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Outcomes
1. Describe the expertise of chaplains on the palliative and ICU teams in caring for patients, families, and staff
2. Describe the effects of the Spiritual Care Assessment and Intervention on the psychosocial distress of family members of ICU patients
3. Evaluate the implications of the study for future research and clinical practice
Importance
Although ICU surrogates experience high distress due to the patient's life-threatening illness, most prior decision making interventions have been unsuccessful in improving surrogate well-being. Additionally, ICU admissions raise concerns about meaning, faith, and spiritual well-being for families that are rarely addressed.
Objective(s)
To determine whether an intervention focused directly on the surrogate's spiritual and emotional well-being would improve the surrogate's outcomes.
Method(s)
We conducted a single-blinded randomized controlled trial of a spiritual care intervention for ICU surrogates in 5 medical, cardiac, and neurological ICUs of one academic medical center. The Spiritual Care Assessment and Intervention involved 4+ proactive visits by a chaplain by phone or in person, assessment of 4 dimensions of spirituality (meaning/purpose, transcendence/peace, relationships, and self-worth), and individually tailored spiritual care interventions. The intervention was delivered by racially and religiously diverse chaplains trained to address diverse patients, including nonreligious patients. The prespecified primary outcome was anxiety (Generalized Anxiety Disorders-7) assessed 6-8 weeks after discharge. Depression (PHQ-9), posttraumatic stress (IES-R), spiritual well-being (FACIT-sp), satisfaction (Patient Satisfaction Instrument—Chaplaincy), and positive religious coping (RCOPE) were secondary outcomes.
Results
We enrolled 192 patient/surrogate dyads, completed follow-up for 128 (66.7%). Patient mean age was 54.8 years (SD 18.2); patients were 45.7% female and 20.7% African American. Surrogates were most commonly the spouse (35.1%). Anxiety was significantly lower in the intervention group at follow-up (GAD-7 intervention group median score of 1 (range 0-5); control 4 (1-9), p < .0001), as were depression (p = 0.0042) and posttraumatic stress symptoms (p = 0.0257). Satisfaction with spiritual care improved (p = .0005) but not spiritual well-being (p = 0.1226) or positive religious coping (p = 0.0857).
Conclusion(s)
The study demonstrates the importance of spiritual care in the well-being of ICU surrogates.
Impact
Results can inform palliative care teams about the value of spiritual care for ICU families and serve as evidence for greater inclusion of chaplains in palliative and intensive care.
Article info
Identification
Copyright
© 2022 Published by Elsevier Inc.
