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Many physicians report barriers to broaching the subject of spirituality, including lack of time and experience, difficulty identifying patients who want to discuss spirituality, and the belief that addressing spiritual concerns is not a physician's responsibility. The spiritual assessment allows physicians to support patients by stressing empathetic listening, documenting spiritual preferences for future visits, incorporating the precepts of patients' faith traditions into treatment plans, and encouraging patients to use the resources of their spiritual traditions and communities for overall wellness.
Conducting the spiritual assessment also may help strengthen the physician-patient relationship and offer physicians opportunities for personal renewal, resiliency, and growth. Family medicine promotes comprehensive care in a holistic context.
As a result, family physicians often broach a diverse array of topics during clinical encounters to assess patients' perceptions of health and their ability to cope. Some of these topics include economic issues, family systems, cultural and social determinants of wellness e. Addressing spirituality may help when forming a comprehensive treatment program for patients with chronic pain.
Spirituality should be addressed as one of the core components of quality palliative care. Because family physicians care for patients of all affiliations, creeds, and beliefs, this article uses the term spirituality because of its greater inclusivity. The perceived importance of spirituality by patients and physicians is borne out by secular opinion polls, medical literature, hospital regulations, and clinical practice guidelines.
Gallup polls indicate that 91 percent of U. Given its pervasiveness, spirituality commonly affects patient encounters. A study of outpatients at six academic medical centers found that in the ambulatory setting, 33 percent wanted their physician to inquire about religious beliefs, and 19 percent wanted their physician to pray with them.
When asked to identify barriers to the spiritual assessment, physicians pointed to a lack of time 71 percent , lack of experience taking spiritual histories 59 percent , difficulty identifying patients who wanted to discuss spiritual issues 56 percent , and the belief that addressing spiritual concerns is not part of the physician's role 31 percent.
Older patients, hospitalized patients, and patients with terminal illness often wish to share their beliefs, to hear those of their physician, and to have their physician pray for or with them. In addition, physicians may wish to assess patients who face existential crises, such as those in whom a chronic disease has been diagnosed, those with worsening illness, or those with new or persistent mental health disease.
Finally, physicians may consider the casual remarks that patients sometimes make about their faith or spiritual practices as cues inviting discussion. In some cases, a spiritual conversation is most easily introduced when patients bring up concerns and crises without prompting.
Before conducting a spiritual assessment, physicians should consider their personal faith tradition, beliefs and practices, positive and negative experiences, attitudes on faith and healing, and comfort and ability to participate in another's spirituality or share their own. Some physicians may not consider themselves spiritual, may not wish to discuss spirituality, or may vary in their level of ease or capability in discussing spiritual concerns. Rather than a coercive responsibility, conducting a spiritual assessment and offering spiritual support are similar to eliciting a social history and empathizing after the delivery of a negative diagnosis.
They provide yet another way to understand and support patients in their experience of health and illness. Several tools exist to help physicians conduct a spiritual history. The FICA Spiritual History Tool Table 1 30 uses an acronym to guide health professionals through a series of questions designed to elicit patient spirituality and its potential effect on health care.
Starting with queries about faith and belief, it proceeds to ask about their importance to the patient, the patient's community of faith, and how the patient wishes the physician to address spirituality in his or her care. Do you have spiritual beliefs that help you cope with stress? If the patient responds "no," consider asking: what gives your life meaning? FICA spiritual history tool. Accessed March 10, What aspects of your spirituality or spiritual practices do you find most helpful? Does your current situation affect your ability to do the things that usually help you spiritually?
As a doctor, is there anything that I can do to help you access the resources that usually help you? Are there any specific practices or restrictions I should know about in providing your medical care? Adapted with permission from Anandarajah G, Hight E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician.
A third tool, the Open Invite, is a patient-focused approach to encouraging a spiritual dialogue.
It is structured to allow patients who are spiritual to speak further, and to allow those who are not to easily opt out. First, it reminds physicians that their role is to open the door to conversation and invite never require patients to discuss their needs. Preaching or prescribing spiritual practices generally is beyond the proper bounds of the physician-patient relationship.
Second, Open Invite provides a mnemonic for the general types of questions a physician may use Table 3. The tool provides questions that allow the physician to broach the topic of spirituality. Is there a way in which you would like for me to account for your spirituality in your health care?
Is there a way in which I or another member of the medical team can provide you with support? Are there resources in your faith community that you would like for me to help mobilize on your behalf? After spiritual needs have been identified, the physician may incorporate the results of the assessment into patient care.
The most basic thing a physician can do is to listen compassionately. Regardless of whether patients are devout in their spiritual traditions, their beliefs are important to them. By listening, physicians signal their care for their patients and recognition of this dimension of their lives. Empathetic listening may be all the support a patient requires. Another way to incorporate the spiritual assessment is to document the patient's spiritual perspective, background, stated impact on medical care, and openness to discussing the topic.
Physicians may find this information helpful when readdressing the subject in the future or during times of crisis when sources of comfort and meaning become crucial. This documentation also helps meet hospital regulatory requirements for conducting a spiritual assessment. An additional way to incorporate the assessment is to consider how different traditions and practices may affect standard medical practice. For instance, patients of the Jehovah's Witness tradition tend to refuse blood transfusion; believers in faith healing may delay traditional medical care in hopes of a miracle; and Muslim and Hindu women tend to decline sensitive and sometimes general examinations by male physicians.
Patients with certain beliefs may experience substantial psychological duress if they believe a condition is caused by a lack of belief or transgressions on their part. Physicians also need to consider how practices may influence acute or chronic health states. For example, many Muslims fast during Ramadan, which may affect glucose control and other physiologic factors in the ambulatory and inpatient settings. Persons of some faiths observe strict dietary codes, such as halal and kosher laws, which may require physicians to alter traditional nutrition counseling.
It is important to remember, however, that patients may not adhere to each specific belief or practice of their faith. Physicians should avoid making assumptions when asking patients how their particular practices may affect their medical care. The spiritual assessment also allows patients to identify spiritual beliefs, practices, and resources that may positively impact their health. If so, does it have resources such as a home visitation program, a food pantry, or health screening? Finally, there may be some instances in which physician and patient faith traditions coincide.
In these cases, if the patient requests, the physician may consider offering faith-specific support.
This may include patient-or physician-led prayer. Given the variety of spiritual practices followed in multicultural societies, it is best not to assume that a physician's spirituality mirrors that of his or her patients. Prayer should not be a goal of a spiritual assessment, and physicians should not attempt to get patients to agree with them on specific faith issues. Assessing and integrating patient spirituality into the health care encounter can build trust and rapport, broadening the physician-patient relationship and increasing its effectiveness.
Practical outcomes may include improved adherence to physician-recommended lifestyle changes or compliance with therapeutic recommendations. Additionally, the assessment may help patients recognize spiritual or emotional challenges that are affecting their physical and mental health. Addressing spiritual issues may let them tap into an effective source of healing or coping.
For physicians, incorporating patient spirituality brings the potential for renewal, resiliency, and growth, even in difficult encounters. Sometimes physicians have few medical solutions for problems that cause suffering, such as incurable disease, chronic pain, grief, domestic violence, and broken relationships. In these situations, providing comfort to patients can increase professional satisfaction and prevent burnout.
Data Sources: A PubMed search was completed using the following keywords and medical subject headings MeSH : spirituality, faith, and religion. The search included randomized controlled trials, clinical trials, meta-analyses, systematic reviews, and review articles. Search dates: November through August We anticipate that readers along the broad spectrum of religious belief may have varying views on this topic.
Some readers may think that spirituality is not an ethically appropriate area for family physicians to address, especially when the faith traditions of physicians and patients differ. In addition, associations between religious beliefs and health outcomes are inconsistent. Add your comments below or tell us what you think at afpedit aafp. Religion, spirituality, and their relevance to medicine: an update.
Larimore WL. Providing basic spiritual care for patients: should it be the exclusive domain of pastoral professionals? Already a member or subscriber? Log in. Reprints are not available from the authors. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U. Army Medical Department or the U. Army Service at large. Definition of spiritual. Merriam-Webster, Inc. Accessed September 28, Definition of religion Merriam-Webster, Inc.
Gallup, Inc. Accessed March 28, King DE, Bushwick B. Beliefs and attitudes of hospital inpatients about faith healing and prayer.
J Fam Pract. Koenig HG. Religious attitudes and practices of hospitalized medically ill older adults. Int J Geriatr Psychiatry.