New knowledge regarding Clinical Value of Human SpiritualityChaplain Nikki Kleinberg, M. Div., BCC Oct 25, 2022
This summer a landmark article in the field of Spirituality and Health literature was published in a prestigious medical journal with large readership, JAMA. As a Spiritual Care Subspecialist (Chaplain) in a high-volume Level I trauma center and tertiary care hospital, my thoughts and feelings are stirred by such high-quality evidence for the clinical value of human spirituality, and I wonder how institutions might apply such evidence to standard practice.
Quality spiritual care is a distinction of many hospital systems, for which recognition might be awarded. But fresh from the buzz of my hospital’s triennial survey by The Joint Commission, I wonder, how might the findings in “Spirituality in Serious Illness and Health” (JAMA, July 12, 2022) influence accountability to the quality and safety standards of The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other healthcare groups, and more deeply involve the field of chaplaincy with its various accreditation and professional organizations.
Surveyors from TJC recently visited my hospital and reviewed patient charts, interacted with staff, observed units, and facilitated other methods to measure quality and safety within our dynamic and complex multicultural healthcare institution.
I didn’t see much of them from my position as a chaplain, though TJC’s Accreditation Manual for Hospitals refers to spirituality, religion, beliefs and cultural diversity in general terms regarding: respect and protection of patient rights, psychosocial services for substance abuse and emotional/behavioral disorders, dietary restrictions, end of life care, patient learning and communication needs assessment, organ and tissue donation, cultural sensitivity trainings for staff, and respect for beliefs in leadership that reflect an institution’s culture of respect.
At present, TJC surveyors generally seek to determine only whether there is some attention to spirituality/religion, but beyond that there is little in the way of assessing the quality and substance of what an institution does that could affect patient rights and outcomes.
However, this article offers enough high-quality evidence to suggest a well-founded and systematic strategy for patient care and outcomes in serious illness, including objective standards for the assessment and provision of spiritual care.
As many care providers from different disciplines consider the implications of this study, I wonder how accountability for spiritual care standards from TJC and others might affect implementation and evolution of spiritual care by generalists and specialists for a variety of cultural and clinical settings.
In tandem or alternatively, we can consider how seriously interacting with spirituality as a determinant of health could inspire creative work that earns prestigious recognition, such as the AMA Foundation’s Excellence in Medicine Awards, Best Hospitals “Honor Roll,” or EM:RAP Challenge Coins.
Evidence-based priorities are competing for resources within health care and beg the question: what are the drivers that improve our institutions? An accountability metric makes people pay attention, and so does competition.
Balboni, T. A., VanderWeele, T. J., Doan-Soares, S. D., Long, K. N. G., Ferrell, B. R., Fitchett, G., Koenig, H. G., Bain, P. A., Puchalski, C., Steinhauser, K. E., Sulmasy, D. P. and Koh, H. K. "Spirituality in serious illness and health." JAMA 328, no. 2 (July 12, 2022): 184-197.