Patients’ spiritual concerns and needs during goals of care conversations: healthcare chaplains’ perspectives

Abstract Healthcare chaplains are critical members of interdisciplinary healthcare teams and routinely facilitate advance care planning (ACP) and goals of care conversations with patients with serious illnesses. These conversations involve discussion of one’s deeply held personal values and beliefs as well as uncertainty, fears, and hopes for current and future health care needs. However, there is limited empirical data on how patients’ spiritual concerns and needs are addressed during these conversations. An online survey of 563 board-certified chaplains was conducted from March to July 2020 to identify chaplains’ roles in facilitating goals of care conversations and included three open-ended questions about patients’ hopes and fears and how chaplains addressed them. Quantitative data and written qualitative responses from 244 chaplains were analyzed using descriptive analysis and content analysis, respectively. Majority of participants were white (83.6%), female (59%), Protestant (63.1%), employed full-time (82%), and worked in community hospital settings (45.5%) or academic medical centers (32.8%). Six major themes emerged from chaplains’ qualitative responses: (1) the utility of ACP; (2) focus on the present moment; (3) achieving a personally defined "good death"; (4) spiritual and religious matters and beliefs; (5) caring for and connection with family; and (6) how to address hopes and fears during ACP. ACP and goals of care conversations reflect profound human desires and needs; they require deeper listening and engagement by interdisciplinary team members to provide adequate spiritual and psychosocial support in addition to providing medical information to fulfill the intended meaning and purpose of ACP.