Addressing the spiritual concerns of patients in the non-intensive care setting. (Letters to the Editor).

To the Editor: Although the benefits of addressing spiritual concerns of patients in the intensive care setting have been documented, less attention has been directed to patients in the non-intensive care unit setting. General medical patients also have significant spiritual concerns, but physicians rarely ask about spiritual matters. (1,2) Assessing patients' spiritual needs can be a complex and time-consuming task for which physicians are not adequately trained. (2) Even though chaplain care is routine in intensive care units (ICU), referrals to chaplains among non-ICU patients occur in only approximately 10% of patients.

One possible approach is to offer spiritual assessment and consultation by a qualified professional chaplain to all general medical patients. Such an approach eliminates the need for untrained medical personnel to perform an assessment of spiritual needs. A consultation by the hospital chaplain would provide an assessment of significant spiritual issues that need to be addressed, directly address those needs, and provide a means to activate the patient's spiritual resources.

We conducted a pilot study to determine whether automatic chaplain consultation would improve patient satisfaction, reduce utilization of hospital services, and improve medical outcome in general medical patients. We performed the study at two hospitals in Charleston, SC, during a 6-month period. Institutional review boards at both institutions reviewed and approved the study protocol. Adults admitted to the family practice service were randomly assigned to receive automatic chaplain consultation or usual care. The chaplains saw patients within 24 hours of admission. All consultations contained at least these three elements: 1) listening and history taking, 2) empathy and expression of caring, and 3) an offer of prayer and spiritual support. The specific content of each consultation varied according to .each patient's needs and concerns. The chaplain returned for subsequent visits as needed. The chaplain visited other patients when requested (usual care). A research assistant helped each patient complete a q uestionnaire at the time of hospital discharge, which included questions regarding demographic characteristics, spiritual well-being, and patient satisfaction with care. Data also were collected regarding length of hospital stay, rate of readmission within 30 days, and total hospital charges. We compared the means for the outcome variables for the two groups with the use of t tests. Analyses were confined to patients who could be confirmed as actually seen by the chaplain in the daily log compared with usual care patients who did not request a chaplain visit.

Ninety-three patients were admitted and eligible for the study during the study period, and 61 had complete data for evaluation. There were no baseline differences in general characteristics between the two groups. There was a trend toward better satisfaction, and a significant difference was noted in the perceived availability of spiritual counseling in the intervention group (P = 0.01). There were no differences in length of stay, readmission rate, or total hospital charges between the two groups (all P > 0.10).

This study found improved satisfaction with the availability of pastoral counseling when chaplain care was automatic but did not find any differences in the use of health services. Comparing the current study to previous research, the impact of chaplains in the non-ICU setting is not documented to the same extent as it is in the ICU. Several previous studies have documented the pivotal role in patient and family emotional and spiritual support played by chaplains. (3,4) In the non-ICU hospital setting, less is known about the possible benefits of chaplain consultation. Although many studies have shown that general medical patients have spiritual concerns, few have evaluated how such needs can be met. Fitchett et al (6) recently conducted interviews with 202 inpatients on general medical and surgical units and found that 35% of patients requested spiritual care services. The current study showed one way to fill an unmet need for spiritual counseling but did not have the power to demonstrate a significant med ical or use benefit of routine chaplain consultation. Further research should be done to explore ways to meet the spiritual needs of general medical non-ICU patients. (Supported in part by a grant from the South Carolina AHEC Consortium, 295 Calhoun Street, Charleston, SC 29425.)

Dana E. King, MD

Elizabeth Platz 

Department of Family Medicine

Medical University of South Carolina 

Charleston, SC

References

(1.) King DE, Bushwick B. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract 1994;39:349-352.

(2.) Ellis MR, Vinson DC, Ewigman B. Addressing spiritual concerns of patients: Family physicians' attitudes and practices. J Fam Pract 1999;48:105-109.

(3.) Sharp CG. Use of the chaplaincy in the neonatal intensive care unit. South Med J 1991;84:1482-1486.

(4.) Abbott KH, Sago JG, Breen CM, Abernethy AP, Tuisky JA. Families looking back: One year after discussion of withdrawal or withholding of life-sustaining support. Crit Care Med 2001;29:197-201.

(5.) Koenig HG, Pargament KI, Nielsen J. Religious coping and health status in medically ill hospitalized older adults. J Nerv Ment Dis 1998;186:513-521.

(6.) Fitchett G, Meyer PM, Burton LA. Spiritual care in the hospital: Who requests it? Who needs it? J Pastoral Care 2000;54:173-186.