay (LOS) in the medical ICU (MICU). METHODS This was a retrospective observational study of usual spiritual care in the adult MICUs of 4 medical centers in the United States over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information. Through bivariate and multivariable analyses associations between spiritual care and LOS were examined. RESULTS In multivariable analysis of the 254 patients, receiving spiritual care was associated with an increased likelihood of being in a higher LOS tertile (adjusted odds ratio = 2.94, p < .001). In post hoc bivariate analysis, cases receiving spiritual care within the first 48 hours of MICU admission revealed a trend toward lower LOS (p = .181). CONCLUSION Spiritual care in the MICU was associated with longer LOS. Early intervention by chaplains who are well-integrated in the ICU may assist patients and their loved ones in coming to terms with grave illness and making difficult treatment decisions. Further well-designed studies of spiritual care interventions that may affect outcomes are needed.
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Affiliation(s)
| | - Alexia Torke
- Indiana University School of Medicine, Daniel F Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, IN, USA
| | - Daniel Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, OH, USA
| | - Katie Rimer
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Kristen Schenk
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
A developing body of evidence indicates that chaplain care is associated with higher levels of patient/family satisfaction with their hospital care. We examined the association between chaplain care and patient experience among patients at Rush University Medical Center in Chicago who responded to Hospital Consumer Assessment of Healthcare Providers and Systems and Press Ganey survey items between 2011 and 2017. Information about chaplain care was taken from the inpatients’ electronic medical record. Our analyses included 11 741 patients, 26.5% of whom had received any chaplain care. Patients with lower self-rated health were more likely to have received chaplain care (P < .001). In bivariate analyses, chaplain care was associated with lower likelihood of reporting the highest score for 4 patient experience items (P < .001). In multi-variable models that adjusted for patient self-rated health and other factors, the association between chaplain care and the 4 patient experience items was nonsignificant. There was no effect modification for patient religious affiliation, self-rated health, or other demographic factors. The chaplain care-patient experience association may be more complex than has initially appeared, and further research is needed to help us better understand it.
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Affiliation(s)
- Annelieke Damen
- PhD student Outcomes of Chaplaincy, University of Humanistic Studies, Utrecht, the Netherlands
| | - Patricia Murphy
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, IL, USA
| | - Francis Fullam
- Health Systems Management, Rush University Medical Center, Chicago, IL, USA
| | - Deirdre Mylod
- Institute for Innovation, SVP Research & Analytics, Press Ganey Associates, South Bend, IN, USA
| | - Raj C Shah
- Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, IL, USA
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Antoine A, Fitchett G, Marin D, Sharma V, Garman A, Haythorn T, White K, Greene A, Cadge W. What organizational and business models underlie the provision of spiritual care in healthcare organizations? An initial description and analysis. J Health Care Chaplain 2020; 28:272-284. [PMID: 33369548 DOI: 10.1080/08854726.2020.1861535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Two-thirds of American hospitals have chaplains. This article explores the organizational and business models that underlie how chaplains are integrated into hospitals. Based on interviews with 14 chaplain managers and the 11 healthcare executives to whom they report at 18 hospitals in 9 systems, we identify three central findings. First, there is significant variation in how spiritual care programs are staffed and integrated into their hospitals. Second, executives and chaplain managers see the value of chaplains in terms of their quality of care, reliability and responsivity to emergent patient and staff needs, and clinical training and experience working within a complex environment. Third, few departments rely on empirical data when making decisions about staffing, tending instead to default to the budgetary status quo. These findings provide the basis for a larger more systematic study.
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Affiliation(s)
- Aja Antoine
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
| | - Deborah Marin
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
| | - Vanshdeep Sharma
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
| | - Andrew Garman
- Department of Health Systems Management, Rush University Medical Center, Chicago, IL, USA
| | - Trace Haythorn
- Association for Clinical Pastoral Education, Atlanta, GA, USA
| | - Kelsey White
- Department of Health Management & System Sciences, University of Louisville, Louisville, KY, USA
| | - Amy Greene
- Center for Spiritual Care, Cleveland Clinic, Cleveland, OH, USA
| | - Wendy Cadge
- Department of Sociology, Brandeis University, Waltham, MA, USA
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Mroz E, Bylund-Lincoln C, Wisolmerski R, Wilkie D, Fitchett G, Handzo G, Chochinov H, Bluck S. Meaning Making as a Central Mechanism of Dignity Therapy for Older Adults With Cancer. Innov Aging 2020. [PMCID: PMC7741986 DOI: 10.1093/geroni/igaa057.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nearly 500,000 older Americans die a cancer-related death each year (National Vital Statistics Report, 2018). Following a diagnosis of a serious illness like cancer, maintaining a sense of dignity is central to a patient’s wellbeing. Dignity Therapy (DT) was recently introduced as an intervention to enhance dignity for terminally ill patients (Chochinov et al., 2005). This therapy provides patients opportunities to foster a sense of dignity though making meaning of their lives (Hack et al., 2010). To date, whether meaning-making actually occurs as a central mechanism of effective DT has not been tested. The current study investigates (i) how often and in what forms meaning-making occurs during DT, and (ii) how patients’ baseline feelings of dignity relate to meaning-making during DT. Participants were 25 male and female cancer outpatients (M age = 63.08; SD = 5.72). They completed the Patient Dignity Inventory (Chochinov et al., 2008) and then participated in Dignity Therapy with a trained provider. Sessions were audio recorded, transcribed, and reliably content-analyzed for meaning-making using an established coding scheme (Park & Folkman, 1997). Content-analysis revealed that all patients made meaning of past life events at least once (range: 1-12 occurrences). Multiple forms of meaning-making emerged, with Finding Benefit and Personal Growth most common. Patients reporting more dignity-related distress prior to DT showed greater meaning-making during the DT session (r = .46, p < 0.05). This study provides foundational evidence that meaning-making is a key mechanism of Dignity Therapy, helping older adults with cancer enhance dignity at end-of-life.
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Affiliation(s)
- Emily Mroz
- University of Florida, Gainesville, Florida, United States
| | | | | | - Diana Wilkie
- University of Florida, Gainesville, Florida, United States
| | - George Fitchett
- Rush University Medical Center, Chicago, Illinois, United States
| | - George Handzo
- HealthCare Chaplaincy Network, New York, New York, United States
| | | | - Susan Bluck
- University of Florida, Gainesville, Florida, United States
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38
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Palmer J, Smith A, Paasche-Orlow S, Fitchett G. Research Literature on the Intersection of Dementia, Spirituality, and Palliative Care: A Scoping Review. Innov Aging 2020. [PMCID: PMC7743530 DOI: 10.1093/geroni/igaa057.3187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care. Thus, we conducted the first scoping review examining the nature and breadth of peer-reviewed studies across these three topics. The scoping review followed methods from The Joanna Briggs Institute Reviewers’ Manual (2015). We developed a priori a scoping review protocol outlining the Population, Concept and Context for study, data sources, search strategy, inclusion/exclusion criteria, and procedure for screening, extracting, and analyzing data. The final sample consisted of 19 studies with the following themes: Characterizing Spiritual Needs, Preferences, and Resources; Characterizing Palliative or Spiritual Care; Predicting Provision of Spiritual Care; and Assessing Spiritual Care Interventions. Eighteen studies were published in the past decade, and eleven were based in Europe. The majority of studies focused on long-term care settings, grouped stages of dementia or did not specify dementia stage, and investigated interventions indirectly related to spiritual palliation. Many studies were limited in sample size and in generalizability / transferability and used less sophisticated research designs. Accordingly, research across dementia, spirituality, and palliative care needs to examine distinct stages of dementia; hospital-, home- and community-based settings; and formal spiritual care interventions (e.g., administered by chaplains) and needs to utilize rigorous study designs (e.g., randomized clinical trials). Such research could advance practice and policy that enhance quality of life for tens of millions of persons with dementia and their family members worldwide.
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Affiliation(s)
| | - Alyssa Smith
- Independently Employed, Bethesda, Maryland, United States
| | | | - George Fitchett
- Rush University Medical Center, Chicago, Illinois, United States
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Cipriano-Steffens TM, Carilli T, Hlubocky F, Quinn M, Fitchett G, Polite B. "Let Go, Let God": A Qualitative Study Exploring Cancer Patients' Spirituality and Its Place in the Medical Setting. J Relig Health 2020; 59:2341-2363. [PMID: 31705446 DOI: 10.1007/s10943-019-00942-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study explored the role of God and spirituality in cancer patients to gain deeper insight into how patients use their spirituality to cope during illness, including how they see the medical team meeting their spiritual needs. From our work, some naturally emerging themes included Finding God in Cancer and Healing, Spiritual Support Desired from Medical Community, Doctor as "Gift from God"?, and Communication and the Power of Talk. Cancer patients not only acknowledged a spiritual need, but a desire for it to be addressed by their medical team as part of their treatment.
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Affiliation(s)
- Toni Marie Cipriano-Steffens
- Department of Medicine, University of Chicago, Chicago, IL, USA.
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA.
| | | | - Fay Hlubocky
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
| | - Michael Quinn
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - George Fitchett
- Department of Religion, Rush University Medical Center, Chicago, IL, USA
| | - Blase Polite
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA
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40
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Sprik PJ, Tata B, Kelly B, Fitchett G. Religious/spiritual concerns of patients with brain cancer and their caregivers. Ann Palliat Med 2020; 10:964-969. [PMID: 32921085 DOI: 10.21037/apm-20-813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022]
Abstract
Research conducted over the last 20 years supports that many patients with cancer engage religion and spirituality (R/S) when coping with their illness. Research on patients with brain cancer is more minimal but mirrors the same findings. This article provides a brief overview of the research about R/S and coping among cancer patients, then summarizes the research about R/S among patients with brain cancer and their caregivers. The following topics are discussed: (I) the importance of R/S to patients with brain cancer and their caregivers, (II) specific R/S needs experienced by patients with brain cancer and their caregivers over the cancer continuum, (III) R/S coping mechanisms engaged by brain cancer patients and their caregivers, and (IV) the healthcare systems' engagement of R/S needs within the healthcare setting. This is followed by professional chaplains' descriptions of their own experience with R/S concerns of patients with brain cancer and their caregivers, and the spiritual care they have offered them. Hear My Voice, a new spiritual life review intervention, is described. Research to deepen understanding of the R/S concerns of patients with brain cancer and their loved ones, and spiritual care interventions offered to them is recommended.
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Affiliation(s)
| | | | - Brian Kelly
- David H. Koch Center for Cancer Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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O'Mahony S, Baron A, Ansari A, Deamant C, Nelson-Becker H, Fitchett G, Levine S. Expanding the Interdisciplinary Palliative Medicine Workforce: A Longitudinal Education and Mentoring Program for Practicing Clinicians. J Pain Symptom Manage 2020; 60:602-612. [PMID: 32276103 DOI: 10.1016/j.jpainsymman.2020.03.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/22/2020] [Accepted: 03/27/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The disparity between gaps in workforce and availability of palliative care (PC) services is an increasing issue in health care. To meet the demand, team-based PC requires additional educational training for all clinicians caring for persons with serious illness. OBJECTIVES To describe the educational methodology and evaluation of an existing regional interdisciplinary PC training program that was expanded to include chaplain and social worker trainees. METHODS From 2015 to 2017, 26 social workers, chaplains, physicians, nurses, and advanced practice providers representing 22 health systems completed a two-year training program. The curriculum comprises biannual interdisciplinary conferences, individualized mentoring and clinical shadowing, self-directed e-learning, and profession-focused seminar series for social workers and chaplains. Site-specific practice improvement projects were developed to address gaps in PC at participating sites. RESULTS PC and program development skills were self-assessed before and after training. Among 12 skills common to all disciplines, trainees reported significant increases in confidence across all 12 skills and significant increases in frequency of performing 11 of 12 skills. Qualitative evaluation identified a myriad of program strengths and challenges regarding the educational format, mentoring, and networking across disciplines. CONCLUSION Teaching PC and program development knowledge and skills to an interdisciplinary regional cohort of practicing clinicians yielded improvements in clinical skills, implementation of practice change projects, and a sense of belonging to a supportive professional network.
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Affiliation(s)
- Sean O'Mahony
- Rush University Medical Center, Chicago, Illinois, USA.
| | - Aliza Baron
- University of Chicago Medical Center, Chicago, Illinois, USA
| | - Aziz Ansari
- Loyola University Medical Center, Maywood, Illinois, USA
| | - Catherine Deamant
- Chicago Medical School-Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Holly Nelson-Becker
- Loyola University Medical Center, Maywood, Illinois, USA; Brunel University, London, UK
| | | | - Stacie Levine
- University of Chicago Medical Center, Chicago, Illinois, USA
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42
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Abstract
Both the healthcare and religious landscapes in the United States are rapidly changing. Despite the dynamic environment that spiritual care managers face, many do not receive management training prior to assuming their roles and many receive little or no training once they are in their roles. This study used mixed methods to examine the applicability of the National Center for Healthcare Leadership (NCHL) competency model to spiritual care manager roles. Interviews were conducted with 10 spiritual care managers across the country, using a Behavioral Event Interviewing (BEI) methodology. Interviews were quantitatively analyzed by using Natural Language Processing and qualitatively analyzed by thematic approach using NVIVO. The results found the EXECUTION domain to be the most discussed theme, followed by RELATIONS, TRANSFORMATION, and BOUNDARY SPANNING. Collectively these analyses suggest the NCHL Leadership Competency Model can provide a useful framework for understanding the roles and development needs of spiritual care managers.
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Affiliation(s)
- Dae Hyun Kim
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Fitchett
- Department of Religion Health and Human Values, Rush University Medical Center, Chicago, IL, USA
| | - Jami L Anderson
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew N Garman
- Department of Health Systems Management, Rush University Medical Center, Chicago, IL, USA
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43
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Palmer JA, Smith AM, Paasche-Orlow RS, Fitchett G. Research Literature on the Intersection of Dementia, Spirituality, and Palliative Care: A Scoping Review. J Pain Symptom Manage 2020; 60:116-134. [PMID: 31923556 DOI: 10.1016/j.jpainsymman.2019.12.369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
Abstract
CONTEXT Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care. OBJECTIVES We conducted the first scoping review examining the nature and breadth of peer-reviewed studies across these three topics to guide future research. METHODS The scoping review followed methods from The Joanna Briggs Institute Reviewers' Manual (2015). We developed a priori a scoping review protocol outlining the population, concept, and context for study; data sources; search strategy; inclusion/exclusion criteria; and procedure for screening, extracting, and analyzing data. RESULTS The final sample consisted of 19 studies with the following themes: characterizing spiritual needs, preferences, and resources; characterizing palliative or spiritual care; predicting provision of spiritual care; and assessing spiritual care interventions. Eighteen studies were published in the past decade, and 11 studies were based in Europe. Most studies focused on long-term care settings, grouped stages of dementia or did not specify dementia stage, and investigated interventions indirectly related to spiritual care. Many studies were limited in sample size and generalizability/transferability and used less sophisticated research designs. CONCLUSION Research across dementia, spirituality, and palliative care needs to examine settings beyond long-term care, distinct stages of dementia, and formal spiritual care interventions plus use rigorous study designs (e.g., randomized clinical trials). Such research could advance practice and policy that enhance quality of life for tens of millions of persons with dementia and their family members worldwide.
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Affiliation(s)
- Jennifer A Palmer
- The Hinda & Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, USA.
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Kørup AK, Wehberg S, Hvidt EA, Hvidt NC, Fitchett G, Hansen DG. Age‐stratified validation of the functional assessment of chronic illness
therapy‐spiritual well‐being
based on a large cohort of Danish cancer survivors. Psychooncology 2020; 29:1217-1223. [DOI: 10.1002/pon.5412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/27/2020] [Accepted: 05/05/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Alex K. Kørup
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
- Department of Mental Health Kolding‐VejleRegion of Southern Denmark Vejle Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
| | - Elisabeth A. Hvidt
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
- Department for the Study of CultureUniversity of Southern Denmark (SDU) Odense Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
- Academy of Geriatric Cancer Research (AgeCare)Odense University Hospital Odense Denmark
| | - George Fitchett
- Department of Religion Health and Human Values, College of Health SciencesRush University Chicago Illinois USA
| | - Dorte Gilså Hansen
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
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Labuschagne D, Torke A, Grossoehme D, Rimer K, Rucker M, Schenk K, Slaven J, Fitchett G. Chaplaincy Care in the MICU: Describing the Spiritual Care Provided to MICU Patients and Families at the End of Life. Am J Hosp Palliat Care 2020; 37:1037-1044. [PMID: 32193950 DOI: 10.1177/1049909120912933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gravely ill patients admitted to the intensive care unit (ICU), and their families experience acute spiritual and existential needs and often require complex decisions about their care. Little is known about what constitutes chaplaincy care for patients or families in ICUs. Chaplains report that participation in medical decision-making is part of their role. OBJECTIVE To describe the spiritual care provided to patients and their families in the ICU. METHODS This was a retrospective observational study of spiritual care for patients and families in the medical ICUs (MICUs) at 4 medical centers over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information (number of visits, length of visit, chaplain categories, and type of spiritual care provided). RESULTS Of the 254 patients, 197 (78%) received a total of 485 spiritual care visits. Seventy-seven percent of visits included provision of emotional/spiritual support; only 15% included decision-making support such as family meetings or goals-of-care conversations. The proportion receiving spiritual care increased as patients neared death or discharge. Staff chaplains were involved in goals-of-care conversations to a greater extent than student or part-time chaplains (P < .05). CONCLUSION Spiritual care was provided to most patients and/or families at the end of life. Low chaplain involvement in decision-making in the MICU suggests opportunities to improve chaplains' contributions to ICU care.
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Affiliation(s)
- Dirk Labuschagne
- Department of Religion, Health and Human Values, 2468Rush University Medical Center, Chicago, IL, USA
| | - Alexia Torke
- Department of Medicine, 12250 Indiana University School of Medicine, Indianapolis, IN, USA.,Daniel F Evans Center for Spiritual and Religious Values in Healthcare, 12250IU Health, Indianapolis, IN, USA
| | - Daniel Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
| | - Katie Rimer
- Department of Spiritual Care and Education, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Martha Rucker
- Department of Spiritual Care, Ascension St. Thomas, Nashville, TN, USA
| | - Kristen Schenk
- Department of Religion, Health and Human Values, 2468Rush University Medical Center, Chicago, IL, USA
| | - James Slaven
- Department of Biostatistics, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, 2468Rush University Medical Center, Chicago, IL, USA
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46
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Canada AL, Murphy PE, Stein K, Alcaraz KI, Leach CR, Fitchett G. Examining the impact of cancer on survivors' religious faith: A report from the American Cancer Society study of cancer survivors-I. Psychooncology 2020; 29:1036-1043. [PMID: 32128944 DOI: 10.1002/pon.5374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/14/2020] [Accepted: 02/29/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The impact of religion/spirituality (R/S) on cancer outcomes, including health-related quality of life (HRQoL), has been the topic of much investigation. Reports of the opposite, that is, the impact of cancer on R/S and associations with HRQoL, are few. The current study sought to explore the positive and negative impacts of cancer on the religious faith of survivors as well as the associations of such impacts with HRQoL. METHODS Participants included 2309 9-year survivors of cancer from the American Cancer Society's Studies of Cancer Survivors-I. The impact of cancer on R/S was measured using items from the Patient-Reported Outcomes Measurement Information System (PROMIS) psychosocial impact of illness-faith, and HRQoL was measured with the 12-item short form (SF-12). Hierarchical regressions were used to examine the impact of cancer on R/S controlling for medical and demographic covariates. RESULTS Consistent with hypotheses, the majority of survivors (70%) reported that cancer had a positive impact on religious faith, while the negative impact of cancer on religious faith was relatively rare (17%). In multivariable models, the negative impact of cancer on faith was associated with poorer HRQoL, both mental and physical, while the positive impact of cancer on faith was associated with greater mental well-being. CONCLUSIONS Cancer has a negative impact on religious faith for a minority of survivors. However, when it is reported, such negative impact is indicative of poorer mental and physical well-being. As such, it is important to identify those survivors at risk early in survivorship and provide support and intervention as needed.
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Affiliation(s)
- Andrea L Canada
- Rosemead School of Psychology, Biola University, La Mirada, California, USA
| | - Patricia E Murphy
- Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA
| | - Kevin Stein
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kassandra I Alcaraz
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia, USA
| | - Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia, USA
| | - George Fitchett
- Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA
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Abstract
Changing U.S. demographics and the growing emphasis on diversity in the healthcare workforce requires professional healthcare chaplains to examine the characteristics of its own workforce. Previous research suggested that chaplains were mainly Caucasian/White and Mainline Protestant. To explore further, this paper presents a baseline sketch of the workforce and identifies important differences among board-certified chaplains (BCCs), certified educators, certified educator candidates (CECs), and clinical pastoral education (CPE) students. Although missing data quickly became the central story of the analysis and thus requires caution in comparison, the preliminary results suggest BCCs and Certified Educators are older and Whiter/more Caucasian than CECs and CPE students. At least one-third of chaplains and Certified Educators identify as Mainline Protestant, but students and CECs reported greater variation in religious affiliation. Chaplains may be similar to users of healthcare and hospitalized persons in terms of gender and race/ethnicity. Recommendations include suggestions for improving the data infrastructure of professional chaplaincy organizations.
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Affiliation(s)
- Kelsey B White
- Department of Health Management and System Sciences, University of Louisville, Louisville, KY, USA
| | | | - Wendy Cadge
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | - George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, IL, USA
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Clevenger C, Cadge W, Stroud IE, Palmer PK, Haythorn T, Fitchett G. Education for professional chaplaincy in the US: mapping current practice in Clinical Pastoral Education (CPE). J Health Care Chaplain 2020; 27:222-237. [PMID: 32031505 DOI: 10.1080/08854726.2020.1723191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In light of questions that have been raised about education for professional healthcare chaplaincy, we examined the skills and knowledge Clinical Pastoral Educators believe students need to perform the essential tasks and responsibilities of a chaplain. At 19 recently re-accredited ACPE centers across the country, we asked educators about the knowledge chaplains need to be effective, the specific content areas they teach, and how didactic education is planned and organized within their programs. Beyond a focus on religious diversity, we found little consensus among educators regarding a core knowledge base that should be taught during CPE. While most respondents in our study recognize the importance of didactic education in preparing students to become chaplains, there is a lack of consistency in didactic curricula across programs. Our findings suggest the need for broader conversation and collaboration among educators, national chaplaincy organizations, and theological schools regarding the goals, priorities, and outcomes of CPE.
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Affiliation(s)
- Casey Clevenger
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | - Wendy Cadge
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | | | - Patricia K Palmer
- Woodruff Health Sciences Center, Department of Spiritual Health, Emory University, Atlanta, GA, USA
| | - Trace Haythorn
- Association of Clinical Pastoral Education, Atlanta, GA, USA
| | - George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, IL, USA
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Fitchett G, Hisey Pierson AL, Hoffmeyer C, Labuschagne D, Lee A, Levine S, O'Mahony S, Pugliese K, Waite N. Development of the PC-7, a Quantifiable Assessment of Spiritual Concerns of Patients Receiving Palliative Care Near the End of Life. J Palliat Med 2020; 23:248-253. [PMID: 31483184 PMCID: PMC6987727 DOI: 10.1089/jpm.2019.0188] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2019] [Indexed: 11/12/2022] Open
Abstract
Background: Attending to the religious/spiritual (R/S) concerns of patients is a core component of palliative care. A primary responsibility of the chaplain is to conduct a thorough assessment of palliative care patients' R/S needs and resources. Problems with current approaches to spiritual assessment in all clinical contexts, including palliative care, include limited evidence for their validity, reliability, or clinical usefulness; narrative content; and lack of clinical specificity. Objectives: The aim of our work was to develop an evidence-based, quantifiable model for the assessment of unmet spiritual concerns of palliative care patients near the end of life. Design: The PC-7 model was developed by a team of chaplains working in palliative care. Phase 1 used literature in the field and the chaplains' clinical practice to identify key concerns in the spiritual care of palliative care patients. Phase 2 focused on developing indicators of those concerns and reliability in the chaplains' rating of them. Results: Key concerns in the model include the following. Need for meaning in the face of suffering; need for integrity, a legacy; concerns about relationships; concern or fear about dying or death; issues related to treatment decision making; R/S struggle; and other concerns. An approach to scoring the patients' degree of unmet spiritual concerns was adapted from the literature. Assessing cases from the chaplains' practice led to high levels of agreement (reliability). Conclusion: Using the PC-7 model, chaplains can describe and quantify the key spiritual concerns of palliative care patients. Further research is needed to test its validity, reliability, and clinical usefulness.
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Affiliation(s)
- George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois
| | | | | | - Dirk Labuschagne
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois
| | - Aoife Lee
- Spiritual Care, Rush Oak Park Hospital, Oak Park, Illinois
| | - Stacie Levine
- Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Karen Pugliese
- Spiritual Care and Education, Northwestern Medicine, Central DuPage Hospital, Winfield, Illinois
| | - Nancy Waite
- Evanston Hospital, NorthShore University Health System, Evanston, Illinois
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Torke AM, Fitchett G, Maiko S, Burke ES, Slaven JE, Watson BN, Ivy S, Monahan PO. The Association of Surrogate Decision Makers' Religious and Spiritual Beliefs With End-of-Life Decisions. J Pain Symptom Manage 2020; 59:261-269. [PMID: 31539603 PMCID: PMC6989362 DOI: 10.1016/j.jpainsymman.2019.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/20/2022]
Abstract
CONTEXT Although religion and spirituality are important to surrogate decision makers, little is known about the role of religion in decision making regarding life-sustaining treatments. OBJECTIVES To determine the relationships between dimensions of religion and spirituality and medical treatment decisions made by surrogates. METHODS This prospective observational study enrolled patient/surrogate dyads from three hospitals in one metropolitan area. Eligible patients were 65 years or older and admitted to the medicine or medical intensive care services. Baseline surveys between hospital days 2 and 10 assessed seven dimensions of religion and spirituality. Chart reviews of the electronic medical record and regional health information exchange six months after enrollment identified the use of life-sustaining treatments and hospice for patients who died. RESULTS There were 291 patient/surrogate dyads. When adjusting for other religious dimensions, demographic, and illness factors, only surrogates' belief in miracles was significantly associated with a lower surrogate preference for do-not-resuscitate status (adjusted odds ratio [aOR] 0.39; 95% CI 0.19, 0.78). Among patients who died, higher surrogate intrinsic religiosity was associated with lower patient receipt of life-sustaining treatments within the last 30 days (aOR 0.66; 95% CI 0.45, 0.97). Belief in miracles (aOR 0.30; 95% CI 0.10, 0.96) and higher intrinsic religiosity (aOR 0.70; 95% CI 0.53, 0.93) were associated with lower hospice utilization. CONCLUSION Few religious variables are associated with end-of-life preferences or treatment. Belief in miracles and intrinsic religiosity may affect treatment and should be identified and explored with surrogates by trained chaplains or other clinicians with appropriate training.
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Affiliation(s)
- Alexia M Torke
- Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA; IU Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA; Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA.
| | - George Fitchett
- Department of Religion, Health and Human Values, College of Health Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Saneta Maiko
- Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA; Indiana Conference, United Methodist Church, Greenwood, Indiana, USA
| | - Emily S Burke
- Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - James E Slaven
- IU Department of Biostatistics, IU School of Medicine, Indianapolis, Indiana, USA
| | | | - Steven Ivy
- Association for Clinical Pastoral Education, Decatur, Georgia, USA
| | - Patrick O Monahan
- IU Department of Biostatistics, IU School of Medicine, Indianapolis, Indiana, USA
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