The Efficacy of Spiritual Care Intervention on Readmissions of Hospitalized Patients Receiving Palliative Care: A Quasi-Experimental Pilot Study Proposal
Restricted accessResearch articleFirst published online 2026
The Efficacy of Spiritual Care Intervention on Readmissions of Hospitalized Patients Receiving Palliative Care: A Quasi-Experimental Pilot Study Proposal
Hospital readmissions in the US place a considerable burden on patients and their caregivers. Our study will investigate whether spiritual intervention during a patient’s hospital stay contributes to lower rates of readmissions 30 days after hospital discharge.
Methods
Two hundred patients receiving palliative care will be randomized into control (n = 100) and intervention groups (n = 100). The control group will receive a standard spiritual support visit, while the intervention group will receive a spiritual intervention consisting of active listening, compassionate presence, assessment of post-discharge resources, and a supportive phone call 5 to 7 days after discharge. The primary outcome will be hospital readmission within 30 days of discharge. Board-certified chaplains will be allowed to use their individual skillsets but within the standardized ACA spiritual care model. Training chaplains to assess patients in the same way will help with this discrepancy as the same form will be used.
Discussion
We hypothesize that patients who receive spiritual intervention with a supportive phone call will experience fewer hospital readmissions. Spiritual intervention will instill.confidence in those patients at risk of readmission by assuring them that the hospital staff remain concerned about their well-being even after discharge.
WeissAJJiangHJ. Overview of Clinical Conditions with Frequent and Costly Hospital Readmissions by Payer, 2018. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs; 2006.
3.
PyakuryalBPudasaineePSharmaA, et al.Emergency department and observation revisits and the hospital readmission reduction program. JAMA Netw Open. 2025;8(7):e2524135. doi:10.1001/jamanetworkopen.2025.24135.
4.
WrightB. In pursuit of a better hospital quality metric for medicare. JAMA Netw Open. 2025;8(7):e2524138. doi:10.1001/jamanetworkopen.2025.24138.
5.
BrownEGBoldRJ. Hospital readmissions: are they preventable?Adv Surg. 2015;49:15-29. doi:10.1016/j.yasu.2015.03.013.
6.
FancherKGWilliamsMV. Hospital readmissions: new pandemic, same old problems?Joint Comm J Qual Patient Saf. 2021;47(11):684-685. doi:10.1016/j.jcjq.2021.09.006.
7.
Garcia-ArceARicoFZayas-CastroJL. Comparison of machine learning algorithms for the prediction of preventable hospital readmissions. J Healthc Qual. 2018;40(3):129-138. doi:10.1097/JHQ.0000000000000080.
8.
HenkeRMKaracaZLinHWierLMMarderWWongHS. Patient factors contributing to variation in same-hospital readmission rate. Med Care Res Rev. 2015;72(3):338-358. doi:10.1177/1077558715577478.
9.
MarafinoBJSchulerALiuVXEscobarGJBaiocchiM. Predicting preventable hospital readmissions with causal machine learning. Health Serv Res. 2020;55(6):993-1002. doi:10.1111/1475-6773.13586.
10.
PooniABrarMSAnpalaganT, et al.Home to stay: a randomized controlled trial evaluating the effect of a postdischarge Mobile app to reduce 30-Day readmission following elective colorectal surgery. Ann Surg. 2023;277(5):e1056-e1062. doi:10.1097/SLA.0000000000005527.
11.
ShusterCHurlburtAYungTWanTStaplesJATamP. Preventability of 28-day hospital readmissions in general internal medicine patients: a retrospective analysis at a quaternary hospital. Qual Manag Health Care. 2018;27(3):151-156. doi:10.1097/QMH.0000000000000174.
12.
KingLHarringtonANichollsSThorntonKTannerE. Towards reduction of preventable hospital readmission: older people and family members’ views on planned self-management of care at home. J Clin Nurs. 2023;32(15-16):4599-4613. doi:10.1111/jocn.16492.
13.
LunderengEDNesAAGHolmenH, et al.Health care professionals’ experiences and perspectives on using telehealth for home-based palliative care: scoping review. J Med Internet Res. 2023;25:e43429. doi:10.2196/43429.
14.
SteindalSANesAAGGodskesenTE, et al.Advantages and challenges of using telehealth for home-based palliative care: systematic mixed studies review. J Med Internet Res. 2023;25:e43684. doi:10.2196/43684.
15.
BowerKAHallockJLiXKentTWardlowL. Cost and utilization implications of a health plan's home-based palliative care program. J Palliat Med. 2024;27(4):464-470. doi:10.1089/jpm.2023.0401.
16.
CharkvianiMSimonettoDAAhrensDJ, et al.Conceptualization of remote patient monitoring program for patients with complex medical illness on hospital dismissal. Mayo Clin Proc Digit Health. 2023;1(4):586-595. doi:10.1016/j.mcpdig.2023.09.005.
17.
FultonJJLeBlancTWCutsonTM, et al.Integrated outpatient palliative care for patients with advanced cancer: a systematic review and meta-analysis. Palliat Med. 2019;33(2):123-134. doi:10.1177/0269216318812633.
18.
WangYFerreiraESavageauJ, et al.Community-based pediatric palliative care: how services support children’s and families’ quality of life. J Palliat Med. 2023;26(12):1634-1643. doi:10.1089/jpm.2023.0147.
19.
GayJCAgrawalRAugerKA, et al.Rates and impact of potentially preventable readmissions at children’s hospitals. J Pediatr. 2015;166(3):613-619. e5. doi:10.1016/j.jpeds.2014.10.052.
20.
CassellJBKerrKMMcClishDK, et al. Effect of a home-based palliative care program on healthcare use and costs. J Am Geriatr Soc. 2016;64(11):2288-2295. doi:10.1111/jgs.14354
21.
Gonzalez-JaramilloVFuhrerVGonzalez-JaramilloNKopp-HeimDEychmullerSMaessenM. Impact of home-based palliative care on health care costs and hospital use: a systematic review. Palliat Support Care. 2021;19(4):474-487. doi:10.1017/S1478951520001315.
22.
LustbaderDMudraMRomanoC, et al.The impact of a home-based palliative care program in an accountable care organization. J Palliat Med. 2017;20(1):23-28. doi:10.1089/jpm.2016.0265.
23.
LutaXOttinoBHallP, et al.Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews. BMC Palliat Care. 2021;20(1):89. doi:10.1186/s12904-021-00782-7.
24.
MeggyesyAMBuehlerKEWilshireCL, et al.Utilization of palliative care resource remains low, consuming potentially avoidable hospital admissions in stage IV non-small cell lung cancer: a community-based retrospective review. Support Care Cancer. 2022;30(12):10117-10126. doi:10.1007/s00520-022-07364-0.
25.
TangemanJCRudraCBKerrCWGrantPC. A hospice-hospital partnership: reducing hospitalization costs and 30-day readmissions among seriously ill adults. J Palliat Med. 2014;17(9):1005-1010. doi:10.1089/jpm.2013.0612.
26.
AounSMBearNRumboldB. The compassionate communities connectors program: effect on healthcare usage. Palliat Care Soc Pract. 2023;17:26323524231205323. doi:10.1177/26323524231205323.
27.
HentschelLWellesenAKrauseLC, et al.Predicting unplanned hospital readmission in palliative outpatients (PRePP) - study protocol of a longitudinal, prospective study to identify informal caregiver-related and structural predictors. BMC Palliat Care. 2022;21(1):62. doi:10.1186/s12904-022-00955-y.
28.
IsenbergSRMeaneyCMayP, et al.The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015. BMC Health Serv Res. 2021;21(1):331. doi:10.1186/s12913-021-06335-1.
29.
PascalLPolazziSPiriouV, et al.Hospital length of stay reduction over time and patient readmission for severe adverse events following surgery. Ann Surg. 2020;272(1):105-112. doi:10.1097/SLA.0000000000003206.
30.
SoltaniMFarahmandMPourghaderiAR. Machine learning-based demand forecasting in cancer palliative care home hospitalization. J Biomed Inf. 2022;130:104075. doi:10.1016/j.jbi.2022.104075.
31.
YangLHollisCStewartE, et al.Evaluation of palliative care related hospital admissions in a regional centre. Am J Hops Palliat Care. 2024;41(9):1058-1060. doi:10.1177/10499091231211470.
32.
BestMButowPOlverI. Doctors discussing religion and spirituality: a systematic literature review. Palliat Med. 2016;30(4):327-337. doi:10.1177/0269216315600912.
33.
HebertRSSchulzRCopelandVArnoldRM. What questions do family caregivers want to discuss with health care providers in order to prepare for the death of a loved one? an ethnographic study of caregivers of patients at end of life. J Palliat Med. 2008;11(3):476-483. doi:10.1089/jpm.2007.0165.
34.
PhelpsACLauderdaleKEAlcornS, et al.Addressing spirituality within the care of patients at the end of life: perspectives of patients with advanced cancer, oncologists, and oncology nurses. J Clin Oncol. 2012;30(20):2538-2544. doi:10.1200/JCO.2011.40.3766.
35.
BabamohamadiHKadkhodaei-ElyaderaniHEbrahimianAGhorbaniR. The effect of spiritual care based on the sound heart model on the spiritual health of patients with acute myocardial infarction. J Relig Health. 2020;59(5):2638-2653. doi:10.1007/s10943-020-01003-w.
36.
Citra WisudaASansuwitoT. Spiritual care needs in patients with coronary heart disease: literature review. Jurnal Inspirasi Kesehatan. 2023;1:139-148. doi:10.52523/jika.v1i2.40.
37.
KoenigHGKingDECarsonVB. Handbook of Religion and Health. Oxford Univeristy Press; 2012.
38.
LoBRustonDKatesLW, et al.Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA. 2002;287(6):749-754. doi:10.1001/jama.287.6.749.
39.
TorkeAMVarner-PerezSEBurkeES, et al.Effects of spiritual care on well-being of intensive care family surrogates: a clinical trial. J Pain Symptom Manag. 2023;65(4):296-307. doi:10.1016/j.jpainsymman.2022.12.007.
40.
van de GeerJVeegerNGrootM, et al.Multidisciplinary training on spiritual care for patients in palliative care trajectories improves the attitudes and competencies of hospital medical staff: results of a quasi-experimental study. Am J Hops Palliat Care. 2018;35(2):218-228. doi:10.1177/1049909117692959.
41.
KoenigHGVanderWeeleTPeteetJR. Handbook of Religion and Health. Oxford University Press; 2024.
42.
AlghanimFFurqanMPrichettL, et al.The effect of chaplain patient navigators and multidisciplinary family meetings on patient outcomes in the ICU: the critical care collaboration and communication project. Crit Care Explor. 2021;3(11):e0574. doi:10.1097/CCE.0000000000000574.
43.
AntoineAFitchettGSharmaV, et al.How do healthcare executives understand and make decisions about spiritual care provision?South Med J. 2021;114(4):207-212. doi:10.14423/SMJ.0000000000001230.
44.
MaCBaoSDullPWuBYuF. Hospital readmission in persons with dementia: a systematic review. Int J Geriatr Psychiatr. 2019;34(8):1170-1184. doi:10.1002/gps.5140.
45.
McDermottKWRoemerM. Most Frequent Principal Diagnoses for Inpatient Stays in U.S. Hospitals, 2018. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs; 2006.
46.
KestenbaumAShieldsMJamesJ, et al.What impact do chaplains have? A pilot study of spiritual AIM for advanced cancer patients in outpatient palliative care. J Pain Symptom Manag. 2017;54(5):707-714. doi:10.1016/j.jpainsymman.2017.07.027.
47.
ChowRTenenbaumLBalboniTAPrsicEH. Medical outcomes of oncology inpatients with and without chaplain spiritual care visit: the yale New Haven hospital experience. JCO Oncol Pract. 2022;18(3):e334-e338. doi:10.1200/OP.21.00600.
48.
DuralG. Spiritual care experiences of nurses working in intensive care units: a qualitative study. Nurs Crit Care. 2024;29(3):545-554. doi:10.1111/nicc.12975.
49.
RomdzatiRYuliandariR. Spiritual care need: the pediatric nurses’ perspective. Open Access Maced J Med Sci. 2021;9(T4):324-326. doi:10.3889/oamjms.2021.5811.
50.
RosendahlJTigges-LimmerKGummertJDziewasRAlbesJMStraussB. Bypass surgery with psychological and spiritual support (the by.pass study): study design and research methods. Am Heart J. 2009;158(1):8-14. e1. doi:10.1016/j.ahj.2009.04.017.
51.
MemaryanNGhaempanahZAghababaeiNKoenigHG. Integration of spiritual care in hospital care system in Iran. J Relig Health. 2020;59(1):82-95. doi:10.1007/s10943-019-00864-0.
52.
D'Andria UrsoleoJCaliCLosiggioRLimoneVMucciEMonacoF. Spiritual care in palliative medicine and end of life: a bibliometric network analysis. J Palliat Med. 2025;28(2):265-279. doi:10.1089/jpm.2024.0007.
53.
YaminfiroozMSaberiMKVakilimofradH, et al.Global research trends in spirituality, religion and health: a bibliometric analysis and visualization. Inform. 2024;3(1):111-126.
BanduraA. Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice-Hall, Inc; 1986:617. xiii, 617-xiii.
59.
BanduraA. Self-Efficacy: The Exercise of Control. W H Freeman/Times Books/ Henry Holt & Co; 1997:604. ix.
60.
AntonovskyA. Unraveling the mystery of health: How people manage stress and stay well, xx. Jossey-Bass; 1987:218. xx.
61.
ZeissAMGallagher-ThompsonDLovettSRoseJMcKibbinC. Self-efficacy as a mediator of caregiver coping: development and testing of an assessment model. J Clin Geropsychol. 1999;5(3):221-230. doi:10.1023/A:1022955817074.
62.
BingenKKupstMJHimelsteinB. Development of the palliative care parental self-efficacy measure. J Palliat Med. 2011;14(9):1009-1016. doi:10.1089/jpm.2011.0069.
63.
KeefeFJAhlesTAPorterLS, et al.The self-efficacy of family caregivers for helping cancer patients manage pain at end-of-life. Pain. 2003;103(1-2):157-162. doi:10.1016/s0304-3959(02)00448-7.
64.
MystakidouKParpaEPanagiotouITsilikaEGalanosAGouliamosA. Caregivers' anxiety and self-efficacy in palliative care. Eur J Cancer Care. 2013;22(2):188-195. doi:10.1111/ecc.12012.
65.
LuszczynskaAScholzUSchwarzerR. The general self-efficacy scale: multicultural validation studies. J Psychol. 2005;139(5):439-457. doi:10.3200/JRLP.139.5.439-457.
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