This work is being presented as a poster presentation at the Annual Assembly of Hospice and Palliative Medicine (AAHPM) in San Diego, CA (March 4-6, 2026). This research was generously funded by Grant #62930 from the John Templeton Foundation, “Expanding Models of Delivery for Online Spiritual Care” (August 2023-July 2026). This blog post includes an updated abstract about this work, as well as an updated list of references to scholarly publications that have been accepted or which are currently in submission or preparation for submission to peer review. View the complete poster here.
Abstract:
Spiritual care is a vital component of holistic palliative and hospice care, but access to chaplains is a significant challenge. Technology, specifically Online Spiritual Care Communities (OSCCs), offers a solution to expand spiritual support. This summary details a three-phase research project that partnered with chaplains to co-design and plan for OSCC implementation.
Phase 1: A formative study with n=22 chaplains and spiritual care providers explored the potential of OSCCs through interviews and user testing of existing online support communities. Chaplains stressed the importance of meeting patients where they are at online and saw OSCCs as a way to increase accessibility and patient-initiated care. Key design considerations included skilled moderation, establishing trust, and developing online-specific chaplaincy interventions. This phase produced a design framework for digital spiritual care interventions [2] and two theoretical models for OSCCs: the “Care Loop” which integrates institutional and online support [1] (pictured above), and a model for peer-provisioned spiritual care overseen by chaplains [6].
Phase 2: A national survey in the USA of 1,010 stakeholders (professional spiritual care providers, as well as lay users including patients and caregivers) showed overwhelming support for implementing OSCCs, confirming their feasibility and acceptability [3,4]. The survey also provided insights into preferred affiliations and design configurations.
Phase 3: Co-design workshops with chaplains were conducted in order to develop community norms, moderation strategies, and prototype interfaces [5]. These include tools for online governance, such as AI-assisted moderation and interactive training interfaces for chaplains and peer supporters.
This project has produced evidence-based guidelines for integrating OSCCs into clinical workflows to complement traditional in-person spiritual care. Future plans include securing funding to implement an OSCC product at CaringBridge.org, which serves ~40 million users annually, and conducting clinical trials to evaluate the impact on patient and family well-being. This co-design approach ensures technological advancements are grounded in established spiritual care principles, creating effective, ethical, and accessible online support for patients and caregivers experiencing spiritual distress.
References:
[1] Alemitu Bezabih, Shadi Nourriz, Anne-Marie Snider, George Handzo, and C. Estelle Smith. Meeting Patients Where They’re At: Toward the Expansion of Professional Chaplaincy Care into Online Spiritual Care Communities. Association for Computing Machinery (ACM) Conference on Computer-Supported Cooperative Work & Social Computing (CSCW) 2025. https://dl.acm.org/doi/10.1145/3757492
[2] C. Estelle Smith, Alemitu Bezabih, Shadi Nourriz, and Jesan Ahammed Ovi. “SPIRIT: A Design Framework To Support Technology Interventions for Spiritual Care Within and Beyond the Clinic.” ACM Conference on Human Factors in Computing Systems (CHI) 2026. Preprint: https://arxiv.org/abs/2601.14435.
[3] Alemitu Bezabih, Anne-Marie Snider, Jesan Ahammed Ovi, Shadi Nourriz, George Handzo, and C. Estelle Smith. “Reddit Ministry”: Conceptualizing Online Communities as Novel Sites for Spiritual Care Delivery. Journal of Health and Social Care Chaplaincy (HSCC): Special issue on Digital Spiritual Care. 2025. https://doi.org/10.1558/hscc.33729
Manuscripts in Submission
[4] Jesan Ahammed Ovi, Alemitu Bezabih, Anne-Marie Snider, Shadi Nourriz, Daniel McKenzie, and C. Estelle Smith. Toward the Development of Online Spiritual Care Communities: Understanding Stakeholder Design Preferences at Scale. (In submission to ACM CSCW 2026.)
[5] Shadi Nourriz, Alemitu Bezabih, and C. Estelle Smith. Professional Spiritual Care Perspectives on the Design and Governance of Online Spiritual Care Communities. (In submission to the ACM Journal of Transactions on Computer-Human Interaction (TOCHI).)
[6] Alemitu Bezabih, Shadi Nourriz, Anne-Marie Snider, and C. Estelle Smith. “Spiritual Care is Everyone’s Job”: Design Goals for Cultivating Meaningful Peer-Provisioned Spiritual Care Interactions Online. (In preparation for submission.)
C. Estelle Smith, Ph.D. 