This past week, HealthCare Chaplaincy Network (HCCN) with funding from the John Templeton Foundation hosted a landmark conference titled “Caring for the Human Spirit: Driving the Research Agenda for Spiritual Care in Health Care.” The event was originally conceived as the capstone event for a three year grant from the John Templeton Foundation that funded six foundational studies which begin to lay the foundation for the workings of spiritual care and chaplaincy care in health care and begin to develop a cadre of health care chaplains engaged in this research.
Certainly, the event more than satisfied its original purpose. The six presentations from the research groups were extraordinary in both the sophistication and power of the results and in the rigor and professionalism with which they were presented. The question of whether professional chaplains can make significant contributions to research in the field and help advance the evidence base for chaplaincy care is now answered in the affirmative. The question of whether spiritual care can be researched productively is also answered in the affirmative.
However, the event turned out to be much more than simply a reporting out of six research groups- as ground breaking as that reporting was. When HCCN issued its call for proposals on this project, we really didn’t know what the quality and quantity of the response was going to be. One guess was twenty proposals would be generated and this guess was generally thought to be optimistic. The call generated 72 responses of which 56 were judged of high enough quality to be presented to the review panel as finalists. Thus, it became immediately clear that there is a tremendous interest in this kind of research, much of it from highly sophisticated research groups.
Given this beginning to the project, it should not have been a surprise that the conference also drew a response far beyond what many would have guessed. Despite a very short lead time for the publicity and the costs of coming to a conference in New York City, the conference drew close to 250 attendees from all over the US and several other countries with another significant audience attending though live streaming video. Anecdotally, the response of those attendees was overwhelmingly positive.
So what does this all mean? History will provide the best answer to this question of course but I am impressed by the similarities to integrating spiritual care in health care. Almost every survey published to date is clear that a majority of patients and family care givers want their spiritual and religious needs integrated into their health care- especially as they make decisions about how that care is to proceed. An increasing number of directives and guidelines including from such prestigious bodies as the World Health Organization promote the universal availability of palliative care and with it the inclusion of spiritual care. And yet, many people who could benefit from palliative care, including in the US, do not get it and many who get something billed as palliative care do not get good spiritual care as part of that care.
So we clearly have a lack of alignment between what many patients and many health care authorities think ought to happen and what is happening. Why? One issue has to do with available workforce. Even hospitals that are looking to hire a physician board certified in palliative care often have trouble finding one. One influential palliative care guidelines panel lists a board certified chaplain as “preferred” rather than required because they were aware that it is currently impossible for many palliative care teams to find a board certified chaplain with the proper training. One initiative that is needed here is to continue to educate palliative care providers about the special contributions of palliative care trained, board certified chaplains so they give preference in hiring to those with these credentials which should result in more chaplains seeking those credentials. Hopefully the conference results can help in that regard
But the other issue is developing the evidence base for spiritual care in palliative care. This conference made a huge contribution but the body of evidence is still very small and not yet at a level that should be considered persuasive. Getting over this barrier is a “chicken and egg” problem. Many funders, especially federal funders, want to see some “evidence” that this line of research is worthwhile but funding is needed to develop that evidence. We need to find courageous funders who will follow the lead of the John Templeton Foundation in building this field.
So is this a new day? Absolutely! Have we achieved our goals of developing the work force and the evidence base for spiritual care and chaplaincy care? No. However, I believe we have now answered the question of whether these goals can be attained. We need to push on because the progress will not happen of its own momentum. But I think we now have a committed community to develop the evidence and the practice models and we have encouraged a lot of chaplains and researchers that this journey is important and worthwhile. Hopefully, we have also persuaded a few more funders and regulators to join the effort.