It is well accepted that attention to spiritual concerns is a core dimension of palliative care. It is similarly well accepted that chaplains are the spiritual care specialists who should address such concerns. However, what chaplains do when they provide care for patients and families is often poorly understood by their palliative care colleagues. Having a clear understanding of what chaplains do is important because it contributes to improved utilization of the spiritual care and other resources of the palliative care team and thereby to better care for patients and families. The aim of this study was to describe what palliative care physicians, nurses, and social workers understand about what chaplains do. Brief surveys were distributed to participants at 2 workshops for palliative care professionals in 2016. The survey was completed by 110 participants. The majority reported that they understood what chaplains do moderately well or very well. Thirty-three percent of the written comments about what chaplains do were very general; 25% were more specific. Only a small proportion of the participants were aware that chaplains provide care for the team, are involved in facilitating treatment decision-making, perform spiritual assessments, and bridge communication between the patient/family/team/community. Based on our survey, palliative care colleagues appear to have a broad understanding of what chaplains do but many may be unfamiliar with important contributions of chaplains to care for patients, families, and teams. These findings point to the need for ongoing education of palliative teams about what chaplains do in palliative care.
Our evaluation suggests that the integration of APNs into a palliative care team for case finding may be a promising strategy, but more work is needed to determine whether reductions in cost are significant.
Previous research has shown that African American and Latino populations prefer more aggressive care at end of life. The purpose of this retrospective chart review was to describe whether having a palliative care consultation affected acceptance of do-not-resuscitate (DNR) status and hospice in these populations. Data were extracted from the medical records of patients who received a palliative care consultation between March 2011 and July 2011. Data extracted were race, age, gender, primary disease process, DNR status at time of consult and at discharge, and whether the patient enrolled in hospice if eligible. Demographic variables were tabulated using descriptive statistics or frequency distributions where appropriate. t Tests and analyses of variance were conducted to examine differences between ethnic groups. The sample size was 199, of which 38% were African American and 15% Hispanic. Prior to consultation, there were statistically significant differences regarding DNR status; after consultation, there were no differences in acceptance of DNR among races. Statistically significant differences among ethnicities remained in hospice enrollment. The authors conclude that palliative care consultations make a significant difference in this patient population. Further research is needed to identify why having a palliative care consultation impacted the decision about code status. KEY WORDSend of life, hospice, racial disparities, resuscitation I t has become widely accepted that minority populations, particularly blacks, are significantly less likely than whites to accept do-not-resuscitate (DNR) status or hospice care and in general prefer more aggressive care at end of life. 1<7 Several studies have found that whites were more likely than blacks to (1) have conversations with physicians about the care of loved ones, 3 (2) have a living will or other advance directive, 3,4,7 and (3) limit or withhold lifesustaining treatment. 1<7 Although many of these studies asked people to make decisions based on hypothetical scenarios, 1,2,4,6,7 there have also been studies examining decisions made in real-world situations. 3<5 Do-not-resuscitate status and hospice are important topics. In the majority of cases, a resuscitation attempt is not successful at returning a patient to his/her prior level of functioning, and in those with cancer, the results are even poorer. 8<11 For those Americans who would like to die at home, hospice provides expert symptom management and psychosocial support for the entire family.Much of the previous research on medical decision making focused on characteristics of patients or their families. Newer research demonstrates that how providers present information and discuss options for care also impacts the decisions that patients and their families make. The focus of this article is the impact of palliative care consultations. Palliative care teams are now widely available in the United States, 12 and palliative care consultations have been shown to increase rates of DNR orders and hospice enroll...
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