How Spiritual Care Impacts the Mental Health of Family Caregivers

Acting as a family caregiver, who often takes on the role of surrogate decision-maker, can lead to elevated stress and anxiety caused by the patient prognosis and complex medical decisions needed to be made. According to a recent Regenstrief Institute study, spiritual care interventions can effectively support the mental health and well-being of family caregivers.

Family caregivers in the intensive care unit (ICU) will make critical healthcare decisions on behalf of patients who may be incapacitated or critically ill and unable to make their own decisions.

The study, published in the Journal of Pain and Symptom Management, examined the well-being of 128 family caregivers receiving enhanced spiritual support compared to individuals provided with usual care from a hospital chaplain.

“Throughout my career as a physician, as I have spoken with patients and family members about critical illness and life and death decision-making, many of them have talked about their religious and spiritual practices and beliefs,” Alexia Torke, MD, with Regenstrief Institute and Indiana University School of Medicine, said in the press release. “Yet, studies addressing the effect of spiritual support on family members of these very sick individuals are lacking.”

“This study, one of the first of its kind, enabled us to actually measure the impact of spiritual care on those who are making decisions for ICU patients who are unable to do so for themselves,” Torke continued.

Family surrogate decision-makers who experienced the enhanced spiritual care model received proactive contact from the chaplain, scheduled semi-structured visits, weekly follow-ups, and bereavement calls. Additionally, the chaplain answered common questions about religion and spirituality that ICU patients and their family members were likely to experience and wonder.

Patients and family caregivers a part of the enhanced spiritual care intervention model visited a chaplain an average of four times during their relative’s ICU stay. In comparison, participants in the usual care arm of the study saw a chaplain half as many times as those in the enhanced spiritual care arm.

That enhanced spiritual care and connection had a positive impact, the researchers found. Participants provided with advanced spiritual support experienced a decrease in anxiety. Alongside those results, family surrogate decision-makers reported greater spiritual well-being and satisfaction with spiritual care.

The enhanced spiritual care model expanded upon usual chaplain practice and could be implemented in hospitals across the country, the researchers mentioned.

These findings could also educate hospitals, payers, and policymakers about the value of chaplain-delivered spiritual care, a commonly underfunded patient resource.

“As we discuss in the paper, spiritual care does not bring in revenue for a hospital,” said Torke.  “Chaplains, at this point in time, don't bill the way physicians do, and so they are not generating income for a hospital. And sometimes when budgets are tight, it's very tempting to cut chaplain programs.”

“By building a research base and research knowledge about spiritual care, we are demonstrating the importance of chaplains to the long-term well-being of our patients and their family members,” Torke continued. “Even though they're not bringing in money, chaplains are an extremely important part of the care environment, providing real support to family members as well as patients in critical ways that not only affect satisfaction and but also health outcomes.”

Family caregiver needs are often overlooked despite holding a critical role in the healthcare system. While there are nearly 42 million Americans who provide care for older adults, research shows that only some are being well-supported by the system.

An unrelated study found that less than 18 percent of healthcare workers asked caregivers about their understanding of older adults’ treatments.

Other studies have shown that direct provider communication is necessary for family caregivers, especially those making surrogate healthcare decisions.

“Speaking indirectly about the prognosis for a patient who is critically ill is commonly viewed as a way to communicate bad news without causing psychological harm,” researchers from the 2020 study explained. “Our findings suggest that indirect statements about prognosis are not simply gentle versions of direct statements. Instead, they are interpreted by family members as evidence that the speaker is more optimistic about the patient’s outcome.”