Chaplain Family Project Multicenter RCT

ABSTRACT ICU admission is a major life crisis that can result in severe distress for the patient's family, both during and after the hospitalization. This includes psychological distress such as anxiety and posttraumatic stress and also spiritual distress, including crises of meaning, purpose, or religious faith. Facing life and death decisions as the surrogate decision maker or experiencing the patient's death further increases distress. Prior interventions to support ICU surrogate decision makers have affected end of life care such as ICU length of stay for patients who die during hospitalization, but few have impacted surrogate well-being. We propose that for an ICU intervention to improve surrogate well-being, it must provide intensive spiritual and psychological support. Healthcare chaplains are highly trained professionals who provide spiritual and emotional support to patients and family members of all faiths and those with no faith affiliation in the healthcare setting. Chaplains are trained to listen deeply to an individual's religious and cultural experiences, providing opportunities to improve the care of marginalized groups who have faced discrimination in healthcare. Connecting religious or spiritual concerns and medical decisions also is a chaplain's skill. Although chaplains are part of the healthcare team in many US ICU's, research about the outcomes associated with chaplains' spiritual care is just emerging, and nearly all available randomized trials examined the effects of chaplains on patient outcomes. To address the need for interventions that reduce surrogate distress, our team has developed the Spiritual Care Assessment and Intervention (SCAI) Framework, an intervention for ICU surrogates that is rigorous, reproducible and consistent with spiritual care standards of practice. Our prior, single site randomized trial of the SCAI framework in the ICU demonstrated improved spiritual and psychological well-being for ICU surrogates in the intervention group, but the study population lacked religious and ethnic diversity. We now propose an NIH Stage 3 multi-center, randomized, attention controlled clinical trial of the SCAI Framework for surrogates to evaluate efficacy in a sample with geographic, religious, racial and ethnic diversity. The study will take place in 6 geographically diverse sites that are also diverse in terms of religion, race and ethnicity. The intervention will be delivered by skilled and highly trained chaplains. Specific aims are: to demonstrate the effects of chaplain- delivered spiritual care on psychological and spiritual outcomes including anxiety, distress, spiritual well-being, posttraumatic stress symptoms and complicated grief; to demonstrate the impact of chaplain-delivered spiritual care on medical decision making; and to examine the effects of spiritual care among historically underserved racial and religious subgroups. Results will guide hospital leaders, policy makers and the healthcare team regarding chaplains' role in improving surrogates' psychological and spiritual health and the quality of decisions for critically ill patients.