Rev. George F. Handzo on not doing the right things right

What About Spiritual Care?
A Response to Nick Jacobs

Editor’s Note: Because of the importance of the findings of Tracy Balboni's study to the profession of chaplaincy, we have chosen to post Rev. Handzo's response here and not in TalkBack. It is our hope that others will respond to Rev. Handzo's questions and concerns.

First, Mr. Jacobs is to be commended for advocating for spiritual care and making the effort to do so publicly [Vol. 4, No. 3]. It is certainly too easy to sit back and let opportunities like this be lost. His general point is well taken. In the journal editorial accompanying Tracy Balboni’s study, Betty Ferrell, a noted nurse-researcher from City of Hope points out that if anyone reported unmet need of 72% for any other dimension of patient care, “cancer care settings concerned with quality would respond.” She ends with, “The first step toward advocacy is personal action. Refer (your patients) to chaplaincy and serve as a model for other oncology professionals by including them in your plan of care…..What percentage of patients do you and your colleagues refer to chaplaincy?”

Our collective temptation might be to yell for all to hear that the answer to this problem is more professional pastoral care. Give us more certified chaplains and all this will go away! Certainly availability is part of the answer. However, the answer is clearly not so straight forward. The researchers reported:

A total of 133 patients (52%) had received visits from chaplains or other clergy. Most whites (83%), African Americans (94%), and Hispanics (100%) stated that the pastoral visit provided some comfort to a lot of comfort. Four patients (3%) reported that the visit made them uncomfortable.

In sum, about half of the patients were visited by a chaplain or clergy and the vast majority felt positively about the visit. It seems reasonable to assume that most of the rest had access to chaplains if they wanted to see them. So, as we know, patients like chaplains and even report satisfaction with our interventions. Yet, some significant number of patients who were visited and took comfort did not have all of their spiritual needs met.

The possibility this study raises for chaplains is, to quote the old QA maxim, that we are doing things right but not doing the right things right. It seems that this is not simply a quantity problem but also one of quality. Could it be that even though people like us, our service is often missing the mark? Could it be that we are incorrect about what patients need from us, or we don’t have the skills to deliver it – maybe as much as half of the time? If someone accused us of this meager level of success, could we prove otherwise?

The question the study does not ask is specifically what the unmet needs were. How can we put screening and assessment systems in place so that we can identify these spiritual needs that we may now be missing? What kind of quality assurance projects and other research do we need to discover what our patients’ spiritual needs truly are?

We need to do some serious looking at these and related questions and be prepared to adjust our practice accordingly.

To read the article to which Mr. Jacobs was referring, please go to:
http://www.usatoday.com/news/health/2007-02-14-spiritual_x.htm?csp=34&POE=click-refer

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.