The utilization and perceptions of chaplaincy among patients of Dharmic religions in a cancer hospital: A mixed methods study.

Abstract

83 Background: Spiritual care administered through chaplaincy services (CS), is an integral component of cancer care in the US; however, chaplaincy utilization (CU) among patients who identify with a Dharmic religion (DR; Hinduism, Buddhism, Sikhism, Jainism) is unknown. This study measures CU and explores perceptions of CS among hospitalized DR patients with cancer. Methods: A retrospective chart review identified patients hospitalized in a specialty cancer center in New York City between 2015 and 2019. The primary objective was to measure proportions of DR and non-DR (NDR) patients with CU (≥1 CS visit); secondary objectives included identifying factors associated with CU. Demographics, length of stay (LOS), total number of CS visits, and disposition were collected. Bivariate and multivariate logistic regression analyses examined associations between religion, age, race, language, LOS and advanced illness (AI; ICU admission, inpatient death, hospice discharge) with CU. Semi-structured interviews were conducted to explore CS perceptions and preferences among DR patients with cancer in 2020. Data was coded and analyzed independently and iteratively by two investigators and themes were identified. Results: Of 54,828 patients, 59% identified as Christian, 14% identified as Jewish, and 2% identified with a DR (n=1163; 58% Hindu, 33% Buddhist, 4.8% Sikh, 3.4% multiple faiths, 0.2% Jain). Compared to NDR patients, DR patients were younger (median age 59 vs. 63, p<0.001), more likely East or South Asian (79% vs. 5.6%, p<0.001), had more AI (23% vs 15%, p<0.001), but lower CU (37% vs 32%, P<0.001). In multivariable analysis, LOS, NDR, and AI were associated with CU (Table); with Non-Hispanic, White as the reference group, race was not associated with CU. Twenty-two patients (91% Hindu, 9% Sikh) were interviewed. Few reported being approached about CS during their admission, and most expressed unfamiliarity with CS. Some felt CS and spiritual care was tailored to Jewish and Christian faiths but not DR. Suggestions for the hospital included having DR-specific chaplains, religious materials, and worship space. Conclusions: Despite more AI, CU was lower among DR patients. DR patients identified unfamiliarity and/or NDR perceptions as barriers to CS and recommended greater access to faith-specific resources. More work is needed to deliver faith-concordant spiritual care for DR patients.[Table: see text]