FACULTY Q&A

The majority of Americans say they are aware of chaplains and desire their services, yet few report previous experience with them in health care, according to a University of Michigan study.

Geila Rajaee

Lead author Geila Rajaee, a doctoral candidate at the U-M School of Public Health, discusses how chaplaincy is perceived in the U.S., and how that might be changing during the pandemic.

Your research took place before the beginning of the coronavirus pandemic. How has it affected the field of chaplaincy?

There has been a significant uptick in awareness of chaplains because of their role in responding to COVID-19 and supporting patients in the hospital with COVID-19 and their family members who couldn’t be there in person as well as clinical staff. I think we’ve seen a significant rise in attention as to what role they actually play because of the pandemic, even though they are more in the background than others on the health care team.

How has the pandemic affected how people evaluate their lives?

For most people, existential questions—”What’s going to happen tomorrow? What’s tomorrow going to look like? Will I be around tomorrow?”—tend to arise when they or a person they love has had a critical illness or injury. Chaplains often work in this space, helping people explore these ‘big’ questions while receiving medical care.

But what the COVID-19 pandemic has done is pushed those questions to the forefront: “What does my life mean? What’s going to happen to me? Will I be here in three months, six months, a year? What about the people that I love? What’s most important to me? Should I keep doing what I’ve been doing, or should I change course?”

My guess is that if we started asking everyday folks, we’d find that a lot more people are expressing existential or spiritual struggle than before the start of the pandemic. They may not articulate using religious language, but it may be questions like, “What is my purpose? What are my values? You know, who am I in this new reality?” But it may also include feelings of anger, abandonment or punishment that are internally and externally focused. And those are the types of questions and existential needs that chaplains are specifically trained to engage with in a clinical setting.

What led your interest in this research?

Prior to returning to Michigan for my master’s in public health, I worked as a clinical chaplain for almost a decade. My experience working in hospice, trauma/acute care and oncology has inspired me to better understand the impact that chaplains make clinically and increase the evidence base of the field. That includes learning more about how people perceive or are aware of chaplains.

What are the practical implications for your research?

In our study, we looked at the awareness and perceptions of U.S. adults as it related to health care chaplains. We found that there may be a gap between what people know and maybe what they think they know: Around 85% of participants indicated awareness of chaplains. However, less than 20% said they had had any contact with them. From my professional experience, most people I worked with had an idea of what a chaplain was, but it usually wasn’t entirely correct.

One of the questions that have come out of this work is, does there need to be greater educational work done to help clarify the role of a healthcare chaplain and what they do and don’t do? I think in a very practical sense, this research can help guide patient and family education within health care settings. I also think it tells us a little bit about what patients might want when we look at what services they may or may not want in different settings.

Is there something that was surprising about your findings?

What was interesting is that more often than not, the participants in the study indicated that they didn’t want services that were more religiously oriented. Services like finding resources for spiritual coping or exploring their religious or spiritual concerns were not of great interest. However, they were more interested in these broader and more existential questions, like to explore their values as it relates to their treatment decisions, to discuss what was most important in the event of a life-threatening illness or injury.

These are bigger, broader existential questions, and they are not necessarily encapsulated by religion.

What would you like people to know about chaplains?

Health care chaplains don’t proselytize or push any one religious tradition or perspective. They work within your religious framework or your framework of meaning. Although most of them come from a faith tradition, there are humanist and nonreligious chaplains, as well. Chaplain training focuses on working within whatever the other person’s source of meaning is, whether it is religious or nonreligious.

Why do you think your study is important?

This paper is important for a couple of reasons. First of all, it fills a literature gap about what people think or believe about chaplains, their experiences with them, or what kinds of services people might want. Second, people in the U.S. becoming less traditionally religious doesn’t mean they don’t have those existential needs and questions.

Given that a significant proportion of our participants wanted to explore what was most important to them in the event of a critical injury or illness tells me that the need for chaplains still exists. What’s my sense of purpose or source of meaning in this moment of crisis? What are my values while experiencing loss or pain? Those existential questions don’t go away, and they aren’t only for those who consider themselves religious.

Rajaee’s study is called “Awareness and preferences for healthcare chaplaincy services among U.S. adults.” Senior author is Minal Patel, professor of health behavior and health education at U-M’s School of Public Health. In the study, Rajaee reported personal fees from UnitedHealthcare, Transforming Chaplaincy and the Association of Clinical Pastoral Education.