2012 Conference

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By Austine Duru, MDiv, MA, BCC

George Fitchett and Patricia Murphy, RSCJ, told chaplains that it is now important to “add research to what we already know” about chaplaincy, theology, the dynamics of disease, healthcare and spiritual care. Fitchett and Murphy made this case May 21 at the NACC National Conference in Milwaukee during a workshop session titled “Evidence-Based Spiritual Care For Chaplains: Update and Prospects.”

When chaplains talk about “evidence based,” Fitchett said, “there are three important components to keep in mind: we use the best evidence available, we use our individual judgment, and we modify these to address the uniqueness of the patient.”

Fitchett, a professor, CPE supervisor and director of research in the Department of Health, Religion and Human Services at Chicago-based Rush University Medical Center, and Murphy, associate professor and staff chaplain at Rush University Medical Center, noted that it has become important to address the issue of research in chaplaincy as more chaplains are involved in interdisciplinary care teams and are expected to demonstrate that their work is legitimate and can be held to the highest professional standards. Also if chaplains claim that pastoral care is integral to the mission and vision of their healthcare systems and institutions, it is critical to back up this claim with some evidence, they said.

They cited Thomas O’Connor’s (2002) definition of evidence-based spiritual care as “the use of scientific evidence on spirituality to inform the decisions and interventions in the spiritual care of persons.”

Fitchett and Murphy identified two schools of thought against evidence-based spiritual care. One school of thought argues that evidence-based spiritual care “can’t be done.” Among these are Don Stiger (Brooklyn, NY), who believes that the “things chaplains deal with such as God, the Spirit, presence, prayer, etc., are much too big and always will be mysteriously beyond our attempts to measure and quantify.” Harriet Mowat (social critic) holds that “at times the good outcome of chaplain care causes distress and anxiety.” She attributes this to the use of the wrong measurements. Tony Walter (United Kingdom – palliative care) argues, “routinization of spiritual care destroys its ethos, leads to vulnerability. The mutual vulnerability of the suffering is the heart of chaplaincy; we can destroy the core by introducing research.”

Another school of thought argues that evidence-based spiritual care “should not be done.” Among these are: Dr. Daniel Sulmasy (bioethicist, Chicago) who believes that “once pastoral care services succumb to the need to prove they can decrease the length of stay or improve patient satisfaction, all will be lost.” Also Ivan Illich, holds that “professionalized spiritual care robs people of the capacity to care for themselves and one another.”

In making the case for evidence-based chaplaincy, the presenters also gave examples of Thomas O’Connor and Elizabeth Meakes, who wrote, “Evidence from research needs to inform our pastoral care. To remove the evidence from pastoral care can create a ministry that is ineffective or possibly even harmful.” O’Connor and Meakes were the first to use the term “evidence-based” pastoral care in their 1998 article. Also in favor of evidence-based spiritual care is Daniel Grossoehme who makes the argument that “good stewardship of creation requires our best, evidence-based, care.”

Fitchett and Murphy who both hold a PhD and have more than 10 years of experience teaching research literacy to chaplains and CPE residents, acknowledged that evidence-based spiritual care is fraught with significant challenges, yet it holds great promise. They pointed workshop participants to Standard 12 of the Standards of Practice for Professional Chaplains in Acute Care Settings, which states in part, “The chaplain practices evidence-based care including ongoing evaluation of new practices and when appropriate, contributes to or conducts research.” This may be an indication that the interest within professional chaplaincy is shifting toward a focus on research as a core competency for every certified chaplain.

The presenters made the case that chaplaincy is a research-informed profession, going back to its humble beginnings with Anton T. Boisen, who, in 1936, published his groundbreaking work titled, Explorations of the Inner World: A Study of Mental Disorder and Religious Experience (Willet, Clark and Company). Fitchett and Murphy acknowledge that advanced research is not for everyone. They do not encourage every chaplain to be involved in advanced research. However, they insist that all healthcare chaplains must be research literate. “A research literate chaplain has the ability to read, understand, and summarize a research study and to explain its relevance for his/her spiritual care.” Also some healthcare chaplains should be able to collaborate with other healthcare professionals/colleagues as co-investigators. And finally, some healthcare chaplains could lead research projects as principal investigators.

Fitchett asks the question, how do chaplains know that what they are doing is working? What is the basis of knowing? he asked. Research, he says, is one way to know. He shared some fascinating examples of chaplaincy-related research being done in the United States, citing the recent works of Katherine R. B. Jankowski, George F. Handzo, Paul S. Bay, Rhonda S. Cooper, Kevin J. Flannelly, Harriet Moet, and many others whose work covers a number of topics and issues ranging from what chaplains really do, to describing and assessing spiritual resources, assessing the impact of the chaplains’ care itself and the impact of chaplains’ care in a multidisciplinary setting.

The presenters noted that the next steps are crucial if individuals are thinking about developing an evidence-based approach to chaplaincy and spiritual care. Fitchett and Murphy offered some important next steps:

1. No more randomized critical trials. Existing randomized clinical trials in spiritual care are unhelpful because they do not tell us in a meaningful way the content of chaplains’ care.
2. Develop a clearer description of chaplains’ care to specific groups of patients through developing a fairly robust data of case studies.
3. Chaplains must be involved in multidisciplinary studies.
4. Chaplains must be more comfortable with the language of outcomes; it is okay to have an agenda, to be outcome oriented.
5. Require research literacy for chaplaincy certification.
6. Teach research literacy in CPE programs. Only three CPE centers in the United States offer strong research programs in their CPE centers.
7. Offer opportunities for continuing education for those who are already chaplains.
8. Create research journal clubs in chaplaincy departments.
9. Find mentors who are experienced researchers/research investigators.

On a positive note, the presenters agree that the quality of research in chaplaincy and spiritual care is constantly improving. A number of peer review resources are now available for those interested in publishing their research findings. Also, research in hospice care is among the robust areas in evidence-based care. All of these are causes for optimism, they indicated.

Austine Duru, staff chaplain at Franciscan St. Margaret Health in Dyer, IN, is a member of the NACC’s Editorial Advisory Panel.

Related links:

www.rushu.rush.edu/rhhv
www.acperesearch.net