At one of the workshops this morning, a speaker made the statement that chaplains were using scripted and particularized spiritual assessment “tools” that may project the chaplain’s assumptions and block the particular expression of the patient’s spirituality. When I sought to correct that assertion during the Q&A, I was told by one of the speakers and several members of the audience that I was incorrect.

The facts of the case are as follows. The standard definition of “spiritual assessment” used in professional healthcare chaplaincy in North America is.

A more extensive [in-depth, on-going] process of active listening to a patient’s story as it unfolds in a relationship with a professional chaplain and summarizing the needs and resources that emerge in that process. The summary includes a spiritual care plan with expected outcomes which should be communicated to the rest of the treatment team.

Fitchett, G., & Canada, A. L. (2010). The Role of Religion/Spirituality in Coping with Cancer: Evidence, Assessment, and Intervention. In J. C. Holland (Ed.). Psycho-oncology, 2nd Edition. New York: Oxford University Press.

This definition clearly does not support the use of a “tool”. This does not mean that no chaplain uses a tool. It only means that this use does not conform to best practice.

There certainly is a substantial lack of clarity here.

The Joint Commission and others do suggest a spiritual assessment. They do not require over even suggest the use of a “tool” which means that the definition above works. Any groups who are requiring the use of a tool are misreading the standards.

The fact is that several institutions that I know of have received advanced accreditation in palliative care without a spiritual assessment “tool”. One of those received a perfect score.

There is a widespread misunderstanding between spiritual “screening”, “history”, and “assessment” tools. For instance, FICA and HOPE are history tools, not assessment tools. They are not recommended for use by chaplains.

At the end of the day, there is a lot of misinformation out there on this topic. I would hope that practitioners would read the regs closely and draw their own conclusions about what is and what is not actually “required”.

George Handzo, BCC, CSSBB
President, Handzo Consulting