01 02 03 Understand Explore Discuss telechaplaincy emerging - PDF document

8/26/2020 Telechaplaincy: Taking Chaplaincy beyond the Patient Room � Rev. Petra Sprik, MPH, MDiv, BCC 1 � Aims 01 02 03 Understand Explore Discuss telechaplaincy emerging best application to research practices clinical context 2 �  The use of telecommunications and virtual technology to deliver spiritual and religious care by healthcare chaplains or other religious/spiritual leaders “Telehealth Chaplaincy”  Telehealth modalities can include telephone, or smartphone applications, live videoconferencing and internet interventions, which are delivered “Telechaplaincy” synchronously or asynchronously 3 1

8/26/2020 � Telechaplaincy: A history Today Research & COVID Response 2000's Telechaplaincy programs 1950's VA Telechaplaincy 1900's Telehealth 4 True or False? � In-person chaplaincy is more effective than telechaplaincy. 5 � � The Research 6 2

8/26/2020 � Lay pastoral telecare of church attenders The Issue The Measures   Large churches unable to Spiritual Wellbeing Scale provide social support  Church Satisfaction Questionnaire The Intervention The Findings  Lay-person delivered  Greater positive change in telephone counseling, weekly spiritual wellbeing or biweekly for 6 months  Trend toward greater church  Randomized Control satisfaction Zwart et al. 2000 7 � Home Telehealth for Holistic End-of-Life Care The Issue The Measures   Physical, emotional and Quality data spiritual needs for veterans  Clinical data with chronic end stage illnesses  Business indicators The Intervention The Findings  Text and videophone to  Better management of provide psychosocial and medical condition spiritual support  Better connection/security Maudlin et al, 2006 8 � Chaplain-led intervention for caregivers of seriously ill patients The Issue The Measures  Quality of life  Physical, emotional and spiritual well-being of  Psychological measures caregivers of patients with life-limiting illnesses  Spiritual/Religious measures The Intervention The Findings  3 semi-structured telephone  Stable outcomes conversations with chaplain  Appreciate aspects of program Steinhauser et al, 2016 9 3

8/26/2020 10 � Telephone-based Chaplaincy Intervention for Parents of Children with Cystic Fibrosis The Issue The Measures   Spiritual Struggles of parents Brief RCOPE of children with cystic fibrosis  Feasibility and Acceptability The Intervention The Findings  3 semi-structured telephone  Acceptable and feasible conversations with chaplain  Positive religious coping  Randomized Control increased Betz et al, 2019 11 � Patient-Reported-Outcome-Directed Telephone-Chaplaincy with Cancer Patients The Issue The Measures  Acceptance of intervention  Identifying patients receptive to telechaplaincy at outpatient cancer center The Intervention The Findings  Telephone from chaplain to  Patients with struggle to find patients who identify meaning/hope, fear of death religious/spiritual need and anxiety more likely to accept an intervention Sprik et al, 2018 12 4

8/26/2020 � Telephone-based Chaplaincy Intervention at Cancer Institute The Issue The Measures   Acceptability of telephone Feasibility intervention to cancer  Acceptability patients as first point of contact The Intervention The Findings  Telephone call as first point of  Acceptable and feasible contact Sprik et al, 2020 13 Sprik et al, 2020 14 Sprik et al, 2020 15 5

8/26/2020 � Nationwide analysis of telechaplaincy practice The Issue The Measures   What does telechaplaincy Survey look like in the US? The Intervention  Survey of NACC, APC and NAJC 16 Have you ever practiced virtual chaplaincy � (VC) ? (N=704; Missing 76) For chaplains not practicing VC: Yes 48% Would you be willing to practice 52% No virtual chaplaincy? (N=365) 113 106 79 46 For chaplains who haven’t practiced 21 virtual chaplaincy: Have you ever had the opportunity to practice virtual chaplaincy? Definitely Probably Undecided Probably Definitely (N=365) Not Not 8% Yes No 92% 17 OF CHAPLAINS PRACTICING VIRTUAL CHAPLAINCY: IN WHICH SETTING(S) HAVE YOU PRACTICED VIRTUAL CHAPLAINCY? (MULTISELECT) TOTAL COUNT (N=338) MISSING:27 206 88 57 54 45 49 30 31 23 20 18 11 14 9 9 5 7 18 6

8/26/2020 For those practicing virtual chaplaincy: Which mediums For those practicing virtual chaplaincy: How have you used? Multiselect much experience do you have practicing virtual chaplaincy? (N=336, Missing 19) (N=340, Missing 25) 112 350 322 300 250 78 68 200 150 40 38 100 64 41 25 16 50 0 LESS THAN 6 6 MONTHS TO 1 YEAR TO LESS 3 YEARS TO LESS 5+ YEARS MONTHS LESS THAN 1 THAN 3 YEARS THAN 5 YEARS YEAR 19 � Expand Reach Reasons for •Geographic distance •Small clinics Telechaplaincy •Outpatient settings •Low mobility/transportation patients •After hours Continuity of care Timeliness •Quick access to many patients •Easy access at time of need Preferred by patients •Symptoms •Comfort of own home •Outside of clinical setting •Anonymity COVID-19 •Prevent spread of COVID-19 to patients/family/staff/yourself •Recommended by the World Health Organization •Operate within healthcare organization’s directives •Conserve PPE •Reduce patient/family fear of transmission •Expand access of care during high-stress time Cost 20 �  Prayer  Ethical consultation  Communion  Staff care  End-of-life support  Advance Directives  Anxiety reduction  Reading scripture Which of these cannot  Developing coping  Pastoral touch strategies be done by  Suicide prevention  Grief counseling phone?  Funeral planning  Treatment compliance  Presence conversations 21 7

8/26/2020  Body language not seen or limited to what is on screen �  Patient/recipient may be doing something else  Physical touch not possible  Silences may feel harder to endure for the chaplain/patient  Not everybody has access to a phone  Technology issues  Hard of hearing/speaking patients are not ideal candidates Weaknesses of Telechaplaincy  Difficulty getting ahold of the patient  Perception of intrusive phone calls  If share office, difficult to get privacy  Physical mirroring not possible  Emotionally draining for chaplain 22 What we still need to know Ideal timing of phone calls Ideal length of phone calls Fleshed-out Intervention strategies Types of spiritual needs ideal for phone Reception in different contexts 23 � Best Practices � for Telechaplaincy 24 8

8/26/2020 � Make sure you are using a system- approved platform 25 � Almost everybody is nervous at first: Just Do it! 26 Check the patient’s chart � before calling 27 9

8/26/2020 � Have an emergency plan. 28 � Limit distraction while you are on the phone 29 � Develop a semi- structured script 30 10

8/26/2020 � Develop a Casual Introduction  “I am calling from the spiritual care department” NOT “This is the chaplain”  “We recognize that medical appointments/hospitalizations can affect you spiritually and emotionally as well as physically. How are you doing/holding up?”  “I don’t have any medical information” 31 Ensure you are talking � to the right person and that this is a good time to talk 32 � Address awkwardness 33 11

8/26/2020 � Do not provide medical information or advice 34 � Ensure that you are HIPAA compliant in your messaging 35 � Intentionally use voice to convey emotion 36 12

8/26/2020 � Use well thought- out language to convey care 37 � Be creative in rituals and interventions 38 � Be creative in deepening the conversation  “As people are going through medical appointments, sometimes medicine’s all we talk about. I would like to know more about you. Tell me something that is really important to you right now.”  “I hear X in the background….”  What feels like the most important thing to you now? 39 13

8/26/2020 � Limit length of the phone call tactfully  “I will need to go in 5 minutes. Is there anything else you wanted to talk about before we end the conversation?”  “We have talked about some pretty important things today. I would like to follow- up with you. Is there a time of day that generally works best?” 40 � Care for yourself and patient with Zoom Fatigue 41 � � Clinical Application 42 14