School of Nursing, The University of Texas at Austin, Austin, TX, USA.
John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
Palliat Support Care. 2024 Feb;22(1):49-56. doi: 10.1017/S1478951522001560.
Advance care planning (ACP) conversations require the consideration of deeply held personal values and beliefs and the discussion of uncertainty, fears, and hopes related to current and future personal healthcare. However, empirical data are limited on how such spiritual concerns and needs are supported during ACP. This study explored board-certified healthcare chaplains' perspectives of patients' spiritual needs and support in ACP conversations.
An online survey of 563 board-certified chaplains was conducted from March to July 2020. The survey included 3 open-ended questions about patients' hopes and fears and about how the chaplains addressed them during ACP conversations. Written qualitative responses provided by 244 of the chaplains were examined with content analysis.
The majority of the 244 chaplains were White (83.6%), female (59%), Protestant (63.1%), and designated to one or more special care units (89.8%). Major themes on patients' hopes and fears expressed during ACP were (1) spiritual, religious, and existential questions; (2) suffering, peace, and comfort; (3) focus on the present; (4) hopes and fears for family; and (5) doubt and distrust. Major themes on how chaplains addressed them were (1) active listening to explore and normalize fears, worries, and doubts; (2) conversations to integrate faith, values, and preferences into ACP; and (3) education, empowerment, and advocacy.
ACP conversations require deep listening and engagement to address patients' spiritual needs and concerns - an essential dimension of engaging in whole-person care - and should be delivered with an interdisciplinary approach to fulfill the intended purpose of ACP.
预先医疗照护计划（ACP）对话需要考虑到个人的深层价值观和信念，并讨论与当前和未来个人医疗保健相关的不确定性、恐惧和希望。然而，关于如何在 ACP 中支持此类精神关怀和需求，实证数据有限。本研究探讨了经过董事会认证的医疗保健牧师对患者在 ACP 对话中精神需求和支持的看法。
2020 年 3 月至 7 月，对 563 名经过董事会认证的牧师进行了在线调查。该调查包括 3 个关于患者的希望和恐惧的开放性问题，以及牧师在 ACP 对话中如何解决这些问题。对 244 名牧师提供的书面定性答复进行了内容分析。
244 名牧师中的大多数是白人（83.6%）、女性（59%）、新教徒（63.1%），并被指定到一个或多个特殊护理病房（89.8%）。在 ACP 中表达的关于患者的希望和恐惧的主要主题包括：（1）精神、宗教和存在主义问题；（2）痛苦、和平与舒适；（3）关注当下；（4）对家庭的希望和恐惧；（5）怀疑和不信任。牧师如何解决这些问题的主要主题是：（1）积极倾听，以探索和规范恐惧、担忧和疑虑；（2）对话，将信仰、价值观和偏好融入 ACP；（3）教育、赋权和倡导。
ACP 对话需要深入倾听和参与，以满足患者的精神需求和关切——这是进行整体人护理的重要方面——并应通过跨学科方法提供，以实现 ACP 的预期目的。
