Open Access Highly Accessed Research article

A national study of chaplaincy services and end-of-life outcomes

Kevin J Flannelly1, Linda L Emanuel2*, George F Handzo3, Kathleen Galek4, Nava R Silton5 and Melissa Carlson6

Author Affiliations

1 The Spears Research Institute, HealthCare Chaplaincy, 307 East 60th Street, New York, NY, 10022, USA

2 Buehler Center on Aging, Health & Society, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 601, Chicago, IL, 60611, USA

3 HealthCare Chaplaincy, 307 East 60th Street, New York, NY, 10022, USA

4 The Spears Research Institute, HealthCare Chaplaincy, 307 East 60th Street, New York, NY, 10022, USA

5 Department of Psychology, Marymount Manhattan College, 221 East 71st Street, New York, NY, 10021, USA

6 Mount Sinai School of Medicine, Annenberg Building Floor 10, 1468 Madison Avenue, New York, NY, 10029, USA

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BMC Palliative Care 2012, 11:10  doi:10.1186/1472-684X-11-10

Published: 2 July 2012



Medicine has long acknowledged the role of chaplains in healthcare, but there is little research on the relationship between chaplaincy care and health outcomes. The present study examines the association between chaplaincy services and end-of-life care service choices.


HealthCare Chaplaincy purchased the AHA survey database from the American Hospital Association. The Dartmouth Atlas of Health Care database was provided to HealthCare Chaplaincy by The Dartmouth Institute for Health Policy & Clinical Practice, with the permission of Dartmouth Atlas Co-Principal Investigator Elliot S. Fisher, M.D., M.P.H. The Dartmouth Atlas of Health Care is available interactively on-line at webcite. Patient data are aggregated at the hospital level in the Dartmouth Atlas of Health Care. IRB approval was not sought for the project because the data are available to the public through one means or another, and neither database contains data about individual patients, i.e. all the variables are measures of hospital characteristics. We combined and analyzed data from the American Hospital Association’s Annual Survey and outcome data from The Dartmouth Atlas of Health Care in a cross-sectional study of 3,585 hospitals. Two outcomes were examined: the percent of patients who (1) died in the hospital, and (2) were enrolled in hospice. Ordinary least squares regression was used to measure the association between the provision of chaplaincy services and each of the outcomes, controlling for six factors associated with hospital death rates.

Results and discussion

The analyses found significantly lower rates of hospital deaths (β = .04, p < .05) and higher rates of hospice enrollment (β = .06, p < .001) for patients cared for in hospitals that provided chaplaincy services compared to hospitals that did not.


The findings suggest that chaplaincy services may play a role in increasing hospice enrollment. This may be attributable to chaplains’ assistance to patients and families in making decisions about care at the end-of-life, perhaps by aligning their values and wishes with actual treatment plans. Additional research is warranted.

Chaplaincy care; Pastoral care; Health outcomes; End-of-life care; Hospice