Newsletter Volume 17 — New Format
Edited by Chaplain John Ehman
1. The ACPE Research Committee Begins Work: An Update, by Judith Ragsdale (pub. 3/11/18)
2. ACPE Research Community of Practice (CoP) (pub. 3/11/18)
3. ACPE National Conference Workshops Focusing on Research (pub. 3/11/18)
4. Research Themes for the 2018 APC/NACC Joint Conference (pub. 3/11/18)
5. Joint Commission Article Supporting Chaplains Emphasizes Research (pub. 3/11/18)
6. Chaplains Facilitating Advance Directive Completion Project Reported in JAMA Internal Medicine (pub. 3/11/18)
7. ACPE Research Committee: Summer 2018 Update, by Judy Ragsdale (pub. 8/8/18) --NEW
8. CPE & Research Literacy at Sisters of Charity Hospital, by Mary Ann Brody (pub. 8/8/18) --NEW
9. Notable Articles from 2017 Not Previously Cited on the ACPE Research Website (pub. 8/8/18) --NEW
1. The ACPE Research Committee Begins Work: An Update, by Judith Ragsdale (pub. 3/11/18)
The ACPE's newly established board-level Research Committee has gotten under way and met by conference call on February 8, 2018 to discuss overall plans and the elements of its charge from the ACPE Board, including:
We are excited ACPE is embracing research as a key aspect of our mission. We hope to guide ACPE in considering how relevant research could beneficially impact our outcomes and education practices. Over the next months, the Committee plans to identify our individual perceptions of ACPE research priorities and gather information from our cognate groups about what they identify as research priorities in ACPE. Our goal is to clarify ACPE research priorities at our ACPE national meeting in May. Our Research website will continue to note developments.
- Identify and establish research priorities for ACPE sponsorship and engagement with a horizon of at least three years.
- Facilitate and collaborate with research focused on the education of CPE supervisors, providers of spiritual care, and spiritual health educators.
- Identify and collaborate with formal and informal leaders in research areas of direct interest to ACPE, including but not limited to the Joint Research Council and the Transforming Chaplaincy initiatives.
- Work with FCPE grant processes and ACPE budget processes to fund research that advances the mission of ACPE; establish and maintain processes to evaluate, approve, and monitor progress of FCPE and ACPE funded research.
Members of the Committee are: Judy Ragsdale (chair), Moses Taiwo (chair elect), Henry Heffernan, Niyoka Nelson, Angela Obu-Anukam; Ramona Reynolds, Michael Doane, Heather Weidemann, Mark Lee, Angelika Zollfrank, and Csaba Szilagyi. We welcome hearing your thoughts about research priorities for ACPE.
[Editor's Note: See also Item #7, below, for a further update.]
2. Update on the ACPE's Research Community of Practice (CoP) (pub. 3/11/18)
The ACPE's newly established Research Community of Practice (CoP) is in the process of formation with the help of its convener, Michael Doane, ACPE Educator and System Director for University of Minnesota Health Spiritual Health Services. Interest in participation has been strong, and Rev. Doane plans to conduct a survey of existing members to better understand areas and levels of member interest. Additionally, he will work closely with the newly formed ACPE Research Committee to foster collaboration and communication.
Communities of Practice have been designated a "flagship activity" for the ACPE, which defines them as "a group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly." CoPs "anchor us in our grassroots tradition" and have three primary purposes:
- To foster supportive and challenging relationships among colleagues,
- To promote best practices in the field of clinical pastoral education (CPE), and
- To provide ongoing professional development for CPE educators, students and clinical members.
The Research CoP will be part of the Communities of Practice "Fishbowl" event at the May 9-11, 2018 ACPE national conference in Atlanta, GA --on Thursday, May 10th, 10:30 AM - 1:30 PM.
The Research website will continue to note developments.
You may contact Rev. Doane for more information or to join the CoP through ResearchCoP@acpe.edu
3. Research-Related Workshops at the ACPE's 2018 National Conference --Notes by John Ehman (pub. 3/11/18)
The ACPE's national conference in Atlanta, GA, May 9-11, 2018, will offer eight workshops, three of which mention research in their official descriptions.
- Compassion-Centered Spiritual Health: Insights from Cognitively-Based Compassion Training (Thursday, May 10, 2018 @ 1:45 PM - 3:15 PM) — Presented by Timothy Harrison and Maureen Jenci Shelton — This workshop explores Cognitively-Based Compassion Training (CBCT), a systematic approach to cultivating compassion (as distinct from empathy) as a skill important for the practice of healthcare professionals. The plan for the session includes the goal: "Become familiar with the research-based benefits of CBCT and the growing field of compassion science."
- Philanthropy and the Future of CPE (Thursday, May 10, 2018 @ 1:45 PM - 3:15 PM) — Presented by Russell H. Davis and T. Greg Prince — While focusing on strategies for building financial support for CPE programs and spiritual care initiatives, this workshop covers "[f]indings from a survey of CPE Centers" on the topic.
- Lessons from the Field: Reflections on Past Innovative CPE Projects (Friday, May 11, 2018 @ 1:30 PM - 4:30 PM) — Presented/Moderated by Jasmine Okafor — This workshop offers a panel of past recipients of Innovative Program Awards: grant funds awarded by the ACPE Foundation to support innovative CPE projects that expand CPE into new settings, and/or test new research, methodology or pastoral theology. Panelists will discuss lessons learned from implementing their projects and offer suggestions for how others might design innovative CPE programs.
NOTE: In addition, the new Research Community of Practice (CoP) will be part of the Communities of Practice "Fishbowl" event on Thursday, May 10th from 10:30 AM to 1:30 PM.
4. Research Themes for the 2018 APC/NACC Joint Conference (pub. 3/11/18)
The Association of Professional Chaplains and the National Association of Catholic Chaplains will hold a joint conference, July 12-15, 2018 in Anaheim, CA, with one of the event's keynote themes being Empowering the Profession through Research. On Saturday, July 14th at 12:00 Noon, plenary speaker Steve Nolan, PhD, Chaplain at Princess Alice Hospice (Esher, UK) and Visiting Research Fellow, University of Winchester (UK) will present on "Lifting the Lid on Chaplaincy: A First Look at Findings from Chaplains' Case Study Research" --a review of the current state of chaplains' case study research providing insight into how colleagues understand what a difference chaplains make.
Also, the conference will offer variety of Professional Development Initiatives and Workshops that revolve around or emphasize research. The following are listed in chronological order. (Note that some are pre-conference activities.)
- Outcomes-based Healthcare Chaplaincy: Introducing the Religious Comfort Index (RCI) (Wednesday, July 11, 2018 @ 8:00 AM - 5:00 PM) — Professional Development Intensive presented by Jack D. Giddens. — OBJECTIVES: To introduce results of a research project that establishes the impact and effectiveness of the Religious Comfort Index (RCI), an outcomes-based metric and system for practicing healthcare chaplaincy; to teach clinical patient skills and a departmental systematic approach to implementing an outcomes-based approach to healthcare chaplaincy as demonstrated by the Religious Comfort Index (RCI) system; and to present the relationship and impact of the Religious Comfort Index (RCI) metric and system on patient satisfaction as measured by HCAHPS scores. — DESCRIPTION: This session intends to introduce clinical skill developments, collaborative departmental developments, and the impact of chaplain interventions on HCAHPS scores from a research project conducted from October 2017 - March 2018 at Providence Hospital in Mobile, Alabama in Collaboration with Ascension Health, Inc., using the Religious Comfort Index (RCI), a metric and system for conducting outcomes-based healthcare chaplaincy co-invented by Dr. Jack D. Giddens, DMIN, BCC, CTP, Catholic Chaplain at Providence Hospital and Instructor of Religion at the University of West Florida; and Dr. Harold G. Koenig, MD, Psychiatrist, Professor, and Director of the Center for Spirituality, Theology and Health at Duke University Medical School.
- Turing a Chaplain Story Into a Chaplain Case Study: a Practical Masterclass in Writing for Publication (Wednesday, July 11, 2018 @ 8:00 AM - 5:00 PM) — Professional Development Intensive presented by Steve Nolan. — OBJECTIVES: Understand the use of chaplain case studies for research and advancing the profession; understand the value of writing a chaplain case study for continuing professional development; and hone skills in writing their own chaplain case study with a view to publication. — DESCRIPTION: Experienced chaplains (minimum 3 years' experience) bring two pieces of written work (each around 2000 words) to the Intensive: one describing their chaplaincy-patient relationship (including some verbatim recording); one analyzing their work (their "Assessment of Spiritual Need," their "Interventions," and the patient "Outcomes"). Participants will work in peer-groups with the tutor to develop their case study towards publication. Following the Intensive, the tutor offers an additional hour's online consultation with each participant, helping them prepare their case towards submission to a peer-reviewed journal. The tutor does not guarantee any participant will have their work published. — Recommended Reading: Fitchett, G. and Nolan, S., Spiritual Care in Practice: Case Studies in Healthcare Chaplaincy (London/Philadelphia: Jessica Kingsley Publishers, 2015); Fitchett, G., "Making our case(s)," Journal of Health Care Chaplaincy 17, nos. 1-2 (2011): 3-18; and McCurdy, D. B. and Fitchett, G., "Ethical issues in case study publication: 'making our case(s)' ethically," Journal of Health Care Chaplaincy 17, nos. 1-2 (2011): 55-74.
- Human Trafficking and Spiritual Care: Developing and Sustaining Spiritual Care Initiatives with Victims and Survivors (Wednesday, July 11, 2018 @ 8:00 AM - 5:00 PM) — Professional Development Intensive presented by Penny Stacy. — OBJECTIVES: To intentionally and critically examine the role Spiritual Care has in the field of Human Trafficking; to become familiar with evidence that persons who have been trafficked can have a spiritual perspective about their experience characterized by resilience and a desire to share new found wisdom; and to help chaplains develop and maintain research protocols/literacy, including the ability to critically read research and, where appropriate, apply findings in their professional practice. — DESCRIPTION: A key challenge for Spiritual Care providers is identifying characteristics of a Human Trafficking victim and ministering to them. Spiritual Care is a key component in helping victims begin inner healing. This professional development intensive is presented by a 17 year survivor of Human Trafficking who is also a Board Certified Chaplain. This educational opportunity will use lecture and interactive experiential research to meet educational objectives. This activity is appropriate for all attendees, including those just starting out or those who are looking to expand their skills in providing spiritual care to this population. The presenter will utilize real case examples to help attendees develop strategies to help themselves, colleagues and survivors with spiritual struggles around this topic. — Recommended Reading: Cooper-White, P., The Cry of Tamar: Violence against Women and the Church's Response (Minneapolis, MN: Fortress Press, 1995, 2012); Wilson, J. M. and Dalton, E., Human Trafficking in Ohio: Markets, Responses, and Considerations (Santa Monica, CA: Rand, 2007); and Lloyd, R., Girls Like Us: Fighting for a World Where Girls Are Not for Sale, an Activist Finds Her Calling and Heals Herself (New York: HarperCollins Publishers, 2011).
- The Value and Practice of Qualitative Research in Spiritual Care (Wednesday, July 11, 2018 @ 8:00 AM - 5:00 PM) — Professional Development Intensive presented by Tim Cranfill. — OBJECTIVES: Demonstrate an understanding of purposes and values of qualitative research in general; demonstrate an understanding of the components and processes involved in qualitative research as applied to spiritual/pastoral care; and conduct a basic qualitative research project of their own. — DESCRIPTION: This workshop will introduce basic and intermediate qualitative research methods to the participants, facilitate an understanding of the general value of qualitative studies, and explore how qualitative studies can specifically relate to and have significant value for spiritual care. Issues such as research validity, protection of human subjects, ethical and legal requirements for the use of an IRB will be discussed along with the processes involved in conducting a qualitative study. A minimum of three specific qualitative methodologies will be introduced. The workshop will include an experiential component where the participants will conduct a "mini-interview" and participate in a coding, analysis and interpretation exercise. Participants will discover the implications of qualitative studies for spiritual care, examples of what qualitative data can tell us, and what care and intervention directions qualitative data can suggest for the provision of spiritual care. As pastoral/spiritual caregivers, we already do this work intuitively with our patients on a day to day basis, why not make the leap to utilizing our current skills as tools for research? As chaplains, we value the judicious use of self in our interactions with patients and one another. In much the same way, qualitative research values the judicious use of the self of the researcher --as the researcher is the tool in qualitative research. The primary aim of this workshop is to enable and encourage participants to return to their home environments and engage in improving the quality of care through the use and application of qualitative research. The secondary aim of this workshop is to encourage and engage participants to contribute to the existing literature on spiritual/pastoral care through the implementation and application of basic, intermediate, and sophisticated qualitative studies. — Recommended Reading: Maxwell, J. A., Qualitative Research Design: An Interactive Approach 3rd. ed. (Thousand Oaks, CA: Sage Publications, 2013).
- Intentional Caring: An Introduction to Outcome Oriented Chaplaincy (Wednesday, July 11, 2018 @ 8:00 AM - 5:00 PM) — Professional Development Intensive presented by Brent Peery. — OBJECTIVES: Understand the historical and theoretical development of outcome oriented chaplaincy; articulate the components of outcome oriented chaplaincy; and demonstrate the practice of outcome oriented chaplaincy. — DESCRIPTION: A confluence of movements within chaplaincy, healthcare and broader culture have made Outcome Oriented Chaplaincy (OOC) a timely topic. We will discuss how OOC can help chaplains provide better care and demonstrate their value within a milieu of evidence-based medicine and organizational quality improvement. — Recommended Reading: Fitchett, G., Assessing Spiritual Needs: A Guide for Caregivers (Lima, OH: Academic Renewal Press, 2002); and Roberts, S., ed., Professional Spiritual and Pastoral Care: A Practical Clergy and Chaplain's Handbook (Woodstock, VT: SkyLight Paths Publishing, 2011).
- Quantitative Research for Beginners (Thursday, July 12, 2018 @ 8:00 AM - 12:00 PM) — Professional Development Intensive presented by George Fitchett, Kelsey White, and Kathryn Lyndes. — OBJECTIVES: Participants will be able to read and interpret tables with simple research findings; participants will be able to explain the meaning of significant and non-significant findings; and participants will have greater confidence for reading chaplaincy-related research and applying findings to their chaplaincy practice. — DESCRIPTION: The workshop will introduce participants to 3 of the most common statistical procedures used in quantitative research: 1) comparing means or proportion of two groups; 2) testing the association between two variables (correlation); and 3) testing the association between two variables while adjusting for the effects of other factors (multiple regression). The workshop will also introduce participants to significance testing (p values). Each of these procedures will be illustrated with reports (tables) from chaplaincy research. Participants will have the opportunity to work in small groups to apply their learning to the interpretation of additional tables from chaplaincy research. — Recommended Reading: Koenig, H. G., Spirituality and Health Research: Methods, Measurement, Statistics, and Resources (West Conshohocken, PA: Templeton Press, 2011); Fitchett, G., White, K. and Lyndes, K., eds., Evidence-Based Healthcare Chaplaincy: A Research Reader (Jessica Kingsley Publishers, forthcoming 2018); and Myers, G. E with Roberts, S., An Invitation to Chaplaincy Research: Entering the Process (John Templeton Foundation, 2014), available online.
- Case Studies: Working with a Format. Dutch Case Studies Project. (Thursday, July 12, 2018 @ 8:00 AM - 12:00 PM) — Professional Development Intensive presented by Martin Walton. — OBJECTIVES: Write a case study in a reflective format; more concretely describe the intentions, theoretical perspectives and outcomes in a case study; and discuss and evaluate case studies in a group using an appreciative approach. — DESCRIPTION: The Dutch Case Studies Project in Chaplaincy Care has developed a reflective format for describing case studies in chaplaincy care and an appreciative approach to the evaluation of cases studies in research communities of chaplains. The PDI participants will be introduced to the format which pays particular attention to issues of context, theory and practice, sense perceptions and the description of outcomes with feedback from clients and client systems. The participant group will subsequently function as a temporary research community in the evaluation of a written case study. — Recommended Reading: Fitchett, G. and S. Nolan, S., Spiritual Care in Practice. Case Studies in Healthcare Chaplaincy (London/Philadelphia: Jessica Kingsley Publishers 2015); Health and Social Care Chaplaincy special issue on chaplains' case studies, publication forthcoming in Spring 2018.
- Analyzing Chaplain Interventions: Presentation and Analysis of a Performance Improvement Initiative (Friday, July 13, 2018 @ 11:15 AM - 12:45 PM) — Workshop presented by Timothy Ford and Alexander Tartaglia. — OBJECTIVES: Identify opportunities for performance improvement for chaplain documentation; discuss "best practice" relationships for chaplain assessment and intervention; and design training interventions to enhance spiritual care documentation and communication. — DESCRIPTION: How do chaplains chart what they do? As part of an ongoing analysis of chaplain electronic charting at one academic medical center, we analyzed our database of over 100,000 charts to determine the relationship between spiritual assessments and chaplain interventions. Findings led to the development of a review by department staff and initiation of a focused intervention for improvement. Presentation will review the analysis of findings and discuss implications for future research opportunities.
- The Spirituality and Science of Self-Compassion (Friday, July 13, 2018 @ 11:15 AM - 12:45 PM) — Workshop presented by Anne Kertz Kernion. — OBJECTIVES: Identify the 3 components of Self-Compassion; list the 5 paths to Self-Compassion; and be able to practice and share techniques to foster Self-Compassion. — DESCRIPTION: Much of current research is confirming the teachings of ancient wisdom traditions about compassion and self-compassion. This workshop will briefly discuss the neurobiological roots of our survival system and how these impact our ability to be compassionate with both ourselves and others. We'll also cover the ways Self-Compassion can improve our health and wellness, allowing us to serve our communities with more energy and joy. Helpful tips on how to practice Self-Compassion (both for ourselves and others) will be included in this multimedia presentation. — Recommended Reading: Neff, K., Self-Compassion: The Proven Power of Being Kind to Yourself (New York: William Morrow, 2011).
- Inter-professional Shared Decision Making: Chaplains as Partners (Friday, July 13, 2018 @ 11:15 AM - 12:45 PM) — Workshop presented by M. Jeanne Wirspa and Karen Pugliese. — OBJECTIVES: Understand the concept of shared decision making (SDM) as central to patient-centered care; examine how chaplains are positioned to address 3 major barriers to shared decision making identified in the medical literature; and explore a new conceptual model for shared decision making: inter-professional SDM that includes the professional healthcare chaplain. — DESCRIPTION: Shared decision making (SDM) is a cornerstone of patient-centered care, pairs the expertise of medical providers with the values, beliefs and goals of the patient. The majority of studies on SDM focus on the physician-patient dyad, with some attention to the role of nurses. Scant research exists on the role played by other members of the healthcare team. This workshop draws on original research into how chaplains contribute to SDM and promotes their role in addressing the following barriers to SDM: 1) The lack of attention to religion/spirituality by other members of the healthcare team; 2) The lack of attention to the patient story and values embedded therein; and 3) medical culture's fast pace, fragmented doctor-patient relationship, and obfuscating use of medical jargon. — Recommended Reading: Charles, C., Gafni, A. and Whelan T., "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science and Medicine 49, no. 5 (September 1999): 651-661; Sohi, J., Champagne, M. and Shidler, S., "Improving health care professionals' collaboration to facilitate patient participation in decisions regarding life-prolonging care: an action research project," Journal of Interprofessional Care 29, no. 5 (2015): 409-414; and White, D. B., "Strategies to support surrogate decision makers of patients with chronic critical illness: the search continues," JAMA 316, no. 1 (July 5, 2016): 35-37.
- Spiritual and Religious Coping of Medical Decision Makers for Hospitalized Older Adult Patients (Friday, July 13, 2018 @ 11:15 AM - 12:45 PM) — Workshop presented by Saneta Maiko. — OBJECTIVES: Investigate the spiritual and religious coping among medical decision makers for critically ill hospitalized patients; clarify the unique findings from all dimensions of spirituality and religion and how they play a role among medical decision makers; and ponder a new way for spiritual and religious care approach that integrates the medical team, family and the community. — DESCRIPTION: Making medical decisions on behalf of others produces emotional distress. Through our research, we have found that spirituality and religion (S/R) have been found to provide significant assistance to cope with this distress, including five key spiritual and religious resources that every patient and family care provider must know. The coping resources identified in this study may guide professional chaplains to design a patient-based and outcome-oriented intervention to reduce surrogate stress, improve communication, patient and surrogate satisfaction, and increase surrogate integration in patient care. — Recommended Reading: Schenker, Y., White, D. B., Crowley-Matoka, M., Dohan, D., Tiver, G. A. and Arnold, R. M., "'It hurts to know... and it helps': exploring how surrogates in the ICU cope with prognostic information," Journal of Palliative Medicine 16, no. 3 (March 2013): 243-249; Geros, K. N., Ivy, S. S., Montz, K., Bohan, S. E. and Torke, A. M., "Religion and spirituality in surrogate decision making for hospitalized older adults," Journal of Religion and Health 55, no. 3 (June 2016): 765-777; and Torke, A. M., Wocial, L. D., Johns, S. A., Sachs, G. A., Callahan, C. M., Bosslet, G. T., Slaven, J. E., Perkins, S. M., Hickman, S. E., Montz, K., Burke, E. S., "The family navigator: a pilot intervention to support Intensive Care Unit family surrogates," American Journal of Critical Care 25, no. 6 (November 2016): 498-507.
- Simplifying Research: Observations and Advice from a Chaplain Who Chairs an IRB (Friday, July 13, 2018 @ 11:15 AM - 12:45 PM) — Workshop presented by Dane R. Sommer. — OBJECTIVES: Participants will review the history of human subjects' research and the mandated establishment of Institutional Review Boards; participants will understand the basic inner-workings of an Institutional Review Board; and participants will strategize how to overcome some of the basic barriers to research that many chaplains face. — DESCRIPTION: Research is the lifeblood of all medical advancements. It is also the most important bridge to future staffing and programmatic development for nearly all chaplain initiatives. Many chaplains are deeply engaged in innovative and creative programs that bring healing and wholeness to patients, families and staff. But we are hesitant to engage in the human subject's research because of difficulty with the development of research proposals and IRB approval. As someone who has been an IRB member for over 25 years and an IRB Chair for over 7 years, and as a researcher, the overall goal of this workshop is to demystify the creative process of transforming a creative idea about research to the ultimate goal of IRB approval. Time will be given for participants to "think out loud" about their ideas for research.
- Compassion-Centered Spiritual Health: Insights from CBCT®, Emory University's Program in Compassion (Friday, July 13, 2018 @ 11:15 AM - 12:45 PM) — Workshop presented by Maureen Jenci Shelton. — OBJECTIVES: Describe the rationale, insights, and practical approach of Emory University's CBCT® (Cognitively-Based Compassion Training), a contemplative program designed specifically to cultivate and sustain compassion in a way that is accessible to people of any-or no-faith tradition; gain an introductory experience of several of CBCT's® distinct reflective exercises, each of which is designed to build skills to support the professional and personal well-being of spiritual care responders; explain how compassion and well-being are skills that can be practiced and developed systematically; and understand the rationale for bringing these skills to spiritual care professionals in order to address personal and professional risks of burnout, depression, and anxiety. — DESCRIPTION: Through the experience of several contemplative exercises, this interactive workshop will introduce participants to CBCT's® approach to expanding and deepening compassion (as distinct from empathy) while avoiding the deleterious impacts of empathetic distress or fatigue. The participant will gain familiarity with research-based benefits of CBCT® and the growing field of compassion science. Participants will also learn about the collaboration of Spiritual Health at Emory Healthcare and Emory's Center for Contemplative Science and Compassion-Based Ethics and their ongoing research into the benefits of formalized compassion training within the field of Chaplaincy.
- What Is a Chaplain Doing in My Doctor's office? Quality of Life Outcomes in Outpatient Oncology (Friday, July 13, 2018 @ 11:15 AM - 12:45 PM) — Workshop presented by Katie Pakos Rimer and Mary Buss. — OBJECTIVES: Consider the impact of embedded palliative and spiritual care on quality of life outcomes for advanced cancer population; survey the content of spiritual care interventions in a dynamic, outpatient, interdisciplinary palliative care oncology setting; and analyze operational challenges to providing spiritual care in a dynamic, outpatient, clinical trial-based oncology clinic in an academic medical center. — DESCRIPTION: In this presentation we will reveal initial findings from our study of the impact of embedded palliative care in an outpatient oncology setting in an academic medical center. We compared several quality of life outcomes (based on the Edmunton Symptom Assessment Scale and FACT spiritual assessment tool) for patients living with advanced cancer and treated by the same oncologists, one with embedded palliative care (palliative care physician and chaplain), and the other without. We will discuss the nature of the spiritual care interventions, the difference in the quality of life outcomes between the two patient populations, and the challenges of providing spiritual care in a setting where patients, families, and even physicians may not expect it.
- Community Partnerships and Cultural Humility: Keys for Intercultural Spiritual Care (Saturday, July 14, 2018 @ 10:15 - 11:45 AM) — Workshop presented by Andrea Cano and Hilda Lethe-Drake. — OBJECTIVES: Assess own understanding of intercultural issues, unconscious bias, and impact on spiritual care; map cultural assets, communities, organizations in patient service areas to build relationships, enhance knowledge, deepen capacity, improve patient and family centered care, and set metrics; and determine ways to advance and maintain intercultural perspectives in chaplaincy standards of care. — DESCRIPTION: This session explores the scope of intercultural perspectives from racial ethnic, gender identity, class, culture, literacy, and geographic distinctions of rural, urban, frontier communities. Invites interactive wisdom sharing with workshop attendees about challenges and effective strategies. Offers chaplain survey results of best practices and issues yet to resolve. Suggests tools and models for personal assessment, cultural mapping, engaging distinct populations, and outcomes for community benefit. Provides a bibliography and webography of recent research and information resources.
- Bereavement Follow-Up Care and Quality Improvement Research: Chaplains Can Do Both (Saturday, July 14, 2018 @ 10:15 - 11:45 AM) — Workshop presented by Chuck Christie and Anita Renahan-White. — OBJECTIVES: Describe steps in designing and implementing a Quality Improvement Initiative; imagine the implementation and practical application of a Chaplain Led Bereavement Follow-Up Project with a Quality Research Component; and begin planning their own care/quality initiative. — DESCRIPTION: Based on a Chaplain-led bereavement program for the next-of-kin (NOK) of patients who have died on the Palliative Care Service. The program has a two-pronged purpose: First, to provide chaplain-led bereavement care to families of the Palliative Care Service. Second, to retain, gather and sort data gleaned from bereavement care to identify quality improvement opportunities in EOL care by the Palliative Care Team and the Medical Center. The Workshop will discuss the steps in designing, implementing, and evaluating a care initiative with a quality research component. Participants will have the opportunity to imagine their own care/quality initiatives.
- The Role of Shadowing in Chaplain Education: Report of a Study Among Palliative Care Chaplains (Saturday, July 14, 2018 @ 10:15 - 11:45 AM) — Workshop presented by Karen Pugliese, George Fitchett, and Casey Ritchie Clevenger. — OBJECTIVES: Examine the results of a qualitative research study on the impact of shadowing as an effective learning methodology for advancing chaplains' professional practice in Palliative Medicine; discuss the benefits and challenges of chaplain observation for fellows, mentors and their respective Palliative Care Teams; and explore future research opportunities using qualitative analysis and evaluation of shadowing in chaplain education, training and supervision. — DESCRIPTION: The workshop will report findings of a study of shadowing among professional chaplains who participated in a 2-year Palliative Medicine education program. During the program chaplain fellows spent 40 hours shadowing (observing) several chaplain mentors. Key findings from interviews with the 7 fellows and 5 mentors will be presented. Additional themes will be highlighted by a panel of several fellows and mentors who participated in the project. Workshop participants will have an opportunity to discuss the implications of the study findings for chaplain education (basic education, specialty education e.g., palliative care, and continuing education).
- Transforming Chaplaincy Roundtable: A Review of the Emerging Research in the Field (Saturday, July 14, 2018 @ 10:15 - 11:45 AM) — Workshop presented by Geila Rajaee, Allison Delaney, and John Betz. — OBJECTIVES: Expose participants to emerging research in the chaplaincy field; and provide a bridge between research and clinical practice. — DESCRIPTION: This workshop will provide an opportunity for the Transforming Chaplaincy Fellows (Cohort 1) to share their experiences and knowledge in the emerging field of research and clinical practice as it relates to chaplaincy.
- Spirituality as an Inherently Psychological Process: Integrating Evidence Based Practices from the Field of Psychology to Create Effective Pastoral Interventions (Saturday, July 14, 2018 @ 10:15 - 11:45 AM) — Workshop presented by Michael Sibley. — OBJECTIVES: The participants will be able to find and evaluate appropriate sources of evidence based literature from the field of psychology and be able to consider the source's capacity to inform a potential pastoral intervention or care technique; the participants will be able to recognize the value of the evidence base from the field of psychology in formulating and delivering pastoral interventions and will learn methods to integrate this evidence base toward their work in their current ministerial context; the participants will be able to take evidence based practices from the field of psychology and utilize them in developing effective pastoral interventions and creating sound evidence based practice in the field of pastoral care moving ultimately toward developing a body of evidence based information that can guide the field of pastoral care and counseling. — DESCRIPTION: A review of the literature related to pastoral interventions in a psychiatric context renders very little in the way of evidence based practice related to effective pastoral interventions for psychiatric patients. The field of psychology, on the other hand possesses a wealth of evidence based interventions and techniques. By integrating the techniques supported by the evidence in the field of psychology with best practices and "doing what works" from a pastoral care perspective, effective pastoral support can occur as the evidence base from the field of psychology can serve as a scaffold for the field of pastoral care as it seeks to develop its own evidence based practice. The purpose of this presentation is to discuss the interplay between psychological interventions and pastoral interventions recognizing that the process by which people grow and develop spiritually also is an inherently psychological process contributing to psychological growth as well. With that in mind, all pastoral interventions have a psychological underpinning as spirituality and the processing of religion is an inherently psychological process. Moving forward, these disciplines have the capacity to inform one another and work together to build interventions and move evidence based practice forward for both the fields of psychology and pastoral care and counseling.
- Evaluating the Impact of Chaplain Care on End-of-Life Outcomes in the ICU (Saturday, July 14, 2018 @ 3:00 - 4:30 PM) — Workshop presented by George Fitchett, Alexia Torke, Daniel Grossoehme, and Kristen Schenk. — OBJECTIVES: Describe impact of chaplain care on length of stay for patients who die in ICUs; describe care provided by chaplains for patients/family members when patients die in ICUs; and discuss implications of research for making the case for provision of spiritual care in ICUs. — DESCRIPTION: This workshop will describe a three-month retrospective chart review study exploring association between chaplain spiritual care and end-of-life outcomes in ICUs. Documentation of chaplain care at six ICU sites (two academic medical centers with board-certified chaplains, two academic medical centers with student chaplains, and two faith-based community hospitals with board-certified chaplains) will be analyzed for a) associations between chaplain care and end-of-life outcomes (length of stay, code status, palliative care, advance directives, and withdrawal of treatment) for patients with advanced illness admitted to ICUs; and b) variations by institution (academic versus community) and chaplain experience (staff versus student).
- Spirituality in the Context of Vicarious Trauma (Sunday, July 15, 2018 @ 8:15 - 9:45 AM) — Workshop presented by Beth Muehlhausen. — OBJECTIVES: Articulate a beginning understanding of qualitative research, specifically phenomenology methodology; identify spiritual patterns that aid in coping with vicarious trauma; and discuss implications for spiritual care departments in caring for front line staff who work with trauma patients and their families. — DESCRIPTION: This workshop will share findings from a qualitative research project that sought to understand the role of spirituality in vicarious trauma. Doctors, nurse practitioners and physicians' assistants who work directly with trauma patients were interviewed in person regarding how their spirituality impacted their work and how their work impacted their spiritual beliefs. The 24 research participants included 19 Christians, 1 Conservative Jew, 1 Hindu, 1 Muslim and 2 Humanists. Physicians represented surgery, orthopedics, emergency, critical care/pulmonology and neurosurgery. Spiritual patterns emerged across religions and specialties including: 1) spirituality as a guiding force 2) strong need for a support system 3) use of coping mechanisms and 4) vicarious growth.
- Integrating Research Literacy into Spiritual Care Education and Practice (Sunday, July 15, 2018 @ 8:15 - 9:45 AM) — Workshop presented by Christina Shu and Pamela Lazor. — OBJECTIVES: Discuss the successful integration of a research literacy educational component into a CPE program and Spiritual Care Department; equip staff chaplains who are interested in research/research literacy to teach and work with CPE students/programs and other chaplains to enhance their research literacy skills; and evaluate the challenges and benefits of building capacity for and implementing a research literacy educational program. — DESCRIPTION: Research literacy is a requirement for board certification and an essential skill for professional chaplains. This workshop focuses on the integration of research literacy into a CPE program and Spiritual Care Department. In 2016, Cedars-Sinai received the Transforming Chaplaincy grant for implementing a research literacy curriculum and developed this curriculum to fit the needs of CPE students, alumni, and staff chaplains. Chaplains who completed the curriculum reported a deeper understanding of research, and greater likelihood to pursue and integrate research into their professional practice. Using research is now incorporated into the routine functioning of our CPE program and Department.
- Qualitative Research Methods for Beginners (Sunday, July 15, 2018 @ 1:00 - 5:00 PM) — Professional Development Intensive presented by Daniel H. Grossoehme. — OBJECTIVES: Distinguish between three qualitative research methods and appropriate uses of each; describe at least two ethical issues in qualitative research; and critically read and understand published qualitative research studies. — DESCRIPTION: Qualitative research is the most accessible means of entry for chaplains into the world of research. Like clinical conversations, qualitative methods elicit people's stories. Using examples from published qualitative studies, we will explore grounded theory, phenomenology, content analysis and case studies with attention to which method is best suited to different research questions. Study design and ethical issues will also be addressed.
- Partnering with the Divine: Integrating the Arts in Spiritual Care (Sunday, July 15, 2018 @ 1:00 - 5:00 PM) — Professional Development Intensive presented by Stephanie Gameros. — OBJECTIVES: Participants will gain an increased theological, clinical and theoretical framework to aid them in integrating the arts as spiritual care; participants will be guided through several exercises which could be applied directly to the patient's bedside; and participants will learn best practices and receive practical applications for the utilization of visual Art, Music, Dance and Poetry in our role as Professional Chaplains. — DESCRIPTION: Facilitators will provide a summary of the clinical research highlighting the healing benefits of the arts, in order to aid chaplains in communicating the need for the arts in healthcare, and to empower chaplains to partner with members of the interdisciplinary team and administrative leaders in developing new programs. Participants will themselves experience the healing power of the arts as spiritual care through various activities involving visual art, poetry, music and dance. This will be a fun and interactive four hours for the participants. — Recommended Reading: Cameron, J., The Artist's Way: A Spiritual Path to Higher Creativity (New York: J.P. Tarcher/Putnam, 2002); Mooney, S. F., Bending Toward Heaven: Poems After the Art of Vincent van Gogh (Eugene, OR: Resource Publications, 2016); and Sacks, O., Musicophilia: Tales of Music and the Brain (New York: Alfred A. Knopf, 2007).
5. Joint Commission Article Supporting Chaplains Emphasizes Research (pub. 3/11/18)
The Joint Commission has highlighted chaplaincy in a two-part article in its January and February issues of The Source, which is touted to healthcare organizations as "the accurate and authoritative resource you need to improve your compliance with Joint Commission accreditation and certification requirements" [--see the publication's web page]. Research is noted throughout, however this is essentially a popular-style report with many declarative statements about chaplains not tied tightly to empirical studies. It appears to rest largely upon interviews with chaplains Stephen King (Seattle Cancer Care Alliance, Seattle, OR), Amy Greene (Cleveland Clinic, Cleveland, OH), and George Fitchett, (Rush University Medical Center, Chicago, IL). Both parts are available through the ACPE website.
"Part 1. Body, Mind, and Spirit" [The Source 16, no. 1 (January 2018): 6-12] features on the first page a sidebar [p. 6] describing research about the contribution of chaplains' involvement to palliative care.* It goes on the address chaplains' potential importance for improving patient and family satisfaction [pp. 9-10], for respecting patient rights [p. 10], for the uplift and support of clinical staff [p. 11], and as "part of the interdisciplinary, collaborative team" [p. 10], with periodic allusions to research. At various points, the role of chaplains is directly and indirectly connected to Joint Commission Standards: for Rights and Responsibilities (i.e., RI.01.01.01), for Leadership (i.e., LD.04.04.05), and for the Provision of Care (i.e., PC.02.01.05).
In "Body, Mind, Spirit, Part 2" [The Source 16, no. 2 (February 2018): 1-6], research is cited regarding screening for chaplain referrals [pp. 1-2], conducting a spiritual history and assessment [pp. 2-3], and assisting with decisions about end-of-life care [p. 3-4], before concluding with comments about how chaplaincy is taking steps toward more evidence-based care [pp. 4-5]. It appears to encourage screening with either the Rush Spiritual Struggle Screening Protocol or by the two questions: "Do you struggle with the loss of meaning and joy in your life?" and "Do you currently have what you would describe as religious or spiritual struggles?" by stating that "[c]urrent research points to using [these]" [p. 2 --citing Fitchett, G. and Risk, J. L., "Screening for spiritual struggle," Journal of Pastoral Care and Counseling 63, nos. 1-2 (2009): 4.1-12; and King, S. D. W., Fitchett, G., Murphy, P. E., Pargament, K. I., Harrison, D. A. and Loggers, E. T., "Determining best methods to screen for religious/spiritual distress," Supportive Care in Cancer 25, no. 2 (February 2017): 471-479]. Again, the material is connected to Joint Commission Standards, particularly regarding the Provision of Care (i.e., PC.01.02.11, PC.01.02.13, and PC. 02.02.13). A link is given at the end to the Transforming Chaplaincy website.
Chaplain researchers may be most interested in the this as a resource for "authoritative" and highly positive statements by the Joint Commission regarding the value of chaplaincy, useful in establishing relevancy and context when composing the introductory or discussion sections of their own articles. One caution about the connections made to specific Joint Commission standards: some of the standards do indeed explicitly mention spiritual care, but others do not; the article posits some connections only through inference. For example: "Chaplains should play an integral role on the interdisciplinary care team, as required by Joint Commission Provision of Care, Treatment, and Services (PC) Standard PC.02.01.05" [Part 1, p. 10]; but that standard, with a single element of performance being "Care, treatment, and services are provided to the patient in an interdisciplinary, collaborative manner," clearly does not stipulate chaplains' involvement. [A listing of Joint Commission Standards for acute care hospitals that specifically mention spirituality/religion/beliefs, may be found linked to our October 2012 Article-of-the-Month, Items of Related Interest §IV —worth comparing to the lists in the Source.] On the whole, this two-part article is one of the most strident endorsements of chaplains ever made by the influential Joint Commission, and its emphasis on research for making its case is significant.
* The summary is from Fitchett, G., "Recent Progress in Chaplaincy-Related Research," Journal of Pastoral Care and Counseling 71, no. 3 (2017): 163-175; referring to research originally reported in Rabow, M. W., Dibble, S. L., Pantilat, S. Z. and McPhee, S. J., "The comprehensive care team: a controlled trial of outpatient palliative medicine consultation," Archives of Internal Medicine 164, no. 1 (January 12, 2004): 83-91; and Rabow, M. W., Petersen, J., Schanche, K., Dibble, S. L. and McPhee, S. J., "The comprehensive care team: a description of a controlled trial of care at the beginning of the end of life," Journal of Palliative Medicine 6, no. 3 (June 2003): 489-499.
6. Chaplains Facilitating Advance Directive Completion Project Reported in JAMA Internal Medicine (pub. 3/11/18)
In a quality improvement project at a community hospital in suburban Chicago, IL, a physician invited a sample of 60 patients to discuss advance care planning with a chaplain in the exam room immediately following the medical encounter. Inclusion criteria were: 70+ years old, with decision-making capacity, and no record of an Advance Directive. All patients accepted, and 48 (80%) completed an Advance Directive during the sessions that lasted a mean of 23.2 minutes (with a SD 7.8 minutes).
The topics explored with the chaplain included: patient's current life circumstances, family members, support systems, experience with critical illness (their own or a loved one), experience with EoL decisions, palliative care and hospice, the role of faith in their lives and the influence of their beliefs on health care decision-making, and the level of medical interventions they might wish for themselves. [p. E1]
This project suggests the feasibility and effectiveness of such medical office discussions with chaplains. In the authors' opinion, "[t]he physician's introduction of the chaplain was vital..." [p. E2].
The project is reported as a Research Letter in JAMA Internal Medicine, online first, January 16, 2018: Lee, A. C., McGinness, C. E., Levine, S., O'Mahony, S. and Fitchett, G., "Using chaplains to facilitate advance care planning in medical practice." The corresponding author is Chaplain Aoife C. Lee, Spiritual Care Department, Rush Oak Park Hospital, 520 S. Maple Ave., Oak Park, IL 60304 (email@example.com). George Fitchett is also a chaplain co-author.
7. ACPE Research Committee: Summer 2018 Update (pub. 8/8/18)
The ACPE Research Committee has been meeting regularly by conference calls since our organization's national gathering in Atlanta in May. In light of elicited input from ACPE members and from leaders of cognate groups regarding research priorities, the Committee has undertaken as a next step in its work a systematic review of studies of Basic/Advanced or Level I/Level II CPE programs and CPE outcomes [--see, for example, the citations in the June 2018 Article-of-the-Month feature]. While the number of studies into CPE per se and into its effectiveness as an educational process is relatively small, the literature holds important insights about methodology and practical foci for future investigation. In the course of this review, some unpublished research has also been discovered, and Chairperson Judy Ragsdale would like to invite anyone with yet-to-be published studies to be in contact (Judy.Ragsdale@cchmc.org).
In other developments, the Committee's original charge [--see the previous news update from 3/11/18, above] has been amended by the ACPE Board to include: "Translating research into practice by making recommendations to update the outcomes based on relevant research."
8. CPE & Research Literacy at Sisters of Charity Hospital, by Mary Ann Brody (pub. 8/8/18)
[The Rev. Mary Ann Brody (firstname.lastname@example.org), is an ACPE Associate Educator and the Clinical Pastoral Education Supervisor at Sisters of Charity Hospital (Catholic Health) in Buffalo, NY.]
I had the privilege of participating in one of the early Transforming Chaplaincy grant projects while I was doing my Certified Educator Candidate training at the University of Rochester Medical Center (URMC). I saw the value of incorporating research literacy in the CPE curriculum. When I began working at the Sisters Hospital CPE program in 2017 and learned of the library resources available to us, I was excited to see how we could incorporate evidence informed care into our CPE program and the Spiritual Care Department. Sisters of Charity Hospital is a community hospital serving the greater Buffalo area in Western New York. I knew the program we envisioned would need to fit our context and resources.
The journey began by establishing a monthly Journal Club for the residents and staff chaplains at the hospital in the summer of 2017. Initially, I selected articles for discussion, distributed them to participants a week prior to our meeting, and facilitated the conversation, intentionally selecting evidence based literature with the goal of improving pastoral practice. This was a new idea for most of the staff.
CPE residents were at that time already engaged in a year-long project that was to be presented near the conclusion of their residency. There was no time allotted for learning research skills, and the project was something completed independently outside of the CPE group process. It did not feel like an integrated part of the students' learning. I saw an opportunity to use residency projects to help build a mindset that valued evidence informed practice. I contacted the consultant that had worked with my students at URMC, and he helped me to think about goals for the curriculum and to investigate the resources available to us at Sisters Hospital. I approached the hospital's librarian, shared my reasons for wanting to add a research literacy component in our curriculum and asked for her assistance. She was eager to help! Together, we planned out a simple structure that we could pilot in 2018, when the next group of CPE residents would arrive. The curriculum was divided into three phases aligning with the three CPE units in our residency.
Phase 1 involved gaining basic knowledge, learning and using the library resources, and developing skills in writing a research question, saving identified literature and recognizing reliable sources. Students were encouraged to use this first unit of CPE and their clinical site as the birthplace for their question for research. The monthly Journal Club became a component of their curriculum, and our librarian came to the first meeting to define evidence informed care, its history in the medical field, and how to evaluate literature. The students began presenting articles for discussion in the Journal Club after mid-unit.
Phase 2 was focused on independent research using the skills they had acquired or honed in the first phase. Students concentrated on refining their questions, making sure they felt relevant to their work and their own interests. They continued researching with the understanding that the hospital librarian was available to help them. As the Journal Club continued, they presented their progress to their peer group for consultation twice during the unit.
Phase 3, presently underway, is geared toward putting it all together. In August, the students will attend a workshop to learn strategies for making a quality presentation. They are also being encouraged to utilize their research when they present case studies in the third CPE unit.
Doing this as an integral part of the CPE residency meant dedicating time in the schedule to be in the library, consult with one another, and do the research. It meant giving up time for some other activities. The advantage is that the curriculum provided a structure for learning that spanned the year. It helped to bring students with less experience in research to a minimum level of competence, so that they could do what was being asked. The librarian was careful to show them how to use public domain resources that would be available to students after they left the residency. That way, students gained resources that would be available to them wherever they ended up working. Students developed a working relationship with the librarian early in the year, and she has been a key resource for their work. The curriculum provided a framework that intentionally paced the work, with students being accountable for meeting benchmarks along the way. As a result, they were less likely to leave it to the last minute or have it fall by the wayside as they performed other tasks required in their residency. It also helped me, as the educator, to remain accountable. I had to plan the time into the schedule, coordinate with the librarian, and do some of the initial orientation around setting up a library account on-line.
As of this writing, the students are in the midst of their second residency unit and our pilot has yet to be tested to completion, but the feedback so far has been encouraging. The residents feel they have learned helpful research skills. They seem excited about what they are studying and learning in their own research. There have been bumps along the way, but regular communication has made it possible to work through most of them. This could never have happened without the partnership we have developed with the hospital librarian. Her enthusiasm and generous availability has been vital to the success of the pilot project.
9. Notable Articles from 2017 Not Previously Cited on the ACPE Research Website (pub. 8/8/18)
The ACPE Research site highlights quite a number of articles over the course of a year, yet this is a fraction of the stream of literature being published (--see the annual annotated bibliography listing from the Penn Medicine Department of Pastoral Care). The following twenty have until now not been noted but may be of special interest to chaplains.
Balboni, M. J., Sullivan, A., Enzinger, A. C., Smith, P. T., Mitchell, C., Peteet, J. R., Tulsky, J. A., VanderWeele, T. and Balboni, T. A. [Dana-Farber Cancer Institute, Harvard Medical School Center for Bioethics, Harvard School of Public Health, Brigham and Women's Hospital, and Initiative on Health, Religion, and Spirituality within Harvard, Boston, MA]. "U.S. clergy religious values and relationships to end-of-life discussions and care." Journal of Pain and Symptom Management 53, no. 6 (June 2017): 999-1009. [(Abstract:) CONTEXT: Although clergy interact with approximately half of U.S. patients facing end-of-life medical decisions, little is known about clergy-congregant interactions or clergy influence on end-of-life decisions. OBJECTIVE: The objective was to conduct a nationally representative survey of clergy beliefs and practices. METHODS: A mailed survey to a nationally representative sample of clergy completed in March 2015 with 1005 of 1665 responding (60% response rate). The primary predictor variable was clergy religious values about end-of-life medical decisions, which measured belief in miracles, the sanctity of life, trust in divine control, and redemptive suffering. Outcome variables included clergy-congregant end-of-life medical conversations and congregant receipt of hospice and intensive care unit (ICU) care in the final week of life. RESULTS: Most U.S. clergy are Christian (98%) and affirm religious values despite a congregant's terminal diagnosis. Endorsement included God performing a miracle (86%), pursuing treatment because of the sanctity of life (54%), postponement of medical decisions because God is in control (28%), and enduring painful treatment because of redemptive suffering (27%). Life-prolonging religious values in end-of-life medical decisions were associated with fewer clergy-congregant conversations about considering hospice (adjusted odds ratio [AOR], 0.58; 95% CI 0.42-0.80), P < 0.0001), stopping treatment (AOR 0.58, 95% CI 0.41-0.84, P = 0.003), and forgoing future treatment (AOR 0.50, 95% CI 0.36-0.71, P < 0.001) but not associated with congregant receipt of hospice or ICU care. Clergy with lower medical knowledge were less likely to have certain end-of-life conversations. The absence of a clergy-congregant hospice discussion was associated with less hospice (AOR 0.45; 95% CI 0.29-0.66, P < 0.001) and more ICU care (AOR 1.67; 95% CI 1.14-2.50, P < 0.01) in the final week of life. CONCLUSION: American clergy hold religious values concerning end-of-life medical decisions, which appear to decrease end-of-life discussions. Clergy end-of-life education may enable better quality end-of-life care for religious patients.]
Beck, D., Cosco Holt, L., Burkard, J., Andrews, T., Liu, L., Heppner, P. and Bormann, J. E. [Veterans Affairs San Diego Healthcare System, San Diego; and the University of California, San Diego, CA]. "Efficacy of the mantram repetition program for insomnia in veterans with posttraumatic stress disorder: a naturalistic study." Advances in Nursing Science 40, no. 2 (April/June 2017): E1-E12. [(Abstract:) Statistics show that more than 80% of Veterans mention posttraumatic stress disorder (PTSD)-related symptoms when seeking treatment. Sleep disturbances and nightmares are among the top 3 presenting problems. Current PTSD trauma-focused therapies generally do not improve sleep disturbances. The mantram repetition program (MRP), a mind-body-spiritual intervention, teaches a portable set of cognitive-spiritual skills for symptom management. The aim of this study was to evaluate the efficacy of the MRP on insomnia in Veterans with PTSD in a naturalistic, clinical setting. Results show that participation in the MRP significantly reduced insomnia, as well as decreased self-reported and clinician-assessed PTSD symptom burden.]
Ceylan, M. E., Onen Unsalver, B. and Evrensel, A. [Uskudar University, Istanbul, Turkey]. "Major depressive disorder with religious struggle and completed suicide after hair transplantation." SAGE Open Medical Case Reports 5 (2017): 2050313X17700744 [electronic journal article designation]. [This intriguing case report speaks to the potential power of the interaction between treatment decisions and patients' spiritual lives, and the risks of spiritual distress in any medical context. (Abstract:) OBJECTIVES: Psychological outcomes of aesthetic surgical procedures like hair transplantation are mostly positive including decreased anxiety, depression and social phobia and increased general well-being, self-efficacy and self-esteem. However, some patients may suffer from post-surgical depression and post-surgical increased suicide rates have been reported for breast augmentation patients. Difficulty adapting to the new image, unfulfilled psychological needs expected to be met by the surgery, side effects of the surgery like tissue swelling or bruising, uncontrolled pain, presence of body dysmorphic disorder and previous history of mood disorder may be some of the risk factors for post-surgical depression. METHODS: Here, we present a case without prior psychiatric history who developed major depressive disorder after hair transplantation and died of suicide. RESULTS: He started experiencing religious struggle related to his decision about the hair transplant which he interpreted as acting against God's will. While religious involvement has been reported to be a protective factor against depression, spiritual struggle, which includes religious guilt, has been described as an important risk factor for depression, hopelessness and suicidality which might explain the severity of depression in our patient. CONCLUSIONS: This case highlights the importance of a detailed psychiatric evaluation and exploration of religious concerns of any patient before any type of aesthetic surgery. Major depressive disorder is a treatable condition; however, mild depression can go unnoticed. Religious belief and related religious practices affect an individual's personal health attitudes; therefore, we think that every physician is needed to explore the religious concerns of any patient during any medical examination or surgical procedure. Relevant religious authorities should be consulted when necessary.]
Fitchett, G., Murphy, P. and King, S. D. W. [Rush University Medical Center, Chicago, IL; and Seattle Cancer Care Alliance, WA]. "Examining the validity of the Rush Protocol to screen for religious/spiritual struggle." Journal of Health Care Chaplaincy 23, no. 3 (July-September 2017): 98-112. [(Abstract:) Effective deployment of limited spiritual care resources requires valid and reliable methods of screening that can be used by nonchaplain health care professionals to identify and refer patients with potential religious/spiritual (R/S) need. Research regarding the validity of existing approaches to R/S screening is limited. In a sample of 1,399 hematopoietic stem cell transplant survivors, we tested the validity of the Rush Protocol and two alternative versions of it. The negative religious coping subscale of the Brief RCOPE provided the reference standard. Based on the Protocol, 21.9% of the survivors were identified as having potential R/S struggle. The sensitivity of the Protocol was low (42.1%) and the specificity was marginally acceptable (81.3%). The sensitivity and specificity of the two alternative versions were similar to those for the unmodified Protocol. Further research with the Rush Protocol, and other models, should be pursued to develop the best evidence-based approaches to R/S screening.] [For more onthe Rush Protocol, see the January 2013 Article-of-the-Month.]
Galanter, M., Josipovic, Z., Dermatis, H., Weber, J. and Millard, M. A. [New York University School of Medicine, New York; and Columbia University, New York, NY]. "An initial fMRI study on neural correlates of prayer in members of Alcoholics Anonymous." American Journal of Drug and Alcohol Abuse 43, no. 1 (January 2017): 44-54. [(Abstract:) BACKGROUND: Many individuals with alcohol-use disorders who had experienced alcohol craving before joining Alcoholics Anonymous (AA) report little or no craving after becoming long-term members. Their use of AA prayers may contribute to this. Neural mechanisms underlying this process have not been delineated. OBJECTIVE: To define experiential and neural correlates of diminished alcohol craving following AA prayers among members with long-term abstinence. METHODS: Twenty AA members with long-term abstinence participated. Self-report measures and functional magnetic resonance imaging of differential neural response to alcohol-craving-inducing images were obtained in three conditions: after reading of AA prayers, after reading irrelevant news, and with passive viewing. Random-effects robust regressions were computed for the main effect (prayer > passive + news) and for estimating the correlations between the main effect and the self-report measures. RESULTS: Compared to the other two conditions, the prayer condition was characterized by: less self-reported craving; increased activation in left-anterior middle frontal gyrus, left superior parietal lobule, bilateral precuneus, and bilateral posterior middle temporal gyrus. Craving following prayer was inversely correlated with activation in brain areas associated with self-referential processing and the default mode network, and with characteristics reflecting AA program involvement. CONCLUSION: AA members' prayer was associated with a relative reduction in self-reported craving and with concomitant engagement of neural mechanisms that reflect control of attention and emotion. These findings suggest neural processes underlying the apparent effectiveness of AA prayer.]
Ghous, M., Malik, A. N., Amjad, M. I. and Kanwal, M. [Riphah International University, Islamabad, Pakistan]. "Effects of activity repetition training with Salat (prayer) versus task oriented training on functional outcomes of stroke." JPMA - Journal of the Pakistan Medical Association 67, no. 7 (July 2017): 1091-1093. [(Abstract:) Stroke is one of most disabling condition which directly affects quality of life. The objective of this study was to compare the effect of activity repetition training with Salat (prayer) versus task oriented training on functional outcomes of stroke. The study design was randomized control trial and 32 patients were randomly assigned into two groups'. The stroke including infarction or haemorrhagic, age bracket 30-70 years was included. The demographics were recorded and standardized assessment tool included Berg Balance Scale (BBS), Motor assessment scale (MAS) and Time Up and Go Test (TUG). The measurements were obtained at baseline, after four and six weeks. The mean age of the patients was 54.44+/-10.59 years with 16 (59%) male and 11(41%) female patients. Activity Repetition Training group showed significant improvement (p<0.05) and is effective in enhancing the functional status as compare to task oriented training group. The repetition with motivation and concentration is the key in re-learning process of neural plasticity.]
Kao, L. E., Lokko, H. N., Gallivan, K., O'Brien, V. and Peteet, J. R. [Brigham & Women's Hospital, Boston, MA]. "A model of collaborative spiritual and psychiatric care of oncology patients." Psychosomatics 58, no. 6 (November-December 2017): 614-623. [(Abstract:) BACKGROUND: Many oncology patients see both chaplains and consultation-liaison (C-L) psychiatrists during medical hospitalizations. Studies show that spirituality and mental health influence one another, and that patients often prefer that physicians understand their spirituality. Though models of inpatient chaplaincy-psychiatry collaboration likely exist, none are apparent in the literature. In this study, we present one model of chaplaincy-psychiatry collaboration, hypothesizing that both specialties would find the intervention helpful. METHODS: From April through December 2015, the C-L psychiatry service at Brigham & Women's Hospital piloted 13 sessions of interdisciplinary rounds, where chaplains and C-L psychiatrists discussed common oncology patients. Participants completed questionnaires including quantitative and qualitative prompts before the intervention, after each session, and at the study's conclusion. RESULTS: Eighteen individuals completed baseline questionnaires. Between baseline and final surveys, the proportion of participants describing themselves as "very satisfied" with the 2 services' integration rose from 0-36%. The proportion of participants feeling "not comfortable" addressing issues in the other discipline declined from 17-0%. The most frequently chosen options on how discussions had been helpful were that they had enhanced understanding of both patient needs (83.3%) and the other discipline (78.6%). Qualitative data yielded similar themes. At conclusion, all respondents expressed preference that interdisciplinary rounds continue. CONCLUSION: This study describes a model of enhancing collaboration between chaplains and C-L psychiatrists, an intervention not previously studied to our knowledge. A pilot intervention of the model was perceived by both specialties to enhance both patient care and understanding of the other discipline.]
Krause, N., Pargament, K. I., Ironson, G. and Hayward, R. D. [University of Michigan, Ann Arbor; Bowling Green State University, Bowling Green, OH; and University of Miami, Coral Gables, FL]. "Spiritual struggles and interleukin-6: assessing potential benefits and potential risks." Biodemography and Social Biology 63, no. 4 (2017): 279-294. [(Abstract:) The purpose of this study is to evaluate the relationship between spiritual struggles and levels of interleukin-6 (IL-6) with a subsample (N = 943) of participants who took part in a nationwide survey. This study, which was completed in 2014, was conducted in the United States. Spiritual struggles refer to difficulties that a person may encounter with his or her faith and include having a troubled relationship with God, encountering difficulties with religious others, and being unable to find a sense of ultimate meaning in life. Based on the notion that spiritual struggles may be associated with personal growth as well physical health problems, it was hypothesized that there is a nonlinear relationship between the two: levels of IL-6 will decline at relatively low levels of spiritual struggles, but levels of IL-6 will increase as spiritual struggles become more severe. The findings support this hypothesis and suggest there is a quadratic relationship between spiritual struggles and IL-6. The clinical implications of these findings are discussed.]
Macdonald, G. [Regent Gardens Medical Practice, Glasgow, Scotland]. "The efficacy of primary care chaplaincy compared with antidepressants: a retrospective study comparing chaplaincy with antidepressants." Primary Health Care Research and Development 18, no. 4 (July 2017): 354-365. [(Abstract:) AIM: To determine the effectiveness of primary care chaplaincy (PCC) when used as the sole intervention, with outcomes being compared directly with those of antidepressants. This was to be carried out in a homogenous study population reflective of certain demographics in the United Kingdom. BACKGROUND: Increasing numbers of patients are living with long-term conditions and 'modern maladies' and are experiencing loss of well-being and depression. There is an increasing move to utilise non-pharmacological interventions such as 'talking therapies' within this context. Chaplaincy is one such 'talking therapy' but within primary care its evidence base is sparse with only one quantitative study to date. There is therefore a need to evaluate PCC excluding those co-prescribed antidepressants, as this is not evidenced in the literature as yet. PCC also needs to be directly compared with the use of antidepressants to justify its use as a valid alternative treatment for loss of well-being and depression. METHODS: This was a retrospective observational study based on routinely collected data. There were 107 patients in the PCC group and 106 in the antidepressant group. Socio-demographic data were collected. Their pre- and post-intervention (either chaplaincy or antidepressant) well-being was assessed, by the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) which is a validated Likert scale. FINDINGS: The majority of both groups were female with both groups showing marked ethnic homogeneity. PCC was associated with a significant and clinically meaningful improvement in well-being at a mean follow-up of 80 days. This treatment effect was maintained after those co-prescribed antidepressants were removed. PCC was associated with an improvement in well-being similar to that of antidepressants with no significant difference between the two groups.]
Nieuwsma, J. A., King, H. A., Jackson, G. L., Bidassie, B., Wright, L. W., Cantrell, W. C., Bates, M. J., Rhodes, J. E., White, B. S., Gatewood, S. J. L. and Meador, K. G. [U.S. Department of Veterans Affairs (VA); University Medical Center, Durham, NC; Vanderbilt University, Nashville, TN; and Department of Defense (DoD), Arlington, VA]. "Implementing integrated mental health and chaplain care in a national quality improvement initiative." Psychiatric Services 68, no. 12 (December 1, 2017): 1213-1215. [(Abstract:) This column describes the development, implementation, and outcomes of a quality improvement learning collaborative that aimed to better integrate chaplaincy with mental health care services at 14 participating health care facilities evenly distributed across the U.S. Department of Veterans Affairs and Department of Defense. Teams of health care chaplains and mental health professionals from participating sites sought to improve cross-disciplinary service integration in six key domains: screening, referrals, assessment, communication and documentation, cross-disciplinary training, and role clarification. Chaplains and mental health providers across all facilities at participating sites were significantly more likely post-collaboration to report having a clear understanding of how to collaborate and to report using a routine process for screening patients who could benefit from seeing a professional from the other discipline. Foundational efforts to enhance cross-disciplinary awareness and screening practices between chaplains and mental health professionals appear particularly promising.]
Park, C. L. and Sacco, S. J. [Department of Psychology, University of Connecticut, Storrs]. "Heart failure patients' desires for spiritual care, perceived constraints, and unmet spiritual needs: relations with well-being and health-related quality of life." Psychology Health and Medicine 22, no. 9 (October 2017): 1011-1020. [(Abstract:) Little information is available about HF patients' desires regarding having their healthcare providers address their spiritual concerns, feeling constrained in doing so, and the extent to which their spiritual needs go unmet. Nearly half of our sample reported high levels of unmet spiritual needs and reported moderately strong desires to have their doctor or other healthcare professional attend to their spiritual needs, and moderately strong feelings of constraint in doing so. Spiritual constraint and unmet spiritual needs were associated with poorer spiritual, psychological and physical well-being, but these effects varied, depending on patients' desire to discuss spiritual needs. These findings have important implications for clinical management of HF patients.]
Packman, W., Bussolari, C., Katz, R., Carmack, B. J. and Field, N. P. [Palo Alto University, Palo Alto; University of San Francisco; and Zen Hospice Project, San Francisco, CA]. "Posttraumatic growth following the loss of a pet." Omega - Journal of Death and Dying 75, no. 4 (September 2017): 337-359. [(Abstract:) The current study examined posttraumatic growth (PTG) experienced by bereaved pet owners following the death of their pet. Using qualitative methodology, we analyzed responses of 308 participants who answered yes to a question about experiencing PTG. Within the five factors model of PTG, the most endorsed included the following: Relating to Others (n=76), Appreciation of Life (n=52), Personal Strength (n=51), Spiritual Change (n=32), and New Possibilities (n=29). Other themes not captured by the PTG included as follows: relating to animals (n=70), continuing bonds (n=53), attachment relationship (n=44), and unconditional love (n=13). Our findings support the notion that PTG occurs for people who have experienced pet loss, with new emergent themes.]
Schultz, M., Meged-Book, T., Mashiach, T. and Bar-Sela, G. [Technion-Israel Institute of Technology, and Rambam Health Care Campus, Haifa, Israel]. "Distinguishing between spiritual distress, general distress, spiritual well-being, and spiritual pain among cancer patients during oncology treatment." Journal of Pain and Symptom Management 54, no. 1 (July 2017): 66-73. [(Abstract:) CONTEXT: Spiritual distress is present in approximately 25% of oncology patients. OBJECTIVES: We examined the extent to which this measure is identical to a variety of other measures, such as spiritual well-being, spiritual injury, spiritual pain, and general distress. METHODS: Structured interview of oncology outpatients over 12 months, approached nonselectively. The presence or absence of spiritual distress was compared against spiritual pain and two spiritual well-being tools: Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12-Item Scale (FACIT-Sp-12) and the Spiritual Injury Scale (SIS). We also examined whether a general distress visual analogue scale sufficed to identify spiritual distress. Other questions concerned demographic and clinical data. RESULTS: Of 416 patients approached, 202 completed the interview, of whom 23% reported spiritual distress. All measures showed significant correlation (receiver operating characteristic, area under the curve: SIS 0.79; distress thermometer [DT] 0.68; FACIT-Sp-12 0.67), yet none were identical with spiritual distress (sensitivity/specificity: SIS 64%/79%; spiritual pain 72%/76%; DT 41%/76%; FACIT-Sp-12 57%/72%). Of the FACIT-Sp-12 subscales, only peace correlated with spiritual distress. A significant predictor of spiritual distress was patients' self-evaluation of grave clinical condition (odds ratio 3.3; 95% CI 1.1-9.5). Multivariable analysis of individual measure items suggests an alternative three-parameter model for spiritual distress: not feeling peaceful, feeling unable to accept that this is happening, and perceived severity of one's illness. CONCLUSION: The DT is not sufficient to identify spiritual distress. The peace subscale of FACIT-Sp-12 is a better match than the measure as a whole. The SIS is the best match for spiritual distress, although an imperfect one.]
Selby, D., Seccaraccia, D., Huth, J., Kurppa, K. and Fitch, M. [Sunnybrook Health Sciences Center, and University of Toronto, Canada]. "Patient versus health care provider perspectives on spirituality and spiritual care: the potential to miss the moment." Annals of Palliative Medicine 6, no. 2 (April 2017): 143-152. [(Abstract:) BACKGROUND: Spirituality and spiritual care are well recognized as important facets of patient care, particularly in the palliative care population. Challenges remain, however, in the provision of such care. This study sought to compare patient and health care professional (HCP) views on spirituality/spiritual care, originally with a view to exploring a simple question(s) HCP's could use to identify spiritual distress, but evolved further to a comparison of how patients and HCPs were both concordant and discordant in their thoughts, and how this could lead to HCP's 'missing' opportunities to both identify spirituality/spiritual distress and to providing meaningful spiritual care. METHODS: Patients (n=16) with advanced illnesses and HCP's (n=21) with experience providing care to those with advanced disease were interviewed using a semi-structured interview guide. Qualitative analysis distress and spiritual care, and screening for spiritual distress). RESULTS: Within each category there were areas of both concordance and discordance. Most notably, HCP's struggled to articulate definitions of spirituality whereas patients generally spoke with much more ease, giving rich examples. Equally, HCP's had difficulty relating stories of patients who had experienced spiritual distress while patients gave ready responses. Key areas where HCP's and patients differed were identified and set up the strong possibility for an HCP to 'miss the moment' in providing spiritual care. These key misses include the perception that spiritual care is simply not something they can provide, the challenge in defining/ recognizing spirituality (as HCP and patient definitions were often very different), and the focus on spiritual care, even for those interested in providing, as 'task oriented' often with emphasis on meaning making or finding purpose, whereas patients much more commonly described spiritual care as listening deeply, being present and helping them live in the moment. CONCLUSIONS: Several discrepancies in perception of spirituality, spiritual distress and spiritual care may hinder the ability of HCP's to effectively offer meaningful spiritual care. A focus on active listening, being led by the patient, and by providing presence may help limit the risk of a disconnect, or a 'miss', in the provision of spiritual care.]
Snowden, A. and Telfer, I. [Edinburgh Napier University, Edinburgh, Scotland]. "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.]
Stephenson, P. S., Sheehan, D. and Shahrour, G. [Kent State University College of Nursing, Kent, OH]. "Support for using five attributes to describe spirituality among families with a parent in hospice." Palliative and Supportive Care 15, no. 3 (June 2017): 320-327. [(Abstract:) OBJECTIVE: The importance of spirituality in the dying process is well documented. However, what spirituality means in these situations is hard to discern because few people (patients, families, researchers, or caregivers) will view spirituality in the same way. The present research supports the use of a spiritual framework consisting of five common attributes (meaning, beliefs, connections, self-transcendence, and value) as a mechanism for viewing spirituality for people nearing the end of life. Using qualitative interviews from two related studies, our study aims to describe the prevalence of spirituality and its nature according to these five spiritual attributes. METHODS: Data from two previous studies were analyzed. The first employed the methods of grounded theory to understand the strategies adolescents used to manage the impending death of a parent. Some 61 participants from 26 families were interviewed, including ill parents/patients, well parents/caregivers, and adolescents. The second study consisted of 15 interviews with the surviving parent and adolescents from 6 of these families after the death of the parent. RESULTS: The original research from which these data were drawn did not seek to describe spirituality. However, spiritual themes were prevalent in the stories of many participants and included each of the five spiritual attributes. SIGNIFICANCE OF RESULTS: Our findings demonstrate the prevalence of spirituality in the everyday lives of these families and supports the use of the spiritual framework according to the five common attributes to describe spirituality.]
Tedeschi, R. G., Cann, A., Taku, K., Senol-Durak, E. and Calhoun, L. G. [University of North Carolina at Charlotte; Oakland University, Rochester, MI; and Abant Izzet Baysal University, Bolu, Turkey]. "The Posttraumatic Growth Inventory: a revision integrating existential and spiritual change." Journal of Traumatic Stress 30, no. 1 (February 2017): 11-18. [(Abstract:) Spiritual Change (SC) is one of 5 domains of posttraumatic growth (PTG). The current Posttraumatic Growth Inventory (PTGI) assesses this area of growth with only 2 items, one focusing on religiosity and the other focusing on spiritual understanding. The addition of 4 newly developed spiritual-existential change (SEC) items, creating an expanded PTGI (Posttraumatic Growth Inventory-X), reflects a diversity of perspectives on spiritual-existential experiences that are represented in different cultures. Samples were obtained from 3 countries: the United States (n = 250), Turkey (n = 502), and Japan (n = 314). Analyses indicated that the newly added items capture additional experiences of growth outside traditional religious concepts, yet still are correlated with the original SC items, especially in the U.S. and Turkish samples. Relationships of the PTGI-X to established predictors of PTG, event-related rumination, and core beliefs, were as predicted in all 3 countries. The new 6-item SEC factor demonstrated high internal reliability, and the 5-factor structure of the expanded scale was supported by confirmatory factor analysis. The resulting 25-item PTGI-X can be used as a validated instrument in a wide range of samples in which traditional religious beliefs are less dominant.]
Telci Caklili, O., Isbilen, B., Yavuz, G., Tulu, S., Mesci, B. and Oguz, A. [Kocaeli State Hospital, Kocaeli; and İstanbul Medeniyet University, İstanbul, Turkey]. "Differences in leptin, ghrelin, and glucagon-like peptide-1 levels between religious fasting and normal fasting." Turkish Journal of Medical Sciences 47, no. 4 (2017): 1152-1156. [(Abstract:) Background/aim: Leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) affect hunger, satiety feelings, and food intake. We hypothesized that during Ramadan, if the brain knows that the body will be hungry until sunset, there may be differences between leptin, ghrelin, and GLP-1 levels in Ramadan and non-Ramadan fasting. Materials and methods: This study had two phases. In the first phase, the participants were asked to skip the dawn meal of Ramadan (suhur), so that 12 h of fasting could be achieved. Participants ceased food intake at midnight, and at noon blood was drawn. Eight participants were selected as a subgroup. These participants gave blood three times a day to detect hormonal changes during Ramadan. Six months later, in the second phase, blood samples were obtained at noon from participants after 12 h of fasting. Results: Analysis was conducted on 30 patients [19 males (63.3%) and 11 females (36.7%)]. There was a significant difference in leptin, ghrelin, and GLP-1 levels between Ramadan fasting and non-Ramadan fasting (P = 0.04, P = 0.02, and P < 0.001, respectively). In the subgroup analysis, there was no statistically significant difference in leptin, ghrelin, and GLP-1 levels over time. Conclusion: The results of this study suggest that the nervous and gastrointestinal systems may behave differently in religious fasting than in nonreligious fasting.]
Wachholtz, A. B., Malone, C. D. and Pargament, K. I. [University of Colorado Denver; University of Massachusetts Medical School; and Bowling Green State University]. "Effect of different meditation types on migraine headache medication use." Behavioral Medicine 43, no. 1 (January-March 2017): 1-8 (electronic journal). [(Abstract:) Spiritual meditation has been found to reduce the frequency of migraines and physiological reactivity to stress. However, little is known about how introducing a spirituality component into a meditation intervention impacts analgesic medication usage. In this study, 92 meditation-naive participants were randomly assigned to one of four groups: (1) Spiritual Meditation, (n = 25), (2) Internally Focused Secular Meditation (n = 23), (3) Externally Focused Secular Meditation (n = 22), or (4) Progressive Muscle Relaxation (n = 22); and practiced their technique for 20 min/day over 30 days while completing daily diaries. Headache frequency, headache severity, and pain medication use were assessed. Migraine frequency decreased in the Spiritual Meditation group compared to other groups (p < 0.05). Headache severity ratings did not differ across groups (p = ns). After adjusting for headache frequency, migraine medication usage decreased in the Spiritual Meditation group compared to other groups (p < 0.05). Spiritual Meditation was found to not affect pain sensitivity, but it does improve pain tolerance with reduced headache related analgesic medication usage.]
Wang, C. W., Chow, A. Y. and Chan, C. L. [University of Hong Kong]."The effects of life review interventions on spiritual well-being, psychological distress, and quality of life in patients with terminal or advanced cancer: a systematic review and meta-analysis of randomized controlled trials." Palliative Medicine 31, no. 10 (December 2017): 883-894. [(Abstract:) BACKGROUND: Life review interventions have been used to alleviate psycho-spiritual distress in people near the end of life. However, their effectiveness remains inconclusive. AIM: To evaluate the effects of therapeutic life review on spiritual well-being, psychological distress, and quality of life in patients with terminal or advanced cancer. DESIGN: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. DATA SOURCES: Five databases were searched from their respective inception through February 2017 for relevant randomized controlled trials. The effects of therapeutic life review were pooled across the trials. Standardized mean differences were calculated for the pooled effects. Heterogeneity was assessed using the I2 test. Study quality was assessed using the Cochrane criteria. RESULTS: Eight randomized controlled trials met the inclusion criteria. The pooled results suggested a desirable effect of therapeutic life review on the meaning of life domain of spiritual well-being (standardized mean difference=0.33; 95% confidence interval, 0.12 to 0.53), general distress (standardized mean difference=-0.32; 95% confidence interval, -0.55 to -0.09), and overall quality of life (standardized mean difference=0.35; 95% confidence interval, 0.15 to 0.56) when compared to usual care only. Of the three outcomes examined, only the pooled effect on overall quality of life remained statistically significant at follow-ups up to 3 months after the intervention (standardized mean difference=0.82; 95% confidence interval, 0.47 to 1.18). CONCLUSIONS: Therapeutic life review is potentially beneficial for people near the end of life. However, the results should be interpreted with caution due to the limited number of randomized controlled trials and associated methodological weaknesses. Further rigorously designed randomized controlled trials are warranted.]