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Minnesota-based chaplain Paul Galchutt, trained as a Lutheran pastor, works with patients facing terminal diagnosis. He recalls a man with brain tumors that weren’t malignant but kept coming back. The nurse recommended he speak with a chaplain, but it raised some hackles for the man. Galchutt had to explain, “I have no interest in making you a Christian. I care about what makes sense to you. I care about how you make sense of the world and what this means to you.”

Contrary to engrained narratives, chaplains support self-described atheists, non-observant people, and individuals from many different faith traditions. As Americans have become less likely to set foot inside formal places of worship—according to Pew Research, only a third of Americans attend religious services once a month or more—the halls of a hospital remain a place where people may find spiritual guidance. A 2019 survey indicated that a surprising 21 percent of the American public had contact with a chaplain in the past two years, more than half of them in healthcare settings.

The encounters are as diverse as the U.S. population. In a Portland, Oregon, hospital, chaplain Shelley Varner Perez arranged a smudging for a patient with an Indigenous background, helped pagans find meaningful readings or poems, and read the Bible to religious people who valued daily readings. She engaged with humanists about “what for them is the highest good and how that influences how they experience their hospital stay,” said Varner Perez, who herself is an ordained American Baptist minister. 

Sociologist of religion Wendy Cadge said without considering the role of chaplains, we’re not seeing the full picture of religion in America. “It’s a story about delivery mechanism. If the traditional mechanism of religious and spiritual content has been the congregation, chaplains have always had a different delivery mechanism,” said Cadge, who wrote a recent book describing chaplaincy both inside and outside of healthcare settings. Cadge describes how chaplains originally served people from their own denomination, but in the last two decades many function more like interfaith chaplains.

Yet if healthcare administrators mainly see the story of religion in America as one of declining interest, how will they staff chaplaincy positions? “It’s really important that chaplains demonstrate their values to their institutions,” said Cadge. 

In response, a growing body of research on the chaplaincy is providing evidence of the impact of chaplains in healthcare. 

George Fitchett, a long-time research chaplain at Rush Medical Center in Chicago, and colleagues recently published a systemic review of about 20 years’ worth of studies considering the impact of spirituality in health outcomes. It concluded with the recommendation that all clinical teams include chaplains and train other members of healthcare teams in spiritual care.

Looking at the most rigorous studies, they found common themes of spirituality being important to patients, and that spiritual care was associated with better quality of life for patients.

 The study is a satisfying capstone for Fitchett, who recently retired. 

Back in the 1990s and early 2000s, people spoke of a need for research to describe what chaplains did and the benefits of their work, said Fitchett. But most of the time, one person would take an interest in it, do some of the work, and then retire or move to a different institution with less support. 

As Fitchett moves on, he leaves behind a cadre of new research chaplains. He met Cadge in the mid-2000s, and the right ingredients fell into place to advance the development of a field for research chaplains that would continue to define their value in healthcare. They founded Transforming Chaplaincy, with funding from the John Templeton Foundation and others. 

First, the program aimed to train chaplains in research methods, and today several hold newly created research chaplain positions within medical universities. Varner Perez, who now works in such a position at Indiana Health University, receives inquiries from other institutions interested in creating similar positions.

Mapping the chaplaincy

Kelsey White, a former fellow along with Varner Perez, first realized she needed research training when she was a chaplain at an outpatient clinic in Birmingham, Alabama. The clinic saw 2,000 people a day, and she was the only chaplain. White observed a “high level of emotional and spiritual distress” even when patients did not ultimately need admission to the hospital. 

“I tried so hard to convince my boss that they needed more chaplains in this clinic,” said White. “I learned how to use Excel to track what I was seeing and doing.” She thought it would help her make a better case, but it didn’t work. 

Now having completed her PhD, she is a chaplaincy researcher at Virginia Commonwealth University with the tools to make that argument. “What our profession really lacked was the research lens and the rigor behind the arguments behind why we do what we do,” she said.

White recently took inventory of the demographic characteristics of chaplains across the U.S. and compared it to Pew’s data on religion and the CDC’s data on users of healthcare and hospitalized persons. She considered chaplaincy training programs and what populations need more pathways into the chaplaincy, including Black Americans and fast growing Asian and Hispanic populations. 

Religious affiliation is tricky, however. Denominations provide different routes for chaplaincy training that could impact the makeup of the workforce. Researchers also note that chaplains can shift their affiliations, particularly during education. Further, as Varner Perez’ experience illustrates, chaplains will serve people’s spiritual needs as best they can even when they are differently affiliated.

Members of the healthcare team

Many former fellows conduct research to describe how chaplains can impact healthcare delivery and enhance their contributions. 

Healthcare staff have spiritual and emotional needs, too. To address that, Varner Perez helped design a practical, research-based guide for staff after a Code Blue—a call for medical response to a patient that needs to be resuscitated. “The Pause” can be 10 minutes after it is safe to take the space to do it. It helps medical professionals to acknowledge their emotions and then move on in their day. 

Paul Galchutt, a research chaplain and PhD student in Minnesota, organized focus groups to better understand how a palliative care team integrates input from chaplains. Commonly, chaplains visit patients and then may leave notes in a health record or participate in team meetings of inter-professionals. One physician said chaplains’ notes influence what they prescribe. Another said it helps them “conjure compassion.” 

He said participants wanted chaplains to report summaries on questions like: How is a patient understanding the illness? What is their sense of future? How are they coping? What resources do they have? What does family mean for them? Who’s the decision maker in the family? Are they religious? 

Fitchett would like to see more research beyond the role of chaplains in palliative care. Past research predominantly focused on end-of-life care, but even people who are not on the brink of death have pressing spiritual and religious needs.

For example, Fitchett wondered,

“How can spiritual care help people with chronic illness stay out of the hospital?”

He knows of an initiative which wants to see how chaplains can support diabetes education and address a type of religious fatalism among racial and ethnic minorities that might lead some people to be less proactive about their health.  

The foundation for a diverse future

Ultimately, the chaplaincy must respond to the diverse and changing religious needs of patients. Varner Perez believes that all people have narratives that inform their worldview, and many people have deep existential concerns, even if they aren’t religious. 

“Our healthcare systems catch people from all different walks of life and perspectives. Folks are looking for someone to connect with about how to make meaning around their experiences. Who’s there for me at a time like this one? That’s the time people dig deeply with some hard questions. As the U.S. becomes more religiously unaffiliated, folks are turning to chaplains in hospitals to have those conversations and spiritual guidance,” said Varner Perez. 

Cadge said that research shows that “regardless of background people appreciate a listening ear, non-judgmental presence, someone to be with them in the midst of difficulty.” Today’s chaplains remain of “service to people across many axes of difference,” and they offer presence and companionship to all people confronting life’s ultimate questions.