Patient-Centered Outcomes of Hospital Based Chaplain Visits: Structured Time Diaries (S756)

Abstract

1.Describe a novel Diary method for documenting the role hospital chaplains play on the care team.2.Identify the most common and describe the breadth of activities chaplains perform with patients with advanced illness. Chaplains are key members of interdisciplinary hospital and palliative care teams, yet little data exists regarding their roles. Describe hospital-based chaplains' activities and experiences during patient and family encounters through an innovative diary-keeping technique. Chaplains at an urban academic medical center used iPads to complete web-based diaries immediately following 3-5 advanced illness patient encounters each day from January to June 2013. Diary data includes content of patient and family encounters and outcomes achieved. The diary is theoretically grounded in chaplaincy education tools and was designed, piloted, and revised with extensive chaplain input. We calculated descriptive statistics. We collected 844 diaries from nine hospital chaplains, one of whom is a member of the palliative care team. The patient or family accepted the chaplain's visit 94.8% of the time. Median visit length was 15 minutes (interquartile range (IQR) 10-30 minutes). Chaplains described 61.0% of visits as “extensive care responses” and 39.0% as “surface conversations.” The most common conversation topics with patients were physical symptoms (41.8%), spiritual/religious matters (37.1%), emotional matters (despair, anxiety) (30.2%), and existential matters (meaning, purpose) (29.8%). The most common chaplain activities were active listening (89.4%), spiritual assessments (32.1%), prayer (22.3%), and touch (22.0%). 42.7% of visits were with patients whose religious background was “very similar” to the chaplain, but in 31.9% of visits the chaplains did not know enough about the patient's religious background to answer. Chaplains reported patients and families becoming more relaxed during the visit 50.1% and 60.4% of the time, respectively. Chaplains spend time with patients and families discussing a range of topics beyond spiritual matters. Active listening was more common than prayer or ritual.