Supplement
Taking a Spiritual Assessment
Discussions of spiritual beliefs and practices can be uncomfortable and awkward for the practicing physician. However, a growing body of evidence points to spirituality as an important coping tool for patients. Consider the following research results:
- In a national survey on prevalence and patterns of use, 35% of respondents reported using prayer for health concerns; 75% prayed for wellness, 22% prayed for specific medical conditions.1
- Another recent study reports that 33% of people would welcome a discussion of their spiritual beliefs in a routine office visit; this number surges to 70% in an end-of-life setting.2
What Patients Want
A 2004 study published in the Annals of Family Medicine examined when patients feel a discussion about spirituality is appropriate, what patients want their physicians to know about their spiritual beliefs, and what they want physicians to do with this information.3 The results help shape a framework for when to take a spiritual assessment. Of the nearly 800 people who completed the survey:
- Seventeen percent said they never want to be questioned about spiritual beliefs; 63% wanted to be asked depending on the nature of the situation; and 20% always wanted their physician to know about their beliefs.
- Of those who sometimes or always wanted to discuss their spiritual beliefs, 87% wanted their physicians to understand how their beliefs influence how they deal with being sick; 85% wanted their physician to understand them better as a person; and 83% wanted their physicians to understand their decision making.
- Among the more than 50% who wanted to talk, providing compassion, encouraging realistic hope, advising how to take better care of oneself when ill, changing treatment, and referral to a spiritual counselor were the actions most commonly endorsed.
- Praying with their physician and having the physician "just listen" were the least preferred courses of action.
- The most acceptable scenarios for spiritual discussion were life-threatening illnesses, serious medical conditions, and loss of loved ones.
Spiritual Assessment Tools
Several tools exist that can guide a physician in taking a spiritual assessment. Tables 1 and 2 outline the HOPE tool, developed by Anandarajah and Hight.4
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References
1. McCaffrey AM, et al. Prayer for health concerns. Arch Intern Med 2004;164:858-862.
2. MacLean CD, et al. Patient preference for physician discussion and practice of spirituality. J Gen Intern Med 2003;18:38-43.
3. McCord G. Discussing spirituality with patients: A rational and ethical approach. Ann Fam Med 2004;2:356-361.
4. Anandarajah G, Hight E. Spirituality and medical practice: Using the HOPE questions as a practice tool for spiritual assessment. Am Fam Physician 2001;63:81-88.
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