December 2020 Article of the Month
by John Ehman, Editor, ACPE Research Article-of-the-Month
and Manager for Pastoral Care, Penn Presbyterian Medical Center, Philadelphia PA
Damen, A., Schuhmann, C., Leget, C. and Fitchett, G. "Can outcome research respect the integrity of chaplaincy? A review of outcome studies." Journal of Health Care Chaplaincy 26, no. 4 (2020): 131-158.
[Editor's Note: This month's selection is available as an open access article from the Journal of Health Care Chaplaincy.]
SUMMARY and COMMENT: If the great value of research resides not merely in the particulars of a set of results but in how much a project stirs further constructive thought, then this month's review and discussion of chaplaincy outcome studies is an important and timely contribution to the literature. Annelieke Damen, a PhD student in Outcomes of Chaplaincy, and Carmen Schuhmann and Carlo Leget from the University of Humanistic Studies, Utrecht, The Netherlands, along with George Fitchett from Rush University Medical Center, Chicago, IL, address a key question in our field and in turn propose four clarifying questions that may help guide investigations in our discipline moving forward. The article includes an extensive but convenient table [--see pp. 135-142] lining out key studies.
The article begins by recognizing the tension between, on the one hand, the process-oriented tradition of chaplaincy practice, which concentrates on "personal competence, presence, and relationship building" [p, 132], and on the other hand, a drive toward outcomes, especially as assessed through research methodology. If outcome-oriented chaplaincy is to be the "operant paradigm for professional chaplaincy in the twenty-first century," then a question for chaplains used to working through a process orientation is "whether adapting to the new reality will be at the cost of distorting what we value and believe to be important about spiritual care" [p. 133]. The authors review the literature for quantitative and mixed-methods outcomes studies in order get a bearing on the state of the science and suggest paths for research that could take into account the concerns of all sides.
They systematically identify 22 key studies, which they characterize mostly as "first attempts to research outcomes of chaplaincy care" [p. 143]. Among the findings of the review:
...[N]ine studies find a higher satisfaction with hospital or overall care of patients and relatives who were visited by a chaplain.... Three studies find a high satisfaction with chaplain care.... Four studies find a positive relationship between chaplaincy care and better patient quality of life... and four studies show an increase in spiritual well-being.... Three studies document a decrease in anxiety by patients visited by a chaplain.... Two studies find an increase in positive religious coping.... One study finds a decrease in medical
costs at the end of life...; one study a shorter length of stay...; one study better mental well-being...; and one study a decrease in dyspnea, primary and urgent care visits, and an increase in sleep quality. [p. 143]
In light of this literature, the authors comment on ways that the divide between process-oriented and outcomes-oriented approaches may be negotiated. After marking the theoretical potential for some common ground between the two orientations, they raise a question that might help highlight areas of practice dear to process-oriented chaplaincy that could also become the subject of outcomes research: namely, "visions of the good":
An understanding of the connection between processes and outcomes in chaplaincy can be advanced by the view that chaplaincy practice--like other professions--is directed toward and guided by an aspiration to certain "visions of the good"....
...[C]haplains aim at effecting some change for the better in their practice. Within chaplaincy, goods are the ends that, however implicit, chaplains strive towards, and these goods constitute what they see as changes for the better. We may understand outcomes in terms of these goods. Chaplaincy practices have a good outcome when they contribute to chaplaincy goods and a bad outcome when they do not. As a result, outcomes, informed by visions of the good inherent in chaplaincy, necessarily resonate in chaplaincy practices.
In this view, processes and outcomes are intrinsically connected in chaplaincy; processes are directed toward outcomes and outcomes guide processes. This also applies to a process-oriented approach to chaplaincy. We might say that chaplains who use a process-oriented approach work with an "agenda" consisting of visions of the good to which they hope to contribute. This is not the same as having an agenda of what they wish to achieve in a particular encounter. Thinking about the outcomes of chaplaincy is then related to the question of what are visions of the goods that guide chaplaincy practices. [pp. 145-146]
There is strong emphasis here on chaplains' intentionality and clarity and on the importance of researchers being "precise, thoughtful, and transparent in their choices when translating chaplaincy goods into outcomes that can be measured empirically" To that end, the authors set out four questions to guide chaplaincy studies:
- What is the audience and context of our study?
- "The choice of the study audience indicates the inevitable political aspect of outcome research: the choices we make when designing an outcome study have a bearing on its status as evidence of the value of chaplaincy. In designing outcome research, we cannot avoid issues of power: who has power in deciding what counts as good healthcare, as appropriate outcomes, and as convincing research." [p. 147] The authors note that the dominant paradigm in healthcare outcomes research is positivist, while "chaplaincy has a strong connection with the constructivist paradigm, according to which facts cannot be separated from interpretation and meaning making" [p. 147]. The authors acknowledge that the power dynamics of the real world may make working within a positivist natural science paradigm advisable. They go on to say, though, that "...we need various narratives in order to get a rich account of the value of chaplaincy that can be recognized by different audiences"...and...[q]uantitative as well as qualitative types of research can provide this evidence" [p. 153].
- What outcomes do we choose?
- "Do we want to study characteristic chaplaincy outcomes that represent intrinsic chaplaincy goods, or do we want to study secondary outcomes of chaplaincy care (e.g., clinical or physiological outcomes)? ...[W]hen we want to prove the value of chaplaincy in healthcare, restricting ourselves to characteristic chaplaincy outcomes may limit the evidential power of our studies. Still, secondary outcomes of chaplaincy are often regarded with suspicion by chaplains..." [pp. 147-148]. "[T]he question that needs to be addressed with respect to the choice of outcome is: how does the understanding of good healthcare represented by a chosen outcome relate to chaplains' visions of good healthcare? ...[A]t at the level of choosing an outcome, respecting the integrity of chaplaincy requires that we explicate the connection between the chosen outcome and chaplains' visions of good healthcare." [p. 148] This requirement is placed against the observation that "there seems to be no shared understanding among chaplains of what constitute characteristic chaplaincy outcomes" [p. 148].
- How do we assess these outcomes?
- "Assessments of outcomes are attempts to capture change that has taken place during a process" [p. 148]. "Chaplains generally consider themselves to be dealing with extremely complex and idiosyncratic change processes, the richness and depth of which is easily lost, especially when assessed quantitatively with standardized outcome measures. However, outcome studies into chaplaincy do not necessarily need to capture the whole complexity of change that occurs in chaplaincy processes. To respect the integrity of the profession does require an explication of the kind of change we are attempting to capture and our considerations regarding the choice of particular methods and instruments."
- Do we choose to establish outcomes in the form of effects of standardized interventions?
- "...[A] main objection to outcome research is that it requires standardization to make outcomes replicable and predictable.... According to this view, standardization runs counter to important chaplaincy values. The rejection of standardized interventions can leave chaplain researchers with no description of the substance of their intervention" [p. 149]. ..."Another possibility is to look at chaplaincy practice as consisting of several elements, some of which are appropriate for standardized research and others that are not. This requires recognition that any standardized intervention does not represent the whole of chaplaincy practice. Therefore, in respecting the integrity of chaplaincy, it is important that we explicate how the standardized intervention that we choose to research is related to chaplaincy practices more generally." [p. 149].
Finally, Damen and colleagues turn these questions back onto the 22 studies in their review, and in doing so they address future research needs and directions. First, as for audiences, the extant studies are aimed at "roughly two different audiences: clinicians and chaplains," but there was little variation in study design, with "the vast majority of the studies hav[ing] a quantitative research design regardless of audience" [p. 150]. They encourage more mixed-methods approaches. Regarding the second question, "...the majority do not appear to be outcomes exclusive to chaplaincy; many could also be considered relevant to the work of other healthcare professionals" [p. 150], like patient satisfaction. ..."The outcomes that seem specific to chaplaincy, for example, spiritual well-being, religious coping, and hope, have been studied less frequently. ...[R]especting the integrity of chaplaincy in choosing an outcome requires that we explicate the connection between the chosen outcome and chaplains' visions of good healthcare. This explanation is missing in most studies" [p. 151] .Third, most outcomes were assessed quantitatively via patient-reported questionnaires developed outside of the field of chaplaincy. Our authors do not evaluate the validity of measures like the FACIT-Sp, Brief RCOPE, etc. for application in this context, but they comment, "None of the studies explicate their rationale for using these measures in relation to chaplaincy goods" [p. 150]. They note, however, that "there is a questionnaire specifically developed for chaplaincy: the Patient Reported Outcome Measure (PROM) by Snowden and Telfer (2017)" and that they are "looking forward to further results from this questionnaire" [p. 151]. And fourth, to the question of establishing outcomes in the form of effects of standardized interventions, "most studies worked with a 'black box' design" and did not look at "specific predefined interventions," leaving "unclear which actions of the chaplain brought about a certain effect" [p. 151]. Yet, three projects [--see Related Items of Interest, §II, below] "offered a framework or semistructured protocol while also keeping the content of conversation highly individualized, since the interventions are intended to enable clients to relate personal stories" [p. 152].
We [have] argued that respecting the integrity of chaplaincy requires explicating how the standardized intervention is related to chaplaincy practice more generally. All three studies clearly explicate how the interventions relate to chaplaincy practice, pointing out that the interventions are embedded in the profession's focus on meaning-making, life review, relational well-being, and sense of loss and hope. [p. 152]
The article offers a perspective that mitigates tensions between an outcome orientation and a process orientation: "...[C]haplaincy is necessarily outcome-oriented because it is aimed at supporting some change for the better towards [chaplaincy's] goods," and "processes are directed toward outcomes and outcomes guide processes" [p. 152]. The four proposed questions hold much for researchers to consider, but perhaps the strongest takeaway from the article is the need for research to "focus more explicitly on characteristic chaplaincy outcomes" [p. 155, italics added]. "As this requires well-founded ideas about what are understood as distinctive features of chaplaincy, we want to point out the importance of having a thorough and continuing dialog among chaplains and chaplaincy researchers about what are characteristic chaplaincy goods and their related outcomes" [p. 155]. It will also be critical to open and reveal the elements of the "'black box' of chaplaincy care" [p. 155], and case studies may be especially useful for that.
Any chaplains undertaking research would be constructively challenged to consider the four questions put forward in this article and how new research could build upon and fill gaps in the literature identified here. The authors describe existing studies as "opportunistic in that chaplaincy researchers have taken advantage of available opportunities" as a function of "the brief history of chaplaincy research and the minimal resources available" [pp. 153-154]. However, they suggest that "with growing resources the time may be ripe for more intentionally developing chaplaincy outcome research" [p. 154]. A plea for a new level of intentionality is at the core of this piece, and for that clarity to come from dialogue among chaplaincy about what matters to chaplaincy and what of our "visions of the good" can be explored through empirical assessment.
This article may be aimed at researchers, but one of the takeaways from it is the general idea that empirical methodology and intentionality of chaplaincy practice are as dialectically significant to clinical chaplains as to researchers, and that tensions between a process orientation and an outcome orientation may be embraced as illuminating and productive. One possible effect of this article may be to help bring clinical chaplains and research chaplains more shoulder-to-shoulder and to open the way for more individuals fully to operate with a nuanced sensibility of both orientations.
The bibliography contains 73 references.
Suggestions for Use of the Article for Student Discussion:
This article may be somewhat challenging for chaplains new to research, but it should be well worth their effort in reading, not only in terms of envisioning research needs but in terms of setting out the relevance of outcomes research for all chaplains. One approach to discussion may be to begin with the question of what "visions of the good" people have for their chaplaincy practice, or, what changes do they have in mind and look for during patient encounters? That discussion alone could take up an hour and probably fill a writing board, but at some point the group should be directed to the task of thinking about what elements or aspects of these "goods" might be measurable beyond a chaplain's intuition or casual observation. What's in the students' awareness when, after a visit, they might say to themselves, "That was a good interaction"? Do any of the outcomes found in the 22 studies have special appeal to the group? Why? (If so, this could lead to a follow-up discussion of one of those articles.) Is it because the outcome touches on a crucial "good" or because it seems to serve some utilitarian/political purpose? Does the students' CPE program tend to direct them toward any specific outcomes, and does the curriculum or institutional documentation process present some degree of standardization for chaplaincy encounters? Advanced students familiar with research might discuss the paper according to the four proposed questions, including some attention to one or more specific measures, like the popular FACIT-Sp or Brief RCOPE, and methodological latitude in Randomized Controlled Trials. Finally, since this article is written in light of some tensions in the field, the students might be asked simply how it has left them feeling. Does it spark creative thought that could lead to clinical or research action?
Related Items of Interest:
I. For more pertaining to chaplaincy and outcomes, see the following recent publications:
Karimi, L. and Tan, H. "Validation of the Patient Reported Outcome Measure of spiritual care (PROM) in an Australian setting." Health and Social Care Chaplaincy 8, no. 1 (2020). [A multi-site study across five hospitals in Australia, undertaken as part of the study to evaluate the validity and reliability of the Patient Reported Outcome Measure of spiritual care (PROM) scale. Two hundred and eighty-one patients participated in the study. Data were analysed using AMOS (version 24) to assess the validity and reliability of the PROM using confirmatory factor analysis (CFA). Predictive (criterion) validity of the scale was also assessed by evaluating the relationship of the PROM scale with the quality of spiritual care. The results demonstrated acceptable validity, model-based reliability and predicative validity for the PROM scale. It is recommended that a further study for cross-validation of the scale in different samples and populations is undertaken. Controlling for other variables such as (positive-negative affect or personality characteristics) for future studies might shed more light on the content validity of the PROM. The study has implications for the longer-term goal of building an evidence base for a spiritual care framework for Australian healthcare organizations and beyond. It is hoped that the data collected will enable spiritual health organizations to contribute to a larger database of evidence, both nationally and internationally.] [See the journal page.]
Kittelson, S., Scarton, L., Barker, P., Hauser, J., O'Mahony, S., Rabow, M., Delgado Guay, M., Quest, T. E., Emanuel, L., Fitchett, G., Handzo, G., Yao, Y., Chochinov, H. M. and Wilkie, D. "Dignity Therapy led by nurses or chaplains for elderly cancer palliative care outpatients: protocol for a randomized controlled trial." JMIR Research Protocols 8, no. 4 (April 17, 2019): e12213 [electronic journal designation]. [(Abstract:) BACKGROUND: Our goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity therapy (DT) has clear feasibility but inconsistent efficacy. DT could be led by nurses or chaplains, the 2 disciplines within palliative care that may be most available to provide this intervention; however, it remains unclear how best it can work in real-life settings. OBJECTIVE: We propose a randomized clinical trial whose aims are to (1) compare groups receiving usual palliative care for elderly patients with cancer or usual palliative care with DT for effects on (a) patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness); and (b) processes of delivering palliative spiritual care services (satisfaction and unmet spiritual needs); and (2) explore the influence of physical symptoms and spiritual distress on the outcome effects (dignity impact and existential tasks) of usual palliative care and nurse- or chaplain-led DT. We hypothesize that, controlling for pretest scores, each of the DT groups will have higher scores on the dignity impact and existential task measures than the usual care group; each of the DT groups will have better peaceful awareness and treatment preference more consistent with their cancer prognosis than the usual care group. We also hypothesize that physical symptoms and spiritual distress will significantly affect intervention effects. METHODS: We are conducting a 3-arm, pre- and posttest, randomized, controlled 4-step, stepped-wedge design to compare the effects of usual outpatient palliative care and usual outpatient palliative care along with either nurse- or chaplain-led DT on patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness). We will include 560 elderly patients with cancer from 6 outpatient palliative care services across the United States. Using multilevel analysis with site, provider (nurse, chaplain), and time (step) included in the model, we will compare usual care and DT groups for effects on patient outcomes and spiritual care processes and determine the moderating effects of physical symptoms and spiritual distress. RESULTS: The funding was obtained in 2016, with participant enrollment starting in 2017. Results are expected in 2021. CONCLUSIONS: This rigorous trial of DT will constitute a landmark step in palliative care and spiritual health services research for elderly cancer patients.] [This report is available freely online.]
Tan, H., Rumbold, B., Gardner, F., Snowden, A., Glenister, D., Forest, A., Bossie, C. and Wyles, L. "Understanding the outcomes of spiritual care as experienced by patients." Journal of Health Care Chaplaincy (2020): online ahead of print, 7/26/20. [(Abstract:) In moving toward professionalising spiritual care in the healthcare system, as an equal partner in whole person care, it has become increasingly important to develop an evidence base for spiritual care interventions, their value and longer-term outcomes for those receiving this care. This study utilised hard copy questionnaires across five Australian general hospitals to investigate patient reported outcomes of in-patient spiritual care. The survey included the Scottish Patient Reported Outcomes Measure (PROM), measures of patient experience and an open-ended question about experience of care. Data indicated a positive correlation between positive experience of spiritual care and a high score on PROM. Qualitative data elaborated on if and how the spiritual care received met patients' needs, the qualities they valued in the provider of this care and impacts of the care they experienced. Further development of the PROM in a variety of situations is however recommended.]
Peery, B. "Outcome Oriented Chaplaincy: Perceptive, Intentional, and Effective Caring." Jessica Kingsley Publishers, 2020. [(From the publisher:) Outcome Oriented Chaplaincy (OOC) is a method of chaplaincy care that emphasizes achieving, describing, measuring, and improving the outcomes that result from a chaplain's work, alongside the parallel framework of evidence-based healthcare. This book examines the underlying principles of OOC and incorporates first-hand accounts of chaplains who have made a measured difference to patients and their families. Brent Peery draws on more than fifteen years of experience within the field of Outcome Oriented Chaplaincy, exploring its evolution and history within the complex culture of healthcare, and how its underlying principles of assessments, interventions, outcomes and documentation are most effectively put into practice. This practical guide will benefit chaplains interested in the approach of OOC, and identify a framework for providing the best spiritual care for those facing life's most difficult moments.] [See especially pp. 75ff for the chapter on Outcomes, including a listing headed Describing the Results of Our Care.]
II. Of the 22 articles identified in our featured study, three "offered a framework or semistructured protocol while also keeping the content of conversation highly individualized, since the interventions are intended to enable clients to relate personal stories" [p. 152]:
Kestenbaum, A., Shields, M., James, J., Hocker, W., Morgan, S., Karve, S., Rabow, M. W. and Dunn, L. B. "What impact do chaplains have? A pilot study of Spiritual AIM for advanced cancer patients in outpatient palliative care." Journal of Pain & Symptom Management 54, no. 5 (November 2017): 707-714. [(Abstract:) CONTEXT: Spiritual care is integral to quality palliative care. Although chaplains are uniquely trained to provide spiritual care, studies evaluating chaplains' work in palliative care are scarce. OBJECTIVES: The goals of this pre-post study, conducted among patients with advanced cancer receiving outpatient palliative care, were to evaluate the feasibility and acceptability of chaplain-delivered spiritual care, utilizing the Spiritual Assessment and Intervention Model ("Spiritual AIM"); and to gather pilot data on Spiritual AIM's effects on spiritual well-being, religious and cancer-specific coping, and physical and psychological symptoms. METHODS: Patients with advanced cancer (n=31) who were receiving outpatient palliative care were assigned based on chaplains' and patients' outpatient schedules, to one of three professional chaplains for three individual Spiritual AIM sessions, conducted over the course of approximately six to eight weeks. Patients completed the following measures at baseline and post-intervention: Edmonton Symptom Assessment Scale (ESAS), Steinhauser spirituality, Brief Religious Coping (Brief RCOPE), Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp-12), Mini-Mental Adjustment to Cancer (Mini-MAC), Patient Dignity Inventory, Center for Epidemiological Studies - Depression (CES-D, 10-item), and Spielberger State Anxiety Inventory (STAI-S). RESULTS: From baseline to post-Spiritual AIM, significant increases were found on the FACIT-Sp-12 Faith subscale, the Mini-MAC Fighting Spirit subscale, and Mini-MAC Adaptive Coping factor. Two trends were observed, i.e., an increase in Positive religious coping and an increase in Fatalism (a subscale of the Mini-MAC). CONCLUSION: Spiritual AIM, a brief chaplain-led intervention, holds potential to address spiritual needs, as well as religious and general coping in patients with serious illnesses.] [This was featured as our August 2017 Article-of-the-Month.]
Piderman, K. M., Radecki Breitkopf, C., Jenkins, S. M., Lapid, M. I., Kwete, G. M., Sytsma, T. T., Lovejoy, L. A., Yoder, T. J. and Jatoi, A. "The impact of a spiritual legacy intervention in patients with brain cancers and other neurologic illnesses and their support persons." Psycho-Oncology (December 7, 2015): published online ahead of print. [(Abstract:) Objective: The objectives were to assess the feasibility of using a novel, comprehensive chaplain-led spiritual life review interview to develop a personal Spiritual Legacy Document (SLD) for persons with brain tumors and other neurodegenerative diseases and to describe spiritual well-being (SWB), spiritual coping, and quality of life (QOL) of patients and their support persons (SP) before and after receipt of the SLD. Methods: Patient-SP pairs were enrolled over a 2-year period. Assessments included the Functional Assessment of Chronic Illness Therapy-Spiritual Expanded Version, Brief Religious Coping Scale, Brief COPE Inventory, and QOL Linear Analog Scale. Baseline assessments were completed prior to an audio-recorded spiritual life review interview with a chaplain. Results: Thirty-two patient/SP pairs were enrolled; 27 completed baseline assessments and the interview. Twenty-four reviewed their SLD and were eligible for follow-up. A total of 15 patients and 12 SPs completed the 1-month follow-up; 10 patients and seven SPs completed the 3-month follow-up. Patients endorsed high levels of SWB and spiritual coping at baseline. Both patients and SPs evidenced improvement on several aspects of SWB, spiritual coping, and QOL at 1 month, but patients' decreased financial well-being was also observed. Patients and SPs demonstrated favorable changes in peacefulness and positive religious coping at both time points. Conclusions: A chaplain-led spiritual life review is a feasible intervention for patients with neurodegenerative disease and results in beneficial effects on patients and SPs.] [See also more articles from this project on our Article-of-the-Month pages for February 2017 and June 2015.]
Steinhauser, K. E., Olsen, A., Johnson, K. S., Sanders, L. L., Olsen, M., Ammarell, N. and Grossoehme, D. "The feasibility and acceptability of a chaplain-led intervention for caregivers of seriously ill patients: a Caregiver Outlook pilot study." Palliative and Supportive Care 14, no. 5 (October 2016): 456-467. [(Abstract:) OBJECTIVE: When caring for a loved one with a life-limiting illness, a caregiver's own physical, emotional, and spiritual suffering can be profound. While many interventions focus on physical and emotional well-being, few caregiver interventions address existential and spiritual needs and the meaning that caregivers ascribe to their role. To evaluate the feasibility and acceptability of the process and content of Caregiver Outlook, we employed a manualized chaplain-led intervention to improve well-being by exploring role-related meaning among caregivers of patients with a life-limiting illness. METHOD: We conducted a single-arm pre-post pilot evaluation among caregivers of patients with advanced cancer or amyotrophic lateral sclerosis (ALS). Caregivers completed three chaplain-led intervention sessions focusing on (1) a relationship review, (2) forgiveness, and (3) legacy. Outcomes administered at baseline and at 1 and 2 weeks after the intervention included quality of life, anxiety, depression, spiritual well-being, religious coping, caregiver burden, and grief. RESULTS: The sample (N = 31) included a range of socioeconomic status groups, and the average age was approximately 60 years. A third of them worked full-time. Some 74% of our participants cared for a spouse or partner, and the other quarter of the sample cared for a parent (13%), child (10%), or other close family member (3%). At baseline, participants did not demonstrate clinical threshold levels of anxiety, depression, or other indicators of distress. Outcomes were stable over time. The qualitative results showed the ways in which Caregiver Outlook was assistive: stepping back from day-to-day tasks, the opportunity to process emotions, reflecting on support received, provoking thoughts and emotions between sessions, discussing role changes, stimulating communication with others, and the anonymity of a phone conversation. Both religious and nonreligious participants were pleased with administration of the chaplain intervention. SIGNIFICANCE OF RESULTS: The acceptability and feasibility of Caregiver Outlook were demonstrated among caregivers of patients with an advanced illness. Our pilot findings suggest minor modifications to study participant screening, interventionist guidance, and the study measures.]
III. Recently published articles pertaining to Patient Reported Outcome Measures (PROMs) are cited above in §I, but note that our authors this month underscore the work of Snowden & Telfer as a "questionnaire specifically developed for chaplaincy" [p. 151] that may hold good promise:
Snowden, A. and Telfer, I. "Patient reported outcome measure of spiritual care as delivered by chaplains." Journal of Health Care Chaplaincy 23, no. 4 (October-December 2017): 131-155. [(Abstract:) Chaplains are employed by health organizations around the world to support patients in recognizing and addressing their spiritual needs. There is currently no generalizable measure of the impact of these interventions and so the clinical and strategic worth of chaplaincy is difficult to articulate. This article introduces the Scottish PROM, an original five-item patient reported outcome measure constructed specifically to address this gap. It describes the validation process from its conceptual grounding in the spiritual care literature through face and content validity cycles. It shows that the Scottish PROM is internally consistent and unidimensional. Responses to the Scottish PROM show strong convergent validity with responses to the Warwick and Edinburgh Mental Well-Being Scale, a generic well-being scale often used as a proxy for spiritual well-being. In summary, the Scottish PROM is fit for purpose. It measures the outcomes of spiritual care as delivered by chaplains in this study. This novel project introduces an essential and original breakthrough; the possibility of generalizable international chaplaincy research.] [NOTE: See especially the table on pp. 23-25 of relevant research and its connection to PROM development.]
And, for more on Patient Reported Outcome Measures, see our January 2019 Article-of-the-Month page.