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The Association of Spiritual Care Providers Activities With Family Members Satisfaction With Care After a Death in the ICU*

Johnson, Jeffrey R. MD, MA; Engelberg, Ruth A. PhD; Nielsen, Elizabeth L. MPH; Kross, Erin K. MD; Smith, Nicholas L. PhD; Hanada, Julie C. MA; Doll O’Mahoney, Sean K. MDiv, BCC; Curtis, J. Randall MD, MPH

doi: 10.1097/CCM.0000000000000412
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Objectives: Spiritual distress is common in the ICU, and spiritual care providers are often called upon to provide care for patients and their families. Our goal was to evaluate the activities spiritual care providers’ conduct to support patients and families and whether those activities are associated with family satisfaction with ICU care.

Design: Prospective cohort study.

Setting: Three hundred fifty-bed tertiary care teaching hospital with 65 ICU beds.

Subjects: Spiritual care providers and family members of patients who died in the ICU or within 30 hours of transfer from the ICU.

Interventions: None.

Measurements and Main Results: Spiritual care providers completed surveys reporting their activities. Family members completed validated measures of satisfaction with care and satisfaction with spiritual care. Clustered regression was used to assess the association between activities completed by spiritual care providers and family ratings of care. Of 494 eligible patients, 275 family members completed surveys (response rate, 56%). Fifty-seven spiritual care providers received surveys relating to 268 patients, completing 285 surveys for 244 patients (response rate, 91%). Spiritual care providers commonly reported activities related to supporting religious and spiritual needs (≥ 90%) and providing support for family feelings (90%). Discussions about the patient’s wishes for end-of-life care and a greater number of spiritual care activities performed were both associated with increased overall family satisfaction with ICU care (p < 0.05). Discussions about a patient’s end-of-life wishes, preparation for a family conference, and total number of activities performed were associated with improved family satisfaction with decision-making in the ICU (p < 0.05).

Conclusions: Spiritual care providers engage in a variety of activities with families of ICU patients; several are associated with increased family satisfaction with ICU care in general and decision-making in the ICU specifically. These findings provide insight into spiritual care provider activities and provide guidance for interventions to improve spiritual care delivered to families of critically ill patients.

1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.

2Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA.

3Seattle Epidemiologic Research and Information Center, Office of Research and Development, Seattle, WA.

4Group Health Research Institute, Group Health, Seattle, WA.

5Department of Spiritual Care, Harborview Medical Center, University of Washington, Seattle, WA.

* See also p. 2131.

Registered at ClinicalTrials.gov: NCT00685893.

Supported, in part, by National Institute of Nursing Research (R01 NR005226) and the Robert Wood Johnson Foundation.

Dr. Johnson received support for article research from the National Institutes of Health (NIH). His institution received grant support from the NIH. Dr. Engelberg received support for article research from the NIH. Her institution received grant support from the NIH and Patient Centered Outcomes Research Institute (PCORI). Ms. Nielsen received support for article research from the NIH. Her institution received grant support from the NIH. Dr. Kross received support for article research from the NIH. Her institution received grant support from the NIH-K23 award. Dr. Smith received support for article research from the NIH. Ms. Hanada received support for article research from the NIH. Her institution received grant support from the NIH. Mr. O’Mahoney received support for article research from the NIH, is employed by Harborview Medical Center, received support for development of educational presentations from University of Washington (stipend for contribution to a presentation on what chaplains need to know about mental illness in 2010), and received support for travel from the Association for Clinical Pastoral Education (ACPE Associate Supervisor). His institution received grant support from the NIH. Dr. Curtis received support for article research from the NIH. His institution received grant support from the NIH, Robert Wood Johnson Foundation, and PCORI.

For information regarding this article, E-mail: jrc@u.washington.edu

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