February 28, 2018
New Year's Resolution: Being Able to Support What We Claim (January 20, 2016)
(Editor’s note: This article was originally published January 20, 2016)
I have never been much for New Year's resolutions. My take for myself at least has always been that I should make changes in my life when I decide I need to make them and when I'm so motivated, not because it is the new year. However, as I am taking some relative down time caused mainly by everyone I work with being on vacation and thinking about the projects I have coming up, one resolution does occur to me that I believe will help me and help advance professional chaplaincy.
My resolution was stimulated by a review article by Blinderman and Billings in the December 24th NEJM in which they make the point that the term, "comfort care", is sometimes used in a "misleading or imprecise manner". One example is when it seems to mean only that the patient has a DNR order while missing all the other implications and opportunities that true comfort care implies. This all too common issue reminds me how easy it is to misuse some very popular terms of the day so that we appear to make claims beyond what the claimant can really support or what is really true. Thus "comfort care" without attention to all the patient's symptoms is not comfort care. Likewise, Betty Ferrell has reminded us that palliative care without attention to all eight domains of the NCP Guidelines is not palliative care.
My particular concern, both for myself and others, is that, in the current health care environment, many stakeholders assume that any claims one makes for one's profession are backed up by evidence and that evidence can be produced if asked for. In other words, any claim is more and more often assumed to be "evidence-based" whether that modifier is used or not. Put another way, to make a claim for what we do or how effectively we do it without being able to provide evidence does not live up to the current standard for making these kinds of claims. Most importantly, it is the evidence-based claims that will advance our profession and the non-evidence claims that will mark us as a profession which cannot or even refuses to document how it contributes.
A pause to be clear what I mean by evidence. It can be in the form of a quantitative research study, which is the form most people think about. However, the common categories of evidence in lists such as the one we used in our work for the US Navy also allows qualitative studies, case studies, consensus panels and even a category called "expert opinion". The latter are considered lower levels of evidence and should be identified as such but they do count as evidence.
The pitfalls for chaplaincy in this regard are many. The late CPE Supervisor, Art Lucas, challenged his students years ago to provide concrete evidence for any outcomes they claimed for a patient visit rather than simply presenting assumptions or belief. I still hear and read claims for the efficacy of chaplaincy such as that we reduce law suits for which there is not a bit of evidence of any kind.
One temptation that I find myself succumbing to from time to time is to confuse what I believe to be true with what I know to be true. For instance, while I firmly believe that chaplaincy services properly targeted and integrated are cost savings to an institution and that some day the research will demonstrate that, there is no evidence yet to support that belief. To be clear, there is no problem with me making this claim as long as I am clear that this is only my opinion and not supported by any other evidence.
Along this same line, it is all too easy in the present environment to make the blanket claim that chaplaincy is "value added" or even that our training or certifications are demonstrably value-added. We as professional chaplains believe this of course (we worked too hard to be trained and certified not to) but the truth is that there is no evidence to support the contention that CPE or the BCC process reliably makes us "better" chaplains or adds value to the health care enterprise. The fact is we can't really even describe yet what "better" means in the context of health care.
So finally to the resolution. I pledge that in my writing and speaking I will strive to support every claim I make with evidence including the level of evidence and to provide the specific citations for that evidence whenever the situation allows so that anyone who desires can verify my claim. If I make a claim that is only my opinion, I will strive to make that clear. These claims include claims for the value added of spiritual care and chaplaincy care, claims for what chaplains should be doing and producing, and claims for the efficacy of chaplaincy education and the competence of chaplains. I challenge my colleagues to strive to meet this same standard and I reserve the right to challenge anyone in the profession who makes claims that are not evidence-based.
As a rabbi friend of mine likes to say, Happy Gregorian New Year!
 Hughes B, Handzo G. 2010. The Handbook on Best Practices for the Provision of Spiritual Care to Persons with Post Traumatic Stress Disorder and Traumatic Brain Injury. United States Department of the Navy, Bureau of Medicine and Surgery.
 VandeCreek, L, Lucas, A. 2001. The Discipline for Pastoral Care Giving: Foundations for Outcome Oriented Chaplaincy. J. of Health Care Chaplaincy, 10(2) and 11.
The Rev. George Handzo, M.Div., BCC, CSSBB, is a board certified chaplain and President, Handzo Consulting where he regularly blogs. He is also Director of Health Services Research and Quality at HealthCare Chaplaincy Network. George is board certified by the Spiritual Care Association. He is also board certified by the Association of Professional Chaplains and is a past president that organization.