Navigating challenges in telechaplaincy: A thematic analysis of an international conference

Figures & data

Table 1. Code system aggregated into levels, themes and codes, with exemplary quotations.

Level	Theme	Code	Exemplary quotation
Individual	Initiating change	Creativity, curiosity, reevaluating old beliefs, being proactive	“So, the pandemic in essence was a Genesis one moment, it gave us an opportunity to create and become a solution.” (CG) “So, we’ve had to become creative. And it is that creativity that we’ll speak to today, as well as just delivery.” (AO)
	Workflow	Technological literacy, appointments, screening & referral, follow-up, documentation & EHR	“I now work primarily remotely again with a few exceptional in-person appointments if the patient desires the in-person. Doctors, APRs, nurses and social workers send over emails and text referrals as they used to, but they now also put in orders for spiritual care.” (JJ) “We created basically the clinical spec and then we worked with their EPIC tech people to create a chaplain work queue embedded fully within EPIC.” (JF)
	Interventions	Bedside visit, crisis management, support groups, primer for later encounter, telling stories	“We saw the importance of providing a continuation of care for our patients and as they left our facility, recognizing that this was a novel disease […] Our team decided to figure out a way to use technology to reach our audience to help provide hope and healing.” (TV) “Other aspects might be considering crisis management when meeting with someone at a distance. Do you have a plan in place and the training required? Should someone express suicidal ideation? Or Should someone begin to present physical distress?” (HV)
	Presence and connection	Self-care, body, touch & non-verbal, (lack of) visual cues, setting & situational awareness, disturbing & distracting, self-presentation, vulnerability,	“[…] custody of the eyes, we called it in seminary, be very aware where your eyes are. So, if you’re working with multiple screens, you need your person, front and center on the screen that has your camera, your documents can be over here, the things that you’re not working on can be over here.” (THB) “So you may have wondered, at some point or another in your work as a chaplain, if I call this patient or caregiver at home, won’t I really be interrupting them in their day?” (JJ)
	Ethics & safety	Consent, security, pastoral secrecy, privacy, risk management	“Become familiar with that platform so that when something goes wrong with it, or something happens, that you don’t raise certain ethically sensitive matters of privacy and confidentiality, because of some glitch in the technology.” (MS) “A big issue certainly is that pastoral secrecy is not given on those channels, which is a great deal for really existential topics and private communication.” (AH)
	Credibility	Accreditation, religious prohibitions, efficacy of ritual, pastoral authority	“I officiated a wedding over zoom. What’s the first reaction you might have to that statement? If you’re like many people that I've shared that story with including chaplains and spiritual care providers, one of the first responses I tend to get as well, but it wasn’t a real wedding. Right?" (KH) “The anointing of the sick as it is classically understood […] cannot be administered over a video or audio connection. The formula of the sacramental ritual, the presence of a priest applying the blessed oil, offering prayers in the presence of a patient cannot be replicated in another way. Okay, with that said, there are some ways forward in the telehealth context I'd like to suggest.” (SO)
Organizational	Strategic alignment	Advocacy, vision & marketing, strategic partners	“With the help from marketing, we were able to craft this registration letter that met all the guidelines that the enterprise established, we were able to scale it by creating a QR code and a hyperlink. We recognize that technology could be a barrier for some people. So, we provided our email addresses and contact information as well.” (TV) “And I had incredible partners in palliative care. So that did make it much, much easier. But I did work with the director of outpatient palliative care, implement all along the way. And I did also check in with the director of spiritual care, all along the way. Those key stakeholders definitely need to be a part of any changes that you make.” (JJ)
	Adapting to new models of care	New delivery models, continuum of care, lack of training, utilization of resources, best practices, patient-centered care	“So, healthcare has at its fingertips, just this infinite amount of information about the people that we serve. And yet, spiritual care had never really tapped into all of that information. So, we began to become far more familiar with parts of our care delivery system, where spiritual care hadn’t been closely aligned, for instance, with our data analysts, with our IT departments, with our billing infrastructure… and started to ask questions […]” (AO) “And so I think that one of the things that will have to change for us in the spiritual care community is that our best practice interventions may actually require a full sort of look at or revision of our delivery models.” (CC)
	Evidence-base	Data, funding, research & assessment	“And so, of course, we did a formal study […] And we found out that it increased their compassion a lot for the patients, and it also helped in transitions of care. […] these files ended up being extremely important in facilitating the conversation between clinicians and the loved ones.” (ET) “We showed that we could use the existing platforms within the enterprise to capitalize on our efforts without any funding.” (TV)
Population	Drivers of Telechaplaincy Adoption	Shift toward outpatient, long-term and chronic care, multifactorial morbidities, heterogeneous patient populations	“As a chaplain myself in an outpatient cos context, pre-COVID, my practice was almost exclusively conducted in person. Whereas at present, I'd say about 90% of my clinical interactions are by virtual means either by phone, or video conferencing.” (HV) “How do we actually identify patients that are at high risk, are high need for spiritual care, who are likely to have spiritual distress? […] You can do this by medical condition, you can look at them in many different ways of grouping those populations, and start using some data-driven processes to identify them” (AO)
	Barriers	Physical distance, socio-economic, patient acceptance	“And so early on, I realized the limitations of not being able to be at two places at the same time, I could be making a hospital or a hospice visit in one part of the county and receive an urgent call about a critically ill or dying patient, located a 45 to 60 minutes’ drive away.” (RD) “The meetings are free, and the virtual platform removes most logistical barriers, our participants have a safe space to interact with fellow COVID-19 survivors. (TV)