Feasibility and acceptability of a telephone-based chaplaincy intervention in a large, outpatient oncology center

Supportive Care in Cancer https://doi.org/10.1007/s00520-020-05598-4 ORIGINAL ARTICLE Feasibility and acceptability of a telephone-based chaplaincy intervention in a large, outpatient oncology center Petra Sprik 1 & Angela Janssen Keenan 2 & Danielle Boselli 3 Daniel Grossoehme 5 & Sherri Cheeseboro 2 & Patrick Meadors 4 & Received: 31 March 2020 / Accepted: 23 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Purpose Telechaplaincy (the use of telecommunications and virtual technology to deliver spiritual and religious care by healthcare chaplains or other religious/spiritual leaders) is a relatively novel intervention that has increasingly been used in recent years, and especially during COVID-19. Telephone-based chaplaincy is one mode of telechaplaincy. The purpose of this study was to (1) describe telephone-based chaplaincy interventions delivered as the first point of contact to patients who screen positive for religious/spiritual concern(s) using an electronic data system, and (2) assess the feasibility and acceptability of delivering interventions in an outpatient cancer institute using this methodology. Methods Patients were screened for religious and spiritual (R/S) concern(s) using an electronic data system. Patients indicating R/S concern(s) were offered a telephone-based chaplaincy intervention and asked to complete a survey assessing acceptability of the intervention. Feasibility and acceptability data were collected. Results Thirty percent of screened patients indicated R/S concern(s). Telephone-based chaplaincy interventions were offered to 100% of eligible patients, establishing contact with 61% of eligible patients, and offering chaplaincy interventions to 48% of those patients. Survey participants report high acceptability of the offered intervention. Conclusion This is the first study examining feasibility and acceptability of telephone-based chaplaincy with oncology patients. Telephone-based chaplaincy is feasible and acceptable within an outpatient oncology setting, supporting the promise of this interventional strategy. Further research is needed to refine practices. Keywords Telechaplaincy . Telehealth . Telephone . Chaplain . Spiritual care . Cancer Background * Petra Sprik 1 Department of Supportive Oncology, Levine Cancer Institute, Charlotte, NC, USA 2 Spiritual Care and Education, Atrium Health, Charlotte, NC, USA 3 Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC, USA 4 Section of Psycho-Oncology, Department of Supportive Oncology, Assistant Professor of Medicine, Levine Cancer Institute, Charlotte NC, USA 5 Haslinger Family Pediatric Palliative Care Center, Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron OH, USA It is estimated that in 2020 1.8 million people will be diagnosed with cancer in the USA [1] and that by 2026, 20.3 million cancer survivors will be in the USA [2]. In order to meet the needs of this large patient population and due to recent trends in healthcare, a large percentage of oncology care is delivered in outpatient settings [3]. Unfortunately, there are barriers that limit accessibility, efficiency, and effectiveness of delivering healthcare in outpatient settings. Two difficult barriers for supportive services to overcome are shorter, outpatient appointments in comparison with longer inpatient stays, which makes it more difficult to access the patient, and the cost of providing services in an outpatient setting [4, 5]. Recently, COVID-19 has added an additional barrier to providing in-person services due to stay-at-home orders [6]. One approach to ameliorate these barriers is providing healthcare services via telehealth. Support Care Cancer The World Health Organization defines telehealth as “the use of telecommunications and virtual technology to deliver healthcare outside of traditional healthcare facilities” [7]. Telehealth modalities can include telephone, smartphone applications, live videoconferencing, and Internet interventions, which are delivered synchronously or asynchronously [8]. The terms “telehealth” and “telemedicine” are often used interchangeably; however, telehealth can include clinical and non-clinical services, where telemedicine only includes clinical services [7, 9]. Telehealth has been used since the early 1900s, grew exponentially in the 1970s with the growth of portable technology, is currently used by a wide variety of healthcare specialties, and is predicted to expand in its utilization [8–10]. At the 2017 annual meeting of the Association of Community Cancer Centers, Lindsay Conway predicted that by 2020, virtual consultation would increase by 60% among cancer care facilities [11]. COVID-19 drastically increased implementation of telehealth in the USA, with predicted long-term utilization of these modalities after the pandemic [6, 12]. Studies examining the impact of telehealth interventions have shown a variety of telehealth services to be feasible and acceptable, producing comparable outcomes to inperson care [9, 13–17]. However, not all aspects of telehealth services are acceptable to patients. A review by Cox and colleagues revealed a more nuanced impression of the acceptability of telehealth services by cancer survivors [4]. Cancer survivors reported the following benefits of telehealth services: enhanced management of one’s care, anonymous space to talk about personal issues, increased time to address patient needs, convenience, and a sense of constant access and being monitored [4]. Reported negative perceptions of telehealth services included feeling like the service was an additional, burdensome responsibility, the format feeling impersonal, and limited technological literacy [4]. Similarly, a study on telehealth genetic counseling showed telehealth to be acceptable, except for some tasks which were difficult when performed distally [17]. When viewed together, these studies suggest that telehealth can be a feasible and acceptable way to meet patient’s needs, but that telehealth may be more acceptable for certain interventions. More study is needed to understand the nuances of how to best deliver telehealth services. Chaplaincy is one healthcare service that has more recently sought to refine its telehealth practices. Healthcare chaplains are individuals who work or volunteer within healthcare contexts to provide spiritual, religious, and emotional support to patients, caregivers, and staff [18]. Within inpatient settings, chaplaincy departments are often too small to meet all patients’ spiritual, religious, and emotional needs [19]; the same is often true in outpatient clinics, with the added challenge of shorter appointments to meet patients. “Telechaplaincy,” the use of telecommunications and virtual technology (which can include but is not limited to, telephone, smartphone applications, live videoconferencing and internet interventions) to deliver spiritual and religious care (...truncated)