Telechaplaincy: A developing field of research and practice, and a call for you to participate in its advancement

March 17, 2022

Petra Sprik, MPH, MDiv, BCC

Chaplain Manager, Department of Supportive Oncology, Levine Cancer Institute, Charlotte, NC

“Telechaplaincy” – this term has increasingly been used over the last few years. You may have heard it before, or it could be new to you. Telechaplaincy is “the delivery of spiritual care where [recipients] and providers are separated by distance” [1]. Chaplains can use a variety of mediums, including but not limited to telephones, videoconferencing, smartphone applications, or web-based communications. Some examples are:

A hospital chaplain using an iPad to interact with patients who have contact-precautions
A chaplain providing a telephone-based program for outpatients
A Navy chaplain texting a serviceperson to offer spiritual encouragement
A clinical pastoral educator videoconferencing their cohort for resident education
A hospice chaplain emailing a family-member recordings to promote goals of grief counseling

While telechaplaincy has been used for decades, the practice has expanded in recent years. This is partly due to healthcare increasingly being offered in outpatient settings, and the need for telehealth during the COVID-19 pandemic. As telechaplaincy has developed, research and practice has improved. However, we still have a long way to go.

I started studying telechaplaincy in 2017. To be honest, my first research project was prompted by my initial discomfort with telephone chaplaincy. The outpatient cancer center in which I worked implemented a screener to assess spiritual needs, and my role was to call anybody who indicated distress. At the time, I did not feel I had the skills to be a good chaplain via phone. I avidly searched for resources or educational opportunities to help me develop these skills. I only found a few articles describing the feasibility of small telephone programs. No best practices had been published. I was concerned that the phone was not the best way to deliver spiritual care, so I conducted my first study. I expected to find that telechaplaincy was possible, but not most effective. This is not what we found.

In our first telechaplaincy study, we found approximately one-third of patients accepted a chaplain intervention offered by phone [2]. Patients who indicated “struggle to find meaning and hope” or “fear of death” were more likely to accept a chaplain intervention by phone than patients who indicated other spiritual needs [2]. The intervention was successful at reaching patients from a distance. This led to a follow-up study, where oncology outpatients expressed high satisfaction with telechaplaincy encounters [3]. Patients who had received chaplain interventions by phone said they preferred to receive chaplaincy services this way [3]. We also identified a limitation: recipients voiced some fear of the chaplain cold calling them, perhaps due to the chaplain being associated with bad news or death [3]. Importantly though, this limitation did not negate patients wanting telechaplaincy.

Through these studies, I realized that telechaplaincy was valuable, and a vital part of extending the reach of spiritual care. I also became more comfortable with telechaplaincy the more I practiced it. Nonetheless, increasing comfort and appreciation for chaplaincy did not decrease my desire for best practices. As I talked to other chaplains and colleagues, they echoed this same need. We saw similarities between in-person chaplaincy and telechaplaincy, but there were also differences. Published, validated best practices would help us be better practitioners. This led to my team’s most recently study describing best practices [4].

In March and April 2019, we surveyed a national sample of chaplains, with 699 respondents [4]. At the time of the survey, approximately half of surveyed chaplains reported having practiced telechaplaincy – this was prior to the pandemic so it is likely higher now. From the national sample, we selected 36 chaplains to interview. We intentionally selected a diverse group of chaplains with a variety of telechaplaincy experiences to get a full picture of how telechaplaincy can be used. Interviewed chaplains described their perceptions of strengths and weaknesses of telechaplaincy, and best practices. Nearly all the chaplains had not participated in any telechaplaincy training since it was not available, so they had developed best practices themselves. Interestingly, there was a lot of overlap between identified best practices– revealing a skillset that may prove essential for telechaplaincy. While the article offers more best practices than described below, here are a few best practices:

When developing a telechaplaincy program, get support from key stakeholders first. Include upper-level and mid-level leadership, Information-technology, chaplains, interdisciplinary teammates, and even participants.
Develop an easy-to-use referral and triage process for telechaplaincy consults, especially if you need to sustain a larger program.
Have a plan for participants who express suicidal ideation or other safety concerns.
Limit distractions, especially from the computer, to be fully present.
Use a flexible script, especially at the beginning of your telechaplaincy practice to help you navigate the conversation, and your initial discomfort.
Verbalize non-verbal communication since recipients are not able to see you.
Be creative with rituals. While physically separated, chaplains can deliver communion, blessings, or other physical rituals.
Establish clear boundaries. Let recipients know when you are available, and how to contact you. They should know you are not a friend, but a professional.
Know that telechaplaincy is not ideal for all interactions. Assess when it is most appropriate. Consider limitations like if the recipient is non-verbal, as well as strengths like the patient being more comfortable at home due to symptom burden.
Do self-care when providing telechaplaincy to avoid burnout [4].

A strength of this study is that it draws best-practices from people who have hands-on experience. These best practices have been used successfully in a variety of settings. However, while the study was an important step in establishing best practices, we still need to know more. Luckily, our team is not the only one doing essential research to advance practice. To name a few: the Spiritual Care Association convened a panel of telechaplaincy experts to describe their current understanding of best practices for telechaplaincy [5]. Spiritual Health Australia developed telechaplaincy guidelines to help practitioners navigate needs during COVID-19 [6]. Sociologist, Fabian Winiger, wrote case studies on how healthcare systems implemented telechaplaincy systems [1]. Large health systems, like Ascension, have made leaps and bounds in developing telechaplaincy programs, and have described their practices [7]. These voices are several of the main contributors advancing the field of telechaplaincy. But – again, the work is not over. It has consistently been noted that chaplains are behind other professions in using telehealth. This does not have to be the case.

Your experience is vital in helping advance understanding and practice of spiritual care. We can develop understanding and practice of telechaplaincy by sharing our knowledge about our practice. The more that we share with one another, the better we can understand how to use telechaplaincy to our advantage. Anybody with experience can help advance this field. This is why Transforming Chaplaincy and The University of Zurich are co-hosting a training series on telechaplaincy. We are calling for anybody with experience to submit a proposal for a presentation, including case studies, vignettes, and didactics. My hope is that you join me in advancing this important field.

References

[1] Winiger, F. (2022) The changing face of spiritual care: current developments in telechaplaincy. J Health Care Chaplain. Mar 8;1-18. doi: 10.1080/08854726.2022.2040895. Epub ahead of print

[2] Sprik, P., Walsh, K., Boselli, D.M. & Meadors, P. (2019) Using patient-reported religious/spiritual concerns to identify patients who accept chaplain interventions in an outpatient oncology setting. Supportive Oncology in Cancer, 27(5), 1861-1869.

[3] Sprik, P., Janssen Keenan, A., Boselli, D., Cheeseboro, S., Meadors, P, & Grossoehme, D. (2020) Feasibility and acceptability of telephone-based chaplaincy intervention in a large, outpatient oncology center. Supportive Care in Cancer, 29(3), 1275-85.

[4] Sprik, P.J., Janssen Keenan, A, Boselli, D & Grossoehme, D. (2022) Chaplains and telechaplaincy: best practices, strengths, weaknesses – a national study. J Health Care Chaplain. Jan 23;1-23. doi: 10.1080/08854726.2022.2026103. Epub ahead of print.

[5] Spiritual Care Association. (2020). Telechaplaincy: Why is it important and how is it best done? https://www.spiritualcareassociation.org/telechaplaincy.html

[6] Spiritual Health Australia (2020). Telehealth Guidelines for Spiritual Care.

[7] Cobb, J. & Chang, C. (2018) Spiritual distress is not confined by walls. Health Progress, May-June, 99(3). Available at https://www.chausa.org/publications/health-progress/archives/issues/may-june-2018/spiritual-distress-is-not-confined-by-walls