Project Summary
Most advanced cancer patients report that religiousness and/or spirituality (R/S) are important to them, yet
most also say that the medical system has not met their R/S needs. Support of dying patients' R/S needs may
prove especially beneficial to those who are religious, including African American (hereafter, “black”) patients
who often rely heavily on religion to cope with cancer. Healthcare chaplains work within medical systems to
provide R/S care. Among advanced cancer patients, visits with healthcare chaplains are associated with
patients' peaceful acceptance of terminal illness, which is associated with higher rates of advance care
planning (ACP), which in turn has proved an effective way to enhance a dying patient's quality of life and
receipt of value-concordant end-of-life (EoL) care. Additionally, preliminary data suggest that healthcare
chaplain visits are associated with higher rates of completing do-not-resuscitate (DNR) orders among black
advanced cancer patients. At present, healthcare chaplains work predominantly in inpatient settings. Thus,
advanced cancer patients in outpatient settings have not benefited from the many positive effects of healthcare
chaplaincy, including having unmet spiritual needs addressed and the benefits of incorporating spiritual care
into EoL decision-making and the cancer care experience. To date, there has not been a randomized
controlled trial (RCT) of effects of early integration of healthcare chaplain-led spiritual care on EoL cancer care.
We propose here to determine the feasibility of conducting such a trial and to explore potential effects of
healthcare chaplain-led spiritual care on spiritual well-being and readiness to engage in ACP among black
advanced cancer patients in outpatient settings. Specifically, we propose: Aim #1: Will determine the
feasibility of conducting an RCT of effects of early integration of healthcare chaplain-led spiritual care into
outpatient oncology care on EoL care. Aim #2: Will explore potential effects of healthcare chaplain-led
spiritual care on spiritual well-being and ACP among black advanced cancer patients in outpatient settings.
Aim #3: Will explore potential mechanisms by which healthcare chaplain-led spiritual care in outpatient
settings affect black advanced cancer patients' EoL care outcomes. Impact: Results will provide evidence of
the feasibility of conducting an RCT of the effects of early outpatient (in advance of a terminal inpatient)
healthcare chaplain-led spiritual care on spiritual well-being and ACP among black advanced cancer patients.
Integration of healthcare chaplain-led spiritual care into outpatient oncology services for advanced cancer
patients may be an impactful, scalable way to improve the EoL cancer care experience among black patients
with advanced cancer.
