Physicians should recognize patients’ spirituality

There is a growing recognition in medical education and practice that the spiritual component of human existence must be recognized and addressed. The American College of Physicians has concluded that physicians are obligated to attend to all dimensions of suffering: the physical, psychosocial, spiritual, and existential.

Similarly, the Joint Commission on Accreditation of Healthcare Organizations (JAHCO), which accredits hospitals, recognizes that spiritual concerns are often important for patients and that hospitals should provide spiritual care. At the same time, some writers have expressed reservations about this movement to incorporate spirituality into health care. There is, for instance, concern that this could be a subtle effort to push religious ideas and values on to patients and providers.   Others question why medicine should be concerned about the spiritual aspect of human experience. After all, what special expertise do physicians and other health professionals have in the area of spirituality? Even if it is granted that health care providers should recognize patients’ spiritual needs, how are they supposed to practically respond to them? This would seem to be a particularly complicated question to answer in our increasingly pluralistic society.

I will offer three reasons why physicians and other health practitioners should recognize and address the spiritual component of their patients’ lives.

The first reason is that understanding a patient’s spirituality is an important part of helping clarify and fulfill his or her goals of care. This is because a patient’s spirituality may significantly affect medical decision-making. For instance, a 2003 study asked patients with lung cancer to rank the importance of seven factors in their medical decision-making. The seven factors were the oncologist’s treatment recommendation, ability of treatment to cure disease, side effects, family doctor’s recommendation, the spouse’s recommendation, children’s recommendation, and faith in God. The study revealed faith in God ranked second importance only after their oncologist’s recommendation.

A number of studies show that higher religiosity is associated with wanting more aggressive care at the end of life.   For instance, a study published in the Journal of the American Medical Association showed that “positive religious coping” (as defined by a validated tool called RCOPE) in patients with advanced cancer is associated with receipt of intensive life-prolonging medical care near death. Although the study does not address the reason for this association, it suggests that spirituality may play an important role in patients’ medical decisions.

A second reason health practitioners must pay attention to spirituality is that doing so improves patients’ quality of life. A study of 1,610 patients with cancer or HIV found that spiritual well-being (as measured by Functional Assessment of Chronic Illness Therapy Spirituality Scale) was associated with quality of life to the same degree as physical well-being and emotional well-being. The study also found that patients with high levels of spiritual well-being were better able tolerate symptoms such as pain.

If spiritual well-being is associated with a higher quality of life, it stands to reason that supporting patients’ spiritual well-being would improve their quality of life. This was shown to be the case in a study of patients with advanced cancer published in the Journal of Clinical Oncology. It revealed that higher overall spiritual support was positively associated with patient quality of life.

A third reason health practitioners must attend to spirituality is that doing so is part of providing holistic care. Dame Cicely Saunders, who is often considered the founder of the modern hospice and palliative care movement, taught that suffering encompasses the physical, social, psychological, and spiritual parts of a person’s life. Betty Ferrel poignantly speaks to this point when she writes, “The (doctor) who dares to ask about spirituality imparts a vital message to the patient that they are being care for by someone who has not forgotten that a broken patient remains a whole person and that healing transcends survival.”

James Marroquin is an internal medicine physician who blogs at his self-titled site, James Marroquin.

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  • http://blog.stevenreidbordmd.com/ Steven Reidbord MD

    I agree very much with this article, but in this day and age it may be a losing battle. Patients are more comfortable with medical “technicians” than holistic practitioners, and fear they will face prejudice and stereotyping if they divulge anything other than medical signs and symptoms to their “provider.” See:
    http://www.kevinmd.com/blog/2014/03/place-religion-exam-room.html
    as well as my rejoinder at:
    http://www.kevinmd.com/blog/2014/03/selfcensoring-patient-information-public-health-hazard.html

  • Kirsti Nore

    I’m lutheran. Is ot OK?

  • guvic

    I keep reading these type of articles and I am convinced that the religious right as in the case of Hobby Lobby are infiltrating medicine to impose religious values on all Americans. As a physician and surgeon of 28 years experience as well as an atheist I have practiced medicine in a very caring, moral and scientifically based as possible. I respect the need of patients to have their religion or in this case their “spiritual comfort blanket”. But to say that we must in addition to all our responsibilities explore and attend those at times irrational “spiritual need of patients” does more a disservice than help take care of the patient problem. Religion or spirituality are been pushed by the religious right as an American duty. This country was not founded on christian values or religious values. As physicians we should take care of our patients effectively using the latest scientific data, empathically, and psychologically but to include a “spiritual” holitistic approach is reaching the quackery aspects of early medicine and I opposed it firmly. As an example this cardiologist starts each day praying and reading the bible to all the patients in his office. It may be an extreme example but it can degenerate in it eventually

    • jimmyquin

      The concept of spirituality refers to issues that commonly emerge during the course of a severe illness in people of all worldviews, including those without a formal religious tradition. Such issues include discerning what matters most in the time one has left to live, making sense of one’s identity amid the loss and change illness can bring, and understanding the cause and meaning of one’s illness. It involves connecting with what considers to be sacred, such as family, friends, and the divine as life fades away. To overlook this part of a patient’s experience of illness is to do a real disservice.

      It should be noted, however, that recognizing patients’ spiritual needs does mean a physician must engage in spiritual counseling or have expertise in this area. Instead, he or she should refer patients with spiritual needs to chaplains, social workers, and others with expertise in these areas.

  • Joe

    As long as the practice of medicine involves life and death, it will necessarily involve religion. Your characterization of such things as “irrational psychosocial demands” is a product of your own religious beliefs and has an affect on your practice whether you choose to acknowledge it or not.

  • Doug Capra

    When did medicine get to this point — where treating the whole person is considered a fad by some? Cariou put it clearly — spiritually isn’t necessarily organized religion. Doctors who don’t “get” this need to study more history and read more philosophy. Study the humanities. They’re called the “humanities” for a reason. They cover the kinds of issues that make us human.