COMMENT AND SUMMARY: This article was selected in part because it gives an interesting profile of how some community clergy report their training and comfort level in dealing with end-of-life care, and in part because it suggests to this reader how an assessment of training and attitudes about end-of-life care might be useful--and a subject of research--for CPE programs.

Suggestions for the Use of the Article for Discussion in CPE: 

This relatively brief and very readable article may be a good means to begin engaging students on the topic of patients' (or congregants') end-of-life needs (and for other articles that may supplement such discussion, see the suggestions in the October 2002 Articles-of-the-Month page.) The article may be well suited for discussion very early in CPE unit, as students may be drawn to consider how their own sense of preparation and comfort level may inform their CPE learning contracts. However, if a CPE program employs a student questionnaire on the subject (as has been suggested, above), the article may be better suited for discussion late in a unit. Students may also be challenged by the article to think of connections between, on the one hand, their training, experience, and comfort levels; and, on the other hand, the frequency with which they provide certain pastoral interventions--these could be basic and enlightening connections that many students may not think about on their own.

Related Items of Interest: 

I.  This month's featured article focuses on clergy attitudes and experiences, but this is in the service of ultimately benefiting the people who, amid end-of-life circumstances, may utilize clergy support. For insight into laypersons' sense of end-of-life needs, including their sense of how clergy support may figure into their total support network, the authors make reference to two studies [--see pp. 34-35]: one by the AARP and one by the Gallup organization.

In 2002, the AARP (American Association of Retired Persons) surveyed members in North Carolina (n=3,586 for a response rate of 45%) about end-of-life issues. Among the findings, 82% of respondents said that it would be "very important" for them to be spiritually at peace as they dealt with their own dying, and 62% of respondents said that it would be "very important" for them to receive comfort from religious/spiritual services or persons, but only 6% had spoken with clergy about advance directives. An extended section of the survey (i.e., item 17) indicated that in relation to a variety of end-of-life needs, respondents tended to look first to family for help, though support from the "faith community" also figured well in the responses. For more on the AARP North Carolina End of Life Survey, see www.aarp.org/research/surveys/life/legal/eol/articles/aresearch-import-68.html --there are links to two reports, each including annotated versions of the survey.

In 1997, the Gallup organization issued a report of a telephone survey of 1,200 adult Americans: "Spiritual beliefs and the dying process," which indicated that a relatively low percentage of the population (36% of respondents) thought of clergy as being an effective comfort to them at the end of life. The full report was once available through the web site of the Nathan Cummings Foundation (www.nathancummings.org), but apparantly no longer. For a brief summary of the report, see the Park Ridge Center's coverage in their Bulletin issue #3 (February-March 1998): "The American Way of Death: Gallup Poll Results," by Laurence J. O'Connell, available at www.parkridgecenter.org/Page150.html. [The Park Ridge Center for Health, Faith, and Ethics no longer publishes its Bulletin, but all issues are available on line and are a considerable resource regarding quite a number of topics.]

II.  In addition to other references cited in the notes to this month's featured article, the following may be of interest concerning the role of clergy in end-of-life care:

[ADDED 3/13/06]: Abrams, D., Albury, S., Crandall, L., Doka, K. J. and Harris, R. "The Florida Clergy End-of-Life Education Enhancement Project: a description and evaluation." American Journal of Hospice and Palliative Care 22, no. 3 (May-Jun 2005): 181-187. [The article describes the Florida Clergy End-of-Life Education Enhancement Project and its evaluation data showing the success of this model in educating clergy about loss, grief dying, and death. "The project indicates that clergy both recognize the need for additional training and are anxious to improve their abilities to minister to the dying and bereaved. The model presented here could easily be applied to local organizations such as hospices or denominational training." (--from the article's Abstract)]

Braun, K. L. and Zir, A. "Roles for the church in improving end-of-life care: perceptions of Christian clergy and laity." Death Studies 25, no. 8 (December 2001): 685-704. [This focus group study of 121 Christian clergy and congregants in Honolulu, HI, explored participants' ideas about a "good death" and potential roles for clergy in end-of-life care. Results indicated a number of roles for Christian clergy or "the church": "(a) to help congregants prepare for death, both spiritually and practically; (b) to facilitate resolution of conflict and forgiveness; (c) to clarify if or how church theology should guide attitudes and practices related to death and dying; (d) to administer the appropriate rituals; and (e) to provide outreach to sick, dying, and bereaved members" (--from the article's Abstract).]

[ADDED 1/29/06]: Moran, M., Flannelly, K. J., Weaver, A. J., Overvold, J. A., Hess, W. and Wilson, J. C. "A Study of Pastoral Care, Referral, and Consultation Practices Among Clergy in Four Settings in the New York City Area." Pastoral Psychology 53, no. 3 (January 2005): 255-266. [This study involved 179 clergy from the catchment areas of four hospitals in New York and Connecticut. Among the findings: "Factor analysis revealed two separate sets of problems presented in pastoral counseling, with respect to clergy's ratings of their competence to address them. The first factor included grief, death and dying, anxiety, and marital problems, in descending order of frequency. The second factor consisted of depression, alcohol/drugs, domestic violence, severe mental illness, HIV/AIDS, and suicide. Clergy were significantly less confident of their ability to deal with Factor 2 problems, yet clergy rarely consulted with mental-health professionals about either type of problem. Less than half of the clergy had training in Clinical Pastoral Education, but those who did tended to feel they were more competent to deal with both types of problems. On average, clergy devoted 3.7 hours per week to visiting patients and nearly 55% said they were "definitely more likely" to refer a patient to a hospital with a pastoral care department." (--from the article's Abstract)]

[ADDED 8/8/06]: Williams, M. L., Cobb, M., Shiels, C. and Taylor, F. "How well trained are clergy in care of the dying patient and bereavement support?" Journal of Pain and Symptom Management 32, no. 1 (July 2006): 44-51. [In this study out of the UK, questionnaires were sent to clergy in the diocese of Sheffield and to "clergy training colleges," yielding the following results: "There was a trend across all denominations that those who had trained more recently were more likely to have received relevant training. Most clergy believed that they possessed adequate liturgical skills, but 13% felt they possessed none or little skill in pastoral care of the dying. Seventy-one percent indicated that they would like further training in pastoral care of the dying and 66.3% desired training in care of the bereaved. Of the 50% of training colleges that responded, the number of hours of training on pastoral care of the dying ranged from 6 to 36 hours (median 23 hours and mean 25 hours) and only 26% believed that their training in pastoral support skills was comprehensive." (--from the abstract)]