Paul Bay, a Pioneer in Spiritual Care Research
George Fitchett, DMin, PhD
Professor, Department of Religion, Health & Human Values,
Rush University Medical Center and Senior Advisor, Transforming Chaplaincy
Rev. Paul Bay, DMin, BCC, a pioneer in spiritual care research, died on May 31, 2023. He was 75 years old (click here for Paul’s obituary). Paul spent his career as a health care chaplain. For 13 years, until he retired in 2013, he worked at Clarion Health, now IU Health, in Indianapolis. It was there that his interest in research about spiritual care (Bay, 2002) found the institutional support which led to his leadership of one of the first randomized clinical trials (RCT) of the effects of chaplains’ care (Bay & Ivy, 2006; Bay et al., 2008).
Prior to the RCT that Paul led, spiritual care leaders had written about the importance of research for spiritual care, especially research that described the benefits associated with spiritual care (e.g., Gleason, 2004). The first clinical trial of chaplain care was the project by William Iler and colleagues (2001). In that project 50 hospitalized patients with COPD were randomly assigned to receive a daily chaplain visit or to the control condition with no chaplain visits. Iler found that compared to the patients with no chaplain visits those who had daily visits had greater reductions in anxiety, greater satisfaction with their hospital stay, and shorter lengths of stay.
Paul saw the value of research that examined whether chaplains’ care contributed to better outcomes for their patients. “I believe I owe it to my patients and myself because it [research] is essential for ‘best practices.’ I am unaware of a better way to be disciplined or improve my art [spiritual care] than scientific inquiry” (Bay, 2002, p. 24). The project Paul led was a RCT of the effects of chaplain visits on outcomes for 170 coronary artery by-pass graft (CABG) patients. The team hypothesized that the chaplain’s care would have beneficial effects on the religious coping, emotional adjustment, and medical recovery of these patients. The patients were randomly assigned to receive chaplain care or not. Patients assigned to the chaplain care group received four visits (1 pre-op, 3 post-op); there was also one visit to their family in the waiting room during the surgery. Each chaplain visit included discussion of a pre-determined question; for example in the first post-op visit the key question was, “What keeps you going?” Key study measures included medical recovery (e.g., post-op length of stay), emotional factors (anxiety, depression, hope), and religious coping. Study data was collected at 3 time points: pre-operatively and 1-and 6-months post-op. At follow-up there were no significant differences between the study groups for the psychological or medical recovery measures. At 1 month follow-up there were marginally significant differences between the intervention and control groups on changes in positive and negative religious coping; at the 6 month follow up these differences were statistically significant.
In their report of the project Paul and his colleagues carefully review the significant and non-significant results. Of note are their observations that at baseline the average level of depression in the sample was similar to non-clinical populations and the average level of hope was high compared to other studies. The same may have been true for anxiety. Here it is useful to compare this study to Iler’s study of the COPD patients. Anxiety is a well-recognized and distressing symptom for patients with COPD. On average the level of anxiety in the patients in Iler’s study was high making it possible for his intervention to provide relief. The important point that Paul and his colleagues discovered is that studies of the effects of chaplains’ care should focus on patients who are experiencing distress and having difficulties coping. When patients’ distress is generally low no intervention is likely to lower it.
With Steve Ivy, Paul published a companion paper about the project (2006). It is essential reading for chaplains who are undertaking research for the first time. In the article they describe factors that are important for success. These include institutional support, a research team, careful attention to the many important project details, and, importantly, a curious chaplain. Here Paul also notes the importance of a pilot study which, had they done one, may have drawn attention to some problems with their study design. Such small-scale studies are especially important in developing and testing spiritual care interventions. The pilot study of the SCAI intervention by Dr. Torke and colleagues (2019) provides a good example.
Despite its limitations Paul’s study is a landmark in spiritual care research. It demonstrated that RCTs could be used to rigorously examine the effects of chaplains’ care. A particular hurdle for an RCT is creating some standardization in the intervention that is being tested. Using a standardized approach to their care would be foreign for many chaplains but Paul and his team introduced a model for how it could be done.
In the years after completing this RCT Paul and colleagues turned their attention to staff care conducting a RCT of the effects of spiritual retreats on the spiritual well-being of nurses (Bay et al., 2012). The background for this study was the observation that wellness, including spiritual wellness, is essential for nurses to be effective healers. For the study, 199 adult ICU and pediatric nurses were randomly assigned to attend two 1-day spiritual retreats or not attend the retreats. The retreats included presentations and small group discussion of the importance of Sabbath time and opportunities to engage in spiritual practices such as journaling and meditation. The study found that, compared to the nurses who did not attend the retreats, those who attended had statistically significant increases in spiritual well-being. In the years since Paul and his colleagues reported these findings other research has shown the vital importance of care for healthcare staff. This study provides evidence for the benefits of one approach to providing that care.
For many years spiritual care research was often the effort of a single individual with limited institutional support. IU Health’s support for Paul’s work was an important exception. IU Health has gone on to be a center of sustained commitment to spiritual care research. This includes the work led by Alexia Torke, MD, Director of its Daniel F. Evans Center for Spiritual and Religious Values in Healthcare as well as the work of Research Chaplain Shelley Varner Perez. Most recently this team has conducted a RCT of a spiritual care intervention (SCAI) to support family caregivers of ICU patients who lack decisional capacity (Torke et al., 2022). That study found that compared to families who received usual care, families who received the SCAI intervention had lower anxiety and greater spiritual well-being. Dr. Torke and her colleagues have recently applied for funding for an expanded multi-site study of the intervention to test its effectiveness in a more diverse group of family caregivers.
Transforming Chaplaincy is pleased that IU Health is one of our partners. As we look forward to findings from new studies like the expanded trial of the SCAI framework we give thanks for the work of pioneers like Paul Bay. His commitment to using research to identify best practices in chaplaincy care set an important example for today’s advances in spiritual care research.
Bay PS. To be, or not to be more scientific? That is the question: yes, absolutely, but… J Health Care Chaplain. 2002;12(1-2):19-27. doi:10.1300/J080v12n01_03.
Bay PS, Beckman D, Trippi J, Gunderman R, Terry C. The effect of pastoral care services on anxiety, depression, hope, religious coping, and religious problem solving styles: a randomized controlled study. J Relig Health. 2008 Mar;47(1):57-69. doi: 10.1007/s10943-007-9131-4.
Bay P, Ivy SS. Chaplaincy research: a case study. J Pastoral Care Counsel. 2006 Winter;60(4):343-52. doi: 10.1177/154230500606000403.
Bay PS, Ivy SS, Terry CL. The effect of spiritual retreat on nurses’ spirituality: a randomized controlled study. Holist Nurs Pract. 2010 May-Jun;24(3):125-33. doi: 10.1097/HNP.0b013e3181dd47dd.
Gleason JJ. Pastoral research: past, present, and future. J Pastoral Care Counsel. 2004 Winter;58(4):295-306. doi: 10.1177/154230500405800402.
Iler WL, Obenshain D, Camac M. The Impact of Daily Visits from Chaplains on Patients with Chronic Obstructive Pulmonary Disease (COPD): A Pilot Study. Chaplaincy Today, 2001, 17(1):5-11.
Torke AM, Maiko S, Watson BN, Ivy SS, Burke ES, Montz K, Rush SA, Slaven JE, Kozinski K, Axel-Adams R, Cottingham A. The Chaplain Family Project: Development, Feasibility, and Acceptability of an Intervention to Improve Spiritual Care of Family Surrogates. J Health Care Chaplain. 2019 Oct-Dec;25(4):147-170. doi: 10.1080/08854726.2019.1580979.
Torke AM, Varner-Perez SE, Burke ES, Taylor TA, Slaven JE, Kozinski KL, Maiko SM, Pfeffer BJ, Banks SK. Effects of Spiritual Care on Well-Being of Intensive Care Family Surrogates: A Clinical Trial. J Pain Symptom Manage. 2023 Apr;65(4):296-307. doi: 10.1016/j.jpainsymman.2022.12.007.