Muslim patients in the U.S. confronting challenges regarding end-of-life and palliative care: the experiences and roles of hospital chaplains

(2023) 22:28 Klitzman et al. BMC Palliative Care https://doi.org/10.1186/s12904-023-01144-1 BMC Palliative Care Open Access RESEARCH Muslim patients in the U.S. confronting challenges regarding end‑of‑life and palliative care: the experiences and roles of hospital chaplains Robert Klitzman1* , Gabrielle Di Sapia Natarelli2, Elizaveta Garbuzova2, Stephanie Sinnappan2 and Jay Al‑Hashimi2 Abstract Introduction Hospital chaplains aid patients confronting challenges related to palliative and end-of-life care, but relatively little is known about how chaplains view and respond to such needs among Muslim patients, and how well. Methods Telephone qualitative interviews of ~ 1 h each were conducted with 23 chaplains and analyzed. Results Both Muslim and non-Muslim chaplains raised issues concerning Islam among chaplains, doctors and patients, particularly challenges and misunderstandings between non-Muslim providers and Muslim patients, espe‑ cially at the end-of-life, often due to a lack of knowledge of Islam, and misunderstanding and differences in perspec‑ tives. Due to broader societal Islamophobia, Muslim patients may fear or face discrimination, and thus not disclose their religion in the hospital. Confusion can arise among Muslim patients and families about what their faith permits regarding end-of-life care and pain management, and how to interpret and apply their religious beliefs in hospitals. Muslims hail from different countries, but providers may not fully grasp how these patients’ cultural practices may also vary. Chaplains can help address these challenges, playing key roles in mediating tensions and working to counter‑ act Muslim patients’ fears, and express support. Yet many Muslim immigrants don’t know what “chaplaincy” is and/or prefer a chaplain of their own faith. Muslim chaplains can play vital roles, having expertise that can heighten trust, and educating non-Muslim colleagues, providing in-depth understanding of Islam (e.g., highlighting how Islam is related to Judaism and Christianity) and correcting misconceptions among colleagues. Hospitals without a Muslim chaplain can draw on local community imams. Conclusions These data highlight how mutual sets of misunderstandings, especially concerning patients’ and families’ decisions about end-of-life care and pain management, can emerge among Muslim patients and non-Muslim staff that chaplains can help mediate. Non-Muslim chaplains and providers should seek to learn more about Islam. Muslim patients and families may also benefit from enhanced education and awareness of chaplains’ availability and scope, and of pain management and end-of-life options. These data thus have several critical implications for future practice, education, and research. *Correspondence: Robert Klitzman Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Klitzman et al. BMC Palliative Care (2023) 22:28 Page 2 of 13 Keywords Religion, Coping, Spirituality, Chaplains, Islam, End-of-life care, Pain management, Hospice, Healthcare communication Introduction The number of Muslim patients in the U.S. has been increasing in recent years [1], raising critical questions about these patients’ experiences and how well their needs are being met. Unfortunately, Islamophobia has also been rising in the U.S. and elsewhere and has been associated with poor mental health and lower healthcare seeking among Muslims [2]. Muslims in the U.K., on self-report questionnaires, had lower scores on indices of mental health and well-being than did Christians [3]. Literature on Muslim patients in the world, particularly in Muslim-majority countries, has highlighted several challenges they may face, especially in non-Muslim majority countries – e.g., regarding maintenance of dignity during death and dying, provider education and support of their faith [4]. Muslims may see suffering as redemptive and death as God’s will, and seek physical and spiritual dignity. The whole family may be the decision maker, and poor outcomes can cause fears of shame in the community.4 Yet Islamic culture is diverse and not monolithic, but rather includes various divisions and sects (e.g., Sunni and Shia) across many countries, shaped by various cultures [5] that can affect the particular challenges that families face. In the U.K., for instance, South Asian Muslim patients may also face potential language barriers [6]. A case study of a Somalian refugee patient in the Midwest U.S. highlighted language barriers as well [7]. Critical questions thus arise about how chaplains and other staff view and respond to the experiences and religious and spiritual needs of Muslim patients in U.S. hospitals. Chaplains and spiritual care can play critical roles in palliative, hospice and end-of-life care, but relatively little is known about how and how well U.S. chaplains meet the religious and spiritual needs of Muslim patients – e.g., whether particular challenges arise and if so, what. We were able to find only one published U.S. empirical study, published in 2015, based on interviews conducted by Abu-Ras and Laird [8] with 10 Muslim, 16 Christian and 7 Jewish chaplains in the New York City area.8 This study suggested that chaplaincy generally focuses on Christianity and Judaism, and pays little attention to Islamic perspectives. Overall, chaplains in this study perceived similarities, but also differences in the pastoral care needs of, and approaches toward, Muslim patients, and disagreed whether they should approach Muslim and non-Muslim patients the same (i.e., using a "one size fits all" approach) or whether specific needs exist and should be addressed. In recent years, chaplaincy has been changing, increasingly emphasizing non-denominational approaches [9]. Yet Abu-Ras and Laird see limitations in a “one size fits all” approach for meeting the religious and spiritual needs of Muslim patients.8 I (...truncated)