Clinical Training Recommendations for Chaplains Caring for Patients with Serious Illness

These training recommendations will help board-certified chaplains address the unique needs of patients living with serious illness.

Assess the Needs and Concerns of Patients

• Know what palliative care is, and when to request a consult
• Assess for emotional, existential, and spiritual distress
• Take the patient’s spiritual history, including whether the patient is part of a faith community
• Assess caregiving needs and resources

Strengthen the Clinician-Patient Relationship and Understand Goals of Care

• Identify the patient’s surrogate decision-maker
• Have conversations with patients to understand what matters most to them now that they have a diagnosis of a serious illness, and participate in shared decision-making that is aligned with patients’ values and preferences
• Conduct skilled conversations with patients and families about:
  • Serious news
  • Patient/family understanding of the meaning of their illness
  • Family conflict
  • Fear and grief
  • Meaning-making
  • Death and dying
• Identify how culture, race, gender, sexual orientation, and context (e.g., social determinants of health) influence patient and family decision-making in the context of a serious illness, and deliver responsive, unbiased care matched to needs and priorities
• Support patients who are eligible for hospice in the process of deciding whether to enroll

Manage Pain and Symptoms

• Assess the spiritual/existential underpinnings of suffering caused by common symptoms associated with serious illness, and alert the care team to symptom burden
• Identify patients that would benefit from a specialty palliative care consult for complex or intractable symptoms, and refer or discuss with the care team

Prevent Crises and Plan Ahead

• Connect patients to spiritual supports, including outreach to faith communities
• Recognize the need for social work or behavioral health services, and make appropriate linkages to these services
• Identify functioning or mental health needs and make appropriate referrals

Complete the Learning Pathway, Foundational Skills for All Chaplains, to acquire these skills.

Examples include chaplains working in geriatrics, home-based care, or nursing home settings

Assess the Needs and Concerns of Patients

• Recognize common sources of suffering for patients with serious illness, and perform a comprehensive assessment using culturally appropriate tools, including:
  • Social risk factors, including presence of caregiver; caregiver burden/needs; racism and other culturally-bound factors that influence care; financial strain; access to housing, food, and transportation
  • Emotional and spiritual distress, and how these might manifest as physical symptoms (e.g., pain, shortness of breath, constipation)
  • Communication barriers (e.g., vision, hearing, language, and health literacy)
  • Protective factors that can support resilience during serious illness

Strengthen the Clinician-Patient Relationship and Understand Goals of Care

• Provide support regarding coping with serious illness and self-care
• Conduct advance care planning conversations and complete advance directives
• Provide bereavement support for families and caregivers
• Support the care team to deliver spiritually-sensitive care; effectively communicate with members of the care team

Manage Pain and Symptoms

• Contextualize treatment and/or interventions to incorporate the values and priorities of each patient to provide person-centered, family-focused, and culturally congruent care
• Assess the feasibility of the care plan with the patient (e.g., whether prescribed medications are accessible and affordable)

Prevent Crises and Plan Ahead

• Identify community resources that can support patients living with serious illness, and their caregivers, either directly or by connecting your patients to a social worker (e.g., housing, food, transportation, faith communities, state and local agencies)

Thank you to the following clinicians for their review of these recommendations: Denise Hess, MDiv, BCC-PCHAC, LMFT