Integrating chaplaincy into healthcare

Spiritual care can be an important source of support for patients dealing with chronic or terminal illnesses, and it is a key component of palliative care | BMJ Supportive & Palliative Care


Studies have shown that patients would like more frequent discussions on religion and spirituality (R/S) while in the hospital, but many patients do not have the chance to do so. One way to ensure that R/S is addressed during a hospital stay is via chaplain referrals. One study showed that chaplain visits are associated with increased patient satisfaction, and patients more often endorsed that staff met their emotional and spiritual needs, although research shows differences among professionals in chaplaincy referral rates; nurses have been shown to have higher likelihood of referring than physicians and social workers (SWs).

With the advent of the electronic health record (EHR), we felt it was important to explore whether or not healthcare professionals (HCPs) are interested in technology for requesting chaplains, and therefore improve access to spiritual care for patients. In fact, some initial research shows potential benefits of using electronic means to better identify and target patients in need of a chaplain visit, and one innovative palliative care service using pagers for referrals was reported as highly valuable by nurses to patients and the clinical team.

Here, we report results from a quality improvement (QI) project aimed at improving chaplaincy referrals, and therefore spiritual care, at a major academic centre in New York City, with a focus on gauging interest in technology-driven means for chaplain referrals.

Full reference: Rhee, J.Y. et al. (2017) Integrating chaplaincy into healthcare: a survey shows providers are interested in technology-based options. BMJ Supportive & Palliative Care. Published Online First: 7th July 2017. 


Internet search query demonstrates increasing public awareness of palliative care

McLean, S. et al. BMJ Supportive & Palliative Care. Published Online: 27 January 2017


Background: A lack of public awareness of palliative care (PC) has been identified as one of the main barriers to appropriate PC access. Internet search query analysis is a novel methodology, which has been effectively used in surveillance of infectious diseases, and can be used to monitor public awareness of health-related topics.

Discussion: Although internet search query surveillance is a novel methodology, it is freely accessible and has significant potential to monitor health-seeking behaviour among the public. PC is rapidly growing in the USA, and the rapidly increasing public awareness of PC as demonstrated in this study, in comparison with the UK, where PC is relatively well established is encouraging in increasingly ensuring appropriate PC access for all.

Read the full abstract here

New go-to website for resources and learning in palliative and end of life care

Nicola Spencer introduces the enhanced Ambitions for Palliative and End of Life Care website which will be the new go-to place for resources and learning | NHS England


Struggling to keep up to date and informed on changes impacting on palliative and end of life care? Not sure where to find the latest resources and improvement examples?

Then you will be pleased to hear we have launched a tailor made national End of Life Care (EoLC) Knowledge Hub providing you with a ‘one stop shop’ of palliative and EoLC information.

This hub provides anyone involved in the commissioning or provision of palliative and end of life care with a quick and easy way to source information, including helpful tools and resources to drive delivery of the Ambitions for Palliative and End of Life Care – a national framework for local action.

Read the full overview here

Find the website here

Identifying professionals’ needs in integrating electronic pain monitoring

Taylor, S. et al. Palliative Medicine. Published online: November 11,2016

B0006861 Memory retrieval
Image source: Spooky Pooka. Wellcome Images // CC BY-NC-ND 4.0

Background: Poor pain assessment is a barrier to effective pain control. There is growing interest internationally in the development and implementation of remote monitoring technologies to enhance assessment in cancer and chronic disease contexts. Findings describe the development and testing of pain monitoring systems, but research identifying the needs of health professionals to implement routine monitoring systems within clinical practice is limited.

Aim: To inform the development and implementation strategy of an electronic pain monitoring system, PainCheck, by understanding palliative care professionals’ needs when integrating PainCheck into routine clinical practice.

Conclusion: Even the most sceptical of health professionals could see the potential benefits of implementing an electronic patient-reported pain monitoring system. Health professionals have reservations about how PainCheck would work in practice. For optimal use, PainCheck needs embedding within existing electronic health records. Electronic pain monitoring systems have the potential to enable professionals to support patients’ pain management more effectively but only when barriers to implementation are appropriately identified and addressed.

Read the abstract here

Implementation of a pilot telehealth programme in community palliative care

Collier, A. et al. Palliative Medicine. April 2016 vol. 30 no. 4409-417
Image source: Esther Vargas // CC BY-SA 2.0

Background: Telehealth technologies are an emerging resource opening up the possibility of greater support if they have utility for patients, carers and clinicians. They may also help to meet health systems’ imperatives for improved service delivery within current budgets. Clinicians’ experiences and attitudes play a key role in the implementation of any innovation in service delivery.

Aim: To explore clinicians’ perspectives on and experiences of the utilisation of a pilot telehealth model and its integration into a specialist community palliative care programme.

Design: Focus groups and interviews generated data that were analysed through the lens of a realistic evaluation theoretical framework.

Setting/participants: The study was conducted in a metropolitan specialist palliative care service in South Australia. Participants (n = 10) were clinicians involved in the delivery of community specialist palliative care and the piloting of a telehealth programme.

Results: Service providers consider telehealth resources as a means to augment current service provision in a complementary way rather than as a replacement for face-to-face assessments. Introducing this technology, however, challenged the team to critically explore aspects of current service provision. The introduction of technologies also has the potential to alter the dynamic of relationships between patients and families and community palliative care clinicians.

Conclusion: Implementation of a pilot telehealth programme in a specialist palliative community team needs to involve clinical staff in service redesign from the outset. Reliable IT infrastructure and technical support is critical for telehealth models to be effective and will aid uptake.

Read the abstract here


Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting

Steel, J.L. et al. Cancer. Published online 11 March 2016.

apple-laptop-notebook-notes-largeBackground: The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life.

Method: A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician’s appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression.

Results: At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen’s d = 0.71), pain (Cohen’s d = 0.62), and fatigue (Cohen’s d = 0.26) and improvements in quality of life (Cohen’s d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen’s d = 0.75) and depression (Cohen’s d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm.

Conclusions: The integration of screening and symptom management into cancer care is recommended.

Read the abstract here

Information and communication technology for managing pain in palliative care: a review of the literature

Allsop, M. et al. BMJ Support Palliat Care 2015;5:481-489 doi:10.1136/bmjspcare-2013-000625


Background Information and communication technology (ICT) systems are being developed for electronic symptom reporting across different stages of the cancer trajectory with research in palliative care at an early stage.

Aim/design This paper presents the first systematic search o the literature to review existing ICT systems intended to support management of pain in palliative care patients with cancer. The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses.

Data sources Four databases (Embase, MEDLINE, PsycINFO and Healthcare Management Information Consortium) from 1990 to December 2012 were searched, with exclusion of papers based on their description of ICT systems and language used.

Results 24 articles met the inclusion criteria, many of which reported the use of non-experimental research designs. Studies were identified at different stages of development with no systems having reached implementation. Most systems captured pain as part of quality-of-life measurement with wide variation in approaches to pain assessment.

Conclusions ICT systems for symptom reporting are emerging in the palliative care context. Future development of ICT systems need to increase the quality and scale of development work, consider how recommendations for pain measurement can be integrated and explore how to effectively use system feedback with patients.

Read the full article via BMJ Supportive & Palliative Care