How Distress Prior to a Spiritual Health Consult is Associated with Patient-Reported and Clinical Outcomes Open Access

Gross, Skylar (Spring 2020)

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Introduction: Chronic diseases are the main contributor to hospitalization in the United States. Consequently, hospitalization has been shown to lead to distress, anxiety, depression, and compromised quality of life for patients. However, religiosity and spirituality has been shown to be an effective coping mechanism for mitigating distress due to hospitalization and chronic diseases. Specifically, hospital chaplains have been associated with decreased stress, anxiety, and depression, in addition to a decreased length of stay and risk of death. Therefore, the spiritual framework of coping suggests that spiritual coping can increase patients meaning-making and improve their overall mental and physical well-being.


Objective: The following study was conducted to understand how hospital distress prior to a spiritual health consult is associated with patient-reported and clinical outcomes. Patients underwent a chaplain consultation, and prior to the chaplain visit, patients’ distress was assessed. After the chaplain visit concluded, patients’ well-being and meaning-making were assessed through a self-report questionnaire. Lastly, patients’ length of stay after the consult and readmission to the hospital within six months was assessed through accessing their respective medical records.

Methods: This prospective secondary data analysis used data from a longitudinal quasi-experimental waitlist crossover study which was conducted from August 2018 through June 2020. The first stage of the data collection was conducted from December 2018 through March 2019. Descriptives and frequencies were conducted for demographic variables; chi square tests, independent sample t-tests, and pearson correlations were conducted between predictor and outcome variables at the bivariate level.


Results: A total of 133 hospital patients in the Metro Atlanta area were recruited from 6 different hospitals and met eligibility criteria. Of patients who were eligible and provided informed consent, 123 participants completed the chaplain consult and survey. In addition, only 106 patients ‘medical records could be accessed. The majority of participants reported high distress prior to the spiritual health consult (n=91;74.0%) of participants experienced high distress prior to the chaplain consult and were not readmitted into the same department within 6 months (n=75;70.8%). In addition, at the bivariate level, meaning-making and well-being were statistically significantly correlated (p<.0001). All other bivariate analyses resulted in null results.


Conclusions: The results from this study, despite mainly being null, suggest important preliminary and descriptive findings. Meaning-making and well-being were statistically significantly correlated, however, these two variables have similar constructs. Moreover, due to this study being observational, causal relationships could not be determined, and the findings could not be generalized. Therefore, further research can be conducted to further fill the gap in literature.

Table of Contents

Chapter 1: Introduction                                                                                                                5

           Purpose                                                                                                                                 5

           Chronic Disease                                                                                                                  5

           Hospitalization                                                                                                                   7

           Distress                                                                                                                                 8

           Religion and Spirituality                                                                                                   8

           Chaplain Benefits                                                                                                               9

           Problem Statement                                                                                                            9

           Theoretical Framework                                                                                                    10


Chapter 2: Review of the Literature                                                                                         11

           Introduction                                                                                                                       11

           Chronic Disease                                                                                                                 11

           Hospitalization                                                                                                                  13

           Distress                                                                                                                               14

           Religious and Spiritual Coping                                                                                       15

           Chaplain Visit                                                                                                                     16

           Theoretical Framework                                                                                                    18

           Study Aim                                                                                                                           23


Chapter 3: Methods                                                                                                                      23

           Participants                                                                                                                         23

           Procedures                                                                                                                           24

           Survey Measures                                                                                                                24

           Medical Record Data                                                                                                          25

           Data Analysis                                                                                                                     26


Chapter 4: Results                                                                                                                        27

           Univariate Analysis                                                                                                           27

           Bivariate Analysis                                                                                                             30



Chapter 5: Discussion                                                                                                                  33

           Overview                                                                                                                            33

           Summary of Key Results                                                                                                   33

           Strengths and Limitations                                                                                                35

           Implications and Future Directions                                                                               36


References                                                                                                                                     39



Figure 1. Spiritual Framework of Coping                                                                                  19

Figure 2. Conceptual Framework of Spiritual Coping                                                            22

Table 1. Patient Demographics                                                                                                  27-28

Table 2. Univariate statistics of patients’ feelings during the spiritual health consult         28-29

Table 3. Univariate statistics of patients’ meaning-making                                                         29-30

Table 4. Univariate statistics of patients’ well-being                                                                        30

Table 5. Distress: Independent sample t-tests for well-being, meaning-making and length of stay 31

Table 6. Chi-Square test of independence for distress and readmission                                          31

Table 7. Readmission: Independent sample t-test for well-being and meaning-making                  32

Table 8. Pearson Correlation for well-being, meaning-making and length of stay                           32


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