A research published in the JAMA Internal Medicine provides empirical evidence of the need for – and effectiveness of – incorporating hospital chaplains as part of patient end-of-life planning before they are hospitalized.

While public opinions research shows that 90% of Americans agree it is important to have end-of-life discussions with their loved ones, only about a third of adults in the U.S. have completed written advance directives (ADs) that spell out wishes for care or designate the person they'd like to carry them out.

Discussing one's end of life wishes can be difficult in any setting, but especially in the hospital with physicians who often do not have the time or training to lead them. But spiritual care director at Rush Oak Park Hospital shared the findings of a quality improvement project showing that 80% of participating patients completed an AD after visiting with a hospital-based chaplain during previously-scheduled physician appointments.

The study shows how important advanced care planning really is and also that hospital chaplains can make these conversations both feasible and acceptable to patients. Advance directives provide patients with the peace of mind in knowing they have things in order to help loved ones if difficult healthcare decisions have to be made. They can also reduce the guilt and depression family members might experience when making decisions that had not been determined in an AD.

The investigators observed that patients are often happy to clarify and document their wishes, particularly around naming a power of attorney for healthcare. The chaplain-facilitated AD conversations, averaging less than thirty minutes in the study, provide a document that they can share with loved ones but is also incorporated into the patient's electronic medical record.

Physicians have been very receptive to incorporating chaplains in this planning as doctors are frequently pressed for time and know these discussions requires a different level of expertise. Chaplains can provide a vital service that often does not have time to offer, and Advanced Care Planning now fits firmly within Medicare reimbursement guidelines. Recent changes in Centers for Medicare policy allow physicians to bill for time spent in conversation about Advanced Care Planning.

The findings of the study will be tested more widely. The researchers are eager to test the initiative in a larger study and to further investigate the contribution professional chaplains can make to ensuring that care at the end of life is guided by patients' deeply-held beliefs.