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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