Dirk Labuschagne1, Alexia Torke2,3, Daniel Grossoehme4, Katie Rimer5, Martha Rucker6, Kristen Schenk1, James Slaven7, George Fitchett1. 1. Department of Religion, Health and Human Values, 2468Rush University Medical Center, Chicago, IL, USA. 2. Department of Medicine, 12250 Indiana University School of Medicine, Indianapolis, IN, USA. 3. Daniel F Evans Center for Spiritual and Religious Values in Healthcare, 12250IU Health, Indianapolis, IN, USA. 4. Haslinger Family Pediatric Palliative Care Center, Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA. 5. Department of Spiritual Care and Education, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA. 6. Department of Spiritual Care, Ascension St. Thomas, Nashville, TN, USA. 7. Department of Biostatistics, 12250Indiana University School of Medicine, Indianapolis, IN, USA.
Abstract
BACKGROUND: Gravely ill patients admitted to the intensive care unit (ICU), and their families experience acute spiritual and existential needs and often require complex decisions about their care. Little is known about what constitutes chaplaincy care for patients or families in ICUs. Chaplains report that participation in medical decision-making is part of their role. OBJECTIVE: To describe the spiritual care provided to patients and their families in the ICU. METHODS: This was a retrospective observational study of spiritual care for patients and families in the medical ICUs (MICUs) at 4 medical centers over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information (number of visits, length of visit, chaplain categories, and type of spiritual care provided). RESULTS: Of the 254 patients, 197 (78%) received a total of 485 spiritual care visits. Seventy-seven percent of visits included provision of emotional/spiritual support; only 15% included decision-making support such as family meetings or goals-of-care conversations. The proportion receiving spiritual care increased as patients neared death or discharge. Staff chaplains were involved in goals-of-care conversations to a greater extent than student or part-time chaplains (P < .05). CONCLUSION: Spiritual care was provided to most patients and/or families at the end of life. Low chaplain involvement in decision-making in the MICU suggests opportunities to improve chaplains' contributions to ICU care.
BACKGROUND: Gravely ill patients admitted to the intensive care unit (ICU), and their families experience acute spiritual and existential needs and often require complex decisions about their care. Little is known about what constitutes chaplaincy care for patients or families in ICUs. Chaplains report that participation in medical decision-making is part of their role. OBJECTIVE: To describe the spiritual care provided to patients and their families in the ICU. METHODS: This was a retrospective observational study of spiritual care for patients and families in the medical ICUs (MICUs) at 4 medical centers over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information (number of visits, length of visit, chaplain categories, and type of spiritual care provided). RESULTS: Of the 254 patients, 197 (78%) received a total of 485 spiritual care visits. Seventy-seven percent of visits included provision of emotional/spiritual support; only 15% included decision-making support such as family meetings or goals-of-care conversations. The proportion receiving spiritual care increased as patients neared death or discharge. Staff chaplains were involved in goals-of-care conversations to a greater extent than student or part-time chaplains (P < .05). CONCLUSION: Spiritual care was provided to most patients and/or families at the end of life. Low chaplain involvement in decision-making in the MICU suggests opportunities to improve chaplains' contributions to ICU care.