title: End-of-life spiritual care at a VA medical center: chaplains' perspectives.
abstract: OBJECTIVE
  Spiritual care is an essential component of quality palliative care. Recognizing the importance, the Department of Veterans Affairs (VA) mandates the inclusion of chaplains in a palliative care consult team (PCCT). The purpose of this study is to explain the process and content of spiritual care provided in a VA Medical Center from chaplains' perspectives.
  
  
  METHODS
  Five Christian chaplains who provide care to patients at end of life were interviewed. Each interview was recorded and transcribed. Analysis based on the grounded theory was used to identify themes from each interview question.
  
  
  RESULTS
  The PCCT in this study appeared to have a strong referral and communication system in which every palliative care patient was seen by a chaplain and the care plan was discussed with an interdisciplinary team. Chaplains reported providing a range of services, which addressed religious, spiritual, emotional, family, and illness concerns. Chaplains were aware of the unique spiritual needs of veterans, including working through guilt for killing in war and requiring forgiveness. Chaplains' ideas for improvement of spiritual care services included increasing time to provide care, providing bereavement care and support to families, and adding chaplains with different religious backgrounds. Chaplains reported how their own spirituality influenced the care they provided.
  
  
  CONCLUSIONS
  Spiritual care in the VA can include a range of services and should consider the unique needs of the veteran population. Future studies can build upon our findings from chaplains to learn about the perspectives of patients, family, and other healthcare providers of spiritual care. This information would allow identification of strengths of current spiritual care practices and areas for care improvement, and ultimately could improve the well-being of patients at the end of life.
authors.affiliation: VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Bei-Hung
authors.initials: BH
authors.lastname: Chang
authors.affiliation: VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Stein
authors.affiliation: Dana Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Kelly
authors.initials: K
authors.lastname: Trevino
authors.affiliation: VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Max
authors.initials: M
authors.lastname: Stewart
authors.affiliation: VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Ann
authors.initials: A
authors.lastname: Hendricks
authors.affiliation: VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Lara M
authors.initials: LM
authors.lastname: Skarf
mesh_terms: D002835:Christianity / Q000523:psychology; D002977:Clergy / Q000523:psychology*; D005260:Female; D066296:Grounded Theory; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010327:Pastoral Care / Q000379:methods*; D029181:Spirituality; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D014481:United States; D014728:Veterans / Q000523:psychology*