Findings of first empirical data on contributions of chaplain interventions in palliative care

By Eric J. Hall, president & CEO, HealthCare Chaplaincy Network

When the latest Clinical Practice Guidelines for Quality Palliative Care guidelines were announced at last year’s AAHPM annual conference, project co-chair Betty Ferrell, PhD, RN, FAAN, FPCN, research scientist at City of Hope, said, “Quality palliative care includes all eight domains. If you are not providing excellent spiritual care, you are not providing palliative care.”

Nonetheless hospital administrators who are skeptical about the value of professional chaplaincy care need data about what chaplains do and their contributions to better patient care.

The first large-scale attempt at forming an evidence base for chaplaincy care effectiveness in health care has culminated in six studies funded by the John Templeton Foundation under a grant managed by HealthCare Chaplaincy Network. The findings were released the inaugural conference of HealthCare Chaplaincy Network’s first annual conference Caring for the Human Spirit: Driving the Research Agenda in Spiritual Care in Health Care March 31 – April 3, 2014, at the New York Academy of Medicine:

Spiritual Assessment and Intervention Model (AIM) in Outpatient Palliative Care for Patients with Advanced Cancer. University of California, San Francisco; Project Director, Laura Dunn, MD, Project Chaplain, Allison Kestenbaum, BCC
This is one of very few studies to provide an in-depth picture of spiritual care work with patients. No validated spiritual assessment tools have existed prior to this study. Even three sessions with a professional chaplain had important, positive effects for patients. The research raises the possibility that spiritual care should be studied as a potentially powerful intervention for patients with various serious illnesses, not just cancer.

Impact of Hospital-Based Chaplain Support on Decision-Making During Serious Illness in a Diverse Urban Palliative Care Population. Emory University (Atlanta); Project Director, Tammie Quest, MD, Project Chaplain, George Grant, ACPE
A diary study of 1140 chaplain-patient encounters demonstrated the value of chaplain-patient communication and revealed that more than half of chaplain visits focused on issues other than spiritual. The study also showed that conversations with patients were more likely to be about “practical matters” (family care, life review, medical care, work) than about “ultimate concerns” (expressed emotions, existential matters, spiritual/religious matters, physical symptoms).

Hospital Chaplaincy and Medical Outcomes at the End of Life. Dana Farber Cancer Institute (Boston):
Project Director, Tracy Balboni, MD, Project Chaplain, Angelika Zollfrank, BCC

The data from this study is a first step in furthering the understanding of how chaplaincy care influences patient well-being and medical decision making at the end of life.

Understanding Pediatric Chaplaincy in Crisis Situations, Children’s Mercy Hospital (Kansas City)
Project Director, John Lantos, MD, Project Chaplain, Dane Sommer, BCC

Researchers analyzed seven in-depth case studies that reveal how medical professionals utilize chaplains in the care of seriously ill children. They learned that most health professionals have little or no understanding of what chaplains do and that this has implications for patient and family care. Key findings showed that: tangible objects are very important (e.g., prayer shawls and teddy bears); physical interaction builds trust (e.g., eye contact).

Caregiver Outlook: An Evidence-Based Intervention for the Chaplain Toolkit. Duke University Medical Center (Durham, NC):Project Director, Karen Steinhauser. PhD, Project Chaplain, Annette Olsen, BCC
For the first time, researchers established that it is feasible for chaplains to use a standardized, low-cost phone-delivered intervention. This has important implications because the intervention is measurable, controllable and transferrable. Both religious and non-religious participants found conversations with the chaplain meaningful and without an agenda.

“What do I do” – Developing a Taxonomy of Chaplaincy Activities and Interventions for Spiritual Care in ICU Palliative Care. Advocate Charitable Foundation & Advocate Health Care (Chicago):
Project Director, Kevin Massey, BCC, Co-Principal Investigator, William Summerfelt, PhD

This study begins to explain how spiritual care is helpful by revealing a common language, list of activities, effects and outcomes for chaplains. The research showed that professional chaplains play a major role in helping patients express their wishes about end of life and advance care planning. The study generated 348 taxonomy items.

If you wish more detail about any of this research, please contact jsiegel@healthcarechaplaincy.org

Highlights of the April Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Differences in the Symptom Experience of Older Oncology Outpatients
Christine Ritchie, Laura B. Dunn, Steven M. Paul, Bruce A. Cooper, Helen Skerman, John D. Merriman, Bradley Aouizerat, Kimberly Alexander, Patsy Yates, Janine Cataldo, and Christine Miaskowski

A Novel Website to Prepare Diverse Older Adults for Decision Making and Advance Care Planning: A Pilot Study
Rebecca L. Sudore, Sara J. Knight, Ryan D. McMahan, Mariko Feuz, David Farrell, Yinghui Miao, and Deborah E. Barnes

Dying With Dementia: Symptoms, Treatment, and Quality of Life in the Last Week of Life
Simone A. Hendriks, Martin Smalbrugge, Cees M.P.M. Hertogh, and Jenny T. van der Steen

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David J. Casarett, MD, MA, Senior Associate Editor, JPSM

Reflections of the AAHPM Research Scholars Program and the NPCRC Foley Retreat

Last October, I was fortunate enough to attend the National Palliative Care Research Center’s “Kathleen M. Foley Research Retreat” as one of AAHPM’s Research Scholars. The annual Foley Retreat brings together the country’s leading experts in palliative and hospice care research to discuss the state of the science, set priorities for future research, and allow for the creation of new friendships and collaborations among colleagues. It is a remarkable experience.

As a non-clinician health services researcher whose work is clinically-focused, it can sometimes be a little bit daunting to find where you belong. Does a non-clinician fit in at a clinical society meeting (like AAHPM’s Annual Assembly)? Sure. But often, the annual meetings of clinical societies predominately cater their offerings towards practitioners – and rightly so. Well, what about more methods-focused organizations? Sure, those are phenomenal meetings, too, but let’s be honest – sometimes those meetings tend to “geek out” over the minutiae of research methods at the expense of real-life applicability. The sweet spot for someone like me can be hard to find.

But enough with my Goldilocks-meets-Little Orphan Annie soliloquy. I can confidently say that after last fall’s NPCRC Foley Retreat, I have found a community where I believe that I belong. The Foley Retreat is one of the most inspiring meetings I’ve attended, and the passion of its attendees is readily apparent. These individuals are the true leaders and innovators in palliative care research. They are the ones actively working to build the evidence base for the care of those with serious illness, the ones who have paved the way for junior palliative care researchers, and the ones who we ultimately aspire to emulate in our careers. Aside from seeing exciting research presented by both junior and senior colleagues funded by NPCRC and ACS, there is another aspect of this retreat worth highlighting. The relaxed atmosphere of the retreat allows for friendly and supportive interactions amongst attendees. Indeed, I have never felt so welcomed during another professional meeting – mid-level and senior researchers were genuinely interested in my work, freely providing their suggestions, perspectives, and general career mentorship. The Foley Retreat makes the nurturing of junior attendees a priority – something that as an early stage investigator myself, I truly appreciate.

I can’t adequately thank AAHPM for its ongoing commitment to my career development. The Research Scholars Program is but one example of how AAHPM is dedicated to supporting and advancing the careers of junior palliative care researchers. Thank you for affording me the opportunity to participate in such a phenomenal experience. I’m already excitedly looking forward to next year’s retreat!

Dio Kavalieratos, PhD
Postdoctoral Fellow, University of Pittsburgh School of Medicine
Adjunct Assistant Professor of Health Policy and Management, University of North Carolina at Chapel Hill

Help Ensure the Issues of the Hospice and Palliative Care Community Are Represented on the National Stage

By Richard S. Pieters, MD MEd FACR

I am an AMA member, delegate and council member.

I originally joined the American Medical Association (AMA) because, like it or not, the politicians in Washington consider the AMA the voice of American physicians. All of the specialty societies can speak for their specialty, but only the AMA speaks for the broad interests of us all. I believe that organized medicine offers the only opportunity to influence our legislators for the good of our profession and our patients, and I consider advocacy to be a professional obligation. As an active member of the Massachusetts Medical Society House of Delegates, I came to recognize the importance of the policymaking function of the House and the important role each delegate plays in the advocacy role of the Society in our state. So, I decided I wanted to be just as involved nationally.

As a Hospice and Palliative Medicine physician, I know that our specialty faces unique regulatory and legislative concerns and a severe workforce issue. AAHPM — through the Academy’s delegate, Dr. Chad Kollas — helped me to achieve election to the AMA Council on Medical Education last June. As a result, I have the ear of the American Board of Medical Specialties (ABMS), the organization that will have to address the workforce problem. Having become board certified in HPM mid-career, I am anxious to ensure that ABMS understands and works to address the challenges associated with mid-career training and board certification. I can assure you that, while they do not always agree with us, they do listen to the collective voice of the AMA Council on Medical Education.

Today, AAHPM is fighting to retain its seat in the AMA House of Delegates and needs to increase the number of Academy members who are members of the AMA to do so. I hope you will join or renew by April 1 and help ensure our continued representation. As a member of the AMA House of Delegates, I have found that it functions as a true democracy, which means policy is set by a majority vote of those present. If it is important to you that the issues of the hospice and palliative care community are represented on the national stage, then you need to assure that our voice continues to be heard on the floor of the AMA House.

Dr. Rick Pieters is a radiation oncologist at UMass Memorial Medical Center. An AAHPM member, Pieters serves as a delegate to the AMA from the Massachusetts Medical Society and as a member of the AMA Council on Medical Education.

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AAHPM Practicing Physician Members: Help AAHPM save its seat in the AMA!

Go to ama-assn.org and join by April 1 to ensure AAHPM meets the requirements for representation in the AMA. Already an AMA member? Don’t forget to renew your membership by April 1!

Measuring What Matters at Annual Assembly

It was an exciting Annual Assembly for the Measuring What Matters team, who presented both a preconference workshop and an concurrent session to the AAHPM/HPNA membership. Some of the supportive & challenging comments we received included:

Measures are power.
Quality measures will happen, and we need to be part of the process!
Now I appreciate the complexity of this work.
Measures should look at what is meaningful, actionable and has potential impact.
Great explanation of the Core Measures process – from the ground up – unique & much appreciated!
Measures will be a driving force for sustainability.
Just because you have measures in place doesn’t mean you have quality.
Measuring What Matters brings leverage to your program. It’s not about saving money but bringing value to patients/families served.

Our quality consultant from Hart Health Strategies, Rachel Groman, commented about MWM: “AAHPM is taking the high road by determining, on its own, what is most important to its member in terms of QI rather than letting federal mandates dictate the direction of the profession. Honestly, I don’t see that much anymore.”

I am deeply grateful for what we’ve accomplished so far, and for the passion and dedication of our co-chairs and panel members. We’ve promised a draft list of measures for AAHPM and HPNA membership to comment on within two months, then we’ll be seeking further input from organizations, patients, families, and the general public.

Katherine Ast

Why I am Helping to Shape the Future

It’s hard to believe that the 2014 AAHPM & HPNA Annual Assembly is over. There is so much preparation that goes into it all year that it’s a bit surreal to be done. In a few days we will start collecting abstracts for Philadelphia and the whole process will start over!

My favorite part of the Assembly (aside from connecting with our amazing attendees) is working with the Developing Countries Scholars. I had the privilege of being the staff liaison to the 2014 Scholars: Edwina Addo, Marcos Borges, Lilian Hidalgo, Farzana Khan, Giorgi Metivishvili, Jean-Luc Nkurikiyimfura, Thai Phan, Srinagesh Simha and Charu Singh. After spending several months corresponding with them I could barely wait to meet them all in person. They are remarkable individuals that I was blessed to meet. The warmth, compassion, and dedication that they all exuded was overwhelming.

Managing the Developing Countries Scholarship program has opened my eyes to the incredible hardships that physicians are facing while trying to provide hospice and palliative care to their communities. The Scholarship Fund was created to provide access to high quality hospice and palliative medicine education to physicians living and practicing in developing countries. The scholarship recipients are able to make meaningful connections and incorporate new knowledge in their practice. The Scholarship Fund is made possible by donations to the Shaping the Future campaign. If you have donated to Shaping the Future- Thank you! If you haven’t donated- there is still time.

Jen Bose
Marketing & Membership Manager

Are You in Danger of Burnout?

Larry Beresford

Are accumulated job stresses affecting your ability to provide high-quality hospice and palliative medicine to your patients? Do you have strategies for easing or managing the stresses of this work? Given this field’s ongoing workforce challenges, it can’t afford to lose a single practicing hospice and palliative medicine physician to job stress or burnout.

The latest issue of the AAHPM Quarterly explores these issues in terms of their particular impact on hospice and palliative medicine and some of the ways experts recommend for getting a better handle on it. Meeting patients and families as they confront serious, advanced, incurable or terminal illnesses and helping them negotiate the changes these impose in their lives demands significant personal engagement. You put your heart on the line every day, but the careers of many veterans in this field testify to the fact that burnout is not an evitable consequence of that engagement.

We’d like to hear more stories of hospice and palliative medicine physicians’ struggles with job stress and burnout, successful or not. Comment below.

Highlights of the March Issue of the Journal of Pain and Symptom Management (JPSM)

Listed below are a few articles from the most recent issue of the journal:

Nurse-Led Follow-Up at Home versus Conventional Medical Outpatient Clinic Follow-Up in Patients With Incurable Upper Gastrointestinal Cancer: A Randomized Study
Madeleen J. Uitdehaag, Paul G. van Putten, Casper H.J. van Eijck, Els M.L. Verschuur, Ate van der Gaast, Chulja J. Pek, Carin C.D. van der Rijt, Rob A. de Man, Ewout W. Steyerberg, Robert J.F. Laheij, Peter D. Siersema, Manon C.W. Spaander, and Ernst J. Kuipers

Risk Factors for Developing Prolonged Grief During Bereavement in Family Carers of Cancer Patients in Palliative Care: A Longitudinal Study
Kristina Thomas, Peter Hudson, Thomas Trauer, Cheryl Remedios, and David Clarke

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Highly or Moderately Emetogenic Chemotherapy: A Randomized, Double-Blind, Placebo-Controlled Study
Naomi Mizukami, Masanori Yamauchi, Kazuhiko Koike, Akihiko Watanabe, Koji Ichihara, Naoya Masumori, and Michiaki Yamakage

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David J. Casarett, MD, MA, Senior Associate Editor, JPSM

Physician Engagement & Influence in Organizational Management

So how is the leadership thing working out? Palliative care, hospice care and healthcare in general has evolved into the most complex team sport of all time. And getting people to move cohesively around a simple common ground effort should not be that hard…but it is. Some try the bull-horn approach (I did that for a while…and it worked as well as me telling my patients to lose weight), other leaders try the expert approach (I am so smart…that I will just do it myself…)- that didn’t work either (and it was really tiring). Leadership is about building influence and the capacity to change anything with your teammates…not to them.

How do we do this? How do we create common ground that everyone knows, supports and contributes to? How do we tap the intelligence of the team (all of us is always smarter than one of us)? How do we effectively communicate with each other. All of this sounds so simple, but so infrequently done. I look forward to spending a day of discovery, skill building and practice to lead your team. See you soon-

Stephen Beeson MD
Founder, PracticingExcellence.com

ACPE faculty Stephen C. Beeson, MD, will lead the 2014 AAHPM Leadership Forum Ignite Program – Physician Engagement & Influence in Organizational Management. Ignite premieres during the 2014 Annual Assembly and will be offered as a full-day learning experience in subsequent years.

Help AAHPM by joining the AMA

Ronald J. Crossno, MD FAAFP FAAHPM

Help AAHPM by joining the AMA. That is a refrain you’ve been hearing repeatedly in recent months. As we approach the midway mark of the second decade of the 21st century, why would any HPM physician choose to be a member of the American Medical Association? Isn’t the AMA a relic of the last century? Something that is reminiscent of smoke-filled rooms and back-room political deals? I was someone who spent much of my professional career as an AMA non-member, but upon digging deeper, what I learned frankly amazed me. The answer to the latter two questions above is an equivocal “NO!” Let me tell you why you should join me as a member of this organization that has truly reinvented itself in recent years.

Our specialty of Hospice and Palliative Medicine has made incredible strides and advances in the last 25 years. Many of us have fought hard to achieve those advances, which may have left us with an “us versus them” mentality, to the point sometimes we forget that we do have external allies. The AMA was one of our earliest such allies, and has continued to be a friend to HPM. We’ve achieved parity within the AMA as a specialty with equal footing to others. We’ve even begun advancing to leadership positions within the AMA internal structure, further helping us to network and forge alliances. This progress has helped HPM gain broader recognition, even more rapidly than could have happened otherwise.

Appreciating this process helps us to also understand why AAHPM needs to remain an active member society of the organization. The analogy that comes to mind is the U.S. Congress and its state representation process. AAHPM is like Wyoming or Rhode Island. These are small states, but they have a seat at the table in the House of Representatives and have completely equal representation in the Senate as the “big dogs” like California or Florida. I think it is probably safe to say that many people in New York or Texas or Hawaii have different political inclinations such that they have significant disagreements. However, that doesn’t mean any of these states are seriously talking of secession. The analogy holds true when one considers AAHPM’s role in the AMA. We don’t have time in this message to provide details, but the networks, connections, and inner workings of the AMA are amazingly diverse and broad. Most people don’t have a clue to this, any more than they understand the political workings of a state besides the one in which they live.

But we must take that analogy a step further. I suspect that anyone reading this can think of a presidential election within the last two decades, the results of which did not make you happy. For the vast majority of us, that wasn’t a reason to emigrate from the U.S., but rather to work for a future change more to our liking. The same holds true for the AMA. All too often, the excuse for not being an AMA member is “I don’t agree with the AMA stance on XYZ.” So is dropping out of the picture the answer to that? No! You’ve got to be at the table, advocating for our position, and working for a future change more to our liking! Sure, the ‘house of medicine’ is pretty fractured into various specialties and factions these days. Within medicine, we readily see that and must deal with it. But those outside of medicine have neither the time nor inclination to recognize or deal with all those factions. The AMA remains the “voice of medicine” to policymakers, whether in government and in private industry.

AAHPM must remain at the table within the AMA, or we lose our ability to influence the future of not only HPM or even Medicine (with the capital “M”), but of American society. We are in real danger of losing that seat, since AMA rules require that a certain percentage of AAHPM members also be AMA members in order to retain our delegate status. Having served as AAHPM’s alternate delegate to our AMA, you say I’m biased, and I am. But I got much more out of that experience than I ever put into it. As a consequence, I want to assure you that I’m not an AMA member out of some expediency purely to benefit AAHPM. I’m proud to be an AMA member! The AMA is an organization that is full of idealists, ready to tackle society’s biggest problems, much like many AAHPM members. THAT is why I encourage you to join me in helping AAHPM keep its full representation within the AMA.

Dr. Crossno is a Senior National Hospice Medical Director for Gentiva Health Services and Past President of the American Academy of Hospice & Palliative Medicine.
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AAHPM Practicing Physician Members: Go to ama-assn.org and join by April 1 to ensure AAHPM meets the requirements for representation in the AMA. Already an AMA member? Don’t forget to renew your membership by April 1!

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