Expanded hospice spiritual care training could lead to improved goal-concordant care delivery.

Gaps in communication training exist for hospice chaplains, according to Edward Peñate, palliative care chaplain-educator at Northwestern Medicine. Though spiritual care professionals are well-poised to understand patients’ beliefs and values, their training and career pathways can be limited when it comes to enhancing skills related to discussions of care, Peñate indicated.

Hospice chaplains often lack formalized education in fostering goals-of-care discussions with patients and families, he said at the Annual Assembly of Hospice & Palliative Care, an event by the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA). Additionally, chaplains’ role in these conversations is often not clearly established in interdisciplinary hospice care models.

“As spiritual care specialists and expert listeners, chaplains are uniquely positioned to participate in important conversations related to patients’ core values, embedded beliefs and their preferences,” Peñate said during the assembly. “What is less clear is how to go about training chaplains to effectively participate in these important conversations. Not only is there no established model, but little research exists in this area.”

Greater goal-concordant care training opportunities and stronger interprofessional integration of chaplains is needed to improve patient experiences and care collaborations, according to Peñate. With strong communication skills for chaplains could impact positive change in clinical outcomes, he stated.

Simulating goals-of-care skill training through role-playing group discussions is one potential effective educational methodology to explore, Peñate said.

Northwestern Memorial Hospital recently launched a chaplaincy workshop project, which included 10 employees in its spiritual care and education department. The two-day workshop explored a variety of training methodologies, including simulated goals-of-care conversations.

Through simulated training environments, hospice chaplains were able to better understand and incorporate their skills in aligning care with a person’s spiritual and cultural beliefs and values, said Dr. John Wagner, hospice and palliative certified physician at Northwestern Medicine.

Chaplains self-reported levels of confidence in discussing goals of care and contributing in a family meeting, showing statistically significant increases in both areas, according to Wagner.

Chaplains who participated in the study cited being able to be more directive in patient encounters, Wagner stated. Though mutual trust and respect among team members increased, chaplain staff cited that collaboration with other clinical team members was a large barrier to improved and deeper involvement in goals of care conversations.

“Simulated [groups] allowed chaplains to apply new skills through active, rather than passive, learning techniques,” Wagner said during the assembly. “These simulated role-play experiences offer chances to refine communication skills in a team environment without the same high stake consequences as bedside encounters.”