• Alexia M Torke, Shelley E Varner-Perez, Emily S Burke, Tracy A Taylor, James E Slaven, Kathryn L Kozinski, Saneta M Maiko, Bruce J Pfeffer, and Sarah K Banks.
• Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, Indiana; Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University Health, Indianapolis, Indiana; IU Center for Aging Research (A.M.T., S.E.V.P., E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana. Electronic address: atorke@iu.edu.
• J Pain Symptom Manage. 2023 Apr 1; 65 (4): 296307296-307.

ContextCritical illness of a family member is associated with high emotional and spiritual distress and difficult medical decisions.ObjectivesTo determine if a semistructured spiritual care intervention improves the well-being of family surrogate decision makers in intensive care (ICU) settings.MethodsThis study is a randomized, allocation-concealed, parallel group, usual care-controlled, single-blind trial of patient/surrogate dyads in five ICUs in one Midwest, academic medical center. Patients were 18 and older admitted to the ICU and unable to make medical decisions. The intervention involved proactive contact from the chaplain, scheduled, semi-structured visits, weekly follow-up, and bereavement calls. The control group received usual care. The primary endpoint was the surrogate's anxiety (Generalized Anxiety Disorders-7 scale), six to eight weeks after discharge.ResultsOf 192 patient/surrogate dyads enrolled, 128 completed outcome assessments. At follow-up, anxiety in the intervention group was lower than control (median score 1 (interquartile range 0,6) vs. 4 (1,9), P = 0.0057). The proportion of patients with a minimal clinically important difference (MCID) in anxiety of 2+ was 65.2% in the intervention group vs. 49.2% in control. The odds of an MCID remained higher in adjusted analysis (Odds Ratio 3.11, 95% confidence interval 1.18, 8.21; P = 0.0218) The adjusted odds of an MCID were higher for spiritual well-being (OR 3.79, CI 1.41,10.17; P = 0.0081). Satisfaction with spiritual care was also higher (adjusted mean 3.5 ± 0.4 vs. 2.9 ± 0.1); P < .0001).ConclusionsProactive, semistructured spiritual care delivered by chaplains improves well-being for ICU surrogates. Results provide evidence for inclusion of chaplains in palliative and intensive care teams.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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