Communication between clinicians and chaplains remains infrequent, found a recent survey of 219 ICU clinicians.1

“Patients and families in the ICU often look to their faith not only to cope with their illness, but also as a framework for their decision-making,” says Philip Jaekyung Choi, MD, the study’s lead author. Choi is an assistant professor in the division of pulmonary and critical care medicine at the University of Michigan in Ann Arbor.

These clinical observations led to a project that studied chaplain involvement in the ICU at Duke University Hospital where Choi was a medical instructor in the department of medicine at the time.2 That study found that chaplain consults were rare, mainly reserved for dying patients, and usually occurred in the last 24 hours of life or even after death.

The next step was for the researchers to learn how clinicians themselves viewed chaplain involvement.

“The main surprising finding was that all clinicians believed that chaplains would be helpful in most clinical scenarios — even when patients survive critical illness,” says Choi. This was true of physicians, nurses, and advance practice providers.

Consistent with the previous study’s findings, all the clinicians regularly consulted chaplains when patients were dying. They were less likely to do so when patients were recovering from critical illness — even though the clinicians said they thought chaplains would be helpful in this circumstance. “It’s unclear exactly why there is this disconnect. But it’s certainly something to explore in the future,” says Choi.

The study confirmed that there is not much direct communication with chaplains. “Even through the medical record, clinicians are not regularly reading chaplain notes,” says Choi.

Unbiased Advocates

Many ethical dilemmas revolve around issues of faith. Patients’ or families’ interpretation of their faith sometimes leads to decision-making that conflicts with what the medical team deems as appropriate.

In these ethically challenging cases, chaplains can bridge communication gaps, says Choi: “Chaplains can serve as unbiased advocates for patients without any specific agenda.”

During any tense encounters between patients and clinicians, particularly when ethical issues come up, there may be potential bias on the clinician side. “Chaplains are trained to help bridge that gap,” says Choi. They do this by understanding the patient and family’s perspective and by communicating with the medical team.

Occasionally, care may seem medically futile, but the family wants to continue aggressive measures because their religion says they are not allowed to withdraw support. The goal is not simply to bring the family into alignment with the medical team’s wishes. That is not the chaplain’s role.

“Chaplains should be brought in so that they can help provide spiritual support through this distressing time and also to understand their beliefs and values,” says Choi.

It is possible that a consensus is reached on the best course of action. “But chaplains should be caring for the patient and family without any specific agenda to change the course of care,” notes Choi.

REFERENCES

1. Choi PJ, Chow V, Curlin FA, et al. Intensive care clinicians’ views on the role of chaplains. J Health Care Chaplain 2018;5:1-10.

2. Choi PJ, Curlin FA, Cox CE. “The patient is dying, please call the chaplain”: The activities of chaplains in one medical center’s intensive care units. J Pain Symptom Manage 2015; 50:501–506.