Chaplaincy Care in the MICU: Examining the Association Between Spiritual Care and End-of-Life Outcomes

Abstract

Background: Seriously ill patients admitted to the Intensive Care Unit (ICU) experience severe spiritual and existential distress. Patients’ surrogate decision makers face the burden of making complex decisions about their loved ones’ care. Experienced chaplains may play a role in assisting with decision-making, possibly by aligning patients’ values and wishes with treatment plans and avoiding non-beneficial aggressive measures. Objectives: To identify associations between chaplaincy care and length of stay (LOS) in the medical ICU (MICU). Methods: This was a retrospective observational study of usual spiritual care in the adult MICUs of 4 medical centers in the United States over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information. Through bivariate and multivariable analyses associations between spiritual care and LOS were examined. Results: In multivariable analysis of the 254 patients, receiving spiritual care was associated with an increased likelihood of being in a higher LOS tertile (adjusted odds ratio = 2.94, p < .001). In post hoc bivariate analysis, cases receiving spiritual care within the first 48 hours of MICU admission revealed a trend toward lower LOS (p = .181). Conclusion: Spiritual care in the MICU was associated with longer LOS. Early intervention by chaplains who are well-integrated in the ICU may assist patients and their loved ones in coming to terms with grave illness and making difficult treatment decisions. Further well-designed studies of spiritual care interventions that may affect outcomes are needed.

The Persistence of Religion as a Master Status for Chaplains

“…She describes chaplains’ work in terms of individual support, rituals and ceremonies, mediating and bridging community, and being present to show how institutional more than personal factors shape what chaplains do (Cadge 2023). Additional typologies of chaplains’ work, some connected to outcomes, further delineate how chaplains spend their time and the influence it can have on patient satisfaction, anxiety, and other individual level measures of recipient well-being (Alghanim et al 2021; Chow et al 2021; Damen et al 2020; Labuschagne et al 2021; Snowden and Telfer 2017; Tan et al 2020).…”