What impact do chaplains have? A pilot study of Spiritual AIM for advanced cancer patients in outpatient palliative care.
Spiritual AIM (Spiritual Assessment & Intervention Model) is a “brief, chaplain-delivered spiritual care intervention” [MS p. 8] that “was developed through 25 years of clinical practice and supervision” [MS p. 4]. Here, a research team that included three chaplains, four physicians and a Social Worker, sought to evaluate its “feasibility and tolerability” and its “impact on…spiritual well-being, religious and cancers-specific coping, and physical and psychological symptoms” [MS p. 3]. The study not only speaks to the potential value of Spiritual AIM and the important process of empirical testing of a spiritual care model but, along the way, also provides insights into a conceptualization of fatalism found in the health care literature. The model is described succinctly: Spiritual AIM posits that every human being, by virtue of being human, has three fundamental or “core” spiritual needs: for meaning and direction (referred to in Spiritual AIM “shorthand” as “Meaning and Direction”); for self-worth and belonging to community (“Self-Worth”); and to love and be loved, often facilitated through seeking reconciliation when relationships are broken (“Reconciliation”). Spiritual AIM asserts that in a crisis — such as facing one’s mortality — one of three core spiritual needs emerges most strongly, influencing the patient’s subjective thoughts and feelings as well as affecting their observable words and behaviors. In Spiritual AIM, the chaplain’s pastoral encounter requires diagnosing an individual’s primary unmet spiritual need, devising and implementing a plan for addressing this need, and evaluating desired and actual outcomes of the intervention. [MS p. 4] A full explanation has been published elsewhere [–see Related Items of Interest, §I, below]. The three chaplain co-authors conducted the intervention with 31 advanced cancer patients being treated at an outpatient palliative care service of an urban, academic, comprehensive cancer center. Three 45-60 minute sessions were audiotaped and transcribed: one followed the patient’s completion of baseline measures, and two subsequently were conducted either in person or by phone, two to three weeks apart. “All chaplains met weekly with researchers to promote consistency in assessment and interventions” [MS p. 5]. Participants completed eight self-report measures, including the FACIT-Sp-12, Brief RCOPE, and the Mini-Mental Adjustment to Cancer scale (Mini-MAC) with five subscales: Fatalism, Fighting Spirit, Anxious Preoccupation, Helplessness/Hopelessness, and Cognitive Avoidance –also calculated as two higher-order coping constructs, i.e., Adaptive Coping (Fighting Spirit, Cognitive Avoidance, Fatalism) and Maladaptive Coping (Helplessness/Hopelessness, Anxious Preoccupation) [–see MS p. 6].