Project Summary
Black patients with advanced cancer who receive cancer care in outpatient settings have unmet spiritual
needs, receive care isolated from their faith communities, and are more likely to receive overly aggressive,
burdensome, futile, and less hospice, end-of-life (EoL) care than their white counterparts. Outpatient oncology
clinics inadequately address Black patients' spiritual needs and lack input from and integration with patients'
faith communities. These systemic, faith-related micro-social deprivations undermine Black patients' decision-
making and quality of EoL care. We have found that 88% of advanced cancer patients report that religiousness
and/or spirituality (R/S) is important to them, yet most (72%) say their R/S needs were not met by the medical
system. Support of dying patients' R/S needs may especially benefit Black patients who often rely heavily on
religion to cope with cancer. Black patients whose R/S care needs were met by the medical system (e.g., who
met with a healthcare chaplain) were much more likely to receive hospice care (OR=6.62) and much less likely
to receive an aggressive intervention (OR=0.16); strikingly, only 1.2% (vs. 11.2% whose R/S needs were not
met) died in an intensive care unit (ICU). Black patients whose R/S needs were met by their faith communities
were much less likely to receive hospice care (OR=0.17) and much more likely to receive aggressive
interventions (OR=8.03) and to die in an ICU (OR=11.2). Thus, disconnected medical system- and faith
community-provided R/S care appears to pull Black patients in dramatically opposite directions with respect to
EoL care. We here propose to address Black patients' unmet spiritual needs and the disconnect from their faith
communities with the following specific aims: Aim 1: Determine effects of health-care chaplaincy alone and
with faith community linkages on EoL outcomes of Black patients with advanced cancer. Strategy:
Conduct a 3-arm (1:1:1 ratio) randomized controlled trial to evaluate intervention effects on EoL outcomes.
Black outpatients with advanced cancer (N=288) will be randomly assigned to receive spiritual care from a
healthcare chaplain alone (Arm #1), a healthcare chaplain in coordination with a faith community spiritual
care provider (Arm #2), or distant intercessory prayer (Control Arm). Outcomes will be patients' spiritual
wellness at 2 months post-intervention, and ICU and hospice use within one year of baseline. Aim 2: Identify
mechanisms by which healthcare chaplain interventions affect patient EoL outcomes. Hypothesis:
More spiritual wellness, medical trust, and readiness to engage in ACP will mediate intervention effects on
hospice enrollment and ICU admissions. Aim 3: Explore barriers to implementation. Strategy: Qualitative
interviews with trial participants and relevant stakeholders will explore barriers to intervention implementation.
Impact: This study will provide evidence of how integration of health-care chaplaincy into outpatient oncology
clinics and its linkage with faith community spiritual care providers promotes spiritual wellness and results in
higher quality EoL decision-making and care for Black patients with advanced cancer.
