A Model for Collaborative Spiritual and Psychiatric Care of Oncology Patients
Larkin Elderon, M.D., Psychiatry Resident, Boston University Medical Center
Kathleen Gallivan, PhD. Director, Spiritual Care Services Department, Brigham and Women's Hospital
Vera O'Brien, MDiv., Staff Chaplain, Brigham and Women's Hospital
John R. Peteet, M.D., Associate Professor of Psychiatry, Harvard Medical School
Background: Many oncology patients at Brigham & Women’s Hospital are seen by both chaplains and consultation/liaison (C/L) psychiatrists during inpatient hospital stays. Chaplains and psychiatrists rarely discuss these cases with one another, a trend consistent with nationwide patterns (Nieuwsma, 2013). We hypothesized that psychiatrists and chaplains would find interdisciplinary discussions of shared patients helpful.
Methods: From April through December 2015, the psychiatry C/L service at Brigham & Women’s Hospital piloted interdisciplinary rounds, where chaplains and C/L psychiatrists discussed common patients. These sessions were specific to oncology cases. Thirteen interdisciplinary rounds were held, discussing a total of 26 patients. Psychiatrists and chaplains participating in the study completed 3 types of questionnaires: baseline (prior to any discussions), post case discussion (referring to a given week’s rounds), and conclusion (after completing all rounds). Each questionnaire included multiple-choice questions and free-text responses. The percentage of participants choosing each response to multiple-choice questions was calculated and compared between baseline and conclusion. Free-text responses will be qualitatively analyzed. The project was approved by the Institutional Review Board. Participation was voluntary and anonymous. Informed consent was obtained prior to data collection.
Results: Eighteen participants completed baseline questionnaires. Fifteen participants completed at least one post case discussion questionnaire (42 total completed), and 11 completed conclusion questionnaires. Between baseline and conclusion, the proportion of participants describing themselves as “very satisfied” (the highest satisfaction ranking) with the level of integration between the two services rose from zero to 36%. Proportion of participants feeling “not comfortable” addressing issues in the other discipline declined from 17% to 0%, and proportion of participants feeling “very comfortable” (the highest comfort ranking) making a referral to the other discipline rose from 44% to 91%. The most frequently chosen options on how discussions had been helpful were that they had enhanced a.) understanding of patient needs (83.3%), and b.) appreciation for what the other discipline had to offer (78.6%). At conclusion, 100% of respondents stated that they felt integrated rounds had been “very helpful” (the highest ranking of four options). Ten participants answered the question of whether they would like for interdisciplinary rounds to continue; all responded affirmatively.
Conclusion: Integrating chaplains in psychiatry C/L rounds was perceived by members of both specialties to be helpful to both caring for patients and understanding the other discipline. After a series of integrated rounds, participants reported increased comfort with the other specialty and greater satisfaction with the level of interdisciplinary integration.
Kathleen Gallivan, PhD. Director, Spiritual Care Services Department, Brigham and Women's Hospital
Vera O'Brien, MDiv., Staff Chaplain, Brigham and Women's Hospital
John R. Peteet, M.D., Associate Professor of Psychiatry, Harvard Medical School
Background: Many oncology patients at Brigham & Women’s Hospital are seen by both chaplains and consultation/liaison (C/L) psychiatrists during inpatient hospital stays. Chaplains and psychiatrists rarely discuss these cases with one another, a trend consistent with nationwide patterns (Nieuwsma, 2013). We hypothesized that psychiatrists and chaplains would find interdisciplinary discussions of shared patients helpful.
Methods: From April through December 2015, the psychiatry C/L service at Brigham & Women’s Hospital piloted interdisciplinary rounds, where chaplains and C/L psychiatrists discussed common patients. These sessions were specific to oncology cases. Thirteen interdisciplinary rounds were held, discussing a total of 26 patients. Psychiatrists and chaplains participating in the study completed 3 types of questionnaires: baseline (prior to any discussions), post case discussion (referring to a given week’s rounds), and conclusion (after completing all rounds). Each questionnaire included multiple-choice questions and free-text responses. The percentage of participants choosing each response to multiple-choice questions was calculated and compared between baseline and conclusion. Free-text responses will be qualitatively analyzed. The project was approved by the Institutional Review Board. Participation was voluntary and anonymous. Informed consent was obtained prior to data collection.
Results: Eighteen participants completed baseline questionnaires. Fifteen participants completed at least one post case discussion questionnaire (42 total completed), and 11 completed conclusion questionnaires. Between baseline and conclusion, the proportion of participants describing themselves as “very satisfied” (the highest satisfaction ranking) with the level of integration between the two services rose from zero to 36%. Proportion of participants feeling “not comfortable” addressing issues in the other discipline declined from 17% to 0%, and proportion of participants feeling “very comfortable” (the highest comfort ranking) making a referral to the other discipline rose from 44% to 91%. The most frequently chosen options on how discussions had been helpful were that they had enhanced a.) understanding of patient needs (83.3%), and b.) appreciation for what the other discipline had to offer (78.6%). At conclusion, 100% of respondents stated that they felt integrated rounds had been “very helpful” (the highest ranking of four options). Ten participants answered the question of whether they would like for interdisciplinary rounds to continue; all responded affirmatively.
Conclusion: Integrating chaplains in psychiatry C/L rounds was perceived by members of both specialties to be helpful to both caring for patients and understanding the other discipline. After a series of integrated rounds, participants reported increased comfort with the other specialty and greater satisfaction with the level of interdisciplinary integration.