Inter-Professional Outpatient Team Publishes on Chaplain ACP Intervention

Hospital physicians and staff regularly engage clinical chaplains to assess and respond to patients’ spiritual and emotional needs. Outside the hospital walls, however, patients continue to bring their complex circumstances, crises and needs to their outpatient medical teams, seeking creative, inter-disciplinary care to help stabilize them in their home environments. In these contexts, certain outpatient populations – especially those with high medical complexity and complex psychosocial barriers – can especially benefit from integrated chaplain care. Sensing an unmet need, DUH Chaplain Services & Education partnered with GIM six years ago to pilot and study the expansion of spiritual care at the Duke Outpatient Clinic, the largest safety-net academic medicine clinic in the Duke Health system.

Over the course of this partnership, the DOC team has been developing, trying and studying new models for chaplaincy care. Most recently, the DOC’s inter-professional team, led by Duke Palliative Care Fellow Dr. Nicole Dussault, published an article in the Journal of General Internal Medicine titled “Evaluating a Clinical Chaplain Pilot Intervention to Facilitate Advance Care Planning in a Primary Care Clinic.” This study brought together chaplaincy, palliative care, medical social work and primary care general internal medicine to examine whether a chaplain can effectively support GIM residents in clarifying and documenting their patients advance care planning (ACP) wishes.

Compared to controls, chaplain intervention patients had a significant increase in ACP notes (35 vs. 2, p =  < 0.001), healthcare power of attorney forms (9 vs. 2, p = 0.02), and advance directive forms (6 vs. 0, p = 0.01). Dussault’s team concluded that a clinical chaplain’s unique training and experience may provide feasible and worthwhile support to help identify patient-specific needs and barriers and facilitate ACP conversations between PCPs and high-risk patients.

Please see the DOC team’s other publications on outpatient religiosity and desire for chaplain services and outpatient, staff, and providers’ factual knowledge about and desire for outpatient chaplain services. Related to advance care planning, see the initial survey of internal medicine resident barriers to completing advance care planning.

This innovative partnership continues, offering new dimensions to training approaches, provision of care and patient support.

Citation

Dussault, N., Henderson, K., Daniel, K. et al. Evaluating a Clinical Chaplain Pilot Intervention to Facilitate Advance Care Planning in a Primary Care Clinic. J Gen Intern Med. 2025 Apr 29. doi: 10.1007/s11606-025-09527-1.). https://doi.org/10.1007/s11606-025-09527-1