What do I do? Developing a taxonomy of chaplaincy activities and interventions for spiritual care in intensive care unit palliative care

Massey et al. BMC Palliative Care (2015) 14:10 DOI 10.1186/s12904-015-0008-0 RESEARCH ARTICLE Open Access What do I do? Developing a taxonomy of chaplaincy activities and interventions for spiritual care in intensive care unit palliative care Kevin Massey*, Marilyn JD Barnes, Dana Villines, Julie D Goldstein, Anna Lee Hisey Pierson, Cheryl Scherer, Betty Vander Laan and Wm Thomas Summerfelt Abstract Background: Chaplains are increasingly seen as key members of interdisciplinary palliative care teams, yet the specific interventions and hoped for outcomes of their work are poorly understood. This project served to develop a standard terminology inventory for the chaplaincy field, to be called the chaplaincy taxonomy. Methods: The research team used a mixed methods approach to generate, evaluate and validate items for the taxonomy. We conducted a literature review, retrospective chart review, focus groups, self-observation, experience sampling, concept mapping, and reliability testing. Chaplaincy activities focused primarily on palliative care in an intensive care unit setting in order to capture a broad cross section of chaplaincy activities. Results: Literature and chart review resulted in 438 taxonomy items for testing. Chaplain focus groups generated an additional 100 items and removed 421 items as duplications. Self-Observation, Experience Sampling and Concept Mapping provided validity that the taxonomy items were actual activities that chaplains perform in their spiritual care. Inter-rater reliability for chaplains to identify taxonomy items from vignettes was 0.903. Conclusions: The 100 item chaplaincy taxonomy provides a strong foundation for a normative inventory of chaplaincy activities and outcomes. A deliberative process is proposed to further expand and refine the taxonomy to create a standard terminological inventory for the field of chaplaincy. A standard terminology could improve the ways inter-disciplinary palliative care teams communicate about chaplaincy activities and outcomes. Keywords: Taxonomy, Spiritual care, Chaplaincy, Palliative care, Standard terminology Background Chaplains are increasingly seen as key members of interdisciplinary palliative care teams, yet what chaplains specifically do in terms of assessments, hoped for outcomes, and interventions remains poorly understood [1]. Chaplains lack a consistent way to describe their activities. Attempts have been made to develop inventories of chaplain activities and propose standard terminologies, yet none of these attempts were empirically based and none of these attempts has emerged as normative [2-6]. Chaplains perform a variety of interventions with therapeutic intent yet lack a unified and consistent * Correspondence: Advocate Health Care, 3075 Highland Parkway, Downers Grove, IL 60515, USA naming set for these interventions which would better portray to the inter-disciplinary medical team what goals and results they strive to achieve. Our study undertook to meet this identified [7] gap in the field of chaplaincy by building an inventory of chaplain activities through a series of mixed methods in which chaplains provided and refined their own terms and verbal preferences for their practice. This was executed in both patient care contexts and through qualitative steps involving groups of chaplains. Methods A qualitative and quantitative approach was used to execute three phases of the study: item generation, validity, and reliability. The Advocate Health Care Institutional Review Board of our organization approved this study. © 2015 Massey et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Massey et al. BMC Palliative Care (2015) 14:10 Item generation Literature and retrospective chart review Four published inventories [2-5] of chaplain activities were reviewed by team members. The review criteria for inclusion included being published and employing research methodology. These inventories were judged by the team members to be the best previous efforts preceding this project. The team incorporated these inventories into a collective initial inventory. As the initial items were emerging from the literature review and the retrospective chart review, the chaplain researchers perceived three categories of “granularity". Some items were very specific concrete actions. Some items were more like goals or outcomes. Some items seemed like something in between concrete items and goals. As the study progressed and as is seen in the results, we began grouping the items into these three categories, which we named “interventions” for concrete items, “intended effects” for goals and outcomes, and “methods". These categories were later validated by the concept mapping phase described below. In the retrospective chart review phase, chaplain care data was taken from patient records (n = 1126 patient encounters) that had at least one interaction with a hospital chaplain and were also seen in the Intensive Care Unit (ICU). Patients who had the following Diagnosis Related Groups (DRG) were included: Intracranial Hemorrhage/Cerebral Infarction (DRG 65), Intracranial Hemorrhage Malignancy of Hepatobiliary System or Pancreas with Morbidity (DRG 435), Respiratory System Diagnosis with Ventilator Support (DRG 207–208), Septicemia or Severe Sepsis with or without Mechanical Ventilation 96+ Hours (DRG 870–711), and Simple Pneumonia and Pleurisy with Complication or Comorbidity (DRG 193). These DRGs were used in this step at the suggestion of the palliative care physician on our team to encompass patients mirroring the palliative care and ICU context that would follow in later steps. External validity Focus group/key informant interviews Board Certified Chaplains (BCCs) and Board Certified Eligible Chaplains (BCC-Es), who contributed to the care of patients, (n = 27) participated in one of five focus groups conducted at five hospitals within our system. The chaplains were asked to complete four tasks based on their experiences within patient care to determine: which items could be categorized together, which items did not apply to their activities, which items were redundant and which new items should be included. Additionally, eight key informant interviews [8] approximating the focus group experience were conducted with chaplains in administrative positions. Page 2 of 8 Construct validity Self-observation and experience sampling methodology [9-11] was used to determine that we were creating a taxonomy that accurately reflected chaplain activities. Three chaplains at di (...truncated)