Bridge to Better End-of-Life Care for Patients with Cancer: Connecting Healthcare Chaplains with Spiritual Care Providers in Faith Communities

Patients with advanced cancer who receive cancer care in outpatient settings have unmet spiritual needs, receive care isolated from their faith communities, and, as a result, are more likely to receive overly aggressive, burdensome, futile, and less hospice, end-of-life (EoL) care. Outpatient oncology clinics inadequately address patients’ spiritual needs and lack input from and integration with patients’ faith communities. These systemic, faith-related micro-social deprivations undermine patients’ decision-making and quality of EoL care. We have found that 88% of advanced cancer patients report that religiousness and/or spirituality (R/S) is important to them, yet most (72%) say their R/S needs were not met by the medical system. Support of dying patients’ R/S needs may especially benefit patients who rely heavily on religion to cope with their cancers. Patients whose R/S care needs were met by the medical system (e.g., who met with a healthcare chaplain) were more likely to receive hospice care, less likely to receive an aggressive intervention, and less likely to die in an intensive care unit (ICU). In stark contrast, patients whose R/S needs were met by their faith communities were less likely to receive hospice care, more likely to receive aggressive interventions, and more likely to die in an ICU. Thus, disconnected medical system- and faith community-provided R/S care appears to pull patients in dramatically opposite directions with respect to EoL care. We here propose to address patients’ unmet spiritual needs and the disconnect from their faith communities with the following specific aims: Aim 1: Determine effects of health-care chaplaincy alone and with faith community linkages on EoL outcomes among patients with advanced cancer. Strategy: Conduct a 3-arm (1:1:1 ratio) randomized controlled trial to evaluate intervention effects on EoL outcomes. Outpatients with advanced cancer (N=288) will be randomly assigned to receive spiritual care from a healthcare chaplain alone (Arm #1), a healthcare chaplain in coordination with a faith community spiritual care provider (Arm #2), or distant intercessory prayer (Control Arm). Outcomes will be patients’ spiritual wellness at 2 months post-intervention, and ICU and hospice use within one year of baseline. Aim 2: Identify mechanisms by which healthcare chaplain interventions affect patient EoL outcomes. Hypothesis: More spiritual wellness, medical trust, and readiness to engage in ACP will mediate intervention effects on hospice enrollment and ICU admissions. Aim 3: Explore barriers to implementation. Strategy: Qualitative interviews with trial participants and relevant stakeholders will explore barriers to intervention implementation. Impact: This study will provide evidence of how integration of health-care chaplaincy into outpatient oncology clinics and its linkage with faith community spiritual care providers promotes spiritual wellness and results in higher quality EoL decision-making and care for patients with advanced cancer.