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EvidenceBased Spiritual Care:

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Some believe evidence-based spiritual care is an oxymoron (O'Connor, 2002a) ... Hope in the midst of challenge: Evidence based pastoral care. ... – PowerPoint PPT presentation

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Title: EvidenceBased Spiritual Care:


1
  • Evidence-Based Spiritual Care
  • Desirable? Feasible?
  • How Do We Get There?
  • Spiritual Care Summit 09 Workshop
  • February 3, 2009

2
Goals
  • The goals of the workshop were for participants
    to
  • 1. Become familiar with the case for and against
    evidence-based spiritual care.
  • 2. Be able to describe 1 example of
    evidence-based spiritual care.
  • 3. Be able to describe 3 steps that are necessary
    for healthcare chaplaincy to become an
    evidence-based profession.

3
Description
  • In this workshop a panel of leaders in spiritual
    care research addressed the challenges of moving
    toward evidence-based spiritual care. The topics
    they covered included
  • Is evidence-based spiritual care desirable?
  • Is it feasible?
  • Are there any examples of it?
  • What will it take to make healthcare chaplaincy
    an evidence-based profession?

4
The Panelists
  • Thomas St. James OConnor, ThD
  • Daniel Grossoehme, DMin, BCC
  • Michele LeDoux Sakauri, D.Min.
  • George Fitchett, PhD, BCC
  • Barbara Brumleve, SSND, PhD was the Moderator.

5
Evidence-Based Spiritual Care
  • Thomas St. James OConnor, ThD
  • Professor, Delton Glebe Chair,
  • Pastoral Counselling, WLS/WLU
  • CPE PCE Supervisor, CAPPE,
  • St. Josephs Health Care, Hamilton, Ontario
  • toconnor_at_wlu.ca

6
What is it?
  • Judicious use of scientific evidence on
    spirituality and religion in the spiritual care
    and therapy of patients/clients.
  • Different levels of evidence not all are
    regarded as equal.
  • McMaster University (Hamilton, Ont, an originator
    of evidence based health care), various levels of
    evidence are noted (OConnor Meakes, 1998)

7
  • 1. Quantitative research with Randomized Control
    Trials (RCT) that are replicated is the highest
    form of evidence.
  • 2. Qualitative research studies
  • 3. Case Studies
  • 4. Theoretical discussion
  • 5. Anecdotal evidence with an emphasis on
    clinical wisdom.

8
  • All the evidence needs to be critically reviewed
    - there are studies which are poorly done with
    questionable findings.
  • At McMaster, huge debate over evidence. One of
    the former assistant deans of the faculty of
    health sciences, and now a CEO, offers
    interesting insight - what kind of evidence and
    for whom.

9
  • Evidence as the result of the search for truth
    (OConnor, 2002b) whether in science, theology,
    social sciences, therapy, spiritual care.
  • Job of chaplain and pastoral counselor is to
    offer the best service to clients/patients
  • That means implementing and using the best
    evidence in spiritual care and therapy.

10
Oxymoron or Paradox
  • Some believe evidence-based spiritual care is an
    oxymoron (OConnor, 2002a) two different
    paradigms that cannot meet. How to measure grace
    and spiritual care?
  • Paradox exist can work together.
  • Ian Barbours four relationships between science
    religion - Religion and Science a) conflict
    b) separate and different c) meeting on the
    boundaries d) integration.
  • Evidence based spiritual care exists in the last
    two relationships.

11
My Experience
  • Mixed - I like it and endorse it knowing that one
    ought to be searching the research for good
    evidence that will help clients.
  • Yet, the spiritual care relationship offers a
    unique context that is different from a doctor
    implementing solid evidence.
  • Importance of clinical wisdom and intuition.
  • Challenge of reading research the gap

12
Steps to Lessening the Gap
  • Require my students in the internship at St.
    Joes to take a graduate course in research.
    Required to do a literature review on spiritual
    care on a clinical population.
  • Then they are required to put their literature
    review into a poster present it at WLU, the
    hospital, a conference and/or to peers.
  • Huge anxiety over this some students give up on
    it but many complete it. Some have won awards
    from the Society for Pastoral Counselling
    Research (SPCR) for their posters.

13
Citations
  • OConnor, T Meakes, E (1998). Hope in the
    midst of challenge Evidence based pastoral care.
    The Journal of Pastoral Care 52(4), 359-368
  • OConnor, T (2002a). Is evidence based spiritual
    care an oxymoron. Journal of Religion and Health
    41(3), 253-261
  • OConnor, T.(2002b). The search for truth Case
    for evidence based chaplaincy. Journal of Health
    Care Chaplaincy, 13(1), 185-194.

14
Evidence-based Pastoral Care
  • Daniel H. Grossoehme, D.Min., BCC
  • Assistant Professor, Division of Pulmonary
    Medicine
  • Staff Chaplain II, Department of Pastoral Care
  • Cincinnati Children's Hospital Medical Center
  • Cincinnati, Ohio
  • Daniel.Grossoehme_at_cchmc.org

15
Introduction Desirable?
  • Yes
  • The lack of demonstrated outcomes leads other
    healthcare team members to
  • Ignore religion/spirituality altogether
  • Reduce it to generic psychological mechanisms
    that any other discipline can handle (no unique
    contributions)
  • Language of the medical center like St. Paul in
    Athens, we need to deliver our message in words
    they understand

16
Introduction Feasible?
  • Yes
  • People already in place doing this work
  • In fact, needs to be done by the theologian in
    residence on the healthcare delivery team, not
    (just) by psychologists of religion, etc
  • Easy, no lack of shared definitions

17
Examples
  • Exist already, but gaps are huge, especially in
    pediatrics

18
Examples Questions about how to deliver
interventions
  • A) If we offer it, they will come
  • (1) Pargaments spiritually-based group
    interventions (advertised publicly for college
    students and HIV women) voluntary, outpatient
    setting
  • (2) Hausmans study of (voluntary) time spent in
    chaplains groups at adolescent residential
    treatment center for delinquentstime spent
    linked to less restrictive living situation one
    year later.
  • (3) On-line religion/spirituality (r/s) support
    group for women w/ breast cancer

19
Examples Questions about how to deliver
interventions
  • B) I know what works!
  • (1) gt40 studies link negative religious coping
    with poorer health outcomes. Demonic attribution
    is a RCOPE styleif a mother tells me that the
    Devil caused her adolescents Sickle Cell disease
    because of her lack of devotion.do I try to
    intervene by changing her attributionwhen it
    may be normal theology in her church? (Cotton
    et al., in preparation)
  • (2) A parent tells me in Cystic Fibrosis Clinic
    during an assessment conversation using FICA
    that, We havent been to church in a whileI
    know we probably should How proactive should
    the chaplain be in offering the observation that
    regular attenders seem to have better health
    outcomes?

20
How to move the profession there (other than by
an act of God)
  • 1) Assessments
  • a) Fitchetts work that those at spiritual risk
    are the least frequent requesters of pastoral
    care while those who already have more r/s
    resources than needs are the most frequent
    requesters
  • b) Need to identify those at spiritual risk
    (or whatever term one uses)
  • c) Need to assess. At least in pediatrics, that
    means assessing the familythe child may be just
    fine but the parents.or vice-versa

21
2) Reframing issues (especially as in case with
parent in cystic fibrosis clinic above) calls
for a more proactive or assertive chaplaincy
than (mere) Rogerian listening that most of us
were trained to offer a) Bay, 2006 study b)
Work of Donald Capps (Reframing, 1990)
How to move the profession there (other than by
an act of God)
22
How to move the profession there (other than by
an act of God)
  • 3) Culture shift
  • a) Low percentage of clergy/chaplains have
    science undergrad majors not a language they/we
    speak (or value?)
  • b) Explicit assessments uncommon
  • c) Not part of our training
  • (1) Assessment
  • (2) Pastoral diagnosis
  • (3) Intervention as active and gt Rogerian sharing

23
Conclusion
24
Bibliography References Cited
  • Bay, P. and S. S. Ivy (2006). "Chaplaincy
    research a case study." J Pastoral Care Counsel
    60(4) 343-52.
  • Hausmann, E. (2004). "Chaplain contacts improve
    treatment outcomes in residential treatment
    programs for delinquent adolescents." Journal of
    Pastoral Care Counseling 58(3) 215-224.
  • Iler, W. L., D. Obenshain, et al. (2001). "The
    impact of daily visits from chaplains on patients
    with chronic obstructive pulmonary disease
    (COPD) a pilot study." Chaplaincy Today 17(1)
    5-11.

25
Evidence Based Spiritual Care Desirable?
Feasible? How Do We Get There?
  • Michele Le Doux Sakurai, D.Min. B.C.C.Mission
    Fellow, Trinity Health Systems
  • Director, Mission Services,
  • Saint Alphonsus Medical Center
  • Boise, Idaho
  • MICHSAKU_at_sarmc.org

26
2002 Dissertation Project Ministry of
PresenceNaming What Chaplains Do at the
Bedside
  • Study Parameters
  • Certified Chaplains
  • Practice directed by Ethical and Religious
    Directives (either certified by NACC or works in
    Catholic Healthcare)

27
Study Tools and Limitations
  • A verbatim from Acute Care, Hospice and Long Term
    Care
  • Surveys that were both qualitative and
    quantitative
  • Study participants were self-selecting NOT A
    RANDOMIZED STUDY

28
Study Results Demography
  • 72 of 101 surveys returned and assessed
  • 28 males (3 Protestant Clergy 8 R.C. Priests)
  • 44 women (3 Protestant Clergy 21 Religious)
  • 11 CPE Supervisors
  • Years as a Chaplain
  • Range 1-33 years
  • Average 11.2 years
  • 22 states represented
  • Arenas of Care
  • Acute Care
  • Hospice
  • Long Term Care/AL/Retirement Communities
  • Parish
  • Physician Offices
  • Behavioral Health/Forensics
  • Teaching

29
Study Results, Part 1 An Emerging Model
  • Key Components of Ministry of Presence
  • ROLE Attending to Suffering
  • VIRTUE (that guides relationship)
    Compassion/Acceptance
  • ASSESSMENT VEHICLE Inviting Story/Dialogue
  • INTERVENTIONAL OPTIONS
  • Listening Presence-------Reframing/Facilitating

30
Part 2 Do Chaplain Interventions Make a
Difference?
  • Identifying Spiritual Pain through the Use of a
    Likert-type scale
  • Despair Hope
  • 1 2 3 4 5
  • Estrangement Reconciliation
  • 1 2 3 4 5
  • Grief Gratitude
  • 1 2 3 4 5
  • Anxiety Peace
  • 1 2 3 4 5
  • Abandonment Reconnection
  • 1 2 3 4 5

31
Part II Measuring Spiritual Pain
  • Identifying Spiritual Pain through the Use of a
    Likert-type scale
  • At the beginning of the patient visit Ive
    sinned, Im not sorry and God doesnt like
    sinners who dont repent.
  • Estrangement X Reconciliation
  • 1 2 3 4 5
  • At the conclusion of the visit Its OK to pray
    even when I sin?
  • Estrangement X Reconciliation
  • 1 2 3 4 5
  • Difference between the beginning and the end of
    the visit
  • Estrangement 2 Point Shift towards
    Reconciliation

32
Part II Results Despair to Hope
  • Shift
  • Acute Care (n 69) 2.40 (n65)
  • Hospice (n 70) 1.62 (n57)
  • LTC (n 70) 1.30 (n49)
  • (Bold indicates that 90 of participants believed
    that this issue was significant to the patient in
    the interaction)

33
Part II Results Estrangement to Reconciliation
  • Shift
  • Acute Care (N 69) 1.62 (n46)
  • Hospice (n 70) 1.98 (n70)
  • LTC (n 70) 1.50 (n56)
  • (Bold indicates that 90 of participants believed
    that this issue was significant to the patient in
    the interaction)

34
Other Issues Identified
  • Pain to comfort
  • Fear to assurance
  • Denial to acceptance
  • Meaningless to meaningful
  • Anger to peace
  • Absurdity to meaning
  • Doubt to faith
  • Confusion to clarity

35
Shift towards Healing What is it Chaplains Do?
  • Inviting Story
  • Non-judgmental presence
  • Behaviors that give chaplains credibility
  • Honesty
  • Openness
  • Ability to risk/be vulnerable
  • Willingness to assist in facilitating the inner
    resources of the other

36
SummaryBenefits of a Spiritual Pain Scale
  • The scale parallels Pain Scale used in many
    hospitals and fits into established paradigm
  • An imbedded tool in the electronic chart is not
    required measurement can be documented in the
    narrative chart note
  • Once refined, the scale can be used as an
    outcomes tool.

37
Evidence-Based Spiritual CareHow Do We Get
There?
  • George Fitchett, D.Min., Ph.D.
  • Department of Religion, Health, and Human Values
  • Rush University Medical Center
  • Chicago, Illinois
  • george_fitchett_at_rush.edu
  • http//www.rushu.rush.edu/rhhv

38
How Do We Get There?
39
Chaplaincy A Research-Informed Profession
40
Source Anton T. Boisen Explorations of the Inner
World A Study of Mental Disorder and Religious
Experience (Willett, Clark Company, 1936)
41
Health care chaplains risk becoming ineffective
and marginalized unless we become a research
informed profession.
A Research-Informed Profession
42
A Research-Informed Profession
  • When health care chaplaincy is a research
    informed profession
  • All health care chaplains will be research
    literate
  • Some health care chaplains will be qualified to
    collaborate in research conducted by health care
    colleagues (co-investigators)
  • A few health care chaplains will be qualified to
    lead research projects (principal investigators)

43
A Research-Informed Profession
  • What is a research literate chaplain?
  • A research-literate chaplain has the ability to
    read, understand, and summarize a research study
    and to explain its relevance for his/her ministry.

44
A Research-Informed Profession
  • How do we become a research-informed profession?
  • Wait for leaders and researchers to get us there?
  • Members demand and participate in a
    transformation of the profession?

45
A Research-Informed Profession
  • What steps are needed to transform health care
    chaplaincy into a research-informed profession?
  • A new requirement for board certification is a
    two page summary of a research study
    demonstrating an understanding of the research
    and its application to ones ministry.
  • All board certified chaplains report 10 hours of
    research-related CE a year for the next 5 10
    years.

46
A Research-Informed Profession
  • Implications of this transformation
  • Need to teach research literacy skills in CPE
    residency programs
  • Need to increase CE offerings about research
  • introduction to research
  • research relevant to health care chaplaincy

47
Board Updates Vision Statement
  • The APC Board of Directors has adopted the
    following new vision statement for the
    association
  • Strengthen the professional competency of
    chaplains, so that chaplains will demonstrate
    quality outcomes to those they serve. Demonstrate
    the distinctive value of professional chaplaincy,
    which can be communicated to external
    stakeholders and result in the promotion of
    professional chaplaincy and social justice.
    (posted November 24, 2008)

48
Chaplaincy boards make commitment to
research-informed profession
A New Vision Statement
  • The boards of 3 major US spiritual care
    organizations, the APC, NACC, and ACPE, announced
    a commitment to transform health care chaplaincy
    into a research-informed profession in the next
    ten years.
  • A spokesperson announced that conversations are
    underway with several major foundations to
    provide support to help implement this
    transformation.

49
Begin with Cases
  • Developing evidence about spiritual care should
    begin with detailed case studies, not clinical
    trials.

50
Begin with Cases
  • The foundation for evidence about spiritual care
    is detailed case studies.
  • These case studies must describe
  • Who the patient was the population
  • What the chaplain did the intervention
  • What changed the outcome

51
Begin with Cases
  • These case studies must describe
  • Who the patient was the population
  • What the chaplain did the intervention
  • What changed the outcome
  • Where is this evidence?
  • How many published cases can we point to that
    include this evidence?

52
Begin with Cases
  • What steps are needed to develop detailed a body
    of case studies that can provide evidence about
    the effects of spiritual care?
  • A new requirement for board certification is a
    detailed case study.
  • Every 5 years all board certified chaplains must
    present a detailed case study for peer review.

53
Begin with Cases
  • Would it be helpful to publish a book of cases?
  • These case studies must describe
  • What the chaplain did the intervention
  • Who the patient was the population
  • What changed the outcome
  • Please contact me if you would like to contribute
    to a casebook.
  • george_fitchett_at_rush.edu
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