Fitchett G, Rasinski K, Cadge W, Curlin FA. Physicians’ Experience and Satisfaction With Chaplains: A National Survey. Arch Intern Med. 2009;169(19):1806-1818. doi:10.1001/archinternmed.2009.308
Religion and spirituality (R/S) are important resources for coping with serious illnesses, but research indicates that patients' R/S needs often go unmet.1 Professional chaplains help patients make effective use of R/S resources in the context of illness,2 but one-third of US hospitals do not have chaplains.3 Even hospitals with chaplaincy programs rarely have sufficient staff to address the needs of all patients. Given these constraints, physicians and other clinical staff play critical roles in directing chaplains to patients who will benefit from their services.4 Unfortunately, little is known about physicians' experience with and impressions of chaplains.
Most physicians have little training to guide referrals to chaplains. Some evidence suggests that in the absence of such training, physicians' referral patterns are shaped by their own R/S values and experiences.5,6 Physicians' referrals may also be shaped by their understanding, or misunderstanding, of chaplains. One study found that physicians with no experience with chaplains feared that chaplains would ignore patients' concerns and disrespect patients' beliefs.7 Using data from a national survey, we examined physicians' self-reported experience and satisfaction with chaplains. Based on earlier findings, we focused specifically on the relationship between physicians' practice context3 and R/S views5,6 and their experience and satisfaction with chaplains.
The methods of this national survey have been reported elsewhere.8 We surveyed 1144 US physicians of all specialties younger than 65 years, who were selected from the American Medical Association Physician Masterfile. We examined physicians' reports of prior experience with chaplains (yes/no) and satisfaction with chaplains (satisfied/dissatisfied). Predictor variables included physician demographics, training about R/S in medicine, practice setting, personal R/S, opinions about addressing R/S in the clinical setting, and the frequency (range, 0 “never” to 4 “always”) of observing R/S to have 3 different positive and 3 different negative effects on patients.
Among eligible physicians, the survey response rate was 63%. The present analysis includes the 1102 physicians actively involved in patient care. Respondents were predominantly male (74%) and came from diverse specialties, 31% worked at teaching hospitals, 12% worked at faith-based hospitals or clinics, and 64% reported caring for high numbers of critically ill patients. Of the respondents, 10% reported no religious affiliation, 59% reported being Christian, 16% reported being Jewish, and 14% reported other affiliations; 41% agreed with the statement, “My whole approach to life is based on my religion.” Forty-one percent of the physicians believed it was appropriate for them to talk about their own R/S with patients when the patient asked about it. Fifty percent of the physicians believed it was appropriate for them to pray with patients when the patient requested it. The physicians reported that R/S “often” had a positive impact on their patients (mean [SD] score, 2.8 [0.5]) and “rarely” had a negative impact (mean [SD] score, 1.3 [0.5]).
Most physicians (89%) reported experience with chaplains. Among these, most (90%) reported being satisfied or very satisfied with chaplains. In a multivariate logistic regression model, experience with chaplains was associated with training about R/S in medicine, seeing large numbers of critically ill patients, practicing psychiatry or obstetrics and gynecology, endorsing positive effects of R/S on patients, and believing that it is appropriate to talk with patients about R/S whenever the physician senses it would be appropriate (Table). In similar models, higher levels of satisfaction were associated with practicing medical or other subspecialties, working in teaching hospitals, endorsing positive effects of R/S on patients, and believing it is appropriate to pray with patients whenever the physician senses it would be appropriate (Table). Physicians from the Northeast and those who endorsed more negative effects of R/S on patients were less likely to be satisfied with chaplains.
On the whole, physicians appear both experienced and satisfied with chaplains. Factors influencing physicians' experience and satisfaction included training in R/S, practice context, observations of positive and negative effects of R/S on patients, and beliefs about when it is appropriate to pray or talk with patients about R/S issues.
This study asked physicians about “experience with chaplains and other pastoral care professionals.” In most hospitals the pastoral care professional is the chaplain, but in future research this wording should be more specific. In addition, the term chaplain may refer to people with diverse training and experience, from clergy who volunteer on occasion to board-certified chaplains with years of clinical experience.2 Unfortunately, this study could not assess any chaplain-specific factors. Nor did we have information about the contexts of physician-chaplain encounters (eg, around patients who are anxious, terminally ill, or who have religious objections to treatment). Other research4 suggests that physicians value some chaplain services, such as providing support around death, more than others. Future studies should examine the situations in which chaplains and physicians interact, the effect of physician training in R/S on such interactions, and the characteristics of interactions that each group finds most satisfying.
Correspondence: Dr Fitchett, Department of Religion, Health, and Human Values, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (George_Fitchett@rush.edu).
Author Contributions:Study concept and design: Fitchett, Cadge, and Curlin. Acquisition of data: Curlin. Analysis and interpretation of data: Fitchett, Rasinski, and Cadge. Drafting of the manuscript: Fitchett, Rasinski, and Cadge. Critical revision of the manuscript for important intellectual content: Cadge and Curlin. Statistical analysis: Rasinski. Obtained funding: Curlin.
Financial Disclosure: None reported.