Supplement: Taking a Spiritual Assessment

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

H: Sources of hope, meaning, comfort, strength, peace, love, and connection O: Organized religion P: Personal spirituality and practice E: Effects on medical care and end-of-life issues Source: 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. Reprinted with permission from: © American Academy of Family Physicians.

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.

H: Source of hope, meaning comfort, strength, peace, love, and connection We have been discussing your support systems. I was wondering, what is there in your life that gives you internal support? What are your sources of hope, strength, comfort, and peace? What do you hold on to during difficult times? What sustains you and keeps you going? For some people, their religious or spiritual beliefs act as a source of comfort and strength in dealing with life's ups and downs; is this true for you? If the answer is "Yes," go on to O and P questions. If the answer is "No," consider asking: Was it ever? If the answer is "Yes," ask: What changed? O: Organized religion Do you consider yourself part of an organized religion? How important is this to you? What aspects of your religion are helpful and not so helpful to you? Are you part of a religious or spiritual community? Does it help you? How? P: Personal spirituality/practices Do you have personal spiritual beliefs that are independent of organized religion? What are they? Do you believe in God? What kind of relationship do you have with God? What aspects of your spirituality or spiritual practices do you find most helpful to you personally? (e.g., prayer, mediation, reading scripture, attending religious services, listening to music, hiking, communing with nature) E: Effects on medical care and end-of-life issues Has being sick (or your current situation) affected 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 you worried about any conflicts between your beliefs and your medical situation/care/decisions? Would it be helpful for you to speak to a clinical chaplain/community spiritual leader? Are there any specific practices or restriction I should know about in providing your medical car? (e.g., dietary restrictions, use of blood products) If the patient is dying: How do your beliefs affect the kind of medical care you would like me to provide over the next few days/weeks/months? Source: 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. Reprinted with permission from: © American Academy of Family Physicians.