Doctor–patient communication about existential, spiritual and religious needs in chronic pain: A systematic review

Abstract

Research documents that many chronic non-malignant pain patients experience existential, spiritual and religious needs; however, research knowledge is missing on if and how physicians approach these needs. We conducted a systematic review to explore the extent to which physicians address these needs in their communication with chronic non-malignant pain patients and to explore the facilitators and challenges of this communication. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching Embase, Medline, Scopus and PsycINFO. The quality of the included articles was assessed based on design-specific screening tools. We included four of 2337 screened articles and found the quality to be good. Physicians’ communication about existential, spiritual and religious needs was given low priority and depended on the patients’ own initiative, except when clinicians were interested in holistic care. Patient dissatisfaction with the physician’s attention to these needs was related to higher pain and depression. Physicians’ challenges for addressing these needs were their tendency to prioritize physiological aspects and close further elaboration of existential needs when addressed by the patients. The main facilitator was the individual physician’s willingness to listen with openness and empathy to the patients’ existential concerns. A tentative conclusion is that physicians rarely meet the existential, spiritual and religious needs of their chronic non-malignant pain patients. This might be due to higher priority of physical aspects, lack of time and a lack of knowledge about the importance of and training in the ability to address these needs. Further research is needed on physicians’ communication about existential, spiritual and religious needs and on their training in here.

Health care providers’ experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study

“…They suggest that for some patients such underlying issues must be addressed if motivation to use and benefit from eHealth intervention is to be expected. These results may argue for blended care where the eHealth intervention could supplement communication with the health care provider where active listening and acknowledgement of existential concerns might be essential [ 69 ]. Adding guidance and personal feedback is also a way of tailoring the intervention [ 70 ], as suggested in the current study.…”

‘Maybe we are losing sight of the human dimension’ – physicians’ approaches to existential, spiritual, and religious needs among patients with chronic pain or multiple sclerosis. A qualitative interview-study

“…Thus, our study suggests that attending to existential, spiritual, and religious needs in the encounter requires a relation with the possibility of addressing both conscious and unconscious needs from a personal, empathic perspective. Moreover, this relational approach seems to be pivotal for treatment of chronic illnesses (Andersen, Assing Hvidt, Hvidt, & Roessler, 2019 ; Vang et al, 2019 ) and even more so in countries with a cultural experience of privacy regarding these needs (Assing Hvidt, Søndergaard, et al, 2017 ; Rosen, 2009 ).…”

“…The three co-authors are all experienced researchers in the field of existential communication in medicine. Existential communication covers how health professionals communicate with patients about the diverse ways to make meaning in life, whether secular, spiritual, or religious (Andersen, Assing Hvidt, Hvidt, Illés, et al, 2019 ; Andersen, Assing Hvidt, Hvidt, & Roessler, 2019 ; Assing Hvidt, Hansen, et al, 2017 ; Roessler & Lindemann, 2014 ). Their prior understandings regarding the use of IPA and the selected themes have informed and enhanced this study and been a subject of discussion between all authors in the research process.…”

“…In a recent review on physicians’ approaches to existential, spiritual, and religious patient needs in the management of chronic pain only four studies were found (Andersen, Assing Hvidt, Hvidt, & Roessler, 2019 ). The results of the review suggest that physicians rarely meet the existential, spiritual, and religious needs of their patients with chronic pain.…”

Clients’ Faith Experiences as an Opportunity or a Challenge for Psychotherapy: A Qualitative Analysis of Clinical Records

“…Although research has shown that faith is a legitimate human expression that influences health, healthcare personnel seemed reluctant to approach these needs (Dezutter et al 2016;Assing Hvidt et al 2016;Andersen et al 2019). This may have been due to a lack of knowledge and/or training, as well as an apprehension regarding imposing their own meaning system on the patients Mueller et al 2001;Best et al 2016).…”