Thanks to our colleagues at the Center to Advance Palliative Care, the latest figures are out on the penetration of palliative care services into the US health care system. The good news is that about two-thirds of hospitals offer palliative care. The bad news of course is that about one-third don’t. Further the rate of growth of palliative care seems to have slowed.
On top of this, I am certain that while the number of hospitals claiming to offer palliative care has hit the two-thirds mark, the number meeting all domains of the National Consensus Project for Quality Palliative Care is way below that number. I know this is true for Domain 5 (Spiritual, Religious and Existential Aspects of Care). And finally, I am certain that even when the palliative care team has a chaplain included, that chaplain is not always fully trained in palliative care.
This latter point may need some explanation. Dr. Diane Meier recently laid out four tactics for improving palliative care. The first two certainly apply to chaplains as well as others on the team.
1 Explicitly ask patients and their families what matters most to them, and ensure that this information is recorded, made available in the medical record, and actively used by all involved parties in decision making about care.
2. Require that all clinicians (doctors, nurses, social workers, and others) receive basic training and certification in pain and symptom management, communication, and coordination of care across time and settings.
My guess is that even many chaplains involved in palliative care do not routinely comply with #1 and very few have the training required in #2. I do trust that most chaplains know a lot about how to be the spiritual care specialist that is our primary role on the team. I suspect far fewer know how to be the physical care generalist and overall team player required by this standard. To be clear, individual chaplains are not primarily to blame here. I would be hard pressed to offer suggestions to a chaplain who wants this training at a level appropriate for chaplains. It is certainly not a regular part of CPE nor of the continuing education events chaplains regularly attend.
The research is now very clear about the desire of patients and their family caregivers to have what matters to them be a major determining factor in how their care is conducted and about the benefits of that inclusion for patient satisfaction and medical outcomes. While as Dr. Meier points out, asking patients about that is everyone’s responsibility, chaplains talk about these matters with patients all the time. The big change is making sure that they do it routinely and that those wishes are documented and remain front and center in the team’s care planning.
As to training, it would seem that the first goal is for chaplains and chaplain educators to appreciate that the knowledge base for working as a chaplain in the health care system includes much more than what has historically been included in delivering spiritual care. Once demand for this training is created, training opportunities will follow.
These two changes in practice and training will improve the care patients and caregivers receive and increase the value chaplains add to the health care system.