Discussing Spirituality With Patients: A Rational and Ethical Approach

Abstract

BACKGROUND This study was undertaken to determine when patients feel that physician inquiry about spirituality or religious beliefs is appropriate, reasons why they want their physicians to know about their spiritual beliefs, and what they want physicians to do with this information. METHODSTrained research assistants administered a questionnaire to a convenience sample of consenting patients and accompanying adults in the waiting rooms of 4 family practice residency training sites and 1 private group practice in northeastern Ohio. Demographic information, the SF-12 Health Survey, and participant ratings of appropriate situations, reasons, and expectations for physician discussions of spirituality or religious beliefs were obtained. RESULTSOf 1,413 adults who were asked to respond, 921 completed questionnaires, and 492 refused (response rate = 65%). Eighty-three percent of respondents wanted physicians to ask about spiritual beliefs in at least some circumstances. The most acceptable scenarios for spiritual discussion were lifethreatening illnesses (77%), serious medical conditions (74%) and loss of loved ones (70%). Among those who wanted to discuss spirituality, the most important reason for discussion was desire for physician-patient understanding (87%). Patients believed that information concerning their spiritual beliefs would affect physicians' ability to encourage realistic hope (67%), give medical advice (66%), and change medical treatment (62%).CONCLUSIONS This study helps clarify the nature of patient preferences for spiritual discussion with physicians. INTRODUCTIONS piritual inquiry in health care is controversial. Patient spirituality and religiosity have been shown to be correlated with reduced morbidity and mortality, better physical and mental health, healthier lifestyles, fewer required health services, improved coping skills, enhanced well-being, reduced stress, and illness prevention. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Many of these studies have been criticized, yet most physicians believe spirituality has a positive effect on physical and mental well-being of patients. [16][17][18][19][20] Patients desire spiritual discussions with physicians, and believe spiritual health is as important as physical health, but they report spiritual discussions rarely take place. 1,12,21 Outpatient studies have found 13% to 73% of patients want physicians to have knowledge of their spiritual or religious beliefs. [22][23][24][25] Problematic physician issues include departing from established areas of expertise to promote nonmedical agendas, lack of spirituality training, ethics of physicians acting as pastoral counselors, the possibility of doing harm, time constraints, invasion of privacy, and diffi culty determining which patients want to talk. 9,16,18,19,26,27 To help physicians develop a holistic, patient-centered assessment of spiritual and religious beliefs, this study investigated (1) acceptance of spiritual discussion in a wide range of clinical scenarios, (2) Item content ...

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