TC Fellow interviews M. Jeanne Wirpsa on SDM
Rev. Marilyn JD Barnes, a Transforming Chaplaincy Fellow, interviewed M. Jeanne Wirpsa, MA, BCC on a recent publication. We thank Marilyn for her work and Jeanne for her time:
As health care systems seek to promote Shared Decision Making (SDM), a process that brings together patient values and wishes with the expert recommendations of the medical team, research by Wirpsa, et al. validates the chaplain’s role in this patient-centered process. This robust, mixed-methods research presents a comprehensive chaplain perspective of their role in SDM, with qualitative data providing input that can be used when training chaplains to engage in the process as a member of the interprofessional team. Additionally, this research benefits staff chaplains, chaplain educators, and chaplain students, serving as a conversation starter with members of the interprofessional team on how to evolve the SDM process to truly be patient-centered (body, mind, and spirit).
I interviewed the primary author of “Interprofessional Models for Shared Decision Making: The Role of the Health Care Chaplain,” M. Jeanne Wirpsa, MA, BCC about this research and her thoughts on future research. She shared that within the existing body of literature about what chaplains do, SDM is an under-recognized study area by both chaplains and other members of the interprofessional team. With almost 25 years in the profession as a bedside chaplain, ethicist, educator and researcher, Wirpsa is passionate about this area of study and is hopeful her research can positively impact patient care.
To that end, Wirpsa identifies three primary ways chaplains support shared decision making and encourages their full integration into practice: 1) paying attention to religious beliefs that often impact or conflict with the care plan; 2) integrating the patient’s story (values, experiences, family relationships) into decision making and care; and 3) mediating the fast pace, language, and fragmentation of modern medicine that increases anxiety in persons who are faced with serious and end-of-life health care decisions. She encourages chaplains to claim the role they play in promoting patient-centered medical decision making by being proactive within their institutions.
Wirpsa et al. reported an unexplained gap: 71% of respondents reported a high frequency of involvement in supporting patients and families in the emotional processing of medical decision making, and yet only 43% reported being adequately integrated into the medical team’s process. Wirpsa attributes this to the fact that “chaplains themselves may not always recognize the role they play in promoting medical decision making by addressing the patient and family’s fear, guilt, unresolved family dynamics, judgement, or forgiveness.” Additionally, Wirpsa shared that “chaplains provide a calming presence which may facilitate the process of decision making when patients or families are overwhelmed or stuck.” To close the gap, Wirpsa believes that changes would need to happen on the system or organizational level as well. Being creative with staffing ratios and how assignments are made to facilitate the presence of chaplains at family or interdisciplinary care meetings might be places to begin. Additionally, she suggested the importance of addressing barriers to communication among team members and shifts, a commitment to including all members of the team from a process (and not relationship model) approach, a unified vision of how decision making occurs, and a shared Goals of Care (GOC) conversation template in the electronic medical record.
As a transition from the results of this particular study to future research opportunities, Wirpsa noted that “educating other clinicians on the chaplain’s contributions to the process and effectively addressing the impact of their contributions” opens the door to a great study of how physicians, nurses, social workers and other members of the healthcare team view chaplain engagement in SDM. She speculates that the lack of education about chaplain training and scope of practice would lead to a low percentage of interprofessional team members believing chaplains are even engaged in the SDM process. The step of linking the chaplain’s role to medical decision making also requires chaplains to adopt a strong voice to speak to their value, have the bandwidth to be engaged, and the skill set to facilitate the process. Wirpsa shared that while in their findings more than 90% of chaplains felt they are well equipped to support the medical decision making process, remaining unclear is the reliability of the responses based upon variation of the definition of “being equipped.” In follow-up interviews and free text comments, many chaplains requested more training for GOC conversations, leading a family meeting, and proactive engagement with interdisciplinary team members.
While an extensive exploration of the role the chaplain plays in supporting other healthcare clinicians during complex medical decision making was beyond the scope of this research, the authors did touch upon it briefly in describing chaplains as “coaches.” Chaplains reported not only coaching family members about what to ask physicians but also coaching the medical team on how to approach the family. Wirpsa suggested that future research on the chaplain’s role in assisting members of the interprofessional team with GOC conversations is fitting; that research could leverage recent studies in palliative care, among others. Finally, Wirpsa suggested that a study on the association between chaplain engagement with advance care planning and concordance between decision outcomes and patient values would be beneficial. There is much research and work to be done, and both she and I are excited about these possibilities.