Spirituality and Health Care
Various modes of intervention or assistance might be considered to address the spiritual concerns of patients. These include the following:
- Exploration within the context of usual medical care.
- Encouragement for the patient to seek assistance from his or her own clergy.
- Formal referral to a hospital chaplain.
- Referral to a religious or faith-based therapist.
- Referral to a range of support groups that are known to address spiritual issues.
At present, very little empirical evidence addresses the specific value of any particular intervention as it may affect spiritual or religious adjustment or well-being; however, there is considerable evidence as to the value of a range of approaches on psychological well-being and adjustment.1 Many support groups may also address the meaning of illness and issues of death and dying, without explicitly framing these subjects as spiritual or religious issues.
Physicians
A task force of physicians and end-of-life specialists suggested several guidelines for physicians who wish to respond to patients' spiritual concerns2:
- Respect the patient's views and follow the patient's lead.
- Make a connection by listening carefully and acknowledging the patient's concerns, but avoid theological discussions or engaging in specific religious rituals.
- Maintain one's own integrity in relation to one's own religious beliefs and practices.
- Identify common goals for care and medical decisions.
- Mobilize other resources of support for the patient, such as referring the patient to a chaplain or encouraging contact with the patient's own clergy.
Inquiring about religious beliefs that may be relevant to medical care decisions is a particularly important aspect of overall medical management, whether for end-of-life decisions or to clarify concerns about treatment.
A common concern is whether to offer to pray with patients. Although one study found that more than one-half of the patients surveyed expressed a desire to have physicians pray with them, a large proportion does not express this preference.3 A qualitative study of cancer patients found that patients were concerned that physicians are too busy, not interested, or even prohibited from discussing religion.4 At the same time, they generally wanted their physician to acknowledge the value of spiritual and religious issues. A suggestion was made that physicians might raise the question of prayer by asking, " Would that comfort you?" The most important guideline is to remain sensitive to the patient's preference; therefore, asking patients about their beliefs or spiritual concerns in the context of exploring how they are coping in general is a viable approach in exploring these issues.
Hospital Chaplains
Traditional means of providing assistance to patients has generally been through the services of hospital chaplains.5,6 Hospital chaplains can play a key role in addressing spiritual and religious issues; chaplains are trained to work with a wide range of issues as they arise for medical patients and to be sensitive to the diverse beliefs and concerns that patients may have.7 Chaplains are generally available in large medical centers, but they may not be available in smaller hospitals on a reliable basis. Chaplains are rarely available in the outpatient settings where most care is now delivered (especially early in the course of cancer treatment, when these issues may first arise).
Another traditional approach in outpatient settings is having spiritual/religious resources available in waiting rooms. This is relatively easy to do, and many such resources exist; however, a breadth of resources covering all faith backgrounds of patients is highly desirable (see Additional Resources section).
Support Groups
Support groups may provide a setting in which patients may explore spiritual concerns. If spiritual concerns are important to a patient, the health care provider may need to identify whether a locally available group addresses these issues. Published data on the specific effects of support groups on assisting with spiritual concerns are relatively sparse, partly because this aspect of adjustment has not been systematically evaluated. A randomized trial compared the effects of a mind-body-spirit group to a standard group support program for women with breast cancer.8 Both groups showed improvement in spiritual well-being, although there were appreciably more differential effects for the mind-body-spirit group in the area of spiritual integration. One author presents a well-developed model of adjuvant psychological therapy that uses a large group format and addresses both basic coping issues and spiritual concerns and healing, using a combination of group exploration, meditation, prayer, and other spiritually oriented exercises.9 In a carefully conducted longitudinal qualitative study of 22 patients enrolled in this type of intervention, researchers found that patients who were more psychologically engaged with the issues presented were more likely to survive longer.10 Other approaches are available but have yet to be systematically evaluated,11,12 have not explicitly addressed religious and spiritual issues, or have failed to evaluate the effects of the intervention on spiritual well-being.13
References
1. Meyer TJ, Mark MM. Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. Health Psychol 1995;14:101-108.
2. Lo B, et al. Discussing religious and spiritual issues at the end of life: A practical guide for physicians. JAMA 2002;287:749-754.
3. King DE, Bushwick B. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract 1994;39:349-352.
4. Hebert RS, et al. Patient perspectives on spirituality and the patient-physician relationship. J Gen Intern Med 2001;16:685-692.
5. Fitchett G, et al. Spiritual care in the hospital: Who requests it? Who needs it? J Pastoral Care 2000;54:173-186.
6. Handzo G. Where do chaplains fit in the world of cancer care? J Health Care Chaplain 1992;4:29-44.
7. Association of Professional Chaplains, Association for Clinical Pastoral Education, Canadian Association for Pastoral Practice and Education, et al. A White Paper. Professional chaplaincy: Its role and importance in healthcare. J Pastoral Care 2001;55:81-97.
8. Targ EF, Levine EG. The efficacy of a mind-body-spirit group for women with breast cancer: A randomized controlled trial. Gen Hosp Psychiatry 2002;24:238-248.
9. Cunningham AJ. Group psychological therapy: An integral part of care for cancer patients. Integrative Cancer Therapies 2002;1:67-75.
10. Cunningham AJ, et al. A prospective, longitudinal study of the relationship of psychological work to duration of survival in patients with metastatic cancer. Psychooncology 2000;9:323-339.
11. Breitbart W. Spirituality and meaning in supportive care: Spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 2002;10:272-280.
12. Cole B, Pargament K. Re-creating your life: A spiritual/psychotherapeutic intervention for people diagnosed with cancer. Psychooncology 1999;8:395-407.
13. Spiegel D, et al. Psychological support for cancer patients. Lancet 1989;2:1447.
Source: National Cancer Institute. Available at: www.cancer.gov/cancertopics/pdq/supportivecare/spirituality/HealthProfessional/page5. Accessed Oct. 17, 2006.
Additional Resources
- International Center for the Integration of Health and Spirituality. Maintains resources on conferences, research, and a newsletter.
- George Washington Institute for Spirituality and Health (www.gwish.org). Focuses on medical education in the area of religion, spirituality, and medicine.
- Mind/Body Medical Institute (www.mbmi.org). Conducts biannual continuing medical education conferences on spirituality and healing.
- Duke University Center for the Study of Religion/Spirituality and Health (www.dukespiritualityandhealth.org). Conducts research on the effects of religion (and spirituality) on physical and mental health.
- University of Minnesota Center for Spirituality & Healing (www.csh.umn.edu/csh/home.html). Focuses on education, outreach, and research in complementary, alternative, and culturally based healing practices.
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