Telehealth is the “delivery of health care services, where patients and providers are separated by distance” (World Health Organization, n.d.). Practiced since the early 1900s, telehealth saw a substantial increase in use in the 1970s with the development of more technologies. Telehealth was widely used by many health care practitioners and was predicted to expand before the COVID-19 pandemic (Sprik et al., 2020b). Due to COVID-19, private insurance claims for telehealth services increased by over 4000% between March 2019 and March 2020 (Lagasse, 2020). The Centers for Medicare and Medicaid Services (CMS) temporarily expanded reimbursement for telehealth services until the end of the pandemic but then made some of the expansions permanent (Lagasse, 2020).
Healthcare chaplains have adopted telehealth practices and developed telechaplaincy, defined as “the use of telecommunications and virtual technology...to deliver spiritual and religious care by healthcare chaplains or other religious/spiritual leaders” (Sprik et al., 2020b). There is no available data about the prevalence of telechaplaincy. It emerged in the mid-1900s and accelerated in the early 2000s (Sprik et al., 2020b). Strano (2014) described a free program offered by a health care non-profit called “Chat with a Chaplain” that received thousands of calls in 2014 from the general public. Parker (2015) reported using telechaplaincy to provide spiritual support to Veterans in rural areas. The onset of COVID-19 further accelerated the use of telechaplaincy in health care as health care leaders put social distancing policies and procedures into place to reduce the spread of the virus (Sprik et al., 2020a).
Telechaplaincy is significant because it expands access to spiritual care for patients who otherwise would not be able to receive it. Research showed that telechaplaincy is feasible and acceptable with Veterans, oncology outpatients, caregivers of seriously ill patients, and parents of children with cystic fibrosis (Sprik et al., 2020b). During the COVID-19 pandemic, telechaplaincy enabled chaplains to adhere to World Health Organization’s (WHO) and Center for Disease Control and Prevention’s (CDC) guidelines for social distancing and thus remain safe. Telechaplaincy also lowered patient and family fears of virus transmission by chaplains and helped chaplains conserve personal protective equipment (PPE) while providing spiritual support (Koonin et al., 2020; Sprik et al., 2020a). Health care staff took comfort in knowing chaplains could give spiritual support and information to the caregivers of intubated COVID-positive patients, which relieved them of the additional burden of doing so when they were highly stressed. Because telechaplaincy permits spiritual care providers to offer spiritual support from anywhere globally, departments of spiritual care were able to enlist telechaplaincy volunteers to help spiritual care staff make phone calls to isolated patients and worried caregivers during infection surges.
Telehealth is likely to continue and expand. In March 2020, in response to the pandemic, then-President Trump began allowing fee-for-service Medicare to reimburse telehealth services (Pifer, 2020). Before March 2020, only 15,000 Medicare beneficiaries used Medicare telehealth services weekly. That number drastically increased to 24.5 million Medicare beneficiaries, or more than one-third of all Medicare fee-for-service recipients between March and October 2020 (Pifer, 2020). During that period, CMS collected data on the efficacy and cost-efficiency of expanding 144 telehealth services to determine if they should continue beyond the pandemic (Pifer, 2020). In December 2020, the President made at least nine of these additional telehealth services permanent (Pifer, 2020). CMS and other government leaders are considering whether to make more telehealth services permanent.
Telechaplaincy is also likely to continue and expand. Given the increased use of telechaplaincy during the pandemic, health and spiritual care leaders are actively collecting data about the efficiency and efficacy of its use. It may turn out that telechaplaincy enables chaplains to provide care to more patients over a week because they no longer have to spend time walking to inpatient rooms in various locations. Beyond the pandemic, telechaplaincy will likely continue in outpatient oncology settings. Sprig et al. (2020b) established that telechaplaincy in outpatient oncology settings is feasible and acceptable. More research is needed to determine how effective it is.
Telehealth is promising for the future of the health care workforce. Potter et al. (2014) found that telehealth increased the likelihood of physicians serving and remaining in rural areas. The Committee on Pediatric Workforce (2015) argued that telemedicine could increase physicians’ capacities to treat more patients, thus mitigating physician workforce shortages.
There is no available data about the prevalence or impact of telechaplaincy on the healthcare chaplaincy workforce. The healthcare chaplaincy workforce skews older, which may result in lower levels of digital literacy and comfort. Kuek and Hakkennes (2020) found that health care professionals under 50 years old had greater confidence in technology and their abilities to use it than health care workers who were over 50. White et al. (2020) found that board-certified chaplains (BCCs) in the U.S. are mostly between 45 and 64 years old. This may all add up to current chaplains struggling with the technological competencies required of telechaplaincy, thus leading to increased dissatisfaction with those jobs, but this is only conjecture. White et al. (2020) found that chaplaincy trainees are younger - nearly 38% are under 44 years old - which may indicate greater comfort with technology and more interest in telechaplaincy.
As the use of telechaplaincy increases, spiritual care leaders need to conduct more research and develop training. First, they should build upon the feasibility and acceptance studies and research the outcomes of telechaplaincy. Second, chaplain researchers should study healthcare chaplains’ attitudes about telechaplaincy to determine barriers to its use. Third, continuing education opportunities should be developed (and possibly required) for chaplains to learn more about how to use various technologies and adapt their practice of spiritual care to telechaplaincy.
Telehealth and telechaplaincy are here to stay and will likely be more widely used across the U.S. over the next several decades. Telehealth services, including telechaplaincy, expand access to care to patients in rural areas, who access outpatient services, and who are unable to receive health care during a pandemic. Fortunately, the government has recognized the cost-savings and comparable health outcomes and has increased reimbursement (not for telechaplaincy, however, as spiritual care is not a reimbursable service). Telehealth promises to address some of the workforce issues that healthcare leaders are facing. It is unknown whether telechaplaincy will do the same. In any case, research on telechaplaincy is needed to determine the outcomes of spiritual care delivered remotely. Likewise, additional training is needed for chaplains to increase their digital literacy so they are prepared to be flexible enough to provide both in-person spiritual care and telechaplaincy.
