In dozens of conversations with family surrogates over the years, Alexia Torke, MD, routinely asked, “How do you cope with making decisions?” Many people talk about the religious and spiritual practices and beliefs from which they draw strength. “In many cases, that included their faith and team members such as chaplains who were willing to listen and help them cope,” says Torke, a medical ethicist and research scientist at the Regenstrief Institute in Indianapolis.
Torke and colleagues developed an enhanced spiritual care model and measured its effect on family members of ICU patients. The team enrolled patients in the study early in their hospital stay so they could see a chaplain as early as possible. “We felt that this could actually be preventive, that we might reduce some of the stress that family members experience, by providing a supportive person who could address spiritual and emotional well-being early on,” Torke reports.
Torke and colleagues interviewed 128 pairs of ICU patients and their surrogate decision-makers (typically family members).1 Participants in the enhanced spiritual care group were contacted to schedule chaplain visits and receive spiritual assessment. Participants in the usual care group saw a chaplain two times during the ICU stay, on average. Those in the enhanced spiritual care group saw a chaplain four times, on average.
Researchers contacted surrogates six to eight weeks after the patient’s discharge from the hospital. If the patient died during the hospital stay, chaplains attempted a bereavement visit within 48 hours. The surrogates enrolled in the enhanced spiritual care model reported less anxiety, more spiritual well-being, and greater satisfaction with spiritual care compared to the surrogates who received usual care. The study’s findings suggest expanded chaplain involvement is beneficial.
However, most surrogate decision-makers never see a chaplain at all during the ICU stay. Torke says ethicists can help connect those people with chaplains.
“When we are approaching the family to talk about a difficult decision on whether to continue life-sustaining treatment, we need to realize how much distress the family member is experiencing,” Torke advises.
During ethics consults, chaplains often go unmentioned. One reason is a limited understanding — on the part of clinicians, ethicists, and surrogates — of the role chaplains play. Many think of a chaplain as someone to call if the patient is dying or if someone wants a Bible reading.
“Those things are important, and chaplains are available to do those things,” Torke notes. “But chaplains define spirituality much more broadly.”
If ethicists or clinicians ask, “Would you like to see a chaplain?” many people would say no, based on the fact the chaplain is not the same faith or that the patient is not religious. In fact, chaplains can support people of any faith, or even those who do not consider themselves religious. Therefore, Torke argues a better question is, “What are the spiritual concerns here?”
“Everybody has spiritual concerns,” Torke explains. The patient or family may say things such as “Why me?” or “How am I going to get through this?” or “I feel so alone.” Upon hearing such statements, ethicists can involve chaplains accordingly.
Torke generally asks patients, “Is there anything I should know about your faith or spiritual beliefs that will help me take care of you?” This opens the door to a discussion on chaplains and how they can help. “No matter what the response, it tells me something important about how the person looks at the world,” Torke says.
Sometimes, the person talks about how important their faith is to coping with illness. Other times, the person describes losing touch with their faith community during an illness. “In ethics consults, just as the family dynamics is something we have grown to appreciate, we can also appreciate that the spiritual dimension of a person might be having a big impact on how they are making decisions,” Torke offers.
REFERENCE
1. Torke AM, Varner-Perez SE, Burke ES, et al. Effects of spiritual care on well-being of intensive care family surrogates: A clinical trial. J Pain Symptom Manage 2022; Dec 14:S0885-3924(22)01030-2. doi: 10.1016/j.jpainsymman.2022.12.007. [Online ahead of print].
Surrogates enrolled in an enhanced spiritual care model reported less anxiety, more spiritual well-being, and greater satisfaction with spiritual care compared to surrogates who received usual care. These results suggest expanded chaplain involvement is beneficial.
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