By Sage Olnick and Lindsay Castle
Patients diagnosed with heart failure face many challenges. They must overcome major lifestyle changes including fluid restriction, sodium restriction, new medications, frequent provider visits, and hospitalizations. At Lancaster General/Penn Medicine Hospital in Lancaster, PA, the interdisciplinary team recognizes that patients with heart failure may feel isolated, anxious, angry, sad, and overwhelmed. One way to address patient’s physical, emotional, and spiritual needs is physician and chaplain collaboration.
When a middle-aged woman was admitted with newly diagnosed heart failure, We (Dr. Lindsay Castle and Chaplain Sage Olnick) partnered to provide her with whole-person care. She had no earlier symptoms of heart disease and self-identified as an independent and active person. While a new diagnosis of heart failure would be challenging for most, this was especially difficult for her, as her mother had died just a few months prior to her hospitalization. Further, she was the primary caregiver for several of her grandchildren, who lived with her. Much of her life, she had cared for others and anticipated the second era of her life to be spent on traveling, enjoying new and old relationships, and taking up new hobbies. All this changed when she was told her heart failure was severe and she would likely need to be evaluated for a heart transplant.
Together, we created a safe space for the patient to explore her grief and anxiety related to her diagnosis and recent losses. Verbally processing her suffering, anxiety, fear, hope, and the unknown helped her to feel less burdened. With her physician and chaplain present to bear witness and join in her suffering, her belief that God is always present with us was reinforced. Through collaborative care, we built a trusting and supportive relationship with the patient. This trust enabled the patient to articulate her hope, fear, goals, and values, which in turn allowed the interdisciplinary team to develop a plan of care that met her wishes.
Physician-chaplain collaboration has many benefits. It lets the provider deliver patient-centered care. A physician’s time is limited, and interaction with the patient generally focuses on the diagnosis and plan for treatment. Often, patients share their fears and concerns, and these are often acknowledged by healthcare providers but rarely fully explored. But in collaboration, Dr. Castle and Chaplain Sage communicate about the emotional needs of patients. Often, Chaplain Sage brings specific barriers to care to Dr. Castle’s attention, including financial concerns, lack of social support, and prior challenging experiences with illness. If the emotional health of the patient is not addressed, results can include poor medication compliance, missed office visits, and recurrent heart failure hospitalizations.
Chaplain Sage has learned that collaboration with physicians fosters relationships and builds trust. Deepened relationships between chaplains and physicians further integrate the chaplain on the heart failure team, creating more referrals and more collaboration. Similarly, when the chaplain knows about the patient’s plan of care, she is better positioned to offer insight about the patient’s spiritual health and make spiritual recommendations.
The benefits to the larger interdisciplinary team include continuity of care. Patients with heart failure develop a long-term relationship with each member of the team, including the chaplain, which helps the patient to feel supported. When a patient with heart failure is admitted to the hospital with fluid overload, it is comforting to see familiar faces of team members.
A chaplain can also offer support to members of the interdisciplinary team. As an active and integrated team member, the chaplain can relate to the daily experiences, stressors, risks for compassion fatigue, and need for resiliency. The chaplain can then offer support that is tailored to the needs of the team, further exemplifying that the spiritual domain of health is a central aspect of whole person care.
While there are many benefits to collaboration, there are challenges. Being physically present on the unit and at team meetings makes the chaplain’s integration and availability crystal clear. It’s plausible that collaboration between the chaplain and physician may be difficult if the chaplain is not as accessible or available.
The team at Lancaster General/Penn Medicine Hospital has learned that dedicating a full-time chaplain to the heart failure team has improved the quality of care provided to patients. Our collaboration is an example of how physician and chaplain collaboration can have a deep impact on the quality of whole-person care for patients with heart failure.
Sage Olnick, MDiv, RN, is a staff chaplain and Lindsay Castle, DO, is a cardiologist at the Heart Group of Lancaster General Health/Penn Medicine in Lancaster, PA.