professors austyn snowden & ewan...
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PROFESSORSAUSTYN SNOWDEN& EWAN KELLYWHAT NEXT FOR THE PROM?
LAUNCH OF ERICHLEUVEN UNIVERSITY6TH JUNE 2017
WHAT NEXT FOR THE PROM?
OVERVIEW▸ The past:
▸ Context
▸ The PROM
▸ What we’ve found out along the way
▸ Some things we didn’t expect
▸ The present
▸ The future
SHOW OFF…
ABOUT ME
▸ 56yr old from Yorkshire, married, 1 daughter
▸ 20 years as clinical mental health nurse
▸ Worked in Australia, Saudi, Channel Isles, England and:
▸ Scotland for last 18 years: rediscovered academia 2006
▸ PhD therapeutic relationship and concurrent analysis
▸ 70 peer review articles, 3 books, 15 chapters, 10 reports
▸ Professor 2011 (UWS), grade 2 prof 2015.
▸ Working on PROM with Iain Telfer and Ewan Kelly since 2010
54%Christian
9%‘Other’.
37%Not religious
CONTEXT: FAITH AND BELIEF IN SCOTLAND
FAITH/BELIEF SCOTLAND
Christian
Not religious
Other faithKey
WHAT ABOUT THE REST OF THE WORLD?
‘SPIRITUAL BUT NOT RELIGIOUS’. VALUES REPRESENT:% PEOPLE QUESTIONING MEANING OF LIFE MINUS % PEOPLE WHO ARE RELIGIOUS.
-20
0
20
40
60More questioning than religious
More religious than questioning
(Zimmer et al 2016)
WHAT NEXT FOR THE PROM?
CONTEXT▸ The PROM has been validated in a Scottish Population.
▸ Whether the PROM will behave in the same way in a different culture needs to be tested.
THE SCOTTISH PROM
BIOGRAPHICAL INFORMATION
THE SCOTTISH PROM
During your visit with the chaplain: None of Some of All of the
When you were in hospital recently you saw a chaplain. This questionnaire is designed to help us understand how the chaplain helped you. You do not have to complete it, but your answers will be treated in the strictest confidence if you do.
Name Age
Address How would you describe yourself?
Postcode Religious
Male Spiritual
Female Both
Other Neither
Austyn Snowden
Springfield farm, Carluke
ML8 3QZ
33
PART 1
THE SCOTTISH PROM: PART 1
During your visit with the chaplain: None of Some of All of the
During your visit with the chaplain: None of the time Rarely
Some of the time
OftenAll of the time
I was listened to
My faith/beliefs were valued
I was able to talk about what was on my mind
My situation was understood
This first set of questions asks about your experience(s) when you met with the chaplain. Please think about how you felt at that time. For each statement please tick the box that best describes your experience(s).
Age, gender and whether religious, spiritual, both or neither.
PART 2: THE PROM QUESTIONS
THE SCOTTISH PROM: PART 2
During your visit with the chaplain: None of Some of All of the
This next set of questions covers the outcomes that seem to be important to people receiving spiritual care. For each statement please tick the box that best describes your experience over the last two weeks.
Over the last two weeks I have felt: None of the time Rarely
Some of the time
OftenAll of the time
I could be honest with myself about how I was really feeling
anxious
I had a positive outlook on my situation
in control of my life
a sense of peace
PART 3: FREE TEXT
THE SCOTTISH PROM: PART 3Finally, please feel free to add any additional comments aboutyour experiences with the chaplain service.
Thank you very much for completing this questionnaire.Please return in envelope to A.N Other, address.©NHSEducationforScotland2014.YoucancopyorreproducetheinformationinthisdocumentforusewithinNHSScotlandandfornon-commercialeducationalpurposes.UseofthisdocumentforcommercialpurposesispermittedonlywiththewrittenpermissionofNES.
I felt listened to and understood. Thank you
ADD SCORES FROM SECTION TWO TO OBTAIN PROM SCORE
SCORING THE PROM: DON’T FORGET TO REVERSE ‘ANXIETY’
Honest Anxious Outlook Control Peace TOTAL
Patient 1 4 (4-)1=3 4 2 3 16
Patient 2 2 (4-)3=1 2 1 2 8
Patient 3 3 (4-)2=2 3 2 3 13
Patient 4 2 (4-)3=1 1 1 1 6
Patient n 4 (4-)1=3 4 3 3 17
VALID AND RELIABLE: SO WHAT DOES IT MEAN?
UNDERSTANDING SCORES
▸ Great range, especially in comparison to e.g. CARE
▸ What score would indicate someone spiritually unwell?
0 12.5 25 37.5 50
zerotwofour
sixeight
tentwelve
fourteensixteen
eighteentwenty
PROM Score Interpretation0 to 5: Lost
Refer to chaplain immediately. Consider admission
PROM Score
0
5
10
15
20
PROM Score
PROM Score Interpretation5 to 10: Spiritually poor
Refer to chaplain
0
5
10
15
20
PROM Score Interpretation10 to 15: Spiritually well
Probably in normal range
PROM Score
0
5
10
15
20
PROM Score Interpretation15 to 20: Inspired
Be jealous?
PROM Score
0
5
10
15
20
TEXT
WHAT DO THE PROM SCORES MEAN?
▸ Rasch analysis: item fit, DIF, item difficulty
▸ Further tests comparing PROM with EQ5D, HADS etc
FURTHER CALIBRATION OF THE PROM
BEFORE AND AFTER: CCL STUDY IN SCOTLAND
0
5
10
15
20
PROM Score after chaplain
0
5
10
15
20
PROM Score before chaplain
EQ5D Score before chaplain EQ5D Score after chaplain
Eq-5D Eq-5D
THINGS WE DIDN’T EXPECT
UNEXPECTED FINDING
I WAS ABLE TO TALK ABOUT WHAT WAS ON MY MIND
▸ Why?
is even more important than
being listened to
‘I was able to talk
about what was on my
mind’
THIS RELATIONSHIP HOLDS IN ALL THE STUDIES USING THE PROM SO FAR.
RELATIONSHIP BETWEEN ‘BEING ABLE TO TALK…’ AND PROM SCORE
0
1
2
3
4
5
Zero 5 10 15 20
Scottish PROM total scores
OK…
WHAT DOES THIS MEAN?
▸ Being ‘able to talk about what was on my mind’ is the most important element of the chaplain encounter for patients.
▸ More important than being listened to, being understood, or having my faith/beliefs valued.
▸ This means there is an important distinction between being able to talk freely and having someone listen to you.
▸ This requires further exploration because it lends itself to important intervention: ‘tell me about what is on your mind’.
COURTEOUS BUT NOT CURIOUS?
Agledahl, Gulbrandsen,Forde, Wifstad
How doctors' politeness masks their existential neglect.
GP FEEDBACKCCL STUDY
Decreased attendance shared
responsibility decreased prescribing
uncovering of hidden issues
GP Ayrshire
Reduced attendance at surgery, mood improvement, less use
antidepressants,benefit from time and sharing
issues GP Lothian
Less attendance, improved mood,
better ability to copewith life and chronic
disease GP Ayrshire
CPN or offered repeated GP appts for non-medical
support.
GP Highlands
sometimes there is no other option other than to
continue to see the patient oneself but with less time
and less effect.
GP Scotland
CMHT referral, antidepressant
prescribingGP Scotland
If CCL wasn’t there:
Outcomes of CCL referral:
COST EFFECTIVENESS ANALYSIS
IF CHAPLAINS SAVE GPS TIME, REDUCE PRESCRIBING AND ATTENDANCE…
SPIRITUAL CARE PROM AND ERICH
Funding received by ERICH to develop a research programme to support and perform specialist Spiritual Care Patient Reported Outcome Measure (PROM) research across 6 European countries in the next 3 years.
AIMS OF PROM PROGRAMME
▸ Promote, initiate and support PROM research in 6 European Countries. ▸ Gather evidence of positive effects of spiritual
care by chaplains in Scotland is validated by PROM research in other European Countries
▸ Research education and support for chaplains▸ Dissemination of findings
(AS AGREED WITH FUNDERS)
HOW?
▸ Develop collaborative partnerships with chaplains/chaplaincy organisations in each participating country
▸ Utilise a cascade model of rollout
Education, mentoring and support for each locality
Local PROM champion
Empower and encourage chaplains
Local administration
WHAT ….INVOLVED FOR CHAPLAINS?
▸ Recruitment of patients
‣ Filling in referral form – reflection and debrief as part of daily routine
▸ Referral form to local administrator
WHO?
Conversations with possible chaplaincy collaborators:▸ The Netherlands
▸ Belgium
▸ Ireland▸ Finland
▸ Czech Republic
▸ Malta▸ Association of Hospice and Palliative Care Chaplains (UK)
ROLE OF ERICH’S STAFFStrategic Direction Director
Central Administration Co-ordinator
Education
Enablement and support Research Co-ordinator
Co-ordination with sites
Develop protocol/ethics support Lead
Analysis of data Researcher
Partner in dissemination of findings
WHAT NEXT FOR THE PROM?
OVERVIEW▸ The past:
▸ Context
▸ The PROM
▸ What we’ve found out along the way
▸ Some things we didn’t expect
▸ The present
▸ The future…?
THANK YOU FOR LISTENING
REFERENCESSnowden, A., & Telfer, I. J. M. (2017). A Patient Reported
Outcome Measure of Spiritual care as delivered by Chaplains. Journal of Health Care Chaplaincy, 1–25. http://doi.org/10.1080/08854726.2017.1279935
Zimmer, Z., Jagger, C., Chiu, C.-T., Ofstedal, M. B., Rojo, F., & Saito, Y. (2016). Spirituality, religiosity, aging and health in global perspective: A review. SSM - Population Health, 2, 373–381. http://doi.org/10.1016/j.ssmph.2016.04.009
@austynsnowden [email protected]