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Patients’ spiritual concerns and needs and how to address them during advance care planning conversations: Healthcare chaplains’ perspectives

Published online by Cambridge University Press:  14 November 2022

Jung Kwak Open the ORCID record for Jung Kwak [Opens in a new window] ,
So Hyeon Bang ,
Shilpa Rajagopal ,
Neha Dronamraju ,
George Handzo  and
Brian P. Hughes
Jung Kwak*
Affiliation:
School of Nursing, The University of Texas at Austin, Austin, TX, USA
So Hyeon Bang
Affiliation:
School of Nursing, The University of Texas at Austin, Austin, TX, USA
Shilpa Rajagopal
Affiliation:
John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
Neha Dronamraju
Affiliation:
The University of Texas at Austin, Austin, TX, USA
George Handzo
Affiliation:
HealthCare Chaplaincy Network, New York, NY, USA
Brian P. Hughes
Affiliation:
HealthCare Chaplaincy Network, New York, NY, USA
*
Author for correspondence: Jung Kwak, School of Nursing, The University of Texas at Austin, 1710 Red River Street, Mail Code: D0100, Austin, TX 78701, USA. Email: jkwak@nursing.utexas.edu
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Abstract

Objectives

Advance care planning (ACP) conversations require the consideration of deeply held personal values and beliefs and the discussion of uncertainty, fears, and hopes related to current and future personal healthcare. However, empirical data are limited on how such spiritual concerns and needs are supported during ACP. This study explored board-certified healthcare chaplains’ perspectives of patients’ spiritual needs and support in ACP conversations.

Methods

An online survey of 563 board-certified chaplains was conducted from March to July 2020. The survey included 3 open-ended questions about patients’ hopes and fears and about how the chaplains addressed them during ACP conversations. Written qualitative responses provided by 244 of the chaplains were examined with content analysis.

Results

The majority of the 244 chaplains were White (83.6%), female (59%), Protestant (63.1%), and designated to one or more special care units (89.8%). Major themes on patients’ hopes and fears expressed during ACP were (1) spiritual, religious, and existential questions; (2) suffering, peace, and comfort; (3) focus on the present; (4) hopes and fears for family; and (5) doubt and distrust. Major themes on how chaplains addressed them were (1) active listening to explore and normalize fears, worries, and doubts; (2) conversations to integrate faith, values, and preferences into ACP; and (3) education, empowerment, and advocacy.

Significance of results

ACP conversations require deep listening and engagement to address patients’ spiritual needs and concerns – an essential dimension of engaging in whole-person care – and should be delivered with an interdisciplinary approach to fulfill the intended purpose of ACP.

Keywords

Advance care planningSerious illness conversationsGoals of care conversationsSpiritual careHealthcare chaplainPalliative careChaplain
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 1 , February 2024 , pp. 49 - 56
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Copyright
© The Author(s), 2022. Published by Cambridge University Press.

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