Medical Sociology of Chaplaincy Referral Timing and Opioid Tapering Disputes in Ugandan Hospice Wards: A Target-Trial Emulation of Spiritual-Care Exposure and Analgesic De-escalation

Chaplaincy referral in Ugandan hospice wards is routinely treated as a marker of holistic care, yet its timing relative to opioid tapering disputes remains sociologically unexamined. The design was evaluated across 2000 replications per cell for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. Power analysis indicated that 52 clusters are required to detect a 5-percentage-point effect at 80% power. The framework distinguishes early from late chaplaincy referral as a time-varying exposure, specifies the tapering dispute as a competing event, and formalises the estimand under assumptions of consistency, positivity and exchangeability. The contribution is methodological and conceptual: it reframes chaplaincy timing as a modifiable organisational exposure rather than a fixed patient characteristic, and it specifies the design conditions under which hospice wards can generate credible evidence about spiritual-care sequencing and analgesic de-escalation.