Chaplain family project multicenter RCT

The National Institute on Aging awarded $719,068 to the Trustees of Indiana University, doing business as Indiana University Indianapolis, on September 30, 2025, under the Aging Research program (CFDA 93.866) to conduct a multicenter randomized controlled trial of chaplain-delivered spiritual care for intensive care unit family surrogates.

The project, titled "Chaplain Family Project Multicenter RCT," develops and tests the Spiritual Care Assessment and Intervention (SCAI) framework—a structured intervention combining intensive spiritual and psychological support delivered by trained healthcare chaplains to family members of ICU patients. The prior single-site trial demonstrated improved spiritual and psychological well-being for ICU surrogates; this expansion tests reproducibility across multiple academic medical centers. Work is performed in Indianapolis, Indiana, with an ultimate completion date of August 31, 2027.

Three sub-recipients deliver site-specific implementation and research support. Wake Forest University Health Sciences (Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina) serves as a recruitment and intervention site, operating seven ICUs with approximately 117 beds; site investigators Dr. Jennifer Gabbard and Dr. Erica Frechman oversee enrollment and intervention delivery by hired chaplain staff. The Regents of the University of California, San Francisco contributes research staff for patient identification, informed consent, survey administration, and chaplain intervention delivery; site investigator Rev. Susan Conrad leads implementation. The Regenstrief Institute Inc. manages all operational aspects of study execution, including IRB applications, participant enrollment coordination, survey administration, data management, and procurement of incentive materials and study supplies, under the direction of Joan Showalter, Director of Operations.

Abstract

ICU admission is a major life crisis that can result in severe distress for the patient's family, both during and after the hospitalization. This includes psychological distress such as anxiety and posttraumatic stress and also spiritual distress, including crises of meaning, purpose, or religious faith. Facing life and death decisions as the surrogate decision maker or experiencing the patient's death further increases distress. Prior interventions to support ICU surrogate decision makers have affected end of life care such as ICU length of stay for patients who DIE during hospitalization, but few have impacted surrogate well-being. We propose that for an ICU intervention to improve surrogate well-being, IT must provide intensive spiritual and psychological support. Healthcare chaplains are highly trained professionals who provide spiritual and emotional support to patients and family members of all faiths and those with no faith affiliation in the healthcare setting. Chaplains are trained to listen deeply to an individual's religious and cultural experiences, providing opportunities to improve the care of marginalized groups who have faced discrimination in healthcare. Connecting religious or spiritual concerns and medical decisions also is a chaplain's skill. Although chaplains are part of the healthcare team in many US ICU's, research about the outcomes associated with chaplains' spiritual care is just emerging, and nearly all available randomized trials examined the effects of chaplains on patient outcomes. To address the need for interventions that reduce surrogate distress, our team has developed the spiritual care assessment and intervention (scai) framework, an intervention for ICU surrogates that is rigorous, reproducible and consistent with spiritual care standards of practice. Our prior, single site randomized trial of the scai framework in the ICU demonstrated improved spiritual and psychological well-being for ICU surrogates in the intervention group, but the study population lacked religious and ethnic diversity. We now propose an NIH stage 3 multi-center, randomized, attention controlled clinical trial of the scai framework for surrogates to evaluate efficacy in a sample with geographic, religious, racial and ethnic diversity. The study will take place in 6 geographically diverse sites that are also diverse in terms of religion, race and ethnicity. The intervention will be delivered by skilled and highly trained chaplains. Specific aims are: to demonstrate the effects of chaplain- delivered spiritual care on psychological and spiritual outcomes including anxiety, distress, spiritual well-being, posttraumatic stress symptoms and complicated grief; to demonstrate the impact of chaplain-delivered spiritual care on medical decision making; and to examine the effects of spiritual care among historically underserved racial and religious subgroups. Results will guide hospital leaders, policy makers and the healthcare team regarding chaplains' role in improving surrogates' psychological and spiritual health and the quality of decisions for critically ILL patients.