Fall 2009 Newsletter
On-Line Newsletter Volume 8, Number 1
Published October 29, 2009
Edited by Chaplain John Ehman, Network Convener
Network members are encouraged to submit articles for upcoming issues.
The Newsletter is published three times a year: Fall, Winter, and Spring-Summer.
(The Winter 2010 issue will be published in February.)
This issue of the Newsletter is also available as a printable PDF.
Table of Contents
- Physicians’ Experience and Satisfaction with Chaplains: A National Survey
- A CPE Research Question: "Out of Everything We’ve Talked About Today, What Has Been the Most Helpful?"
- Research in the Department of Religion, Health and Human Values at Rush University Medical Center
- New Articles by Scott Murray on Methodology, and More on Spiritual Trajectories of End-of-Life Experience
- Incidence of EMTs Offering to Contact Chaplains in Non-Resuscitation Cases
- GWish Announces SOERCE
- California Mental Health & Spirituality Initiative
- 12th Spirituality Research Symposium at Penn, and Activities of the HUP Department of Pastoral Care
1. Physicians’ Experience and Satisfaction with Chaplains: A National Survey
A research letter in this week's Archives of Internal Medicine [vol. 169, no. 19 (October 26, 2009): 1808-1810] reports "Physicians’ experience and satisfaction with chaplains: a national survey," by George Fitchett, Kenneth Rasinski, Wendy Cadge, and Farr A. Curlin. The survey of 1102 physicians found that "[m]ost physicians (89%) reported experience with chaplains," and "[a]mong these, most (90%) reported being satisfied or very satisfied with chaplains" [p. 1108]. Data showed that "higher levels of satisfaction were associated with practicing medical or other subspecialties, working in teaching hospitals, endorsing positive effects of R/S on patients, and believing it is appropriate to pray with patients whenever the physician senses it would be appropriate" [p. 1108]. In the geographic regions of the Midwest, West, and South, satisfaction with chaplains was similarly strong, but it was significantly lower in the Northeast.
This research builds particularly upon earlier work: Curlin, F. A., Lantos, J. D., Roach, C. J., Sellergren, S. A. and Chin, M. H., "Religious characteristics of US physicians: a national survey," Journal of General Internal Medicine 20, no. 7 (July 2005): 629-634; which our Network featured as an Article-of-the-Month in October 2005.
2. A CPE Research Question: "Out of Everything We’ve Talked About Today, What Has Been the Most Helpful?" --by Reverend Stephen W. Overall, with Reverend Dr. Larry VandeCreek
Several years ago, a CPE Student came to supervision with a question; "How might I be able to learn what a patient most values from a visit with a chaplain?" After a few Socratic-type reflective questions, I asked the student to reflect on what she most often remembered about her visits, and what did she notice or hear the patient say as she was about to leave that might give her a clue. She recalled that her usual manner of building rapport with her patients included inviting them to share, as they were comfortable, their experience of being in hospital and how their faith had or had not been particularly helpful in supporting them through their health crisis/illness. She also usually asked patients how she might be spiritually supportive during their hospital stay.
The student decided to try an "experiment" and simply ask the patient, at the end of each visit, "Out of everything we’ve talked about today, what has been the most helpful?" The results were quite satisfying to the student, and she began to see how she could improve her listening skills by merely "checking in" with the patient at the end of each visit to be sure she had touched upon the really significant spiritual needs of her patients or at least to glean how she might do so on a repeat visit.
The student’s question intrigued a number of her peers, and with the aid of a fellow ACPE Supervisor, Larry VandeCreek, we proposed that this question be asked by a number of CPE students in various healthcare settings during a summer CPE program. Although the results were never actually formalized or tabulated, a total of 55 CPE students asked 5 patients each this question at the conclusion of their visits.
I have not attempted to replicate this study since that time, but we do believe there might be some valuable lessons to be learned, and possibly some statistically validating information for chaplains and CPE students providing pastoral care and spiritual support for a myriad of hospitalized persons in the future, if such a study were undertaken.
For the original draft of the instructions to students for collecting the information/data, and the reporting form, click HERE. We invite any who would like to explore this matter to try this question out with a few patients and see what they might "teach you" about how they value(d) your particular care.
--September 28, 2009
[Editor's Note: Chaplain Overall (St. Luke's Hospital, Kansas City, MO) may be contacted at email@example.com ]
3. Research in the Department of Religion, Health and Human Values at Rush University Medical Center, Chicago, IL --by Patricia E. Murphy
Our research division includes George Fitchett, DMin, PhD, and Patricia Murphy MA, PhD.
A central aim of our research program is to expand our understanding of the relationship between religion/spirituality and health and to assist chaplains and other health care professionals to apply this information for more effective spiritual care. With this in mind, our aim is to transform chaplaincy to a research informed profession.
While research has been a part of the department for many years, our formal research program began in 1990. Early investigations in our program examined how patients use religion to cope with their illness, patient satisfaction with spiritual care, and outcomes of the department's Clinical Pastoral Education program.
Our research has been supported by departmental and university funds. We have also received more than $500,000 in grants from other agencies, including the National Institute on Aging, the Fetzer Institute, and the E. Rhodes and Leona B. Carpenter Foundation. Our research has been recognized with awards from the Association for Clinical Pastoral Education, the Council on Ministry in Specialized Settings, and the Joint Council on Research in Pastoral Care and Counseling.
Collaboration is a hallmark of our program. Some of our research partners are colleagues in other departments at Rush University Medical Center, including Behavioral Medicine, Psychiatry, Preventive Medicine, and Physical Medicine and Rehabilitation. We also work with colleagues from other Medical Centers such as Northwestern University Medical Center and the University of Chicago Medical Center. Some of our recent research partners are the American Cancer Society and the Hastings Center.
Our research is focused in the following areas:
Religious and Spiritual Coping with Illness -- Many patients turn to religious or spiritual beliefs and practices for consolation and assistance in response to a crisis. Some individuals are able to find the solace and support they seek in their faith, but others are not, and a time of religious struggle may follow. In many cases this period of religious struggle is brief; however, there are some for whom the struggle endures. Our research seeks to improve our understanding of religious coping with illness, both its positive and negative elements, in order to inform spiritual interventions by chaplains and other health care providers.
Race/Ethnicity Related to Religion and Spirituality -- There are racial/ethnic differences in religion and spirituality. We seek to understand how these differences influence the relationship between religion/spirituality and health.
Religion, Spirituality, and Wellness -- There is growing evidence that religion/spirituality can be a protective factor against disease. We are also engaged in research in this area.
Health Care Chaplaincy and Clinical Pastoral Education -- Our research examines the work of health care chaplains. We have developed and tested curricula designed to help health care chaplains become research literate. We have also examined Clinical Pastoral Education programs, including evidence leading to their effectiveness.
Spiritual Assessment -- Our department has long been recognized, nationally and internationally, as a leader in the explicit assessment of spiritual needs and resources. We have played a leading role in developing models for spiritual screening and spiritual assessment.
Measurement of Religion and Spirituality -- Research about the relationship between religion/spirituality and health depends on good measures of religion and spirituality. Our research includes psychometric studies of several of the key instruments used in measuring religion/spirituality.
For more information, visit www.rushu.rush.edu/rhhv
[Editor's Note: Dr. Murphy may be contacted at Patricia_Murphy@rush.edu ]
4. New Articles by Scott Murray on Methodology, and More on Spiritual Trajectories of End-of-Life Experience
In 2007, Scott A. Murray and colleagues from the Primary Palliative Care Research Group at the University of Edinburgh published the intriguing study, "Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure" [Journal of Pain and Symptom Management 34, no. 4 (October 2007): 393-402]. The study offered graphic representations of the trajectories of patients' social, psychological, and spiritual experiences that followed from physical declines in end-stage disease. The article was featured as our November 2007 Article-of-the-Month. A new article on this subject has been published in the Easter 2009 issue of Triple Helix: see Murray, S. A., "Spiritual support in Palliative care," available freely online from the Christian Medical Fellowship (UK).
Now, Professor Murray informs our Network of two recent methodology papers in the British Medical Journal (www.bmj.com) that may be useful to chaplains:
Murray, S. A., Kendall, M., Carduff, E., Worth, A., Harris, F. M., Lloyd, A., Cavers, D., Grant, L., and Sheikh, A. "Use of serial qualitative interviews to understand patients’ evolving experiences and needs." BMJ 339 (September 2009): 958-960. The authors offer a brief overview of longitudinal qualitative research.
Kendall, M., Murray, S. A., Carduff, E., Worth, A., Harris, F., Lloyd, A., Cavers, D., Grant, L., Boyd, K. and Sheikh, A. "Use of multiperspective qualitative interviews to understand patients’ and carers’ beliefs, experiences, and needs." BMJ 339 (October 2009): b4122 [online full text only]. The article describes how to conduct multiperspective studies, especially when exploring the individual and interrelated needs and perceptions of patients, families, and caregivers, and the relational dynamics involved in their interaction.
5. Incidence of EMTs Offering to Contact Chaplains in Non-Resuscitation Cases
A recent study conducted in King County, Washington, "Reasons 9-1-1 is called for cardiac arrest cases in which no resuscitation is attempted" [by Meischke, H., Chavez, D., Feder, S., Rea, T., Albert, T. and Eisenberg, M., in Prehospital Emergency Care 13, no. 3 (July-September 2009): 335-340] states: "The most frequently reported service provided by EMTs for [the study population] was to 'offer to contact a chaplain'" [p. 335, abstract; and see also pp. 336 and 338]. Their data show that Emergency Medical Technicians offered to contact a chaplain in 34% of cases where no resuscitation was desired and in 45% of cases where resuscitation was not started because of irreversible death [--see p. 338, Table 2].
In a personal communication with the lead author, Hendrika Meischke, at the University of Washington, the "chaplain" offered by EMTs was clarified as referring to chaplains connected to Fire Departments. Dr. Meischke conveyed information from Mike Helbock, Training Manager with the Emergency Medical Services Division of the Department of Public Health in Seattle, that referrals to fire chaplains were not part of a formal protocol but were a common and long-standing practice.
The King County study suggests to this reader that the typically distinct worlds of fire chaplaincy and health care chaplaincy may be divided for patients and families along the fine line of an EMT's assessment about whether to transport a patient to a hospital. Since chaplaincy training for those in fire department and health care institutions likely differs in most cases, what might be the differences in the way patients/families experience chaplaincy in the "field" vis-a-vis at the hospital? Chaplains' insights and ideas for research would be welcome: contact firstname.lastname@example.org .
6. GWish Announces SOERCE
The George Washington Institute for Spirituality and Health (GWish) has announced the creation of SOERCE: The Spirituality and Health Online Education and Resource Center, available through the www.gwish.org website. This resource, supported by a grant from the John Templeton Foundation, is being advertised as "the premiere online location for educational and clinical resources in the fields of spirituality, religion, and health" [--from the website]. There is an emphasis on research-oriented material, and our ACPE Research Network Newsletters are linked there.
SOERCE is not only a place to find material but to share it. "We invite everyone working on spirituality and health issues to contribute to SOERCE as a way of sharing your knowledge and expertise." The website gives a form for submissions. Access is by registration, but that is free.
7. California Mental Health & Spirituality Initiative
The California Mental Health & Spirituality Initiative (www.mhspirit.org) was begun in 2008 with the support of county behavioral health authorities in the state. This non-profit initiative, based in the Center for Multicultural Development at the California Institute for Mental Health (Sacramento), principally provides a website intended to be "a primary resource on the Internet for people interested in mental health and spirituality. The website includes a modest listing of "Scientific Literature," and one of the leaders of the initiative is David Lukoff, a psychologist who has authored a number of Medline-indexed articles on spirituality and mental health [e.g.: "Spirituality in the recovery from persistent mental disorders," Southern Medical Journal 100, no. 6 (June 2007): 642-646; "Visionary spiritual experiences," Southern Medical Journal 100, no. 6 (June 2007): 635-641; and, with others, "Religious and spiritual case reports on MEDLINE: a systematic analysis of records from 1980 to 1996," Alternative Therapies in Health & Medicine 5, no. 1 (January 1999): 64-70]. While the project is not focused on research per se, an article in the May-June 2009 issue of California Psychologist [Lukoff, et al., "Spirituality and mental health: a consumer-driven holistic approach to recovery," pp. 14-18] notes: "To respond to…needs identified in research, the Initiative plans to create face-to-face and e-learning courses to improve the spiritual competency of mental health providers in addressing religious and spiritual needs and to support the spiritual journeys of consumers and families" [p. 17].
Chaplains, especially in California, may want to watch for sponsored events, and researchers may find in the Initiative another network interested in spirituality & health studies.
8. 12th Spirituality Research Symposium at Penn, and Activities of the HUP Department of Pastoral Care
The 12th annual Spirituality Research Symposium at the University of Pennsylvania was co-hosted by the Department of Pastoral Care at the Hospital of the University of Pennsylvania (HUP), Penn's Center for Spirituality and the Mind, and the Penn Geriatric Education Center. Among the presenters: Harold G. Koenig, MD, MHSc, founding Co-Director of the Center for Spirituality, Theology, and Health at Duke University Medical Center, gave the keynote address: "Religion, Spirituality, and Health in Older Adults." Also, Andrew B. Newberg, MD, a leading researcher in the neurology of religion, and author of How God Changes Your Brain (2009), spoke on "The Aging Brain and Spiritual Capacity." These annual symposia were begun in 1998 by the Department of Pastoral Care as a way to encourage discussion and collaboration on research into spirituality & health among clinicians, academicians, chaplains, and community clergy. One of the handouts was a sample list of recent spirituality & health research articles, taken from the Department's 2008 bibliography. (For all of the Department's annual bibliographies, see: www.uphs.upenn.edu/pastoral/resed/bibindex.html.)
Also, since 2000, the Department of Pastoral Care has sponsored a monthly Spirituality, Religion, and Health Interest Group at the Hospital of the University of Pennsylvania. Recent topics and presenters have included: "Facing the End of Life as a Hospital Patient: Spiritual Care Needs and Opportunities," with Christina M. Puchalski, MD, Director, George Washington Institute for Spirituality and Health, and Associate Professor, George Washington University School of Medicine and Health Sciences; "The Perspectives and Institutional Realities of Hospital Chaplains," with Wendy Cadge, PhD, Assistant Professor of Sociology, Brandeis University, and Fellow, Radcliffe Institute for Advanced Study, Harvard University; "Differentiating Visionary Spiritual Experiences from Psychotic Hallucinations," with David J. Hufford, PhD, Professor Emeritus, Penn State University; "Aging, Dementia, and Well-Being," with Rabbi Dayle A. Friedman, Director of Hiddur: The Center for Aging and Judaism at the Reconstructionist Rabbinical College, and author of Jewish Pastoral Care; "A Discussion of a New Anthology Project on Religion, Death, and Dying in America," with Lucy Bregman, PhD, Professor of Religion, Temple University; "How Hinduism Views Pain and Suffering," with Sarah M. Whitman, MD, Assistant Professor of Psychiatry, Drexel University College of Medicine; and "Spiritual Transformation and Complementary Therapies Use among Cancer Survivors," with Jun James Mao, MD, MSCE, Assistant Professor, Department of Family Medicine and Community Health, Hospital of the University of Pennsylvania.
The Department is currently completing a study of the impact of illness and treatment on dimensions of spirituality for oncology patients.
For more information, visit www.uphs.upenn.edu/pastoral