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Summer 2011 Newsletter

On-Line Newsletter Volume 9, Number 3
Published June 28, 2011

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 Summer.
(The Fall 2011 issue will be published in October.)


Table of Contents

  1. Update on the ACPE Board Motion on Research
  2. Call for Collaboration on Research on the Impact of Clinical Pastoral Education on Clergy Health
  3. Update and Request Regarding Research into Chaplains' Documentation
  4. Update on "Spiritual Skills" Research
  5. Reading List for the Summer 2011 Duke Spirituality and Health Workshops
  6. Canadian Study: "...From Chaplains to Spiritual Care Providers"
  7. Health Study of Air Force Chaplains
  8. Dissemination of Religion and Health Research
  9. Survey of Spirituality and Health Content in US Medical School Curricula
  10. New "Spirituality/Medicine Interface Project" Theme Issue from the Southern Medical Journal
  11. Research Network Website Given High Marks in Review
  12. Research from 2010 Not Previously Noted on the Research Network Website


1.     Update on the ACPE Board Motion on Research

The ACPE research initiative which was generated by the Board of Representatives' motion in 2010 [see the Winter 2011 Newsletter, §1] remains in process, though on a slower timetable than anticipated. The motion -- for the Executive Director to "work with interested ACPE supervisors and centers and other research experts to design a research initiative for the ACPE" -- originally involved Teresa Snorton, who is now transitioning out of the role of Executive Director; however, Dr. Snorton has expressed to the Network her commitment to see that this transition does not interrupt proper follow-through with the Board. Updates will be posted on our website as they are available. Thanks go again to those who submitted project proposals.


2.     Call for Collaboration on Research on the Impact of Clinical Pastoral Education on Clergy Health

ACPE Supervisor Beth Jackson-Jordan (Carolinas Medical Center NorthEast, Concord, NC) writes regarding a new project:

I am developing a research project to study the impact of CPE on the emotional, physical and spiritual health of clergy. A 2008 Duke Divinity School Clergy Health Initiative survey of over 1,700 United Methodist clergy in North Carolina revealed higher than average rates of serious physical and mental health conditions as well as increased numbers of young clergy leaving the profession within the first five years. Does Clinical Pastoral Education teach practices that promote a healthy lifestyle and effective coping skills for clergy? Is CPE effective for teaching practices that help clergy manage conflict and maintain healthy relationships? Does CPE help clergy identify and know how to address signs of compassion fatigue? What, if any, curriculum changes would increase the effectiveness of CPE as a means of promoting resilience and longevity in ministry? These are some of the research questions I have identified through a survey of the current literature on clergy burnout. I am interested in using both quantitative and qualitative methods in this research. Please contact me if you are interested in collaborating on this project.
Rev. Jackson-Jordan may be contacted at or 704-403-3335.


3.     Update and Request Regarding Research into Chaplains' Documentation

A reminder and update of Sharon Ghamari-Tabrizi's project on chaplains' documentation [--see also the Winter 2011 Newsletter, §2]:

I am making a study of chaplaincy documentation formats, both historically, from the days of Anton Boisen and Russell Dicks, through to the present.

I would be grateful if Research Network participants (particularly CPE supervisors) could send to me copies of old chaplain record notes, verbatims or blank forms. I am interested in tracking differences in record formats and styles across the decades. So if you have old verbatims from the 60s, 70s, 80s, I would greatly appreciate receiving them either as paper copies or digital PDFs.

Interested people can contact me at: I look forward to your historical and contemporary contributions!

Dr. Ghamari-Tabrizi is currently the David B. Larson Fellow at the Kluge Center of the Library of Congress. She is a historian of science making the transition to a second career in healthcare chaplaincy and will begin her MDiv studies at Harvard Divinity School in the Fall 2011. More on her work in general can be found at


4.     Update on "Spiritual Skills" Research

ACPE Supervisor Gordon Hilsman (Franciscan Health System, Tacoma, WA; continues his research of Spiritual Skills. (For background, see the Spring-Summer 2009 Newsletter, §2.) He is currently receiving data studying the self-assessment of 103 spiritual skills by first-unit students before and after their unit of CPE. So far, 18 groups are participating from four different ACPE regions. The data will be compared to a similar study of CPE residents' self-assessments before and after a residency. Ten Pacific Region centers are participating in that study, to be concluded in August 2011.

This data of CPE students will then be compared to earlier data, using the same survey instrument, from physicians, registered nurses, chaplains, CPE supervisors, and health care managers. Publication will hopefully follow. A proposal is in to present salient conclusions at the ACPE annual conference in Arlington, VA in February 2012.

[This current work on Spiritual Skills follows Dr. Hilsman's earlier research identifying Spiritual Needs in patients' own words and connecting those needs with chaplain functions and outcomes for study --as presented at the 2005 ACPE conference in Hawaii.]


5.    Reading List for the Summer 2011 Duke Spirituality and Health Workshops

For the eighth year, the Duke Center for Spirituality, Theology and Health will hold five-day workshops, hosted by Dr. Harold G. Koenig. There will be two sessions this summer: July 18-22 and August 15-19, each limited to 25 participants. Details are available from the CSTH Website.

The Association of Professional Chaplains (APC) has indicated that this educational event provides 30.5 hours of continuing education that can be applied to the educational hours required by the Board of Chaplaincy Certification, Inc. Tuition discounts are available for members of APC members and for members of other professional societies. Full tuition scholarships may be available for applicants with high potential for academic research careers and serious financial hardships, especially graduate students in pre- or post-doctoral programs.

Network members may be especially interested in the recommended reading list, available by clicking HERE.


6.     Canadian Study: "...From Chaplains to Spiritual Care Providers"

Barbara Pesut, from the School of Nursing at the University of British Columbia, has teamed with colleagues from Trinity Western University, adjust faculty from the Associated Canadian Theological Schools Seminary (Langley, British Columbia), and a Spiritual Care Provider at Langley Memorial Hospital, to analyze a subset of data from a large ethnographic study of how spiritual and religious plurality was being handled in Canadian health care services. The study, "Hospitable hospitals in a diverse society: from chaplains to spiritual care providers," Journal of Religion and Health [vol. 51, no. 3 (September 2012): 825-836] works from interviews with 14 Spiritual Care Providers and 7 spiritual care volunteers in the context of a programmatic drive to hire providers able to offer spiritual care to a diverse population. The use of the title "Spiritual Care Provider" (SPC) was a part of the initiative to move away from the term "chaplain" and its historic association with Christianity. The authors state in summary:

...[F]indings from these participants concerned legitimizing and crafting the role of SCPs to become part of the health care team. The sophistication with which participants were able to articulate strategies for negotiating spiritual and religious diversity speaks to the potential for the SCP role to provide for spiritual needs within secular institutions in an increasingly globalized context. Notably, as this publication was being prepared, this same Health Authority laid off the majority of the SCPs in the face of budget deficits. [p. 833]
The article is of interest both for giving a Canadian perspective on chaplaincy issues and for illustrating the personal task by chaplains of "brokering diversity" [see pp. 832 and 834]. To this reader, however, the discussion about diversity here is relatively basic.


7.     Health Study of Air Force Chaplains

The June 2011 issue of the Journal of Traumatic Stress [vol. 24, no 3] has published a study of "Deployment Stressors and Outcomes Among Air Force Chaplains," by Hannah C. Levy and Lauren M. Conoscenti, of the National Center for PTSD, VA Boston Healthcare System; John F. Tillery, of the Air Force Chaplains Corps College; and Benjamin D. Dickstein and Brett T. Litz, of the National Center for PTSD, VA Boston Healthcare System and Boston University. The abstract is as follows:

Military chaplains are invaluable caregiver resources for service members. Little is known about how chaplains respond to the challenge of providing spiritual counsel in a warzone. In this exploratory study, 183 previously deployed Air Force chaplains completed an online survey assessing operational and counseling stress exposure, posttraumatic stress disorder (PTSD) symptoms, compassion fatigue, and posttraumatic growth. Despite reporting exposure to stressful counseling experiences, Air Force chaplains did not endorse high compassion fatigue. Rather, chaplains experienced positive psychological growth following exposure to stressful counseling experiences. However, 7.7% of Air Force chaplains reported clinically significant PTSD symptoms, suggesting that they are not immune to deployment-related mental health problems. Simultaneous regression analyses revealed that counseling stress exposure predicted compassion fatigue (β = .20) and posttraumatic growth (β = .24), suggesting that caretaking in theatre is stressful enough to spur positive psychological growth in chaplains. Consistent with findings from previous studies, hierarchical regression analyses revealed that operational stress exposure predicted PTSD symptom severity (β = .33) while controlling for demographic variables.


8.     Dissemination of Religion and Health Research

An article currently in press at the Journal of Religion and Health (but downloadable ahead of print for subscribers) addresses two questions: Is religion and health research disseminating into the American public? and Do religious persons incorporate religion and health research into their understanding of the connection between religion and health? In "'It’s medically proven!': assessing the dissemination of religion and health research," Steven M. Frenk, Steven L. Foy and Keith G. Meador from Duke, report two studies:

First, we search[ed] three newspapers (The New York Times, The Los Angeles Times, and The Atlanta Journal-Constitution) and three news magazines (Newsweek, Time, and U. S. News and World Report) for articles that mention religion and health research. In the second study, we analyze[d] interview transcripts for respondents’ mentions of religion and health research when discussing the relationship between religion and health. Our results indicate substantial growth over time in media reporting on religion and health research but reveal that only a limited portion of religious persons cite such research in explaining their conceptualizations of the connection between religion and health. [--from the article's Abstract]
Nevertheless, the authors conclude that "religion and health research is reaching beyond academia, and in some instances, is informing people’s understanding of the relationship between religion and health" [p. 10 of 11 of the unnumbered prepublication version].

NOTE: Steven M. Frenk and Keith G. Meador, along with Sarah A. Mustillo and Elizabeth G. Hooten, have another article in press that promises to be valuable for research: "The Clergy Occupational Distress Index (CODI): background and findings from two samples of clergy," which presents a new five-item index. The article was posted ahead of print on the Journal of Religion and Health website on March 16, 2011.


9.     Survey of Spirituality and Health Content in US Medical School Curricula

A recent survey of US medical schools, conducted by Harold G. Koenig and colleagues at Duke University Medical Center, found that about 90% of schools have at least some course or curricular content on Spirituality and Health. This is up from a reported 70% in 2006. However, while medical school deans recognized that 90% of patients may emphasize spirituality in their care and coping, and while 81% of students considered Spirituality and Health content valuable, only 64% of faculty were said to believe that such content was valuable, and only 25% of deans said that their schools would open additional curricular time for Spirituality and Health even if given funding/training assistance. Sixty-two percent of deans did think that online resources in this area would be valuable to support educators. This is the first systematic assessment of Spirituality and Health content in US medical schools. The citation is: Koenig, H. G., Hooten, E. G., Lindsay-Calkins, E. and Meador, K. G., "Spirituality in medical school curricula: findings from a national survey," International Journal of Psychiatry in Medicine 40, no. 4 (2010): 391-398.


10.     New "Spirituality/Medicine Interface Project" Theme Issue from the Southern Medical Journal

Though the Southern Medical Association closed its Spirituality/Medicine Interface Project website in 2010 (--for background, see our Fall 2010 Newsletter, §10), the April 2011 issue [vol. 104, no. 2] of the Southern Medical Journal offers another of the project's special theme sections, this time on Spirituality and Cancer. All of the brief articles are presently FREE through the journal's website via the Table of Contents page (scroll down to the bottom). None of the pieces of this installment are reports of studies, but they may be of interest in a broader context of research. They are:

  • "Spirituality and cancer: an introduction," by Dyer, A. R. (pp. 287-288)
  • "The role of spirituality in hippocratic medicine," by Herrell, H. E. (pp. 289-291)
  • "Reflections on cancer and spirituality," by Grosch, W. N. (pp. 292-293)
  • "Spirituality and medicine: dying with grace," by Mehta, J. B. (pp. 294)
  • "Understanding the role of religion in cancer care in Appalachia," by Behringer, B. and Krishnan, K. (pp. 295-296)
  • "The need for a new 'new medical model': a bio-psychosocial-spiritual model," by Dyer, A. R. (pp. 297-298)
  • "Spirituality and pediatric cancer," by Purow, B., Alisanski, S., Putnam, G. and Ruderman, M. (pp. 299-302)


11.     Research Network Website Given High Marks in Review

A recent search for websites noting our Research Network site turned up a highly positive review on the Spirituality, Medicine & Health site ( edited by Dr. Wesley Wildman of Boston University. In his review, Dr. Wildman is critical of our site's layout (style, ease of navigation), but in spite of this says that it makes up by "offering extraordinary useful and eclectic resources" and providing "a wealth of articles, information, and links of interest to the general reader or the scholarly researcher." He concludes: "A superb and fascinating resource."

Network members may be interested generally in the Spirituality, Medicine & Health site. And, in a communication from Dr. Wildman, he suggests that our Network may also find useful the site for the IBCSR (Institute for the Biocultural Study of Religion) Research Review. Dr. Wildman is a co-founder of the IBCSR.


12.     Research from 2010 Not Previously Noted on the Research Network Website

Each year the Department of Pastoral Care at the University of Pennsylvania Health System produces an annotated bibliography of Medline-indexed articles on Spirituality & Health [--see]. A handout of this bibliography is a standard part of the department's annual Spirituality Research Symposium. The total of 321 entries from 2010, selected from over 1,800 articles indexed under the headings of "Religion and Medicine," "Religion and Psychology," "Religion," "Spirituality," and "Pastoral Care," shows the continued vitality of the literature.

While our Research Network highlights a good number of articles in the course of a year, the following 23 from the UPHS bibliography have until now gone unnoted but may be of special interest.

Ai, A. L., Ladd, K. L., Peterson, C., Cook, C. A., Shearer, M. and Koenig, H. G. [University of Pittsburgh, PA]. "Long-term adjustment after surviving open heart surgery: the effect of using prayer for coping replicated in a prospective design." Gerontologist 50, no. 6 (December 2010): 798-809. [(Abstract:) PURPOSE: despite the growing evidence for effects of religious factors on cardiac health in general populations, findings are not always consistent in sicker and older populations. We previously demonstrated that short-term negative outcomes (depression and anxiety) among older adults following open heart surgery are partially alleviated when patients employ prayer as part of their coping strategy. The present study examines multifaceted effects of religious factors on long-term postoperative adjustment, extending our previous findings concerning prayer and coping with cardiac disease. DESIGN AND METHODS: analyses capitalized on a preoperative survey and medical variables from the Society of Thoracic Surgeons' National Database of patients undergoing open heart surgery. The current participants completed a mailed survey 30 months after surgery. Two hierarchical regressions were performed to evaluate the extent to which religious factors predicted depression and anxiety, after controlling for key demographics, medical indices, and mental health. RESULTS: predicting lower levels of depression at the follow-up were preoperative use of prayer for coping, optimism, and hope. Predicting lower levels of anxiety at the follow-up were subjective religiousness, marital status, and hope. Predicting poorer adjustment were reverence in religious contexts, preoperative mental health symptoms, and medical comorbidity. Including optimism and hope in the model did not eliminate effects of religious factors. Several other religious factors had no long-term influences. IMPLICATIONS: the influence of religious factors on the long-term postoperative adjustment is independent and complex, with mediating factors yet to be determined. Future research should investigate mechanisms underlying religion-health relations.]

Bamford, C. and Lagattuta, K. H. [University of California, Davis]. "A new look at children's understanding of mind and emotion: the case of prayer." Developmental Psychology 46, no. 1 (January 2010): 78-92. [(Abstract:) Multiple methods were used to examine children's awareness of connections between emotion and prayer. Four-, 6-, and 8-year-olds and adults (N = 100) predicted whether people would pray when feeling different emotions, explained why characters in different situations decided to pray, and predicted whether characters' emotions would change after praying. Four- and 6-year-olds exclusively judged that positive emotions motivate prayer, whereas 8-year-olds and adults most often predicted that negative emotions would cause people to pray and that praying could improve emotions. There was also a significant increase between 4 and 8 years in explaining prayer as motivated by need for assistance, for thanksgiving, and for conversation, as well as for explaining postprayer emotions in relation to God or prayer. Religious background predicted individual differences in reasoning only for 4-year-olds.]

Bekelman, D. B., Parry, C., Curlin, F. A., Yamashita, T. E., Fairclough, D. L. and Wamboldt, F. S. [Denver VA Medical Center, CO]. "A comparison of two spirituality instruments and their relationship with depression and quality of life in chronic heart failure." Journal of Pain & Symptom Management 39, no. 3 (March 2010): 515-526. [(Abstract:) Spirituality is a multifaceted construct related to health outcomes that remains ill defined and difficult to measure. Spirituality in patients with advanced chronic illnesses, such as chronic heart failure, has received limited attention. We compared two widely used spirituality instruments, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) and the Ironson-Woods Spirituality/Religiousness Index (IW), to better understand what they measure in 60 outpatients with chronic heart failure. We examined how these instruments related to each other and to measures of depression and quality of life using correlations and principal component analyses. The FACIT-Sp measured aspects of spirituality related to feelings of peace and coping, whereas the IW measured beliefs, coping, and relational aspects of spirituality. Only the FACIT-Sp Meaning/Peace subscale consistently correlated with depression (r=-0.50, P<0.0001) and quality of life (r=0.41, P=0.001). Three items from the depression measure loaded onto the same factor as the FACIT-Sp Meaning/Peace subscale (r=0.43, -0.43, and 0.71), whereas the remaining 12 items formed a separate factor (Cronbach's alpha=0.82) when combined with the spirituality instruments in a principal component analysis. The results demonstrate several clinically useful constructs of spirituality in patients with heart failure and suggest that psychological and spiritual well-being, despite some overlap, remain distinct phenomena.]

Bonaguidi, F., Michelassi, C., Filipponi, F. and Rovai, D. [Institute of Clinical Physiology, National Research Council, Pisa, Italy]. "Religiosity associated with prolonged survival in liver transplant recipients." Liver Transplantation 16, no. 10 (October 2010): 1158-1163. [(Abstract:) We tested the hypothesis that religiosity (ie, seeking God's help, having faith in God, trusting in God, and trying to perceive God's will in the disease) is associated with improved survival in patients with end-stage liver disease who have undergone orthotopic liver transplantation. We studied a group of 179 candidates for liver transplantation who responded to a questionnaire on religiosity during the pretransplant psychological evaluation and underwent transplantation between 2004 and 2007. The demographic data, educational level, employment status, clinical data, and results of the questionnaire were compared with the survival of patients during follow-up, regardless of the cause of any deaths. Factorial analysis of responses to the questionnaire revealed 3 main factors: searching for God (active), waiting for God (passive), and fatalism. The consistency of the matrix was very high (consistency index = 0.92). Eighteen patients died during follow-up (median time = 21 months). In multivariate analysis, only the searching for God factor [hazard ratio (HR) = 2.95, 95% confidence interval (CI) = 1.05-8.32, (2) = 4.205, P = 0.040] and the posttransplant length of stay in the intensive care unit (HR = 1.05, 95% CI = 1.01-1.08, (2) = 8.506, P = 0.035) were independently associated with survival, even after adjustments for the waiting for God factor, fatalism, age, sex, marital status, employment, educational level, viral etiology, Child-Pugh score, serum creatinine level, time from the questionnaire to transplantation, donor age, and intraoperative bleeding. Patients who did not present the searching for God factor were younger than those who did, but they had shorter survival times (P = 0.037) and a 3-fold increased relative risk of dying (HR = 3.01, 95% CI = 1.07-8.45). In conclusion, religiosity is associated with prolonged survival in patients undergoing liver transplantation.]

Chang, B. H., Casey, A., Dusek, J. A. and Benson, H. [Boston University School of Public Health, Boston, MA]. "Relaxation response and spirituality: pathways to improve psychological outcomes in cardiac rehabilitation." Journal of Psychosomatic Research 69, no. 2 (August 2010): 93-100. [(Abstract:) OBJECTIVES: Studies have shown beneficial effects from practicing the relaxation response (RR). Various pathways for these effects have been investigated. Previous small studies suggest that spirituality might be a pathway for the health effects of the RR. In this study, we tested the hypothesis that increased spiritual well-being by eliciting the RR is one pathway resulting in improved psychological outcomes. METHODS: This observational study included 845 outpatients who completed a 13-week mind/body Cardiac Rehabilitation Program. Patients self-reported RR practice time in a questionnaire before and after the 13-week program. Similarly, data on spiritual well-being, measured by the subscale of Spiritual Growth of the Health-Promoting Lifestyle Profile II, were collected. The psychological distress levels were measured by the Symptom Checklist-90-Revised. We tested the mediation effect of spiritual well-being using regression analyses. RESULTS: Significant increases in RR practice time (75 min/week, effect size/ES=1.05) and spiritual well-being scores (ES=0.71) were observed after participants completed the program (P<.0001). Patients also improved on measures of depression, anxiety, hostility and the global severity index with medium effect sizes (0.25 to 0.48, P<.0001). Greater increases in RR practice time were associated with enhanced spiritual well-being (beta=.08, P=.01); and enhanced spiritual well-being was associated with improvements in psychological outcomes (beta=-0.14 to -0.22, P<.0001). CONCLUSION: Our data demonstrated a possible dose-response relationship among RR practice, spiritual and psychological well-being. Furthermore, the data support the hypothesis that spiritual well-being may serve as a pathway of how RR elicitation improves psychological outcomes. These findings might contribute to improved psychological care of cardiac patients.]

Chokkhanchitchai, S., Tangarunsanti, T., Jaovisidha, S., Nantiruj, K. and Janwityanujit, S. [Phranakhon Sri Ayutthaya Hospital, Bangkok, Thailand]. "The effect of religious practice on the prevalence of knee osteoarthritis." Clinical Rheumatology 29, no. 1 (January 2010): 39-44. [(Abstract:) The aim of this study is to evaluate the effect of religious practice on the prevalence, severity, and patterns of knee osteoarthritis (OA) in a Thai elderly population with the same ethnicity and culture but different religions. A house-to-house survey was conducted in two subdistricts of Phranakhon Sri Ayutthaya province where inhabitants are a mixture of Buddhists and Muslims. One hundred fifty-three Buddhists and 150 Muslims aged >or= 50 years were evaluated demographically, physically, and radiographically. Those suffering knee pains were questioned about severity using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores and examined for their range of knee motion. Radiographic knee OA (ROA) was defined as Kellgren-Lawrence radiographic grade >or=2 while symptomatic knee OA (SOA) was defined as knee symptoms of at least 1 month in a knee with ROA. Muslims had on average a higher number of daily religious practices than their Buddhist neighbors (p < 0.001). The prevalence of knee pain and ROA was significantly higher in Buddhists than in Muslims (67.11 vs. 55.80, p = 0.02 for knee pain; 85.62 vs. 70.67, p = 0.02 for ROA). For SOA, Buddhists showed a trend towards higher prevalence than Muslims (47.71 vs. 37.32, p = 0.068). No significant difference was found when the range of motion and WOMAC scores were compared between the two groups. Muslims had a lower prevalence of OA than their Buddhists counterparts with the same ethnicity but different religious practice. The Muslim way of praying since childhood, forcing the knees into deep flexion, may stretch the soft tissue surrounding the knee and decrease stiffness and contact pressure of the articular cartilage.]

Coin, A., Perissinotto. E., Najjar. M., Girardi, A., Inelmen, E. M., Enzi, G., Manzato, E. and Sergi, G. [University of Padova. Italy]. "Does religiosity protect against cognitive and behavioral decline in Alzheimer's dementia?" Current Alzheimer Research 7, no. 5 (August 2010): 445-452. [(Abstract:) BACKGROUND: several studies have shown that religiosity has beneficial effects on health, mortality and pathological conditions; little is known about religiosity in Alzheimer's disease and the progression of its cognitive, behavioral and functional symptoms. Our aim was to identify any relationship between religiosity and the progression of cognitive impairment and behavioral disorders in mild-moderate Alzheimer's disease, and any relationship between the patient's religiosity and the stress in caregivers. MATERIALS AND METHODS: 64 patients with Alzheimer's disease were analyzed at baseline and 12 months later using the Mini-Mental State Examination (MMSE), the Behavioral Religiosity Scale (BRS) and the Francis Short Scale (FSS). Caregivers were also questioned on the patient's functional abilities (ADL, IADL), the behavioral disturbances (NPI), and on their stress (NPI-D, CBI). Patients were divided into 2 groups according to BRS: a score of <24 meant no or low religiosity (LR), while a score of > or =24 meant moderate or high religiosity (HR). FINDINGS: LR patients had worsened more markedly after 12 months in their total cognitive and behavioral test scores. Stress was also significantly higher in the caregivers of the LR group. Global BRS and FSS scores correlated significantly with variations after 1 year in the MMSE (r: 0.50), NPI (r:-0.51), NPI-D (r:-0.55) and CBI (r:-0.62). A low religiosity coincided with a higher risk of cognitive impairment, considered as a 3-point decrease in MMSE score (OR 6.7, CI: 1.8-24.7). INTERPRETATION: higher levels of religiosity in Alzheimer's dementia seem to correlate with a slower cognitive and behavioral decline, with a corresponding significant reduction of the caregiver's burden.]

Davison, S. N. and Jhangri, G. S. [University of Alberta, Edmonton, Canada]. "Existential and supportive care needs among patients with chronic kidney disease." Journal of Pain & Symptom Management 40, no. 6 (December 2010): 838-843. [(Abstract:) CONTEXT: Living with chronic kidney disease (CKD) is associated with spiritual distress and frequently precipitates a search for meaning and hope; yet, very little is known about these patients' spiritual needs. OBJECTIVES: To describe the nature, prevalence, and predictors of spiritual and supportive care needs in CKD. METHODS: Prospective cohort study of 253 CKD patients who completed a seven-item spiritual and seven-item supportive care needs assessment. RESULTS: Patients reported a mean (standard deviation [SD]) number of 2.9 (2.6) spiritual needs, with 69.1% of patients reporting at least one spiritual need. The mean (SD) number of supportive care needs was 3.5 (2.1), with 91.4% of patients reporting at least one of these needs. Thirty-two percent of the patients had high spiritual needs (defined as reporting >=5 of the seven needs). Similarly, 37% of the patients reported high supportive care needs. Neither spiritual nor supportive care needs were associated with age, gender, race, marital status, dialysis modality, time on dialysis, or comorbidity. CONCLUSION: These patients had substantial spiritual and supportive care needs. There were no clear predictors of high spiritual or supportive care needs, highlighting the importance of evaluating all CKD patients for unmet needs. Health professionals will need to better understand and attend to CKD patients' spiritual needs to optimize quality care.]

Flannelly, K. J., Galek, K., Ellison, C. G. and Koenig, H. G. [The Spears Research Institute, HealthCare Chaplaincy, New York, NY]. "Beliefs about God, psychiatric symptoms, and evolutionary psychiatry." Journal of Religion & Health 49, no. 2 (June 2010): 246-261. [(Abstract:) The present study analyzed the association between specific beliefs about God and psychiatric symptoms among a representative sample of 1,306 U.S. adults. Three pairs of beliefs about God served as the independent variables: Close and Loving, Approving and Forgiving, and Creating and Judging. The dependent variables were measures of General Anxiety, Depression, Obsessive-Compulsion, Paranoid Ideation, Social Anxiety, and Somatization. As hypothesized, the strength of participants' belief in a Close and Loving God had a significant salutary association with overall psychiatric symptomology, and the strength of this association was significantly stronger than that of the other beliefs, which had little association with the psychiatric symptomology. The authors discuss the findings in the context of evolutionary psychiatry, and the relevance of Evolutionary Threat Assessment Systems Theory in research on religious beliefs.]

Grossoehme, D. H., Ragsdale, J., Cotton, S., Wooldridge, J. L., Grimes, L. and Seid, M. [Cincinnati Children's Hospital Medical Center, OH]. "Parents' religious coping styles in the first year after their child's cystic fibrosis diagnosis." Journal of Health Care Chaplaincy 16, nos. 3-4 (July 2010): 109-122. [(Abstract:) Parents of children diagnosed with cystic fibrosis described it as "devastating." Given religion's importance to many Americans, parents may utilize religious coping. Relatively little is known about parents' use of religious coping to handle their child's illness. Interviews with 15 parents about their use of religion in the year following their child's cystic fibrosis diagnosis were coded for religious coping styles. Sixteen styles were identified. Positive religious coping styles were more frequent than negative styles (previously associated with poorer health outcomes), and occurred more frequently than in other studies. Religious coping styles used to make meaning, gain control, or seek comfort/intimacy with God were equally prevalent. The most common styles were: Pleading, Collaboration, Benevolent Religious Reappraisals, and Seeking Spiritual Support. Parents described active rather than passive coping styles. Religious coping involving religious others was rare. Clinical attention to negative religious coping may prevent it becoming chronic and negatively affecting health.]

Harris, B. A., Berger, A. M., Mitchell, S. A., Steinberg, S. M., Baker, K. L., Handel, D. L., Bolle, J. L., Bush, E. G., Avila, D. and Pavletic, S. Z. [Pain and Palliative Care Service, National Institutes of Health Clinical Center, National Cancer Institute, Bethesda, MD]. "Spiritual well-being in long-term survivors with chronic graft-versus-host disease after hematopoietic stem cell transplantation." Journal of Supportive Oncology 8, no. 3 (May-June 2010): 119-125. [(Abstract:) Spiritual well-being (Sp-WB) is a resource that supports adaptation and resilience, strengthening quality of life (QOL) in patients with cancer or other chronic illnesses. However, the relationship between Sp-WB and QOL in patients with chronic graft-versus-host disease (cGVHD) remains unexamined. Fifty-two participants completed the Functional Assessment of Chronic Illness Therapy-Spiritual WellBeing (FACIT-Sp) questionnaire as part of a multidisciplinary study of cGVHD. Sp-WB was generally high. Those with the lowest Sp-WB had a significantly longer time since diagnosis of cGVHD (P = 0.05) than those with higher Sp-WB. There were no associations between Sp-WB and demographics, cGVHD severity, or intensity of immunosuppression. Participants with the lowest Sp-WB reported inferior physical (P = 0.0009), emotional (P = 0.003), social (P = 0.027), and functional well-being (P < 0.0001) as well as lower overall QOL (P < 0.0001) compared with those with higher Sp-WB. They also had inferior QOL relative to population norms. Differences between the group reporting the lowest Sp-WB and those groups who reported the highest Sp-WB scores consistently demonstrated a significant difference for all QOL subscales and for overall QOL. Controlling for physical, emotional, and social well-being, Sp-WB was a significant independent predictor of contentment with QOL. Our results suggest that Sp-WB is an important factor contributing to the QOL of patients with cGVHD. Research is needed to identify factors that diminish Sp-WB and to test interventions designed to strengthen this coping resource in patients experiencing the late effects of treatment.]

Hodge, D. R. and Limb, G. E. [Arizona State University, Phoenix, AZ]. "A Native American perspective on spiritual assessment: the strengths and limitations of a complementary set of assessment tools." Health and Social Work 35, no. 2 (May 2010): 121-131. [(Abstract:) Mental health practitioners are increasingly called on to administer spiritual assessments with Native American clients, in spite of limited training on the topic. To help practitioners better understand the strengths and limitations of various assessment instruments from a Native perspective, this study used a sample of recognized experts in Native American culture (N = 50) to evaluate a complementary set of spiritual assessment instruments or tools. Specifically, each instrument's degree of consistency with Native culture was evaluated along with its strengths and limitations for use with Native clients. A brief overview of each instrument is provided, along with the results, to familiarize readers with a repertoire of spiritual assessment tools so that the most culturally appropriate method can be selected in a given clinical context.]

Koszycki, D., Raab, K., Aldosary, F. and Bradwejn, J. [University of Ottawa, Ontario, Canada]. "A multifaith spiritually based intervention for generalized anxiety disorder: a pilot randomized trial." Journal of Clinical Psychology 66, no. 4 (April 2010): 430-441. [(Abstract:) This pilot trial evaluated the efficacy of a multifaith spiritually based intervention (SBI) for generalized anxiety disorder (GAD). Patients meeting DSM-IV criteria for GAD of at least moderate severity were randomized to either 12 sessions of the SBI (n=11) delivered by a spiritual care counselor or 12 sessions of psychologist-administered cognitive-behavioral therapy (CBT; n=11). Outcome measures were completed at baseline, post-treatment, and 3-month and 6-month follow-ups. Primary efficacy measures included the Hamilton Anxiety Rating Scale, Beck Anxiety Inventory, and Penn State Worry Questionnaire. Data analysis was performed on the intent-to-treat sample using the Last Observation Carried Forward method. Eighteen patients (82%) completed the study. The SBI produced robust and clinically significant reductions from baseline in psychic and somatic symptoms of GAD and was comparable in efficacy to CBT. A reduction in depressive symptoms and improvement in social adjustment was also observed. Treatment response occurred in 63.6% of SBI-treated and 72.3% of CBT-treated patients. Gains were maintained at 3-month and 6-month follow-ups. These preliminary findings are encouraging and suggest that a multifaith SBI may be an effective treatment option for GAD. Further randomized controlled trials are needed to establish the efficacy of this intervention.]

Lynn, C. D., Paris, J., Frye, C. A. and Schell, L. M. [University of Alabama, Tuscaloosa, AL]. "Salivary alpha-amylase and cortisol among pentecostals on a worship and nonworship day." American Journal of Human Biology 22, no. 6 (November 2010): 819-822. [(Abstract:) OBJECTIVES: This investigation used a biomarker of sympathetic nervous system activity novel to biocultural research to test the hypothesis that engaging in religious worship activities would reduce baseline stress levels on a non-worship day among Pentecostals. METHODS: As detailed in Lynn et al. (submitted for publication), stress was measured via salivary cortisol and -amylase among 52 Apostolic Pentecostals in New York's mid-Hudson Valley. Saliva samples were collected at four predetermined times on consecutive Sundays and Mondays to establish diurnal profiles and compare days of worship and non-worship. These data were reanalyzed using separate analyses of covariance on -amylase and cortisol to control for individual variation in Pentecostal behavior, effects of Sunday biomarkers on Monday, and other covariates. RESULTS: There was a significant decrease in cortisol and an increase in -amylase on a non-worship day compared with a service day. Models including engagement in Pentecostal worship behavior explained 62% of the change in non-service day cortisol and 73% of the change in non-service day -amylase. CONCLUSIONS: Engagement in Pentecostal worship may be associated with reductions in circulatory cortisol and enhancements in -amylase activity.]

Mao, J. J., Cronholm, P. F., Stein, E., Straton, J. B., Palmer, S. C. and Barg, F. K. [University of Pennsylvania, Philadelphia, PA]. "Positive changes, increased spiritual importance, and complementary and alternative medicine (CAM) use among cancer survivors." Integrative Cancer Therapies 9, no. 4 (December 2010): 339-347. [(Abstract:) PURPOSE: Spirituality is an important component of the cancer experience. This study aims to assess characteristics of spiritual health following a cancer diagnosis, and evaluate the relationship between spiritual change and the use of complementary and alternative medicine (CAM) among a population-based cohort of cancer survivors. METHOD: A mailed, cross-sectional survey was completed by 614 cancer survivors identified through the Pennsylvania Cancer Registry. All subjects were 3 to 4.5 years postdiagnosis. Relationships between various characteristics of spiritual health and CAM use were examined, along with clinical and sociodemographic factors. RESULTS: Although large proportions of individuals reported that having cancer had positively affected their spiritual well-being (eg, 40.3% experienced highly positive spiritual changes, 68% felt a high sense of purpose, 75.9% reported being very hopeful), some individuals experienced negative spiritual change (36.1%) and continued to experience high levels of uncertainty (27.2%). In multivariate analyses, those survivors who felt spiritual life became more important (adjusted odds ratio [AOR] = 1.92, 95% confidence interval (CI) = 1.21-3.04, P = .006), or experienced positive changes resulting from the cancer experience (AOR = 1.99, 95% CI = 1.26-3.15, P = .003), were more likely to use CAM than those who stated otherwise. CONCLUSIONS: Having cancer affects many different aspects of spiritual well-being, both positively and negatively. Positive changes and increased spiritual importance appear to be associated with the use of CAM. Prospective research is needed to test whether integrating CAM into conventional cancer care systems will facilitate positive, spiritually transformative processes among diverse groups of cancer survivors.]

Mohr, S., Borras, L., Betrisey, C., Pierre-Yves, B., Gilliéron, C. and Huguelet, P. [University Hospital of Geneva, Geneva, Switzerland]. "Delusions with religious content in patients with psychosis: how they interact with spiritual coping." Psychiatry 73, no. 2 (2010): 158-172. [(Abstract:) Delusions with religious content have been associated with a poorer prognosis in schizophrenia. Nevertheless, positive religious coping is frequent among this population and is associated with a better outcome. The aim of this study was to compared patients with delusions with religious content (n = 38), patients with other sorts of delusions (n = 85) and patients without persistent positive symptoms (n = 113) clinically and spiritually. Outpatients (n = 236) were randomly selected for a quantitative and qualitative evaluation of religious coping. Patients presenting delusions with religious content were not associated with a more severe clinical status compared to other deluded patients, but they were less likely to adhere to psychiatric treatment. For almost half of the group (45%), spirituality and religiousness helped patients cope with their illness. Delusional themes consisted of: persecution (by malevolent spiritual entities), influence (being controlled by spiritual entities), and self-significance (delusions of sin/guilt or grandiose delusions). Both groups of deluded patients valued religion more than other patients, but patients presenting delusions with religious content received less support from religious communities. In treating patients with such symptoms, clinicians should go beyond the label of "religious delusion," likely to involve stigmatization, by considering how delusions interact with patients' clinical and psychosocial context.]

Murphy, P. E., Canada, A. L., Fitchett, G., Stein, K., Portier, K., Crammer, C. and Peterman, A. H. [Rush University Medical Center, Chicago, IL]. "An examination of the 3-factor model and structural invariance across racial/ethnic groups for the FACIT-Sp: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II)." Psycho-Oncology 19, no. 3 (March 2010): 264-272. [(Abstract:) OBJECTIVES: Recent confirmatory factor analysis (CFA) of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) Scale in a sample of predominantly white women demonstrated that three factors, Meaning, Peace, and Faith, represented a psychometric improvement over the original 2-factor model. The present study tested these findings in a more diverse sample, assessed the stability of the model across racial/ethnic groups, and tested the contribution of a new item. METHODS: In a study by the American Cancer Society, 8805 cancer survivors provided responses on the FACIT-Sp, which we tested using CFA. RESULTS: A 3-factor model provided a better fit to the data than the 2-factor model in the sample as a whole and in the racial/ethnic subgroups (Deltachi(2), p<0.001, for all comparisons), but was not invariant across the groups. The model with equal parameters for racial/ethnic groups was a poorer fit to the data than a model that allowed these parameters to vary (Deltachi(2)(81)=2440.54, p<0.001), suggesting that items and their associated constructs might be understood differently across racial/ethnic groups. The new item improved the model fit and loaded on the Faith factor. CONCLUSIONS: The 3-factor model is likely to provide more specific information for studies in the field. In the construction of scales for use with diverse samples, researchers need to pay greater attention to racial/ethnic differences in interpretation of items.]

Murray, S. A., Kendall, M., Boyd, K., Grant, L., Highet, G. and Sheikh, A. [Centre for Population Health Sciences, University of Edinburgh, Scotland]. "Archetypal trajectories of social, psychological, and spiritual wellbeing and distress in family care givers of patients with lung cancer: secondary analysis of serial qualitative interviews." BMJ [British Medical Journal] 340 (2010): c2581 [online journal]. [(Abstract:) OBJECTIVE: To assess if family care givers of patients with lung cancer experience the patterns of social, psychological, and spiritual wellbeing and distress typical of the patient, from diagnosis to death. DESIGN: Secondary analysis of serial qualitative interviews carried out every three months for up to a year or to bereavement. SETTING: South east Scotland. PARTICIPANTS: 19 patients with lung cancer and their 19 family carers, totalling 88 interviews (42 with patients and 46 with carers). RESULTS: Carers followed clear patterns of social, psychological, and spiritual wellbeing and distress that mirrored the experiences of those for whom they were caring, with some carers also experiencing deterioration in physical health that impacted on their ability to care. Psychological and spiritual distress were particularly dynamic and commonly experienced. In addition to the "Why us?" response, witnessing suffering triggered personal reflections in carers on the meaning and purpose of life. Certain key time points in the illness tended to be particularly problematic for both carers and patients: at diagnosis, at home after initial treatment, at recurrence, and during the terminal stage. CONCLUSIONS: Family carers witness and share much of the illness experience of the dying patient. The multidimensional experience of distress suffered by patients with lung cancer was reflected in the suffering of their carers in the social, psychological, and spiritual domains, with psychological and spiritual distress being most pronounced. Carers may need to be supported throughout the period of illness not just in the terminal phase and during bereavement, as currently tends to be the case.]

Penderell, A. and Brazil, K. [McMaster University, Hamilton, Ontario, Canada]. "The spirit of palliative practice: a qualitative inquiry into the spiritual journey of palliative care physicians." Palliative and Supportive Care 8, no. 4 (December 2010): 415-420. [(Abstract:) OBJECTIVE: Much is known about the important role of spirituality in the delivery of multidimensional care for patients at the end of life. Establishing a strong physician-patient relationship in a palliative context requires physicians to have the self-awareness essential to establishing shared meaning and relationships with their patients. However, little is known about this phenomenon and therefore, this study seeks a greater understanding of physician spirituality and how caring for the terminally ill influences this inner aspect. METHOD: A qualitative descriptive study was used involving face-to-face interviews with six practicing palliative care physicians. RESULTS: Conceptualized as a separate entity from religion, spirituality was described by participants as a notion relating to meaning, personal discovery, self-reflection, support, connectedness, and guidance. Spirituality and the delivery of care for the terminally ill appeared to be interrelated in a dynamic relationship where a physician's spiritual growth occurred as a result of patient interaction and that spiritual growth, in turn, was essential for providing compassionate care for the palliative patient. Spirituality also served as an influential force for physicians to engage in self-care practices. SIGNIFICANCE OF RESULTS: With spirituality as a pervasive force not only in the lives of palliative care patients, but also in those of healthcare providers, it may prove to be beneficial to use this information to guide future practice in training and education for palliative physicians in both the spiritual care of patients and in practitioner self care.]

Sulmasy, D. P., Astrow, A. B., He, M. K., Seils, D. M., Meropol, N. J., Micco, E. and Weinfurt, K. P. [Department of Medicine, MacLean Center for Clinical Medical Ethics, and Divinity School, University of Chicago, IL]. "The culture of faith and hope: patients' justifications for their high estimations of expected therapeutic benefit when enrolling in early phase oncology trials." Cancer 116, no. 15 (August 1, 2010): 3702-3711. [(Abstract:) BACKGROUND: Patients' estimates of their chances of therapeutic benefit from participation in early phase trials greatly exceed historical data. Ethicists worry that this therapeutic misestimation undermines the validity of informed consent. METHODS: The authors interviewed 45 patients enrolled in phase 1 or 2 oncology trials about their expectations of therapeutic benefit and their reasons for those expectations. They used a phenomenological, qualitative approach with 1 primary coder to identify emergent themes, verified by 2 independent coders. RESULTS: Median expectations of therapeutic benefit varied from 50% to 80%, depending on how the question was asked. Justifications universally invoked hope and optimism, and 27 of 45 participants used 1 of these words. Three major themes emerged: 1) optimism as performative, that is, the notion that positive thoughts and expressions improve chances of benefit; 2) fighting cancer as a battle; and 3) faith in God, science, or both. Many participants described a culture in which optimism was encouraged and expected, such that trial enrollment became a way of reflecting this expectation. Many reported they had been told few patients would benefit and appeared to understand the uncertainties of clinical research, yet expressed high expected personal therapeutic benefit. More distressed participants were less likely to invoke performative justifications for their expectations (50% vs 84%; P=.04). CONCLUSIONS: Expressions of high expected therapeutic benefit had little to do with reporting knowledge and more to do with expressing optimism. These results have implications for understanding how to obtain valid consent from participants in early phase clinical trials.]

Trevino, K. M., Pargament, K. I., Cotton, S., Leonard, A. C., Hahn, J,. Caprini-Faigin, C. A. and Tsevat, J. [Bowling Green State University, Bowling Green, OH]. "Religious coping and physiological, psychological, social, and spiritual outcomes in patients with HIV/AIDS: cross-sectional and longitudinal findings." AIDS and Behavior 14, no. 2 (April 2010): 379-389. [(Abstract:) The present study investigated the relationships between positive religious coping (e.g., seeking spiritual support) and spiritual struggle (e.g., anger at God) versus viral load, CD4 count, quality of life, HIV symptoms, depression, self-esteem, social support, and spiritual well-being in 429 patients with HIV/AIDS. Data were collected through patient interview and chart review at baseline and 12-18 months later from four clinical sites. At baseline, positive religious coping was associated with positive outcomes while spiritual struggle was associated with negative outcomes. In addition, high levels of positive religious coping and low levels of spiritual struggle were associated with small but significant improvements over time. These results have implications for assessing religious coping and designing interventions targeting spiritual struggle in patients with HIV/AIDS.]

VandeCreek, L. "Defining and advocating for spiritual care in the hospital." Journal of Pastoral Care and Counseling 64, no. 2 (2010): 5.1-10 [online journal]. [(Abstract:) A definition of spiritual care and attention to the scientific literature can strengthen the advocacy efforts of hospital funded chaplaincy programs. Adapting Pargament's work, spiritual care is defined here as giving professional attention to the subjective spiritual and religious worlds of patients, worlds comprised of perceptions, assumptions, feelings, and beliefs concerning the relationship of the sacred to their illness, hospitalization, and recovery or possible death. Results from the scientific literature are then presented in response to four advocacy related questions: 1) How do hospital decision makers and chaplains perceive the experience of hospitalization, 2) Does a need for spiritual care exists; is it relevant, 3) Who can best provide spiritual care, and 4) Are chaplain visits helpful? This definition and advocacy material can be useful when decision makers review the funding of spiritual care.]

Winter-Pfandler, U. and Morgenthaler, C. [Swiss Institute of Pastoral-Sociology, St. Gallen, Switzerland]. "Are surveys on quality improvement of healthcare chaplaincy emotionally distressing for patients? A pilot study." Journal of Health Care Chaplaincy 16, nos. 3-4 (July 2010): 140-148. [(Abstract:) In recent years, much research work has been done in the field of religion/spirituality and healthcare. Many chaplains are wary of doing research because they assume it is cumbersome or potentially deleterious to ill patients. The aim of the present pilot study is, therefore, to find out if research on quality improvement of healthcare chaplaincy is emotionally distressing for patients. In connection with a questionnaire about quality improvement proceeding of healthcare chaplaincy, patients were asked subsequently to assess whether the completion of the questionnaire was emotionally distressing for them. A total of 91.89% of the 37 respondents said that the completion of the questionnaire was not or only slightly emotionally distressing for them. Furthermore, analyses for significant differences showed no effect, except for a significant association with the anxiety scale. Findings from this study suggest that participants found no objective reasons not to do research in healthcare chaplaincy.]



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