Partners in Healing: Fostering Dialogues Between Physicians and Chaplains About the Role of Spiritual Care in Healthcare
TJ Douglas, MDiv, New York Presbyterian Weill-Cornell, New York City, NY; Rachel Rim, MDiv, BCC, NYP Columbia, New York City, NY; Ronald Adelman, MD, New York Presbyterian Weill-Cornell, New York City, NY; and Rev. Jon Overvold, MDiv, BCC, New York Presbyterian, New York City, NY
Learning Objectives
1. Describe an interdisciplinary curriculum between physicians in training and chaplains in training, focused on care for the human spirit (of patients and clinicians) in the hospital setting
2. Outline the goals, methods and outcomes of cross-discipline dialogues in a reflective learning environment
Background/Rationale
Spiritual care is a crucial but often neglected element of health care. A central argument of our curriculum is that all beings are spiritual beings, if spirituality is loosely but profoundly defined as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred”(Puchalski).
Research shows an unmet need for spiritual care from medical teams, leading to poorer health outcomes, poorer end of life outcomes, and higher patient (and clinician) distress. Research shows that spiritual needs are common among patients in serious illness, that most patients (regardless of religious / spiritual identity) want their care team to address their spiritual / existential suffering; and that spiritual care from the medical team plays a significant role in medical decision making and positive healthcare outcomes. Lack of training is the primary cause of this unmet need - around what spiritual care means, how to offer it at a basic level as a “spiritual generalist,” and when to refer patients to a chaplain as “spiritual specialist.”
Holistic care requires medical teams who can address the human spirit. Medical training overlooks physicians’ care for their own human spirit, making it challenging to be present to patients’ spiritual distress, or make appropriate chaplaincy referrals. Chaplains often work on the margins, not emboldened to share humanist or spiritual insights in such a medicalized world, even when such insights are crucial to the care plan. The result is that many patients in need of spiritual care never receive it, and many key insights are not shared between these disciplines, to the detriment of patient care.
Methods/Methodology
The aims of our curriculum were to (1) provide spiritual care training to physicians; (2) equip chaplains to step into role as integral members of the team; (3) strengthen the partnership between chaplains and doctors; (4) provide space for reflection, connection to self, and meaning-making.
Authors designed a 16-hour curriculum in four sessions: (1) spirituality and the chaplain-doctor partnership (2) the chaplain’s role on the interdisciplinary team; (3) spiritual and emotional issues related to pain and suffering; (4) death and dying. Each consisted of a case study, large group didactic, small group discussion, and cross-discipline partnered reflections.
Authors conducted a pre and post survey, and post-program interviews using a questionnaire addressing changes in skills, awareness and knowledge, and welcomed narrative feedback. A thematic analysis was conducted.
Results:
Physicians reported increases in the following: awareness of chaplain’s role; frequency of chaplaincy collaboration; understanding importance of a patient’s spirit in their care plan; skill in conducting spiritual screenings / histories; ability to traverse difficult existential terrain with patients; awareness of how spiritual distress manifests; recognizing importance of caring for their own spirit in their work; connection to meaning in work.
Chaplains reported an increase in the following: understanding value of their role/voice to the care plan and IDT; confidence engaging the IDT; partnership with physicians in clinical work; understanding stressors and distress factors physicians face and where chaplains could be helpful.
Physician quotes:
“This course made me aware of chaplaincy as a field. I used to think chaplains were religious-specific only. Now I see them as addressing the existential Pandora's box that opens in illness. Just like I’d call a nephrologist for a kidney problem, I’ll call a chaplain if someone needs spiritual or existential support. I now know how to recognize these needs and I’m less afraid of them. This has helped me feel less distressed when a patient I have is suffering in non-physical ways.”
“A lot of people lose themselves in medical training. You watch them harden. You worry about whether they’ll come back. It’s hard to tend to your own spiritual needs in this work. I needed this space to reconnect to why I got into medicine and to make more room for meaning in my patient care.”
Conclusions
This curriculum enhanced the attitudes /competence of participants in navigating spiritual distress and understanding chaplains and physicians as partners in healing. It suggests that cross-discipline, reflective learning between physicians and chaplains allows for integration of the human spirit in medicine, strengthening comprehensive patient-centered care and mitigating clinician burnout.
1. Describe an interdisciplinary curriculum between physicians in training and chaplains in training, focused on care for the human spirit (of patients and clinicians) in the hospital setting
2. Outline the goals, methods and outcomes of cross-discipline dialogues in a reflective learning environment
Background/Rationale
Spiritual care is a crucial but often neglected element of health care. A central argument of our curriculum is that all beings are spiritual beings, if spirituality is loosely but profoundly defined as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred”(Puchalski).
Research shows an unmet need for spiritual care from medical teams, leading to poorer health outcomes, poorer end of life outcomes, and higher patient (and clinician) distress. Research shows that spiritual needs are common among patients in serious illness, that most patients (regardless of religious / spiritual identity) want their care team to address their spiritual / existential suffering; and that spiritual care from the medical team plays a significant role in medical decision making and positive healthcare outcomes. Lack of training is the primary cause of this unmet need - around what spiritual care means, how to offer it at a basic level as a “spiritual generalist,” and when to refer patients to a chaplain as “spiritual specialist.”
Holistic care requires medical teams who can address the human spirit. Medical training overlooks physicians’ care for their own human spirit, making it challenging to be present to patients’ spiritual distress, or make appropriate chaplaincy referrals. Chaplains often work on the margins, not emboldened to share humanist or spiritual insights in such a medicalized world, even when such insights are crucial to the care plan. The result is that many patients in need of spiritual care never receive it, and many key insights are not shared between these disciplines, to the detriment of patient care.
Methods/Methodology
The aims of our curriculum were to (1) provide spiritual care training to physicians; (2) equip chaplains to step into role as integral members of the team; (3) strengthen the partnership between chaplains and doctors; (4) provide space for reflection, connection to self, and meaning-making.
Authors designed a 16-hour curriculum in four sessions: (1) spirituality and the chaplain-doctor partnership (2) the chaplain’s role on the interdisciplinary team; (3) spiritual and emotional issues related to pain and suffering; (4) death and dying. Each consisted of a case study, large group didactic, small group discussion, and cross-discipline partnered reflections.
Authors conducted a pre and post survey, and post-program interviews using a questionnaire addressing changes in skills, awareness and knowledge, and welcomed narrative feedback. A thematic analysis was conducted.
Results:
Physicians reported increases in the following: awareness of chaplain’s role; frequency of chaplaincy collaboration; understanding importance of a patient’s spirit in their care plan; skill in conducting spiritual screenings / histories; ability to traverse difficult existential terrain with patients; awareness of how spiritual distress manifests; recognizing importance of caring for their own spirit in their work; connection to meaning in work.
Chaplains reported an increase in the following: understanding value of their role/voice to the care plan and IDT; confidence engaging the IDT; partnership with physicians in clinical work; understanding stressors and distress factors physicians face and where chaplains could be helpful.
Physician quotes:
“This course made me aware of chaplaincy as a field. I used to think chaplains were religious-specific only. Now I see them as addressing the existential Pandora's box that opens in illness. Just like I’d call a nephrologist for a kidney problem, I’ll call a chaplain if someone needs spiritual or existential support. I now know how to recognize these needs and I’m less afraid of them. This has helped me feel less distressed when a patient I have is suffering in non-physical ways.”
“A lot of people lose themselves in medical training. You watch them harden. You worry about whether they’ll come back. It’s hard to tend to your own spiritual needs in this work. I needed this space to reconnect to why I got into medicine and to make more room for meaning in my patient care.”
Conclusions
This curriculum enhanced the attitudes /competence of participants in navigating spiritual distress and understanding chaplains and physicians as partners in healing. It suggests that cross-discipline, reflective learning between physicians and chaplains allows for integration of the human spirit in medicine, strengthening comprehensive patient-centered care and mitigating clinician burnout.