Buehler Center on Aging, Health & Society, Northwestern University Feinberg School of Medicine, 750 N, Lake Shore Drive, Suite 601, Chicago, IL, 60611, USA.
BMC Palliat Care. 2012 Jul 2;11:10. doi: 10.1186/1472-684X-11-10.
Medicine has long acknowledged the role of chaplains in healthcare, but there is little research on the relationship between chaplaincy care and health outcomes. The present study examines the association between chaplaincy services and end-of-life care service choices.
HealthCare Chaplaincy purchased the AHA survey database from the American Hospital Association. The Dartmouth Atlas of Health Care database was provided to HealthCare Chaplaincy by The Dartmouth Institute for Health Policy & Clinical Practice, with the permission of Dartmouth Atlas Co-Principal Investigator Elliot S. Fisher, M.D., M.P.H. The Dartmouth Atlas of Health Care is available interactively on-line at http://www.dartmouthatlas.org/. Patient data are aggregated at the hospital level in the Dartmouth Atlas of Health Care. IRB approval was not sought for the project because the data are available to the public through one means or another, and neither database contains data about individual patients, i.e. all the variables are measures of hospital characteristics. We combined and analyzed data from the American Hospital Association's Annual Survey and outcome data from The Dartmouth Atlas of Health Care in a cross-sectional study of 3,585 hospitals. Two outcomes were examined: the percent of patients who (1) died in the hospital, and (2) were enrolled in hospice. Ordinary least squares regression was used to measure the association between the provision of chaplaincy services and each of the outcomes, controlling for six factors associated with hospital death rates.
The analyses found significantly lower rates of hospital deaths (β = .04, p < .05) and higher rates of hospice enrollment (β = .06, p < .001) for patients cared for in hospitals that provided chaplaincy services compared to hospitals that did not.
The findings suggest that chaplaincy services may play a role in increasing hospice enrollment. This may be attributable to chaplains' assistance to patients and families in making decisions about care at the end-of-life, perhaps by aligning their values and wishes with actual treatment plans. Additional research is warranted.
医学长期以来一直承认牧师在医疗保健中的作用，但对牧师关怀与健康结果之间的关系研究甚少。本研究考察了牧师服务与临终关怀服务选择之间的关联。
HealthCare Chaplaincy 从美国医院协会购买了 AHA 调查数据库。达特茅斯卫生保健图集数据库由达特茅斯卫生政策与临床实践研究所提供给 Healthcare Chaplaincy，得到了达特茅斯图集联合首席研究员 Elliot S. Fisher，医学博士，公共卫生硕士的许可。达特茅斯卫生保健图集可在 http://www.dartmouthatlas.org/ 上在线互动使用。患者数据在达特茅斯卫生保健图集汇总到医院级别。由于该项目的数据可以通过一种或另一种方式提供给公众，而且两个数据库都不包含关于个体患者的数据，即所有变量都是医院特征的衡量标准，因此没有寻求机构审查委员会的批准。我们将美国医院协会年度调查数据与达特茅斯卫生保健图集的结果数据结合起来，对 3585 家医院进行了横断面研究。检查了两个结果：（1）患者在医院死亡的比例，和（2）患者入组临终关怀的比例。使用普通最小二乘法回归来衡量在提供牧师服务的医院与不提供牧师服务的医院之间，提供牧师服务与每个结果之间的关联，控制与医院死亡率相关的六个因素。
分析发现，与未提供牧师服务的医院相比，接受牧师服务的医院患者的医院死亡率显著降低（β=0.04，p<0.05），而临终关怀入院率显著升高（β=0.06，p<0.001）。
这些发现表明，牧师服务可能在增加临终关怀的入组率方面发挥作用。这可能归因于牧师在患者和家属做出临终关怀决策时提供的帮助，通过使他们的价值观和愿望与实际治疗计划保持一致。需要进一步研究。
