Research Publications
Delivering Clinical Pastoral Education (CPE) Remotely: Educators’ Views and Perspectives During the COVID-19 Pandemic and Beyond.
Citation
Szilagyi C, Tartaglia A, Palmer PK, et al. Delivering Clinical Pastoral Education (CPE) Remotely: Educators’ Views and Perspectives During the COVID-19 Pandemic and Beyond. Journal of Pastoral Care & Counseling. May 2022.
Abstract
Many Clinical Pastoral Education programs pivoted to remote delivery during the COVID-19 pandemic. Our survey explored educators’ preparedness, self-efficacy, and views regarding remote Clinical Pastoral Education. Few respondents were either very (14.2%) or not at all (16.5%) prepared. Most were confident facilitating remote learning (69.8%–88.5%), believing remote Clinical Pastoral Education can achieve outcomes equivalent to in-person (59.1%). Six qualitative themes emerged: educator development, educator challenges, remote Clinical Pastoral Education efficacy, remote group dynamics, clinical practice/supervision implications, and benefits and opportunities.
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Learning compassion and meditation: a mixed-methods analysis of the experience of novice meditators.
Citation
Mascaro, J. S., Florian, M. P., Ash, M. J., Palmer, P. K., Sharma, A., Grant, G., & Raison, C. L. (2022). Learning compassion and meditation: a mixed-methods analysis of the experience of novice meditators. Frontiers in Psychology, 13:805718. doi: 10.3389/fpsyg.2022.805718.
Abstract
Over the last decade, numerous interventions and techniques that aim to engender, strengthen, and expand compassion have been created, proliferating an evidence base for the benefits of compassion meditation training. However, to date, little research has been conducted to examine individual variation in the learning, beliefs, practices, and subjective experiences of compassion meditation. This mixed-method study examines changes in novice meditators’ knowledge and contemplative experiences before, during, and after taking an intensive course in CBCT® (Cognitively-Based Compassion Training), a contemplative intervention that is increasingly used for both inter- and intrapersonal flourishing. The participants in this study (n = 40) were Christian healthcare chaplains completing a 1-year residency in Clinical Pastoral Education (CPE) who learned CBCT as part of their professional chaplaincy training curriculum. Prior to and upon completion of training, we surveyed participants to assess their beliefs about the malleability of compassion, types of engagement in compassion meditation, and perceptions of the impact of taking CBCT. We also conducted in-depth interviews with a subset of participants to gain a qualitative understanding of their subjective experiences of learning and practicing compassion meditation, a key component of CBCT. We found that participants reported increases in the extent to which they believed compassion to be malleable after studying CBCT. We also found high levels of variability of individual ways of practicing and considered the implications of this for the study of contemplative learning processes. This multi-methodological approach yielded novel insights into how compassion practice and compassion-related outcomes interrelate, insights that can inform the basic scientific understanding of the experience of learning and enacting compassion meditation as a means of strengthening compassion itself.
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COVID-19 and Clinical Pastoral Education: How ACPE Educators Pivoted Amid the Pandemic
Citation
Szilagyi, C., Tartaglia, A., Palmer, P. K., Fleenor, D. W., Jackson-Jordan, E., Knoll Sweeney, S., & Slaven, J. E. (2022). COVID-19 and Clinical Pastoral Education: How ACPE Educators Pivoted Amid the Pandemic. Journal of Pastoral Care & Counseling, 15423050211073572.
Abstract
Clinical Pastoral Education (CPE) programs faced extraordinary challenges during the COVID-19 pandemic. We examined how ACPE-certified educators responded to maintain program delivery. Survey results (n=210) suggested a substantial and abrupt increase in remote delivery for CPE instruction and supervised clinical practice, primarily driven by those previously fully in-person. Respondents reported abrupt changes impacted 1152 students. Participants rated their utilization and helpfulness of professional, organizational, and technology resources during the pivot and beyond.
A Mixed-Method Study to Identify: Causes of Burnout among Oncology Clinical Research Coordinators
Citation
Mascaro JS, Palmer PK, Ash MJ, Peacock C, Escoffery C, Grant G, Raison CL (2021). Incivility Is
Associated with Burnout and Reduced Compassion Satisfaction: A Mixed-Method Study to Identify
Causes of Burnout among Oncology Clinical Research Coordinators. International Journal of Environmental Research and Public Health, 18(22):11855.
Abstract
While oncology clinical research coordinators (CRCs) experience a combination of factors that are thought to put them at increased risk for burnout, very little research has been conducted to understand the risk factors associated with burnout among CRCs. We used a mixed-method approach, including self-report questionnaires to assess burnout and compassion satisfaction, as well as individual and interpersonal variables hypothesized to impact CRC well-being. We also conducted a focus group to gain a more nuanced understanding of coordinators’ experiences around burnout, teamwork, resilience, and incivility. Coordinators reported relatively moderate levels of burnout and compassion satisfaction. Resilience, sleep dysfunction, stress, and incivility experienced from patients/family were significant predictors of burnout. Resilience and incivility from patients/family were significant predictors of compassion satisfaction. Themes that emerged from the focus group included that burnout is triggered by feeling overwhelmed from the workload, which is buffered by what was described as a supportive work culture based in teamwork. This study identified variables at the individual and interpersonal level that are associated with burnout and compassion satisfaction among oncology CRCs. Addressing these variables is of critical importance given that oncology CRCs and team-based coordinator care are vital to the success of clinical trials.
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Feasibility, Acceptability, and Preliminary Effectiveness of a Compassion-Centered Team Intervention to Improve Clinical Research Coordinator Resilience and Well-Being
Citation
Mascaro JS, Palmer PK, Ash MJ, Peacock C, Sharma A, Escoffery C, Raison R (2021). Feasibility, Acceptability, and Preliminary Effectiveness of a Compassion-Centered Team Intervention to Improve Clinical Research Coordinator Resilience and Well-Being. JCO Oncology Practice, 17:7, e936-e946.
Abstract
PURPOSE:
Oncology clinical research coordinators (CRCs) and team-based coordinator care are critical for the success of clinical trials. However, CRCs typically report elevated anxiety and burnout and many oncology centers have high levels of coordinator attrition. To address the need for a team-based intervention to reduce burnout and promote resilience and cohesion among CRCs, we developed a compassion-centered, team-based intervention, Compassion-Centered Spiritual Health Team Intervention (CCSH-TI).
METHODS:
Participants were CRCs working in disease-specific teams within a comprehensive cancer center. CRCs were randomly assigned by team to either participate in four 60-minute sessions of CCSH-TI or receive the intervention after the study. To evaluate whether CCSH-TI is feasible and acceptable, we used a mixed-method approach including self-report questionnaires and a focus group. To evaluate the impact of CCSH-TI, we assessed self-reported resilience, well-being, burnout, and team civility before and immediately after the intervention period (ClinicalTrials.gov identifier: NCT04060901).
RESULTS:
Attendance varied by team, but all teams had rates more than 60%. Coordinators rated high levels of credibility of CCSH-TI to improve burnout, and the majority reported that they received benefits, particularly in resilience and stress management, indicating acceptability. Coordinators randomly assigned to CCSH-TI reported an increase in resilience compared with coordinators randomly assigned to the wait-list group (F(41) = 4.53, P = .039).
CONCLUSION:
Data from this pilot study indicate that CCSH-TI may be a feasible, credible, acceptable, and effective intervention to augment individual resilience among CRCs. However, the quantitative and qualitative data suggest that more comprehensive and systematic programming is necessary to truly mitigate burnout.
The prevalence, grouping, and distribution of stressors and their association with anxiety among hospitalized patients
Citation
Palmer PK, Wehrmeyer K, Florian MP, Raison C, Idler E, Mascaro JS (2021). The prevalence, grouping, and distribution of stressors and their association with anxiety among hospitalized patients. PloS one,16(12): e0260921.
Abstract
Anxiety is prevalent among hospital inpatients and it has harmful effects on patient well-being and clinical outcomes. We aimed to characterize the sources of hospital distress and their relationship to anxiety. We conducted a cross-sectional study of inpatients (n = 271) throughout two Southeastern U.S. metropolitan hospitals. Participants completed a survey to identify which of 38 stressors they were experiencing. They also completed the State Trait Anxiety Inventory six-item scale. We evaluated the prevalence of stressors, their distribution, and crude association with anxiety. We then used multivariate logistic regression to estimate the association between stressors and clinically relevant anxiety, with and without adjusting for demographic variables. We used factor analysis to describe the interrelationships among stressors and to examine whether groups of stressors tend to be endorsed together. The following stressors were highly endorsed across all unit types: pain, being unable to sleep, feelings of frustration, being overwhelmed, and fear of the unknown. Stressors relating to isolation/meaninglessness and fear/frustration tend to be endorsed together. Stressors were more frequently endorsed by younger, female, and uninsured or Medicaid-insured patients and being female and uninsured was associated with anxiety in bivariate analysis. After controlling for the sources of distress in multivariate linear analysis, gender and insurance status no longer predicted anxiety. Feelings of isolation, lack of meaning, frustration, fear, or a loss of control were predictive. Study results suggest that multiple stressors are prevalent among hospital inpatients and relatively consistent across hospital unit and disease type. Interventions for anxiety or emotional/spiritual burden may be best targeted to stressors that are frequently endorsed or associated with anxiety, especially among young and female patients.
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Compassion Meditation Training for Hospital Chaplain Residents: A Pilot Study
Citation
Ash MJ, Walker ER, DiClemente RJ, Florian MP, Palmer PK, Wehrmeyer K, Regi LT, Grant GH, Raison CL, Mascaro JS (2020). Compassion Meditation Training for Hospital Chaplain residents: A Pilot Study. J Health Care Chaplain, Feb 13:1-16. doi: 10.1080/08854726.2020.1723189. [Epub ahead of print]
Abstract
This study examines the effectiveness of incorporating compassion meditation training into a clinical pastoral education (CPE) curriculum to enhance compassion satisfaction and reduce burnout among hospital chaplain residents. Specifically, a longitudinal, quasi-experimental design was used to examine the impact of Cognitively-Based Compassion Training (CBCT), a group-delivered compassion meditation intervention.
Hospital chaplain residents (n = 15) were assigned to participate in a CBCT intervention or a waitlist comparison group. Chaplains assigned to CBCT reported significant decreases in burnout and anxiety compared to the waitlist group; effects were not maintained at 4-month follow-up. Other outcomes, including compassion satisfaction, did not differ significantly but were trending in the expected direction. Findings suggest that compassion meditation training incorporated into CPE promotes chaplain wellbeing, although it may be necessary to extend CBCT throughout residency to sustain effects.
Training Healthcare Chaplains: Yesterday, Today and Tomorrow
Citation
Cadge W, Fitchett G, Haythorn T, Palmer PK, Rambo S, Clevenger C, Stroud E (2019). Training Healthcare Chaplains: Yesterday, Today and Tomorrow. J Pastoral Care Counsel, 73(4):211-221.
Abstract
This article invites theological school educators, clinical pastoral education educators, representatives of the professional healthcare chaplaincy organizations, and social scientists to begin a shared conversation about chaplaincy education. To date, we find that theological educators, clinical educators, professional chaplains, and the healthcare organizations where they work are not operating from or educating toward a common understanding of what makes healthcare chaplains effective.
Before we identify five key questions that might help us be in shared conversation and move towards educating the most effective chaplains, we briefly describe the history of education for healthcare chaplaincy. We then describe what we learned in interviews in 2018 with 21 theological and 19 clinical educators who are educating healthcare chaplains in theological schools and clinical pastoral education residency programs, year-long educational programs in hospitals and other settings that focus on preparing people for staff chaplain jobs. Their different approaches and frames inform the five questions with which we conclude.
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Training chaplains and spiritual caregivers: The Emergence and Growth of Chaplaincy Programs in the Theological Education
Citation
Cadge, W., Stroud, I.E., Palmer, P.K., Fitchett, G., Haythorn, T., Clevenger, C. (2020) Training Chaplains and Spiritual Caregivers: The Emergence and Growth of Chaplaincy Programs in Theological Education. Pastoral Psychol 69, 187–208.
Abstract
This paper describes the history of chaplaincy programs in theological education, the content of their curricula, the goals of the programs as described by faculty, and the programs’ approaches to issues of spiritual and religious diversity. It is based on a sample of 21 schools that offer specific chaplaincy education through masters of divinity or masters of arts degrees. We conducted semi-structured interviews with faculty at these schools and reviewed materials from course catalogues and other sources. We found substantial growth in chaplaincy-focused programs in theological schools in the last 20 years as well as the lack of standardization across them that one might expect in a rapidly growing field. The programs mostly developed independent of one another. They have not come to consensus about the skills and competencies chaplains need to do their work and have only engaged in that question across institutions in limited ways. As a group, these programs are also not well connected to clinical chaplaincy training or the day-to-day employment requirements of paid chaplaincy positions. We describe opportunities for collaboration that might strengthen this emerging field and better position it in the changing religious landscape.
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Practical matters and ultimate concerns, "Doing," and "Being": A diary study of the chaplain's role in the care of the seriously ill in an urban acute care hospital
Citation
Idler EL, Grant GH, Quest T, Binney Z, Perkins MM (2015). Practical matters and ultimate concerns, "Doing," and "Being": A diary study of the chaplain's role in the care of the seriously ill in an urban acute care hospital. Journal for the Scientific Study of Religion, 54(4): 722-738.
Abstract
Systematic observational studies of the chaplain’s role and function in the secular health-care setting are few. With an episode-based diary recorded on handheld digital tablets, palliative care chaplains at a large urban hospital with a diverse patient population recorded details of patient visits in near-real time. Cluster analysis revealed groups of activities we called "doing" and "being," and conversation topics of "practical matters" and "ultimate concerns”; chaplains were most satisfied with visits that involved all of these. Chaplains offer patients and families a space to express significant concerns; however, visits with spiritual or religious activities or topics were relatively rare. Broad quality of life concerns are central to the evolving professional role of chaplains in the secular setting of the modern hospital.
Workings of the human spirit in palliative care situations: a consensus model from the Chaplaincy Research Consortium
Citation
Emanuel L, Handzo G, Grant G, Massey K, et al. (2015). Workings of the human spirit in palliative care situations: a consensus model from the Chaplaincy Research Consortium. BMC Palliative Care, 14:29.
Abstract
Background: Chaplaincy is a relatively new discipline in medicine that provides for care of the human spirit in healthcare contexts for people of all worldviews. Studies indicate wide appreciation for its importance, yet empirical research is limited. Our purpose is to create a model of human spiritual processes and needs in palliative care situations so that researchers can locate their hypotheses in a common model which will evolve with relevant findings. Methods: The Model Building Subgroup worked with the Chaplaincy Research Consortium as part of a larger Templeton Foundation funded project to enhance research in the area. It met with members for an hour on three successive occasions over three years and exchanged drafts for open comment between meetings. All members of the Subgroup agreed on the final draft. Results: The model uses modestly adapted existing definitions and models. It describes the human experience of spirituality during serious illness in three renditions: visual, mathematical, and verbal so that researchers can use whichever is applicable. The visual rendition has four domains: spiritual, psychological, physical and social with process arrows and permeable boundaries between all areas. The mathematical rendition has the same four factors and is rendered as an integral equation, corresponding to an integrative function postulated for the human spirit. In both renditions, the model is notable in its allowance for direct spiritual experience and a domain or factor in its own right, not only experience that is created through the others. The model does not describe anything beyond the human experience. The verbal rendition builds on existing work to describe the processes of the human spirit, relating it to the four domains or factors. Conclusions: A consensus model of the human spirit to generate hypotheses and evolve based on data has been delineated. Implications of the model for how the human spirit functions and how the chaplain can care for the patient or family caregiver’s spiritual coping and well-being are discussed. The next step is to generate researchable hypotheses, results of research from which will give insight into the human spirit and guidance to chaplains caring for it.
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Religion as a Social Determinant of Public Health
Citation
Idler EL, Ed. (2014). Religion as a Social Determinant of Public Health. New York, NY: Oxford University Press.
Description
Frequently in partnership, but sometimes at odds, religious institutions and public health institutions work to improve the well-being of their communities. There is increasing awareness among public health professionals and the general public that the social conditions of poverty, lack of education, income inequality, poor working conditions, and experiences of discrimination play a dominant role in determining health status. But this broad view of the social determinants of health has largely ignored the role of religious practices and institutions in shaping the life conditions of billions around the globe.
In Religion as a Social Determinant of Public Health, leading scholars in the social sciences, public health, and religion address this omission by examining the embodied sacred practices of the world's religions, the history of alignment and tension between religious and public health institutions, the research on the health impact of religious practice throughout the life course, and the role of religious institutions in health and development efforts around the globe. In addition, the volume explores religion's role in the ongoing epidemics of HIV/AIDS and Alzheimer's disease, as well as preparations for an influenza pandemic. Together, these groundbreaking essays help complete the picture of the social determinants of health by including religion, which has until now been an invisible determinant.
Ways of Knowing Compassion: How Do We Come to Know, Understand, and Measure Compassion When We See It?
Citation
Mascaro JS, Florian MP, Ash MJ, Palmer PK, Frazier T, Condon P and Raison C (2020) Ways of Knowing Compassion: How Do We Come to Know, Understand, and Measure Compassion When We See It? Front. Psychol. 11:547241. doi: 10.3389/fpsyg.2020.547241
Abstract
Over the last decade, empirical research on compassion has burgeoned in the biomedical, clinical, translational, and foundational sciences. Increasingly sophisticated understandings and measures of compassion continue to emerge from the abundance of multidisciplinary and cross-disciplinary studies. Naturally, the diversity of research methods and theoretical frameworks employed presents a significant challenge to consensus and synthesis of this knowledge. To bring the empirical findings of separate and sometimes siloed disciplines into conversation with one another requires an examination of their disparate assumptions about what compassion is and how it can be known. Here, we present an integrated theoretical review of methodologies used in the empirical study of compassion. Our goal is to highlight the distinguishing features of each of these ways of knowing compassion, as well as the strengths and limitations of applying them to specific research questions. We hope this will provide useful tools for selecting methods that are tailored to explicit objectives (methods matching), taking advantage of methodological complementarity across disciplines (methods mixing), and incorporating the empirical study of compassion into fields in which it may be missing.
Education for professional chaplaincy in the US: mapping current practice in Clinical Pastoral Education (CPE)
Citation
Clevenger C, Cadge W, Stroud IE, Palmer PK, Haythorn T, Fitchett G. Education for professional chaplaincy in the US: mapping current practice in Clinical Pastoral Education (CPE). J Health Care Chaplain. 2020 Feb 7:1-16. doi: 10.1080/08854726.2020.1723191.
Abstract
In light of questions that have been raised about education for professional healthcare chaplaincy, we examined the skills and knowledge Clinical Pastoral Educators believe students need to perform the essential tasks and responsibilities of a chaplain. At 19 recently re-accredited ACPE centers across the country, we asked educators about the knowledge chaplains need to be effective, the specific content areas they teach, and how didactic education is planned and organized within their programs. Beyond a focus on religious diversity, we found little consensus among educators regarding a core knowledge base that should be taught during CPE. While most respondents in our study recognize the importance of didactic education in preparing students to become chaplains, there is a lack of consistency in didactic curricula across programs. Our findings suggest the need for broader conversation and collaboration among educators, national chaplaincy organizations, and theological schools regarding the goals, priorities, and outcomes of CPE.